Ruth C. Brown

Genetic determinants of depression: recent findings and future directions.

Learning ObjectivesAfter participating in this activity, learners should be better able to: 1. Evaluate current evidence regarding the genetic determinants of depression 2. Assess findings from studies of gene-environment interaction 3. Identify challenges to gene discovery in depression AbstractDepression is one of the most prevalent, disabling, and costly mental health conditions in the United States and also worldwide. One promising avenue for preventing depression and informing its clinical treatment lies in uncovering the genetic and environmental determinants of the disorder as well as their interaction (G×E). The overarching goal of this review article is to translate recent findings from studies of genetic association and G×E related to depression, particularly for readers without in-depth knowledge of genetics or genetic methods. The review is organized into three major sections. In the first, we summarize what is currently known about the genetic determinants of depression, focusing on findings from genome-wide association studies (GWAS). In the second section, we review findings from studies of G×E, which seek to simultaneously examine the role of genes and exposure to specific environments or experiences in the etiology of depression. In the third section, we describe the challenges to genetic discovery in depression and promising strategies for future progress.

Longitudinal course of panic disorder with and without agoraphobia using the national epidemiologic survey on alcohol and related conditions (NESARC)

Few naturalistic, longitudinal studies of panic disorder with and without agoraphobia (PD/PDA) exist, limiting our knowledge of the temporal rates of incidence, relapse, and chronicity, or the factors that predict category transition. Data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) wave 1 (n=43,093) and wave 2 (n=34,653) were utilized to determine transitional rates, and predictors of category transitions, over a 3-year period. Analyses revealed very high 3-year remission rates for PD and PDA (75% and 67%, respectively), although relapse also was relatively frequent (PD=12%; PDA=21%). Logistic regression revealed previous history of panic attacks, generalized anxiety disorder/major depression (GAD/MDD), nicotine dependence, female sex, younger age, and major financial crises to be reliable predictors of incidence and relapse. The direction and magnitude of association of many predictor variables were similar for PD and PDA, with notable exceptions for social anxiety and romantic relationship factors. Clinicians should be aware of the relapsing-remitting nature of PD and PDA and, thus, take caution to not reduce or eliminate effective treatments prematurely. Similarly, the current study suggests clinicians pay particular attention to concurrent factors relevant to relapse in PD/PDA that may also be clinically addressed (e.g., co-morbid MDD/GAD and nicotine dependence).

Factor structure of measures of anxiety and depression symptoms in African American youth.

Previous research has suggested that the factor structure of anxiety measures is different in African American samples compared to majority population samples. However, these findings may be due to misuse of analytic methods rather than meaningful differences in the underlying presentation of anxiety. To address this, we examined the factor structure of two measures of child anxiety: the Revised Children’s Anxiety and Depression Scale and the Multidimensional Anxiety Scale for Children in a sample of 229 African American youth. Contrary to previous research, confirmatory factor analyses yielded good fit for the original factor structures of both measures. These results suggest that the underlying factor structure of these measures may not be significantly different for African American and majority population youth as previously thought. The effect of data analytic procedures on subsequent conclusions and theory is discussed and recommendations are made.

Testing the Temporal Relationship Between Maternal and Adolescent Depressive and Anxiety Symptoms in a Community Sample

Transactional models have been used to explain the relationship between maternal depression and child behavioral problems; however, few studies have examined transactional models for maternal depression and adolescent depression and anxiety. Using an autoregressive cross-lagged analysis, we examined the longitudinal association between maternal and adolescent depression to determine the extent to which maternal depression influences adolescent depression and anxiety, and vice versa, over the course of a 4-year period. Participants were a community sample of 277 mother–adolescent dyads with offspring 10 to 14 years of age at the 1st year used in the analyses (43.7% female; 35% African American, 2.9% Hispanic/Latino). Depressive symptoms were assessed using maternal self-report (Center for Epidemiological Studies-Depression Scale; Radloff, 1977), and adolescent depression and anxiety were assessed by self-report (Revised Child Anxiety and Depression Scale; Chorpita, Yim, Moffitt, Umemoto, & Francis, 2000). The final model, χ2(14) = 23.74, p = .05 (TLI = .97, CFI = .98, RMSEA = .05), indicated that maternal depression was significantly associated with adolescent depression 2 years later. Of interest, adolescent depression did not significantly predict maternal depression, and the association between maternal and adolescent depression was not moderated by gender, age, or ethnicity. The association between maternal depression and adolescent anxiety was weaker than that observed for adolescent depression. Results suggest that the transaction model of maternal depression may not extend to adolescent depression and anxiety. Furthermore, maternal depression can have an enduring effect on adolescent depression, and continued research and clinical monitoring over extended periods is warranted.

Race as a Moderator of the Relationship Between Distress Tolerance and Cigarette Smoking

The present study examined the role of distress tolerance (DT) and race in relation to cigarette smoking. For this study, between 2008 and 2010, 153 women (62.1% White, 37.9% African American) from the Washington, DC metropolitan area completed a computerized behavioral DT task and self-reported smoking history. Results suggest that low DT (OR = .23, p = .03) and the interaction between DT and race (OR = 4.58, p = .05) were significantly related to greater odds of being a smoker, such that African American women, but not White women, with low DT were at increased risk for being a lifetime smoker.

Cognitive-Behavioral Therapy for Adolescents

Cognitive-behavioral therapy (CBT) is mental health treatment with strong scientific evidence supporting its use with adolescents for a variety of problems. This article provides a broad overview of CBT with adolescents divided into three main sections. In the first section, the theories underlying the CBT approach are described. Specifically, behavior theory and cognitive theory are reviewed. Further, how the two theories have been integrated into what is called cognitive-behavior theory is discussed. In the second section, a description of specific interventions found in CBT and which modalities are used to deliver CBT is provided. Finally, in the third section, scientific evidence on the use of CBT for four common problem areas for adolescents is described: (a) anxiety disorders, (b) depression, (c) externalizing behavior problems, and (d) eating disorders.

Does Parenting Influence the Enduring Impact of Severe Childhood Sexual Abuse on Psychiatric Resilience in Adulthood

This study examined the effect of parenting on the association between childhood sexual abuse (CSA) and psychiatric resilience in adulthood in a large female twin sample (n = 1423) assessed for severe CSA (i.e., attempted or completed intercourse before age 16). Severe CSA was associated with lower resilience to recent stressors in adulthood (defined as the difference between their internalizing symptoms and their predicted level of symptoms based on cumulative exposure to stressful life events). Subscales of the Parental Bonding Instrument were significantly associated with resilience. Specifically, parental warmth was associated with increased resilience while parental protectiveness was associated with decreased resilience. The interaction between severe CSA and parental authoritarianism was significant, such that individuals with CSA history and higher authoritarianism scores had lower resilience. Results suggest that CSA assessment remains important for therapeutic work in adulthood and that addressing parenting may be useful for interventions in children with a CSA history.

Sleep Disturbances in OEF/OIF/OND Veterans: Associations with PTSD, Personality, and Coping.

STUDY OBJECTIVES Sleep disturbances are well documented in relation to trauma exposure and posttraumatic stress disorder (PTSD), but correlates of such disturbances remain understudied in veteran populations. We conducted a preliminary study of sleep disturbances in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans (n = 133; mean [standard deviation] age = 29.8 [4.7] y). METHODS Veterans were assigned to one of three groups based on responses to the Clinician Administered PTSD Scale: control (no trauma-exposure [TE] or PTSD), TE, and PTSD. Sleep disturbance was assessed using the Pittsburgh Sleep Quality Index (PSQI). Measures of resilience, trauma load, personality, coping, alcohol use, and mild traumatic brain injury were also assessed via self-report. RESULTS The PTSD group had significantly more disturbed sleep (PSQI global score mean = 8.94, standard deviation = 3.12) than control (mean = 5.27, standard deviation = 3.23) and TE (mean = 5.34, standard deviation = 3.17) groups, but there were no differences between TE and control. The same pattern emerged across most PSQI subscales. Results of linear regression analyses indicated that current smoking, Army (versus other military branches), neuroticism, and using substances to cope were all significant correlates of higher sleep disturbance, whereas post-deployment social support was associated with less sleep disturbance. However, when combined together into a model with PTSD status, only neuroticism and substance use coping remained significant as predictors of more disturbed sleep. CONCLUSIONS These initial findings suggest that TE itself may not be an independent risk factor for disturbed sleep in veterans, and that neurotic personality and a tendency to cope by using substances may partially explain sleep disturbance, above and beyond a diagnosis of PTSD.

Pre-Typhoon Socioeconomic Status Factors Predict Post-typhoon Psychiatric Symptoms in a Vietnamese Sample

PurposeExposure to natural disasters has been associated with increased risk for various forms of psychopathology. Evidence indicates that socioeconomic status (SES) may be important for understanding post-disaster psychiatric distress; however, studies of SES-relevant factors in non-Western, disaster-exposed samples are lacking. The primary aim of the current study was to examine the role of pre-typhoon SES-relevant factors in relation to post-typhoon psychiatric symptoms among Vietnamese individuals exposed to Typhoon Xangsane.MethodsIn 2006, Typhoon Xangsane disrupted a mental health needs assessment in Vietnam in which the Self Reporting Questionnaire-20 (SRQ-20), and the Demographic and Health Surveys Wealth Index, a measure of SES created for use in low-income countries, were administered pre-typhoon. The SRQ-20 was re-administered post-typhoon.ResultsResults of a linear mixed model indicated that the covariates of older age, female sex, and higher levels of pre-typhoon psychiatric symptoms were associated with higher levels of post-typhoon psychiatric symptoms. Analysis of SES indicators revealed that owning fewer consumer goods, having lower quality of household services, and having attained less education were associated with higher levels of post-typhoon symptoms, above and beyond the covariates, whereas quality of the household build, employment status, and insurance status were not related to post-typhoon psychiatric symptoms.ConclusionEven after controlling for demographic characteristics and pre-typhoon psychiatric symptoms, certain SES factors uniquely predicted post-typhoon psychiatric distress. These SES characteristics may be useful for identifying individuals in developing countries who are in need of early intervention following disaster exposure.

A cluster-analytic approach to determining drinking motives and personality typologies: Trauma group differences and respective relations to PTSD and problematic alcohol use.

Veterans with posttraumatic stress disorder (PTSD) are at elevated risk for alcohol use problems, a relationship commonly explained by using alcohol to cope with unpleasant symptoms of PTSD. However, patterns of alcohol use motives, more broadly, have not been well characterized in veteran samples, nor have they been evaluated in the context of other relevant factors, such as normative personality traits. The aims of the present study were to identify empirically derived drinking motive and personality typologies to determine whether these typologies differ as a function of PTSD status (i.e., nontrauma control, trauma exposed−no PTSD, and PTSD) and to evaluate associations between typology and PTSD symptom severity and alcohol consumption, respectively. Cluster analyses identified a 4-cluster solution. Results indicated that these typologies differed significantly according to trauma group as well as across levels of PTSD symptom severity and alcohol use. Specifically, Cluster 4 represented individuals at highest risk for both PTSD symptom severity and alcohol use compared to all the other typologies; Cluster 1 demonstrated lowest risk for PTSD symptom severity and alcohol use compared to all other typologies; and although Clusters 2 and 3 did not differ according to PTSD symptom severity, individuals in Cluster 2 had significantly higher alcohol use. These results represent certain “at risk” versus “protective” typologies that may facilitate the identification of individuals at risk for comorbid PTSD and problematic alcohol use.