Functional connectivity analysis of childhood depressive symptoms.

BACKGROUND: Childhood depression is a highly distinct and prevalent condition with an unknown neurobiological basis. We wish to explore the resting state fMRI data in children for potential associations between neural connectivity and childhood depressive symptoms. METHODS: A longitudinal birth cohort study with neuroimaging data obtained at 4.5, 6.0 and 7.5 years of age and the Children Depression Inventory 2 (CDI) administered between 8.5 and 10.5 years was used. The CDI score was used as the dependent variable and tested for correlation, both simple Pearson and network based statistic, with the functional connectivity values obtained from the resting state fMRI. Cross-validated permutation testing with a general linear model was used to validate that the identified functional connections were indeed implicated in childhood depression. RESULTS: Ten functional connections and four brain regions (Somatomotor Area B, Temporoparietal Junction, Orbitofrontal Cortex and Insula) were identified as significantly associated with childhood depressive symptoms for girls at 6.0 and 7.5 years. No significant functional connections were found in girls at 4.5 years or for boys at any timepoint. Network based statistic and permutation testing confirmed these findings. CONCLUSIONS: This study revealed significant sex-dependent associations of neural connectivity and childhood depressive symptoms. The regions identified are implicated in speech/language, social cognition and information integration and suggest unique pathways to childhood depressive symptoms.

Los trastornos depresivos de la infancia y la adolescencia. Principales signos de alerta. Orientación para el tratamiento / Depressive disorders of childhood and adolescence. Main warning signs. Guidance for treatment

La depresión ha dejado de ser una enfermedad solo de adultos para presentarse cada vez más frecuentemente en niños y adolescentes, muy especialmente en la última década. Este diagnóstico puede llegar a ser un problema severo y de larga duración, que puede interferir en todos los aspectos del desarrollo del menor, su familia y su comunidad. El presente trabajo consiste en una revisión bibliográfica y actualizada sobre la depresión infanto-juvenil para facilitar su detección precoz desde los servicios de Pediatría en Atención Primaria y su derivación para el tratamiento precoz en los equipos de salud mental infanto-juvenil. Primero, presentamos los factores de vulnerabilidad y los factores de protección; luego, los síntomas y criterios diagnósticos para cada etapa del desarrollo, así como herramientas para el diagnóstico diferencial. Por último, se revisan brevemente los tratamientos basados en la evidencia disponibles y cómo intervenir en cada nivel de gravedad (AU)

Depression has ceased to be an illness only for adults, to appear more and more frequently in children and adolescents, especially in the last decade. This diagnosis can become a severe and long-lasting problem, which can interfere in all aspects of the development of the child, his family, and his community. The present work consists of a bibliographic and updated review on child and adolescent depression to facilitate the early detection at the pediatric primary services, and early derivation for treatment at the child and adolescent mental health services. First, we present the risk factors and protective factors that may signal populations-at-risk; then, the main symptoms and the diagnostic criteria for each stage of development, as well as tools for differential diagnosis. Finally, we briefly review the evidence-based treatments at each level of severity. (AU)

Mediators between Positive and Negative Parenting and Child Depressive and Anxious Symptoms: Findings from a Diverse, At-Risk Sample.

BACKGROUND: Although children's depressive and anxious symptoms have been broadly construed as internalizing problems, the current study sought to identify factors that may differentially contribute to these two mental health problems in a high-risk sample. Prior research has not adequately tested both depressive versus anxious symptoms simultaneously, nor has it adequately considered the role of negative versus positive parenting simultaneously, thereby neglecting the potential overlap in both sets of constructs. Overlooking such potential statistical overlap obfuscates how factors may differentially contribute to either depressive versus anxious symptoms. Existing research has also focused on lower-risk community samples. METHOD: The present study investigated whether children's negative self-concept or maladaptive attributional style mediated the link between both negative and positive parenting in a racially diverse, at-risk sample of 65 primary school-age children recruited from mental health agencies. RESULTS: When tested together, more negative parenting, but not less positive parenting, retained direct effects on both depressive and anxious symptoms. Both negative self-concept and maladaptive attributional style fully mediated the association between less positive parenting and children's depressive symptoms, whereas positive self-concept, but not attributional style, mediated between less positive parenting and anxious symptoms. CONCLUSIONS: The current findings underscore potential differential intervention targets for these two internalizing problems and highlight the need for future research to consider both depressive and anxious symptoms, and related predictors, simultaneously to control for their shared variance.

Prenatal determinants of depressive symptoms in childhood: Evidence from Growing Up in New Zealand.

BACKGROUND: Young people who experience depression are at an increased risk of adverse psychosocial and developmental outcomes that can persist over the lifecourse. Identifying maternal prenatal risk factors that may contribute to childhood depressive symptoms can be useful when considering mental health intervention. METHODS: The current study included 3,925 children from the Growing Up in New Zealand (GUiNZ) study who had complete data for self-reported depressive symptoms and mothers' antenatal information. Depressive symptoms were measured at age 8 using the Centre for Epidemiological Studies Depression Scale for Children (CESD-10) short form questionnaire. Hierarchical linear regression was used to determine the relationship between prenatal factors and depressive symptoms at age 8. RESULTS: When controlling for sociodemographic characteristics, our hierarchical linear regression revealed that the most significant maternal prenatal predictors of high depressive symptoms at age 8 were maternal perceived stress, smoking during pregnancy, body mass index (BMI) in the overweight/obese range, and paracetamol intake. LIMITATIONS: One limitation with the current study was a reduction in the sample due to attrition. This may have affected our statistical power, reflected in our modest effect sizes. The sample remained both socioeconomically and ethnically diverse, however our results should be interpreted with respect to the sample and not the whole New Zealand population. CONCLUSIONS: A combination of maternal mental health and lifestyle factors contribute to depressive symptoms for children, possibly through foetal programming. Our results emphasise the importance of mental and physical health support for expectant mothers.

Depression in 3/6-year-old children: clinical and psychosocial outcomes in later childhood and adolescence.

BACKGROUND: In recent years, epidemiological and clinical studies have revealed that depressive disorders can present in early childhood. To clarify the validity and prognostic significance of early childhood-onset depression, we investigated diagnostic and functional outcomes in later childhood and adolescence. METHODS: A community sample (N = 516) was assessed for psychopathology at ages 3 and 6 using the Preschool Age Psychiatric Assessment. When participants were 9, 12, and 15 years old, children and parents completed the Kiddie Schedule for Affective Disorders and Schizophrenia and measures of symptoms and functioning. RESULTS: In models adjusting for covariates, depressed 3/6-year-old children were more likely to experience subsequent episodes of depressive disorders and exhibited significantly higher rates of later anxiety disorder, attention deficit hyperactivity disorder, and suicidality compared to children without depressive disorders at age 3/6. Early childhood depression was also associated with higher levels of mother, but not child, reported depressive symptoms at age 15 compared to children without depressive disorders at age 3/6. Finally, depression at age 3/6 predicted lower levels of global and interpersonal functioning and higher rates of treatment at age 15 compared to children without depressive disorders at age 3/6. CONCLUSIONS: Results support the clinical significance of depression in 3/6-year-old children, although further studies with larger samples are needed.

Childhood-onset depression and arterial stiffness in young adulthood.

OBJECTIVES: The literature on childhood-onset depression and future compromised vascular function is suggestive but limited. The objective of this study was to determine if arterial stiffness, a predictor of future cardiovascular disease (CVD), measured in young adulthood, is associated with childhood-onset depression. METHODS: Cardiometabolic risk factors and pulse wave velocity (PWV), a measure of arterial stiffness, were cross-sectionally assessed in young adults with a history of childhood-onset depression (clinical diagnosis of major depressive episode or dysthymic disorder; N = 294 probands; initially recruited via child mental health facilities across Hungary; mean age of first depressive episode = 10.4 years), their never-depressed full biological siblings (N = 269), and never-depressed controls (N = 169). The mean ages of probands, siblings, and controls at the PWV visit were 25.6, 25.0, and 21.7 years, respectively, and 8.8% of the probands were in a current depressive episode. RESULTS: Controlling for age, sex, age*sex, education, and family clusters, PWV (m/s) did not statistically differ across the groups (probands = 7.01; siblings = 6.98; controls = 6.81). However, after adjusting for key covariates, there were several across-group differences in CVD risk factors: compared to controls, probands and siblings had higher diastolic blood pressure and lower high-density lipoprotein cholesterol, probands had higher triglycerides, and siblings had higher body mass index (all p < 0.05). CONCLUSION: We found limited evidence of an association between a history of childhood-onset depression and young adulthood arterial stiffness. However, our findings of elevated cardiovascular risk factors in those with childhood-onset depression suggest that pediatric depression may predispose to increased CVD risk later in life and warrants further investigation.

Sustained remission of child depression despite drift in parent emotion management skills 18 weeks following Parent Child Interaction Therapy: emotion development.

Whether effects of psychotherapies for depression are sustained after treatment is an important clinical issue. In older depressed children and adolescents such treatments have been shown to be sustained for several months. Rates of remission ranged from 62-69% at 3 months-1 year in one large scale study. To date there has been no data to inform whether the effects of earlier interventions for depression in the preschool period are sustained. To address this, we used data from a randomized controlled trial of a novel early intervention for depression called "Parent Child Interaction Therapy Emotion Development" (PCIT-ED) that has shown efficacy for depression, parenting stress and parenting practices. Participants and their caregivers were re-assessed 18 weeks after treatment completion. All study procedures were approved by the Washington University School of Medicine Internal Review Board prior to data collection. Study findings demonstrated a high rate of sustained gains in remission from depression, decreased parenting stress and parental depression 18 weeks after completion of a trial of PCIT-ED in a population of young children. Parental response to the child expression of emotion, a key treatment target drifted back towards baseline after 3 months. Relapse rates were 17% and predictors of relapse were the presence of an externalizing disorder, a higher number of co-morbid disorders and poorer guilt reparation and emotion regulation measured at treatment completion. This extends the body of literature demonstrating parent-child interaction therapy (PCIT) to have sustained effects on targeted disruptive symptom profiles to early childhood depression. This relatively low relapse rate after 18 weeks is comparable or better than many empirically proven treatments for depression in older children.

Depressive Symptoms, Body Mass Index, and Physical Activity Self-Efficacy in African American Children.

In recent decades, the prevalence of childhood depression and obesity has increased worldwide. African American (AA) children are more obese than White peers and experience many factors that can influence the onset of depressive symptoms. While depression and obesity have been examined in adolescents, there is a paucity of research in AA children. This study examined the relationships among depressive symptoms, obesity, and physical activity self-efficacy in AA children. A community sample of 65 AA children completed questionnaires for depressive symptoms and physical activity self-efficacy and also had body mass index (BMI) and BMI Z-scores calculated. Correlational statistics were used to examine associations between variables. Clinically significant total depression scores were present in 22% of children, while 48% were overweight or obese. Overall, children reported high physical activity self-efficacy. Higher depressive symptoms were associated with higher BMI Z-scores. Results also indicated significant correlations between the children's physical activity self-efficacy and depressive symptoms. Findings suggest that the associations between depressive symptoms, BMI, and physical activity self-efficacy in AA children merit additional examination. Early identification of depression in children may inform future approaches to treatment of psychological and physiological problems within the clinical setting. Screening for childhood depressive symptoms in primary care settings, especially those that specifically treat childhood obesity, can be instrumental in early identification of children with depression. Healthcare providers should be knowledgeable of the clinical presentation of depression and engaged in depression screening.

Preliminary evaluation of the utility of parental ratings in a Child Network.

INTRODUCTION: Children in the US have a high incidence of psychiatric disorders, but the symptoms of these illnesses are often poorly recognized and treated. We thus created a Child Network for parents of children aged 2-12 to rate their child on a weekly basis on a secure website so that longitudinal ratings could be easily visualized. METHODS: After giving informed consent, parents filled out: a one-time questionnaire and a 97 item Child Checklist; and then rated the severity of depression, anxiety, ADHD, oppositional behavior, and mania each week. The new Checklist ratings were correlated with the 23 previous validated in adults (the M-3), and symptom burden was compared with diagnoses received in the community. RESULTS: The 23 item M-3 ratings were highly correlated with the more extensive Child Checklist. Symptom severity also corresponded to diagnoses received in the community. An example of the longitudinal weekly ratings of a child with a dysphoric mania is also presented. CONCLUSIONS: The convergence of scores on the adult and child portions of the Child Checklist and the ease of visualization of symptoms and response to treatment suggest the utility of the ratings in the Child Network.

Prevalence of childhood depression in school going adolescents in an urban Indian school.

BACKGROUND: Understanding the prevalence of a psychiatric disorder among children is essential for formulating sound public health policy. AIM: This study is aimed to estimate the prevalence of depression in urban school-going adolescents and its association with age, sex, and birth order. MATERIALS AND METHODS: A total of 500 participants in the age group 12-16 years from a working-class community, studying in an urban school, were selected for the study. The children with a score greater than or equal to 19 on the CDI scale were taken for the second phase, and diagnosis of depression was confirmed by a psychiatric consultant through a clinical interview. In clinically diagnosed cases, all help was rendered, including follow-up. RESULTS: The prevalence of clinical depression among school-going children of age group 12-16 years was 8.4%. There was no significant gender difference in the prevalence of clinical depression. Significantly, more children had clinical depression in the age group of 14-16 years than in the 12-14 years of age group. Depressive symptoms were more among children with first birth order. CONCLUSIONS: These results show that depression is common in school going urban adolescents in India and highlight the need for screening school-age children for depression so that early intervention can be provided.

Gender differences in trajectories of depressive symptoms across childhood and adolescence: A multi-group growth mixture model.

BACKGROUND: This study sought to identify depression trajectories across childhood and to model a range of child and family predictors of whether a child may be on an increasing trajectory towards depressive disorder in adolescence. METHODS: Multi-group growth mixture modelling (MGMM) was used on a sample of 4983 children from the Longitudinal Study of Australia Children (LSAC). Depressive symptoms of these children were assessed over 10-years with six time-points, administered every second year commencing at 4 years via the parent report version of the Strength and Difficulties Questionnaire. Predictors of class membership were also examined. RESULTS: Four trajectories were found to be the best fitting model characterising low-stable (75%); decreasing (11%); increasing (9%); high and rising (6%) groups. Females were more likely to be in a trajectory of increasing depressive symptoms between 4 and 14 years of age than males. Reactive temperament and maternal depression at four and six years of age were consistent predictors of increasing and high trajectories while persistent temperament acts as a protective factor for females. LIMITATIONS: The findings should be interpreted in the light of limitations due to common-method variance and the absence of diagnostic indicators of depressive disorder. CONCLUSIONS: We conclude that there are gender differences in patterns of depressive symptoms from childhood to adolescence and meaningful predictors of these early developmental trajectories. Preventative interventions in childhood targeting parents with depression and children with temperamental difficulties may be indicated.

Hypertensive disorders of pregnancy and the risk of offspring depression in childhood: Findings from the Avon Longitudinal Study of Parents and Children.

Hypertensive disorders of pregnancy (HDP) may increase the risk of offspring depression in childhood. Low birth weight is also associated with increased risk of mental health problems, including depression. This study sought to investigate (a) whether there is an association between HDP and the risk of depression in childhood and (b) whether low birth weight mediates this association. The current study is based on the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective, population-based study that has followed a cohort of offspring since their mothers were pregnant (n = 6,739). Depression at the age of 7 years was diagnosed using parent reports via the Development and Well-Being Assessment (DAWBA). Log-binomial regression and mediation analyses were used. Children exposed to HDP were 2.3 times more likely to have a depression diagnosis compared with nonexposed children, adjusted Risk Ratio [RR], 2.31; 95% CI, [1.20, 4.47]. Low birth weight was a weak mediator of this association. Results were adjusted for confounding variables including antenatal depression and anxiety during pregnancy.This study suggests that fetal exposure to maternal hypertensive disorders of pregnancy increased the risk of childhood depression. The study adds to the evidence suggesting that the uterine environment is a critical determinant of neurodevelopmental and psychiatric outcomes.

Hospitalization Costs and Financial Burden on Families with Children with Depression: A Cross-Section Study in Shandong Province, China.

BACKGROUND: Depression, one of the most frequent mental disorders, affects more than 350 million people of all ages worldwide, with China facing an increased prevalence of depression. Childhood depression is on the rise; globally, and in China. This study estimates the hospitalization costs and the financial burden on families with children suffering from depression and recommends strategies both to improve the health care of children with depression and to reduce their families' financial burden. METHODS: The data were obtained from the hospitalization information system of 297 general hospitals in six regions of Shandong Province, China. We identified 488 children with depression. The information on demographics, comorbidities, medical insurance, hospitalization costs and insurance reimbursements were extracted from the hospital's information systems. Descriptive statistics were presented, and regression analyses were conducted to explore the factors associated with hospitalization costs. STATA14 software was used for analysis. RESULTS: The mean age of children with depression was 13.46 ± 0.13 years old. The availability of medical insurance directly affected the hospitalization costs of children with depression. The children with medical insurance had average total hospitalization expenses of RMB14528.05RMB (US$2111.91) and length of stay in hospital of 38.87 days compared with the children without medical insurance of hospital with expenses of RMB10825.55 (US$1573.69) and hospital stays of 26.54 days. Insured children's mean out-of-pocket expenses (6517.38RMB) was lower than the those of uninsured children (RMB10825.55 or US$1573.69), significant at 0.01 level. Insured children incurred higher treatment costs, drug costs, bed fees, check-up fees, test costs and nursing fees than uninsured patients (p < 0.01). CONCLUSIONS: Children suffering from depression with medical insurance had higher hospitalization costs and longer hospitalization stays than children without medical insurance. While uninsured inpatients experienced larger out-of-pocket costs than insured patients, out-of-pocket hospital expenses strained all family budgets, pushing many, especially low-income, families into poverty-insured or uninsured. The different hospital cost structures for drugs, treatment, bed fees, nursing and other costs, between insured and uninsured children with depression, suggest the need for further investigations of treatment regimes, including over-demand by parents for treatment of their children, over-supply of treatment by medical staff and under-treatment of uninsured patients. We recommend more careful attention paid to diagnosing depression in girls and further reform to China's health insurance schemes-especially to allow migrant families to gain basic medical insurance.

Reliability and validity of the Children's Depression Inventory-Japanese version.

BACKGROUND: Depression has major negative consequences for individuals and society, and psychological assessment tools for early disease detection are needed. The aim of this study was to investigate the reliability and validity of an updated Japanese version of the Children's Depression Inventory (CDI-J) and set a cut-off score for the detection of depression. METHODS: The participants consisted of 465 children and adolescents aged 7-17 years. The control (CON) groups consisted of students recruited from elementary and junior-high school (CONEJ) and children recruited from among hospital staff members (CONRE), while the outpatient clinical (OPC) groups consisted of pediatric psychosomatic outpatients (OPCPD) and adolescent psychiatric outpatients (OPCPS). The CON and OPC CDI-J scores underwent factor analysis using varimax rotation, followed by measurement invariance analysis. The Youth Self-Report (YSR) was administered to assess concurrent validity. The Mini-International Neuropsychiatric Interview was administered to the OPC group to diagnose current depressive symptoms. Receiver operating characteristics (ROC) analysis was conducted to evaluate case-finding performance and to set cut-off points for the detection of depression. RESULTS: The CDI-J was reliable in terms of internal consistency (Cronbach α = 0.86; mean inter-item correlation, 0.16). Re-test reliability was substantial (mean interval 18 days: γ = 0.59, P < 0.05). The four-factor solution exhibited adequate internal consistency (range, 0.52-0.73) and correspondence (Pearson correlation of 0.65 with the YSR) for both the CON and OPC groups. On ROC analysis the optimal cut-off score was 23/24. CONCLUSION: The CDI-J can be used as a reliable and well-validated instrument alongside standard diagnostic procedures.

A comparative study of temperamental, behavioral, and cognitive changes in thalassemia major, thalassemia minor, and normal population.

BACKGROUND: Temperament in children and adolescents acts as a trait marker which can predict behavioral abnormalities. There was no systemic study in India which has compared the temperamental, behavioral and cognitive changes associated with this hemoglobinopathy among thalassemia major (TM) group. MATERIALS AND METHODS: The specific objectives of this study were to find the clinicodemographic profile of individuals and parents, the behavioral, temperamental profile of children of beta TM and correlation of temperamental profile with number of blood transfusions, cognitive profile of children having beta TM, minor and age-matched control children and adolescents. RESULTS: Child and adolescents having TM have more temperamental and behavioral problems (P < 0.001) and have more psychopathology in comparison to Tm group. Descriptive statistics of the groups and group comparison (ANOVA) shows statistically significant difference in Temperament Measurement Schedule (TMS) total, CPMS total, TMT A, TMT B, and Children's Depression Rating Scale (CDRS) scales (P = 0.000). Descriptive statistics and group comparison (Chi-square test) show significance in number of blood transfusions not with other parameters (P < 0.001). Comparison between TM (Case) and Tm (Control) (t-test) shows significance with only TMS total and CPMS scales, not in other scales. The correlation matrix showed significant correlation in-between all the parameters (blood transfusion, TMS, CPMS, TMT A, TMT B, and CDRS). DISCUSSION: Those who have been diagnosed as TM have more behavioral and cognitive problems than their comparators. Youngsters receiving more blood transfusions due to their ailments scored higher in childhood depression rating scale. CONCLUSION: The temperamental, behavioural and cognitive profile are key determinants of both internalizing and externalizing symptoms and management plan can be guided accordingly as reflected in this study.

Depressive Symptoms of Chinese Children: Prevalence and Correlated Factors among Subgroups.

Economic growth and socioeconomic changes have transformed nearly every aspect of childhood in China, and many are worried by the increasing prevalence of mental health issues among children, particularly depression. To provide insight into the distribution of depressive symptoms among children in China and identify vulnerable groups, we use data from the 2012 China Family Panel Survey (CFPS), a survey that collected data from a large, nationally representative sample of the Chinese population. Using the CFPS data, we construct a sample of 2679 children aged 10-15 years old from 25 provinces in China. According to our results, the incidence of depression varies by geographic area. Specifically, we find that rates of depressive symptoms are significantly lower in urban areas (14% of sample children) than in rural areas (23% of sample children). Our results also show that children from ethnic minorities, from poorer families, and whose parents are depressed are more likely to be depressed than other children. In contrast, we find that depressive symptoms do not vary by gender.

Structural analysis of depression indicators scale-children and adolescents (BAID-IJ): a bifactor-ESEM approach / Análise estrutural da bateria de avaliação de indicadores de depresão infantojunenil: uma abordagem ESEM bifactor / Análisis estructural de la depresión indicadores niños escala- y adolescentes: un enfoque bifactorial-ESEM

Depression in children and adolescents has reached alarming levels, evidencing an ever-greater need for early diagnosis of the disorder. Depression is a construct closely related to other indicators and the broad track of symptoms. The Depression Indicator Assessment Battery was developed to measure the core symptoms of depression, loneliness, helplessness, self-esteem and self-concept. Participants were 976 children and adolescents, aged 8-18 years. The data was collect from two public schools and from public mental health care services in Brazil. The internal structure was studied with the comparison of six different exploratory and confirmatory models, each one nest different assumptions. The comparison of models indicated that a latent bifactor explanatory structural equation model better explains the variance of data. The latent structure expected for the battery was confirmed, taking in account the complexity of measure correlated constructs, linking the theory to the measure.

A depressão em crianças e adolescentes tem atingido níveis alarmantes, evidenciando uma necessidade cada vez maior para o diagnóstico precoce da doença. A depressão é um construto intimamente relacionado com indicadores e uma ampla faixa de sintomas. A Bateria de Avaliação de Indicadores de Depressão Infantojuvenil (BAID-IJ) foi desenvolvido para medir os sintomas nucleares da depressão, solidão, desamparo, a autoestima e autoconceito. Participaram da pesquisa 976 crianças e adolescentes de 8-18 anos. Os dados foram coletados a partir de duas escolas públicas e de serviços públicos de saúde mental no Brasil. A estrutura interna foi estudada com a comparação de seis diferentes modelos exploratórios e confirmatórios. A comparação entre os modelos indicou que a modelagem de equação estrutural do fator latente exlicou melhor a variância dos dados. A estrutura latente prevista para a bateria foi confirmada, levando em conta a complexidade da medida correlacionada construções, ligando a teoria à medida.

Depresión en niños y adolescentes ha alcanzado niveles alarmantes, lo que evidencia una cada vez mayor necesidad de un diagnóstico precoz de la enfermedad. La depresión es una construcción muy relacionado con otros indicadores y la pista amplia de síntomas. La Batería de Evaluación de Indicadores Depresión fue desarrollado para medir los principales síntomas de la depresión, la soledad, el desamparo, la autoestima y el autoconcepto. Los participantes fueron 976 niños y adolescentes, con edades entre 8-18 años. Los datos fueron cobrar de dos escuelas públicas y de los servicios públicos de salud mental en Brasil. La estructura interna se estudió con la comparación de seis modelos exploratorio y confirmatorio diferentes, cada uno de anidación supuestos diferentes. La comparación de los modelos indica que un modelo latente bifactorial exploratoria estructural ecuación, con un factor general y de cinco factores correlacionados grupos que explican mejor la varianza del instrumento. La estructura latente esperado para la batería se confirmó, teniendo en cuenta la complejidad de la medida correlacionada construcciones, vinculando la teoría con la medida.

A Randomized Clinical Trial Comparing Family-Focused Treatment and Individual Supportive Therapy for Depression in Childhood and Early Adolescence.

OBJECTIVE: Despite the morbidity and negative outcomes associated with early-onset depression, few studies have examined the efficacy of psychosocial treatment for depressive disorders during childhood. Integrating family in treatment could have particularly salutary effects during this developmental period. This trial compared immediate posttreatment effects of family-focused treatment for childhood depression (FFT-CD) with those of individual supportive psychotherapy (IP) for children 7 to 14 years old with depressive disorders. METHOD: Children were randomized to 15 sessions of FFT-CD (n = 67) or IP (n = 67) over 4 months. The primary treatment outcome was adequate clinical depression response, defined as at least a 50% decrease in score on the Children's Depression Rating Scale-Revised (CDRS-R). Additional outcomes included patient-centered outcomes (parent- and child-reported treatment satisfaction), remission (defined as CDRS-R score ≤28), change in continuous CDRS-R score, and change in child and parent reports of depressive and non-depressive symptoms and social adjustment. RESULTS: Significant improvement was evident across groups for depressive and non-depressive symptoms, global response, and functioning and social adjustment. Compared with children randomized to IP, children randomized to FFT-CD showed higher rates of adequate clinical depression response (77.7% versus 59.9%; number needed to treat = 5.72; odds ratio 2.29; 95% CI 1.001-5.247; t = 1.97, p = .0498). Across treatments, families reported high satisfaction; compared with IP families, FFT-CD families reported greater knowledge and skills for managing depression. There were no significant differences between treatment arms on secondary outcomes. CONCLUSION: Results support the value of psychosocial intervention, emphasize the important role that families play, and highlight the potential for FFT-CD for supporting recovery in children with depression. Clinical trial registration information-Systems of Support Study for Childhood Depression; http://clinicaltrials.gov; NCT01159041.

Anxiety- and depressive-like profiles during early- and mid-adolescence in the female Wistar Kyoto rat.

Approaches for the development of preclinical models of depression extensively use adult and male animals owing to the discrepancies arising out of the hormonal flux in adult females and adolescents during attainment of puberty. Thus the increased vulnerability of females towards clinical depression and anxiety-related disorders remains incompletely understood. Development of clinical models of depression in adolescent females is essential in order to evolve effective treatment strategies for adolescent depression. In the present study, we have examined the anxiety and depressive-like profiles in a putative animal model of childhood depression, the Wistar Kyoto (WKY) rat, during early adolescence (∼postnatal day 30) and mid-adolescence (∼postnatal day 40). Female adolescent WKY rats, tested on a series of behavioural tests modelling anxiety- and depressive-like behaviours with age-matched Wistars as controls, demonstrated marked differences during early adolescence in a strain- and age-specific manner. Anxiety indices were obtained from exposure to the elevated plus maze, where social communication vide 50-kHz ultrasonic vocalizations was also assessed, while immobility and other parameters in the forced swim test were screened for depressive-like profiles. Sucrose preference, used as a measure of anhedonia in animals, was lower in WKYs at both ages tested and decreased with age. Anxiety-related behaviours were prominent in WKY rats only during early adolescence. WKY female rats are anxious during early adolescence and exhibit anhedonia as a core symptom of depression during early- and mid-adolescence, thus indicating that inclusion of female animals in preclinical trials is essential and will contribute to gender-based approaches to diagnosis and treatment of adolescent depression in females.

Effect of Changes in Sleep Quantity and Quality on Depressive Symptoms Among Korean Children.

This study aims to determine whether changes in sleep quantity and quality in childhood are associated with incidence of depressive symptoms. We used the three waves of the Korean Children & Youth Panel Survey (2011-2013). Statistical analysis using a generalized estimating equation model was performed. The 2,605 subjects analyzed included 1,453 students in 2012 and 1,152 students in 2013 without depressive symptoms in the prior year. We found that deteriorated or consistently poor sleep quality were important risk factors for depressive symptoms in children. We suggest that early detection and intervention of poor sleep quality in elementary school is required to reduce early onset depressive symptoms.