Patrick Pössel

Impact of comorbidity in prevention of adolescent depressive symptoms.

Despite the well-known relevance of comorbidity, few studies have examined the impact of comorbid anxiety or externalizing symptoms on the prevention of depressive symptoms in adolescents. To replicate earlier positive effects of a cognitive-behavioral prevention program of depressive symptoms and to test the hypothesis that the prevention program would be less effective in adolescents with comorbid anxiety and externalizing symptoms, the authors conducted a study involving 301 8th-grade students randomly divided into an intervention group and a nonintervention control group. The randomized design included baseline, postintervention, and 6-month follow-up. The prevention program included 10 sessions held in a regular school setting. The prevention program showed positive effects on depressive symptoms independent of comorbid symptoms. These effects were found mainly with girls independent of their depressive symptoms at baseline, and in part with boys with less severe depressive symptoms at baseline. It is surprising that negative effects of the prevention program on depressive symptoms were found on the depression of boys with more severe depressive symptoms at baseline. The prevention program’s low rate of attrition and high recruitment rate support the generalizability of the results.

Promoting Adaptive Emotion Regulation and Coping in Adolescence A School-based Programme

Particularly in adolescence, fostering adaptive emotion regulation is an important aim in health promotion. Expressive writing in combination with psycho-education on emotion regulation seems especially appropriate to serve this aim. In this study, school classes were randomly assigned either to a prevention (N = 208) or to a non-treatment control group (N = 151). The prevention group showed significant improvements regarding negative affect, grades, and days absent compared to the control-group. A combination of expressive writing with elements of psycho-education of emotion regulation might be an effective preventive tool, as it seems to improve psychosocial adjustment by establishing functional emotion regulation strategies.

A longitudinal study of cortical EEG activity in adolescents.

BACKGROUND The objective of this study is to test Davidsons, and Heller and Nitschkes models stating cortical activity in adolescents to be a marker for increased risk for depression. METHODS Alpha activity was measured in 80 adolescents from medial-frontal (F3/4), lateral-frontal (F7/8), and medial-parietal (P3/4) electrodes, as well as self-reported depression and anxiety twice within 12 months. Step-wise hierarchical regression analyses with anxiety as covariate were calculated with alpha asymmetry as predicting variable and depression as target variable and vice versa. RESULTS Independent of whether anxiety was used as covariate or not, frontal and parietal alpha asymmetry predict depression, but depression did not predict alpha activity. CONCLUSIONS The results partially support both models and conclusions drawn by studies with remitted depressed subjects. However, it remains unclear if anxious arousal has a partial influence on the predictive association between alpha activity and depression.

A Randomized Controlled Trial of a Cognitive-Behavioral Program for the Prevention of Depression in Adolescents Compared With Nonspecific and No-Intervention Control Conditions

Adolescent depression is a common and recurrent disorder associated with significant impairment and other forms of psychopathology. Finding an effective intervention that prevents depression in adolescents is an important public health priority. Participants were 518 high school students (mean age = 15.09; SD = 0.76) from the mid-south of the United States. Participants were randomly assigned to 1 of 3 conditions: a cognitive-behavioral program (CB; n = 166), nonspecific control (NSp; n = 175), or a no-intervention control condition (NIC; n = 177). Both the CB and NSp conditions consisted of 90-min sessions administered once a week over a 10-week period during regular school hours. Depressive symptoms were assessed with the Childrens Depression Inventory (CDI) at baseline; postintervention; and at 4-, 8-, and 12-month follow-ups. The Time × Condition interaction was significant, F(8, 478.57) = 3.32, p = .001, indicating that at the 4-month follow-up, youth in the CB condition had significantly lower CDI scores compared with those in the NSp (p = .047, g = 0.29; CI [0.06, 0.52]) and the NIC conditions (p = .003, g = 0.30; CI [0.07, 0.53]). Future studies need to examine the importance of theory-driven change mechanisms, interpersonal relationships, and structural circumstances in schools as factors impacting the long-term effects of CB prevention programs.

Associations between teacher emotional support and depressive symptoms in Australian adolescents : a 5-year longitudinal study.

Approximately 1/5 of adolescents develop depressive symptoms. Given that youths spend a good deal of their lives at school, it seems plausible that supportive relationships with teachers could benefit their emotional well-being. Thus, the purpose of this study is to examine the association between emotionally supportive teacher relationships and depression in adolescence. The so-called principle-effect and stress-buffer models could explain relationships between teacher emotional support and depressive symptoms, yet no study has used both models to test bidirectional relationships between teacher support and depressive symptoms in students separately by sex. Four-thousand three-hundred forty-one students (boys: n = 2,063; girls: n = 2,278) from Grades 8 to 12 completed the Center for Epidemiological Studies Depression Scale (CES-D), List of Threatening Experiences Questionnaire (LTEQ), and an instrument developed for the study to measure teacher support annually for 5 years. Results support neither of the 2 proposed models. Instead, they indicate that in the 1st years of high school, students of both sexes with average and high numbers of stressful events benefit from teacher support, while teacher support might have iatrogenic effects on students experiencing low numbers of stressful events. Possible explanations for the findings and future research are discussed.

Effekte pharmakologischer und psychotherapeutischer Interventionen auf Depressionen bei Kindern und Jugendlichen

Contrary to earlier assumptions, the current consensus is that depression constitutes an important issue in the mental health of children and adolescents. Thus, effective therapy options for depressive children and adolescents are needed. Randomized, controlled intervention studies are reviewed: 24 studies on pharmacological interventions, 11 studies on psychological interventions, and two on combination therapy. For approximately half of the intervention methods (pharmacotherapy: 3/8; psychotherapy: 2/5) no randomized, controlled studies carried out. Furthermore, only some SSRI (fluoxetin, citalopram and sertralin) yielded positive results with regard to depressive symptoms. Beyond these results, fluoxetin is the sole pharmacological treatment during which suicidality does not increase as compared to results for a placebo control group (Hammad et al., 2006; Whittington et al., 2004). Earlier studies of CBT, IPT, and family therapy reported predominantly positive effects. Nevertheless, initial results for combination therapies (SSRI & CBT) indicate an advantage of this therapy approach over mono-therapies. Empirical data are described, followed by a discussion of the strengths and limitations of the earlier studies.

Simulated micro-gravity and cortical inhibition: a study of the hemodynamic-brain interaction

The present study was carried out to determine the inhibitory cortical processes induced by changes in hemodynamics. Previous experiments in humans conducted in our laboratory have shown that there is a close relationship between posture and delta and theta EEG activity. The most pronounced effects were obtained during the 6 degrees head-down tilt (HDT) position. In space medicine the HDT procedure is very frequently employed to simulate micro-gravity and to determine the neurohormonal counter-regulations evoked by the expansion of central volume. Twenty male subjects spent 23 h in bed in 6 degrees HDT and 23 h in 6 degrees HUT (head-up tilt) positions during which EEG (frontal, central, parietal, occipital), startle responses, and reaction-times were measured every 2 h (from 10:00 h till 20:00 h). The effects of cardiovascular deconditioning (CD) regularly occurring after HDT were assessed by examining orthostatic tolerance and the physical work capacity (bicycle ergometry). As expected, 23 h HDT led to more pronounced CD than HUT. Spectral power analyses of EEG revealed increases in delta and theta frequency hands similar to those found during HDT in previous EEG studies. In addition, subjects responded more slowly (S1-S2 reaction-time task) during HDT as compared with HUT bedrest. The influence of HDT on startle response, however, was not in keeping with the initial hypothesis (i.e. dampening of reflex activity). The EEG data and the sensorimotor performance indicated that the body fluid shift towards the thoracic cavity induced by HDT resulted in signs of cortical inhibition. In addition to neural mechanisms, other processes must be postulated which are closely related to the counter-regulation evoked by the varying body positions.

Promoting Adaptive Emotion Regulation and Coping in Adolescence

Particularly in adolescence, fostering adaptive emotion regulation is an important aim in health promotion. Expressive writing in combination with psycho-education on emotion regulation seems especially appropriate to serve this aim. In this study, school classes were randomly assigned either to a prevention (N = 208) or to a non-treatment control group (N = 151). The prevention group showed significant improvements regarding negative affect, grades, and days absent compared to the control-group. A combination of expressive writing with elements of psycho-education of emotion regulation might be an effective preventive tool, as it seems to improve psychosocial adjustment by establishing functional emotion regulation strategies.

Vergleich zweier schulbasierter Programme zur Prävention depressiver Symptome bei Jugendlichen

Zusammenfassung. Theoretischer Hintergrund: Depressive Storungen im Jugendalter sind ein weitverbreitetes Problem mit weitreichenden psychosozialen Folgen. Um beidem vorzubeugen wurde ein kognitiv-verhaltenstherapeutisches und ein auf dem Paradigma des Expressiven Schreibens beruhendes universales schulbasiertes Praventionsprogramm entwickelt. Fragestellung: Haben die beiden Praventionsprogramme positive Wirkung auf depressive Symptomatik und Lebenszufriedenheit Jugendlicher? Methode: Es wurde eine randomisierte Kontrollgruppenstudie mit 3-Monats Follow-up an 579 Realschulern und -schulerinnen der 8. Klasse durchgefuhrt. Ergebnisse: Das kognitiv-verhaltenstherapeutische Programm wirkt in Abhangigkeit der Ausgangssymptomatik kurz- bzw. mittelfristig auf die depressive Symptomatik, wahrend das Schreibprogramm unabhangig von der Ausgangssymptomatik kurz- und mittelfristig positiv auf die Lebenszufriedenheit wirkt. Schlussfolgerungen: Trotz Einschrankungen in Bezug auf die Vergleichbarkeit beider Programme li...

Depression as a risk factor for breast cancer: investigating methodological limitations in the literature

PurposeA relationship between depression and the development of breast cancer has not been convincingly shown in the research conducted over the past three decades.MethodsIn an effort to better understand the conflicting results, a review was conducted focusing on the methodological problems associated with this literature, including time frame between the assessment of depression and the diagnosis of breast cancer and the use of somatic items in measuring depression. Fifteen breast cancer prospective studies were reviewed.ResultsWhile twelve of the studies found positive associations between depression and breast cancer development, three studies found negative associations. With regard to the predictive associations between depression and breast cancer incidence, the findings revealed that (a) studies using a longer time frame found a stronger association than studies using a shorter time frame and (b) studies utilizing depression measures that did not contain somatic items found a smaller association than studies utilizing depression measures that did contain these items.ConclusionsFuture studies should ensure that sufficient periods of time between the measurement of depression and the assessment of cancer and avoid measuring depression using somatic items.