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Depression: HELP
Articles by Randy Patrick Auerbach
Based on 33 articles published since 2008
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Between 2008 and 2019, R. Auerbach wrote the following 33 articles about Depression.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Review Cognitive Vulnerability to Major Depression: View from the Intrinsic Network and Cross-network Interactions. 2016

Wang, Xiang / Öngür, Dost / Auerbach, Randy P / Yao, Shuqiao. ·From the Medical Psychological Institute of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China (Drs. Wang and Yao) · Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA (Drs. Öngür and Auerbach). ·Harv Rev Psychiatry · Pubmed #27148911.

ABSTRACT: Although it is generally accepted that cognitive factors contribute to the pathogenesis of major depressive disorder (MDD), there are missing links between behavioral and biological models of depression. Nevertheless, research employing neuroimaging technologies has elucidated some of the neurobiological mechanisms related to cognitive-vulnerability factors, especially from a whole-brain, dynamic perspective. In this review, we integrate well-established cognitive-vulnerability factors for MDD and corresponding neural mechanisms in intrinsic networks using a dual-process framework. We propose that the dynamic alteration and imbalance among the intrinsic networks, both in the resting-state and the rest-task transition stages, contribute to the development of cognitive vulnerability and MDD. Specifically, we propose that abnormally increased resting-state default mode network (DMN) activity and connectivity (mainly in anterior DMN regions) contribute to the development of cognitive vulnerability. Furthermore, when subjects confront negative stimuli in the period of rest-to-task transition, the following three kinds of aberrant network interactions have been identified as facilitators of vulnerability and dysphoric mood, each through a different cognitive mechanism: DMN dominance over the central executive network (CEN), an impaired salience network-mediated switching between the DMN and CEN, and ineffective CEN modulation of the DMN. This focus on interrelated networks and brain-activity changes between rest and task states provides a neural-system perspective for future research on cognitive vulnerability and resilience, and may potentially guide the development of new intervention strategies for MDD.

2 Review Mapping anhedonia-specific dysfunction in a transdiagnostic approach: an ALE meta-analysis. 2016

Zhang, Bei / Lin, Pan / Shi, Huqing / Öngür, Dost / Auerbach, Randy P / Wang, Xiaosheng / Yao, Shuqiao / Wang, Xiang. ·Medical Psychological Institute, The Second Xiangya Hospital of Central South University, 139 Renmin (M) Road, Changsha, Hunan, 410011, People's Republic of China. · Key Laboratory of Biomedical Information Engineering of Education Ministry, Institute of Biomedical Engineering, Xi'an Jiaotong University, Xi'an, Shanxi, 710049, People's Republic of China. · Department of Psychology, Shanghai Normal University, Shanghai, 200234, People's Republic of China. · Harvard Medical School and McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA. · Department of Anatomy and Neurobiology, Xiangya School of Medicine, Central South University, Changsha, 410013, People's Republic of China. · Medical Psychological Institute, The Second Xiangya Hospital of Central South University, 139 Renmin (M) Road, Changsha, Hunan, 410011, People's Republic of China. wang0916xia@gmail.com. ·Brain Imaging Behav · Pubmed #26487590.

ABSTRACT: Anhedonia is a prominent symptom in neuropsychiatric disorders, most markedly in major depressive disorder (MDD) and schizophrenia (SZ). Emerging evidence indicates an overlap in the neural substrates of anhedonia between MDD and SZ, which supported a transdiagnostic approach. Therefore, we used activation likelihood estimation (ALE) meta-analysis of functional magnetic resonance imaging studies in MDD and SZ to examine the neural bases of three subdomains of anhedonia: consummatory anhedonia, anticipatory anhedonia and emotional processing. ALE analysis focused specifically on MDD or SZ was used later to dissociate specific anhedonia-related neurobiological impairments from potential disease general impairments. ALE results revealed that consummatory anhedonia was associated with decreased activation in ventral basal ganglia areas, while anticipatory anhedonia was associated with more substrates in frontal-striatal networks except the ventral striatum, which included the dorsal anterior cingulate, middle frontal gyrus and medial frontal gyrus. MDD and SZ patients showed similar neurobiological impairments in anticipatory and consummatory anhedonia, but differences in the emotional experience task, which may also involve affective/mood general processing. These results support that anhedonia is characterized by alterations in reward processing and relies on frontal-striatal brain circuitry. The transdiagnostic approach is a promising way to reveal the overall neurobiological framework that contributes to anhedonia and could help to improve targeted treatment strategies.

3 Review Adolescent depression: stress and reward dysfunction. 2014

Auerbach, Randy P / Admon, Roee / Pizzagalli, Diego A. ·From the Department of Psychiatry, Harvard Medical School; Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA. ·Harv Rev Psychiatry · Pubmed #24704785.

ABSTRACT: LEARNING OBJECTIVES: After participating in this educational activity, the physician should be better able to 1. Evaluate the relationship between reward processes, stress, and depression. 2. Assess the characteristics of the three etiological models of stress and reward processes. 3. Identify the biological basis for stress and reward processes. Adolescence is a peak period for the onset of depression, and it is also a time marked by substantial stress as well as neural development within the brain reward circuitry. In this review, we provide a selective overview of current animal and human research investigating the relationship among reward processes, stress, and depression. Three separate, but related, etiological models examine the differential roles that stress may play in relation to reward dysfunction and adolescent depression. First, the reward mediation model suggests that both acute and chronic stress contribute to reward deficits, which, in turn, potentiate depressive symptoms or increase the risk for depression. Second, in line with the stress generation perspective, it is plausible that premorbid reward-related dysfunction generates stress--in particular, interpersonal stress--which then leads to the manifestation of depressive symptoms. Third, consistent with a diathesis-stress model, the interaction between stress and premorbid reward dysfunction may contribute to the onset of depression. Given the equifinal nature of depression, these models could shed important light on different etiological pathways during adolescence, particularly as they may relate to understanding the heterogeneity of depression. To highlight the translational potential of these insights, a hypothetical case study is provided as a means of demonstrating the importance of targeting reward dysfunction in both assessment and treatment of adolescent depression.

4 Review Processes of change in CBT of adolescent depression: review and recommendations. 2012

Webb, Christian A / Auerbach, Randy P / Derubeis, Robert J. ·Department of Psychology, University of Pennsylvania, 3815 Walnut Street, Philadelphia, PA 19104-1696, USA. webb@sas.upenn.edu ·J Clin Child Adolesc Psychol · Pubmed #22867130.

ABSTRACT: A growing body of research supports the efficacy of cognitive-behavioral therapy (CBT) for adolescent depression. The mechanisms through which CBT exerts its beneficial effects on adolescent patients suffering from depression, however, remain unclear. The current article reviews the CBT for adolescent depression process literature. Our review focuses on several process variables: the therapeutic alliance, patient cognitive change, and therapist adherence to, and competence in, the theory-specified techniques of therapy. Given that the vast majority of CBT process research has been conducted in the context of adult psychotherapy, we also review relevant adult research as a framework for understanding adolescent process research and to inform future investigations. Methodological issues are addressed and recommendations for future process research are raised.

5 Article Cognitive versus behavioral skills in CBT for depressed adolescents: Disaggregating within-patient versus between-patient effects on symptom change. 2019

Webb, Christian A / Stanton, Colin H / Bondy, Erin / Singleton, Paris / Pizzagalli, Diego A / Auerbach, Randy P. ·Center for Depression, Anxiety, and Stress Research and Department of Psychiatry, Harvard Medical School-McLean Hospital. · Division of Child and Adolescent Psychiatry, Columbia University. ·J Consult Clin Psychol · Pubmed #30998049.

ABSTRACT: OBJECTIVE: Despite a growing body of research supporting the efficacy of cognitive-behavioral therapy (CBT) for depressed adolescents, few studies have investigated the role of the acquisition and use of CBT skills in accounting for symptom improvement. The present study examined the role of cognitive versus behavioral skills in predicting symptom improvement in depressed youth. Analyses considered different raters of patient skills (patient vs. therapist) as well as disaggregated between-patient versus within-patient effects. METHOD: Data were derived from a 12-week clinical trial of CBT for depressed adolescent females (N = 33; ages 13-18 years; 69.7% White). Both therapist-report and patient-report measures of CBT skills (skills of cognitive therapy) were acquired at 5 time points throughout therapy: Sessions 1, 3, 6, 9, and 12. Depressive symptoms (Beck Depression Inventory-II) were assessed at every session. RESULTS: Therapist and patient ratings of CBT skills showed small to moderate associations (rs = .20-.38). Intraclass correlation coefficients indicated that the majority of the variance in skills scores (61-90%) was attributable to within-patient variance from session to session, rather than due to between-patient differences. When disaggregating within-patient and between-patient effects, and consistent with a causal relationship, within-patient variability in both patient-rated (b = -2.55; p = .025) and therapist-rated (b = -2.41; p = .033) behavioral skills predicted subsequent symptom change. CONCLUSIONS: Analyses highlight the importance of the acquisition and use of behavioral skills in CBT for depressed adolescents. Findings also underscore the importance of disentangling within-patient from between-patient effects in future studies, an approach infrequently used in process-outcome research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

6 Article Non-Suicidal self-injury and suicide in depressed Adolescents: Impact of peer victimization and bullying. 2019

Vergara, Genesis A / Stewart, Jeremy G / Cosby, Elizabeth A / Lincoln, Sarah Hope / Auerbach, Randy P. ·Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA. · Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Columbia University, New York, NY, USA; Division of Clinical Developmental Neuroscience, Sackler Institute, New York, NY, USA. Electronic address: rpa2009@columbia.edu. ·J Affect Disord · Pubmed #30448758.

ABSTRACT: BACKGROUND: While prior research has demonstrated that peer victimization and bully perpetration contribute to non-suicidal self-injury (NSSI) and suicidal thoughts and behaviors (STBs), it remains unclear whether these interpersonal processes differentiate self-injuring adolescent suicide ideators and attempters. METHODS: The study included adolescents aged 13-18 years (n = 223; M = 15.31, SD = 1.34) recruited from an acute inpatient program. Participants were divided into two groups: (1) NSSI RESULTS: NSSI LIMITATIONS: The study is cross-sectional, and reports of peer victimization and bully perpetration rely on self-report assessment. CONCLUSIONS: Peer victimization and bully perpetration differentiated adolescent suicide ideators and attempters, highlighting the need to address bully perpetration in addition to peer victimization in suicide interventions and research.

7 Article The associations between non-suicidal self-injury and first onset suicidal thoughts and behaviors. 2018

Kiekens, G / Hasking, P / Boyes, M / Claes, L / Mortier, P / Auerbach, R P / Cuijpers, P / Demyttenaere, K / Green, J G / Kessler, R C / Myin-Germeys, I / Nock, M K / Bruffaerts, R. ·Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium; School of Psychology, Curtin University, Perth, Australia. Electronic address: Glenn.Kiekens@kuleuven.be. · School of Psychology, Curtin University, Perth, Australia. · Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium. · Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium. · Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA. · Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. · School of Education, Boston University, Boston, MA, USA. · Harvard Medical School, Department of Health Care Policy, Harvard University, Boston, MA, USA. · Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium. · Department of Psychology, Harvard University, Cambridge, MA, USA. · Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium; Institute for Social Research, Population Studies Center, University of Michigan, Ann Arbor, MI, USA. ·J Affect Disord · Pubmed #30014957.

ABSTRACT: BACKGROUND: Theoretical and empirical literature suggests that non-suicidal self-injury (NSSI) is an important correlate of suicide risk. The present study was designed to evaluate: (a) whether NSSI is associated with increased odds of subsequent onsets of suicidal thoughts and behaviors (STB) independent of common mental disorders, (b) whether NSSI is associated with increased risk of transitioning from suicide ideation to attempt, and (c) which NSSI characteristics are associated with STB after NSSI. METHOD: Using discrete-time survival models, based on retrospective age of onset reports from college students (n = 6,393, 56.8% female), we examined associations of temporally prior NSSI with subsequent STB (i.e., suicide ideation, plan, and attempt) controlling mental disorders (i.e., MDD, Broad Mania, GAD, Panic Disorder, and risk for Alcohol Dependence). NSSI characteristics associated with subsequent STB were examined using logistic regressions. RESULTS: NSSI was associated with increased odds of subsequent suicide ideation (OR = 2.8), plan (OR = 3.0), and attempt (OR = 5.5) in models that controlled for the distribution of mental disorders. Further analyses revealed that NSSI was associated with increased risk of transitioning to a plan among those with ideation, as well as attempt among those with a plan (ORs = 1.7-2.1). Several NSSI characteristics (e.g., automatic positive reinforcement, earlier onset NSSI) were associated with increased odds of experiencing STB. LIMITATIONS: Surveys relied on self-report, and thus, there is the potential for recall bias. CONCLUSIONS: This study provides support for the conceptualization of NSSI as a risk factor for STB. Investigation of the underlying pathways accounting for these time-ordered associations is an important avenue for future research.

8 Article The DSM-5 nonsuicidal self-injury disorder among incoming college students: Prevalence and associations with 12-month mental disorders and suicidal thoughts and behaviors. 2018

Kiekens, Glenn / Hasking, Penelope / Claes, Laurence / Mortier, Philippe / Auerbach, Randy P / Boyes, Mark / Cuijpers, Pim / Demyttenaere, Koen / Green, Jennifer G / Kessler, Ronald C / Nock, Matthew K / Bruffaerts, Ronny. ·Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium. · School of Psychology, Curtin University, Perth, Australia. · Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium. · Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium. · Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA. · Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. · School of Education, Boston University, Boston, MA, USA. · Harvard Medical School, Department of Health Care Policy, Harvard University, Boston, MA, USA. · Department of Psychology, Harvard University, Cambridge, MA, USA. · Institute for Social Research, Population Studies Center, University of Michigan, Ann Arbor, MI, USA. ·Depress Anxiety · Pubmed #29697881.

ABSTRACT: BACKGROUND: Approximately one in five college students report a history of nonsuicidal self-injury. However, it is unclear how many students meet criteria for the recently proposed DSM-5 nonsuicidal self-injury disorder (NSSI-D). In this study, we used full NSSI-D criteria to identify those students most in need of clinical care. METHODS: Using data from the Leuven College Surveys (n = 4,565), we examined the 12-month prevalence of DSM-5 NSSI-D in a large and representative sample of incoming college students. We also explored the optimal frequency threshold as a function of interference in functioning due to NSSI, and examined comorbidity patterns with other 12-month mental disorders (i.e., major depressive disorder, broad mania, generalized anxiety disorder, panic disorder, and alcohol dependence) and suicidal thoughts and behaviors (STB). RESULTS: Twelve-month NSSI-D prevalence was 0.8% and more common among females (1.1%) than males (0.4%). The proposed 5+ diagnostic threshold was confirmed as yielding highest discrimination between threshold and subthreshold cases in terms of distress or disability due to NSSI. A dose-response relationship was observed for NSSI recency-severity (i.e., 12-month NSSI-D, subthreshold 12-month NSSI-D, past NSSI, no history of NSSI) with number of 12-month mental disorders and STB. NSSI-D occurred without comorbid disorders for one in five individuals, and remained associated with severe role impairment when controlling for the number of comorbid disorders. CONCLUSIONS: These findings offer preliminary evidence that DSM-5 NSSI-D is uncommon among incoming college students, but may help to improve the deployment of targeted resource allocation to those most in need of services. More work examining the validity of NSSI-D is required.

9 Article A longitudinal investigation of the Concise Health Risk Tracking Self-Report (CHRT-SR) in suicidal patients during and after hospitalization. 2018

Villegas, Ana C / DuBois, Christina M / Celano, Christopher M / Beale, Eleanor E / Mastromauro, Carol A / Stewart, Jeremy G / Auerbach, Randy P / Huffman, Jeff C / Hoeppner, Bettina B. ·Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. · Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA. · Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA. · Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA. Electronic address: bhoeppner@mgh.harvard.edu. ·Psychiatry Res · Pubmed #28954699.

ABSTRACT: The Concise Health Risk Tracking Self-Report (CHRT-SR) scale is a brief self-report instrument to assess suicide risk. Initial investigations have indicated good psychometric properties in psychiatric outpatients. The aims of this paper were to examine the construct validity and factor structure of the twelve- (CHRT-SR12) and seven-item (CHRT-SR7) versions and to test if clinically expected within-person changes in suicide risk over time were measurable using the CHRT-SR in two study cohorts hospitalized for suicidal ideation or behavior: (1) patients with major depressive disorder (MDD) who participated in a psychological intervention trial, n = 65, and (2) participants with bipolar disorder or MDD in an observational study, n = 44. The CHRT-SR12 and self-report measures of hopelessness, depression, and positive psychological states were administered during admission and several times post-discharge. Both versions showed good internal consistency in inpatients and confirmed the three-factor structure (i.e., hopelessness, perceived lack of social support and active suicidal ideation and plans) found in outpatients. CHRT-SR scores had strong correlations with negative and positive affective constructs in the expected directions, and indicated decreases in suicide risk following discharge, in line with clinical expectations. The CHRT-SR12 and CHRT-SR7 are promising self-report measures for assessing suicide risk in very high-risk patient populations.

10 Article Peer Victimization and Suicidal Thoughts and Behaviors in Depressed Adolescents. 2018

Stewart, Jeremy G / Valeri, Linda / Esposito, Erika C / Auerbach, Randy P. ·Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA. jstewart@mclean.harvard.edu. · Center for Depression, Anxiety and Stress Research, McLean Hospital, Mailstop 331, de Marneffe building, room 239, 115 Mill Street, Belmont, MA, 02478-9106, USA. jstewart@mclean.harvard.edu. · Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA. · Psychiatric Biostatistics Laboratory, McLean Hospital, Mailstop 331, 115 Mill Street, Belmont, MA, 02478-9106, USA. · Center for Depression, Anxiety and Stress Research, McLean Hospital, Mailstop 331, de Marneffe building, room 239, 115 Mill Street, Belmont, MA, 02478-9106, USA. ·J Abnorm Child Psychol · Pubmed #28444481.

ABSTRACT: Suicide is a leading cause of death among youth worldwide, and depressed adolescents are at a significantly elevated risk to report suicidal ideation, planning, and attempts. Peer victimization is a robust predictor of adolescent suicidal thoughts and behaviors (STBs), but little research has focused on why bullying leads to suicidal thoughts and behaviors. To address this empirical gap, we recruited 340 (246 female) depressed adolescents ages 13-19 (M = 15.59, SD = 1.41) within 48 h of admission for acute psychiatric treatment. At the initial assessment, participants were administered clinical interviews characterizing psychopathology, nonsuicidal self-injury, and STBs (ideation, plans, and attempts). Further, they completed questionnaires assessing 3 forms of victimization (overt, relational, and reputational), recent risky behavior engagement, and psychiatric symptom severity. Controlling for internalizing symptoms and age, overt and reputational bullying were associated with more frequent past month suicide attempts, but not suicide ideation. Past month risky behavior engagement, but not NSSI, mediated the relation between victimization and attempts. However, sex differences revealed that this effect only held for males whereas bullying was directly associated with suicide attempts among females. In contrast, overt and relational bullying were non-linearly associated with suicide plans, and these relations were not mediated by risky behaviors or NSSI. Results highlight the complex network of factors that lead victimized adolescents to engage in STBs and may inform targeted suicide prevention and intervention programs.

11 Article Neuroanatomical Prediction of Anhedonia in Adolescents. 2017

Auerbach, Randy P / Pisoni, Angela / Bondy, Erin / Kumar, Poornima / Stewart, Jeremy G / Yendiki, Anastasia / Pizzagalli, Diego A. ·Department of Psychiatry, Harvard Medical School, Boston, MA, USA. · Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA. · Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA. · McLean Imaging Center, McLean Hospital, Belmont, MA, USA. ·Neuropsychopharmacology · Pubmed #28165037.

ABSTRACT: Anhedonia is a transdiagnostic risk factor implicated in mental illness onset, treatment non-response, and suicidal behaviors. Prior cross-sectional research in adults has shown that anhedonia is associated with reduced dorsal striatal volume, but it is unknown whether this relationship extends to adolescents and whether reduced striatal volume prospectively predicts anhedonia. To address these gaps, the current study investigated whether striatal volume predicted anhedonia severity in adolescents. At baseline, healthy female adolescents aged 12-14 years (n=50) completed a clinical assessment, and structural MRI data were acquired on a 3 Tesla MR scanner. While in the scanner, participants also completed a peer feedback task where subjective ratings following peer 'acceptance' or 'rejection' were obtained. At the three-month follow-up, participants provided self-report assessments of anhedonia, depression, and anxiety symptoms. Three main findings emerged. First, in cross-sectional analyses, right nucleus accumbens volume was inversely related to anhedonia severity. Second, reduced bilateral putamen volume prospectively predicted anhedonia severity while controlling for baseline anhedonia, depression, and anxiety symptoms. Third, a blunted subjective response to peer acceptance (ie, neutral response to positive feedback), but not a more negative subjective response to peer rejection, contributed to anhedonia severity, but only among youth with smaller putamen volume. Collectively, these results suggest that smaller volume in striatal regions critically implicated in reward processing is associated with current and future anhedonic symptoms among healthy female youth. These anatomical features may confer vulnerability to anhedonia and thus, may inform early identification of individuals at high risk for mental illness.

12 Article Internet-based cognitive behavior therapy for major depressive disorder: A randomized controlled trial. 2017

Rosso, Isabelle M / Killgore, William D S / Olson, Elizabeth A / Webb, Christian A / Fukunaga, Rena / Auerbach, Randy P / Gogel, Hannah / Buchholz, Jennifer L / Rauch, Scott L. ·Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA. · Department of Psychiatry, Harvard Medical School, Boston, MA, USA. · Department of Psychology, University of Arizona, Tucson, AZ, USA. ·Depress Anxiety · Pubmed #28009467.

ABSTRACT: BACKGROUND: Prior research has shown that the Sadness Program, a technician-assisted Internet-based cognitive behavioral therapy (iCBT) intervention developed in Australia, is effective for treating major depressive disorder (MDD). The current study aimed to expand this work by adapting the protocol for an American population and testing the Sadness Program with an attention control group. METHODS: In this parallel-group, randomized controlled trial, adult MDD participants (18-45 years) were randomized to a 10-week period of iCBT (n = 37) or monitored attention control (MAC; n = 40). Participants in the iCBT group completed six online therapy lessons, which included access to content summaries and homework assignments. During the 10-week trial, iCBT and MAC participants logged into the web-based system six times to complete self-report symptom scales, and a nonclinician technician contacted participants weekly to provide encouragement and support. The primary outcome was the Hamilton Rating Scale for Depression (HRSD), and the secondary outcomes were the Patient Health Questionnaire-9 and Kessler-10. RESULTS: Intent-to-treat analyses revealed significantly greater reductions in depressive symptoms in iCBT compared with MAC participants, using both the self-report measures and the clinician-rated HRSD (d = -0.80). Importantly, iCBT participants also showed significantly higher rates of clinical response and remission. Exploratory analyses did not support illness severity as a moderator of treatment outcome. CONCLUSIONS: The Sadness Program led to significant reductions in depression and distress symptoms. With its potential to be delivered in a scalable, cost-efficient manner, iCBT is a promising strategy to enhance access to effective care.

13 Article Abnormal neural responses to feedback in depressed adolescents. 2017

Webb, Christian A / Auerbach, Randy P / Bondy, Erin / Stanton, Colin H / Foti, Dan / Pizzagalli, Diego A. ·Department of Psychiatry, Harvard Medical School. · Department of Psychology, Yale University. · Department of Psychological Sciences, Purdue University. ·J Abnorm Psychol · Pubmed #27935729.

ABSTRACT: Depression rates surge in adolescence, particularly among females. Recent findings suggest that depressed adolescents are characterized by hypersensitivity to negative outcomes and blunted responsiveness to rewards. However, our understanding of the pathophysiology and time course of these abnormalities remains limited. Due to their high temporal resolution, event-related potentials (ERPs) provide an ideal probe to investigate these processes. In the present study, healthy (n = 25) and depressed (n = 26) female adolescents (13-18 years) completed a gambling task during 128-channel ERP recording. Time-domain analyses focused on ERPs linked to initial processing of negative versus rewarding outcomes (feedback-related negativity; FRN), and later, elaborative processing (late positive potential; LPP). Additionally, time-frequency analyses were used to decompose the FRN into its 2 constituent neural signals: loss-related theta and reward-related delta activity, thereby allowing us to separately probe these 2 putative mechanisms underlying FRN abnormalities in depression. Relative to healthy adolescents, depressed youth showed potentiated FRN (loss vs. reward) responses. Time-frequency analyses revealed that this group difference in the FRN was driven by increased loss-related theta activity in depressed youth, and not by reward-related delta activity. For the LPP, healthy adolescents exhibited sustained positivity to rewards versus losses, whereas depressed adolescents showed the opposite pattern. Moreover, an enhanced LPP to losses was associated with rumination. In summary, the LPP may be a sensitive probe of depressive rumination, whereas FRN-linked theta activity may represent a neural marker of hypersensitivity to negative outcomes in depressed youth. Implications for treatment and future ERP research are discussed. (PsycINFO Database Record

14 Article Psychological interventions to reduce suicidality in high-risk patients with major depression: a randomized controlled trial. 2017

Celano, C M / Beale, E E / Mastromauro, C A / Stewart, J G / Millstein, R A / Auerbach, R P / Bedoya, C A / Huffman, J C. ·Harvard Medical School,Boston, MA,USA. · Department of Psychiatry,Massachusetts General Hospital,Boston, MA,USA. ·Psychol Med · Pubmed #27876105.

ABSTRACT: BACKGROUND: Positive psychological constructs have been associated with reduced suicidal ideation, and interventions to cultivate positive feelings have the potential to reduce suicide risk. This study compares the efficacy of a 6-week, telephone-based positive psychology (PP) intervention against a cognition-focused (CF) control intervention among patients recently hospitalized for depression and suicidal ideation or behavior. METHOD: A total of 65 adults with a current major depressive episode reporting suicidal ideation or a recent suicide attempt were enrolled from participating in-patient psychiatric units. Prior to discharge, participants were randomized to the PP (n = 32) or CF (n = 33) intervention. In both interventions, participants received a treatment manual, performed weekly PP (e.g. gratitude letter) or CF (e.g. recalling daily events) exercises, and completed weekly one-on-one telephone sessions over 6 weeks. Between-group differences in hopelessness (primary outcome), depression, suicidality and positive psychological constructs at 6 and 12 weeks were tested using mixed-effects models accounting for intensity of post-hospitalization psychiatric treatment. RESULTS: Compared with PP, the CF intervention was associated with significantly greater improvements in hopelessness at 6 weeks (β = -3.15, 95% confidence interval -6.18 to -0.12, effect size = -0.84, p = 0.04), but not 12 weeks. Similarly, the CF intervention led to greater improvements in depression, suicidal ideation, optimism and gratitude at 6 and 12 weeks. CONCLUSIONS: Contrary to our hypothesis, the CF intervention was superior to PP in improving hopelessness, other suicide risk factors and positive psychological constructs during a key post-discharge period among suicidal patients with depression. Further study of this CF intervention is warranted in populations at high suicide risk.

15 Article Adolescent self-injurers: Comparing non-ideators, suicide ideators, and suicide attempters. 2017

Stewart, Jeremy G / Esposito, Erika C / Glenn, Catherine R / Gilman, Stephen E / Pridgen, Bryan / Gold, Joseph / Auerbach, Randy P. ·Department of Psychiatry, Harvard Medical School, McLean Hospital, Center for Depression, Anxiety and Stress Research, Belmont, MA, USA. Electronic address: jstewart@mclean.harvard.edu. · Department of Psychiatry, Harvard Medical School, McLean Hospital, Center for Depression, Anxiety and Stress Research, Belmont, MA, USA. · Department of Clinical and Social Sciences in Psychology, University of Rochester, Rochester, NY, USA. · Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA; Department of Social and Behavioral Sciences and Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA. ·J Psychiatr Res · Pubmed #27716512.

ABSTRACT: Adolescent non-suicidal self-injury (NSSI) and suicidality are serious health concerns; however, factors that contribute to the transition from NSSI to suicide ideation and suicide attempts are unclear. To address this gap, we investigated whether demographic characteristics, child maltreatment, and psychiatric factors are associated with the level suicidality among adolescents with a history of self-injury. Participants were three groups of adolescent inpatient self-injurers (n = 397, 317 female), aged 13-18 years (M = 15.44, SD = 1.36): (a) non-ideators (n = 96; no current suicide ideation and no lifetime suicide attempts), (b) suicide ideators (n = 149; current ideation and no lifetime attempts), and (c) suicide attempters (n = 152; current ideation and at least one lifetime attempt). Participants completed interviews assessing psychiatric diagnoses, suicidality, and NSSI characteristics, as well as questionnaires on childhood trauma, psychiatric symptoms, and risky behavior engagement. Depression severity was associated with greater odds being a suicide ideator (p < 0.001, OR = 1.04) and an attempter (p < 0.001, OR = 1.05) compared to a non-ideator. Suicide attempters used more NSSI methods and reported greater risky behavior engagement than non-ideators (p = 0.03, OR = 1.29 and p = 0.03, OR = 1.06, respectively) and ideators (p = 0.015, OR = 1.25 and p = 0.04, OR = 1.05, respectively); attempters used more severe NSSI methods (e.g., burning). Our results identify a wide range of risk markers for increasing lethality in a sample at high risk for suicide mortality; future research is needed to refine risk assessments for adolescent self-injurers and determine the clinical utility of using risk markers for screening and intervention.

16 Article Predictors of Rehospitalization for Depressed Adolescents Admitted to Acute Psychiatric Treatment. 2017

van Alphen, Nienke R / Stewart, Jeremy G / Esposito, Erika C / Pridgen, Bryan / Gold, Joseph / Auerbach, Randy P. ·Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands. · Division of Child and Adolescent Psychiatry, McLean Hospital, Belmont, Massachusetts, USA. · Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts, USA. · McLean Hospital, 115 Mill St, Mailstop 331, de Marneffe Bldg, Room 240, Belmont, MA 02478. rauerbach@mclean.harvard.edu. ·J Clin Psychiatry · Pubmed #27529444.

ABSTRACT: OBJECTIVE: Presently, little is known about what factors predict adolescent psychiatric rehospitalization. Thus, the present study tested whether a battery of demographic and clinical characteristics predicted readmission within 6 months of discharge. METHODS: Participants were 165 adolescents (112 females) aged 13-19 years (mean = 15.61, SD = 1.48) admitted to an acute residential treatment program between November 25, 2013, and November 18, 2014. Patients met diagnostic criteria (DSM-IV-TR) for current major depressive disorder or dysthymia. At admission, participants completed a battery of clinical interviews and questionnaires assessing demographics, early life stress, comorbid diagnoses, psychiatric symptoms, suicidality, self-injury, and risky behavior engagement. At discharge, psychiatric symptoms were reassessed. Readmission to the same residential service was monitored over a 6-month period following discharge. RESULTS: Overall, 12.1% of adolescents were rehospitalized. We conducted a series of Cox regression survival analyses to test demographic and clinical predictors of patients' time to readmission. More frequent self-injurious behaviors in the month prior to hospitalization was significantly associated with a more rapid time to rehospitalization (β = 0.05, SE = .02, Wald₁ = 4.35, P = .037, OR = 1.05, 95% CI = 1.003-1.10). CONCLUSIONS: It is critical to more effectively manage self-injury during the treatment of depressed adolescents, as this is the strongest predictor of later rehospitalization.

17 Article The 6-month effectiveness of Internet-based guided self-help for depression in adults with Type 1 and 2 diabetes mellitus. 2017

Ebert, D D / Nobis, S / Lehr, D / Baumeister, H / Riper, H / Auerbach, R P / Snoek, F / Cuijpers, P / Berking, M. ·Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany. · Division of Online Health Trainings, Innovation Incubator, Leuphana University, Lüneburg, Germany. · Department for Health Care Policy, Harvard University, Boston, MA, USA. · Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany. · Department of Clinical Psychology, VU University, Amsterdam, The Netherlands. · Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, MA, USA. · Department of Medical Psychology, VU University Medical Centre and Academic Medical Center, Amsterdam, The Netherlands. · Institute for Health and Care Research (EMGO), VU University Medical Centre, Amsterdam, The Netherlands. ·Diabet Med · Pubmed #27334444.

ABSTRACT: AIM: The aim of this research is to examine the 6-month effects of an Internet-based guided self-help intervention for comorbid depressive symptoms in people with diabetes. METHODS: Participants (n = 260) with Type 1 or 2 diabetes and elevated depressive symptoms [Center for Epidemiological Studies Depression Scale (CES-D) ≥ 23] were randomly assigned to a guided Internet-based self-help intervention or a control condition (treatment as usual + online psychoeducation about depression). The primary outcome was a change in depressive symptom severity (CES-D) from baseline to 6-month follow-up. The secondary outcomes included numbers of people achieving treatment response (reliable change of depressive symptoms) and remission (CES-D ≤ 16), as well as the effects on glycaemic control, diabetes-related emotional distress and diabetes acceptance. Repeated measures analysis of variance examined between-group differences using intent-to-treat principles. RESULTS: Both conditions showed improvements in depression severity: intervention condition, d = 1.48 [95% confidence interval (95% CI): 1.21 to 1.76]; control condition d = 0.55 (95% CI: 0.30 to 0.80). Changes were significantly greater in the intervention condition with a large between-group effect size (d = 0.83, 95% CI: 0.57 to 1.08). Accordingly, effects on response [relative risk (RR) = 2.60 (95% CI: 2.01 to 3.36), P < 0.001] and remission [RR = 3.36 (95% CI: 2.98 to 5.44), P < 0.001] were in favour of the intervention group, as were differences in change in diabetes emotional distress (d = 0.50, 95% CI: 0.04 to 0.54), and physical and mental functioning [Short Form Health Survey (SF-12) Physical d = 0.27 (95% CI: 0.01 to 0.51) and SF-12 Mental d = 0.68 (95% CI: 0.11 to 0.40)]. The intervention group was not superior with regard to glycaemic control, diabetes self-management and diabetes acceptance. CONCLUSIONS: The trial indicates that Internet-based guided self-help treatments for depression in people with diabetes can have sustained effects on depressive symptoms, well-being and emotional distress associated with diabetes.

18 Article Self-referential processing in adolescents: Stability of behavioral and ERP markers. 2016

Auerbach, Randy P / Bondy, Erin / Stanton, Colin H / Webb, Christian A / Shankman, Stewart A / Pizzagalli, Diego A. ·Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA. · Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts, USA. · Department of Psychology, Yale University, New Haven, Connecticut, USA. · Department of Psychology, University of Illinois at Chicago, Chicago, Illinois, USA. ·Psychophysiology · Pubmed #27302282.

ABSTRACT: The self-referential encoding task (SRET)-an implicit measure of self-schema-has been used widely to probe cognitive biases associated with depression, including among adolescents. However, research testing the stability of behavioral and electrocortical effects is sparse. Therefore, the current study sought to evaluate the stability of behavioral markers and ERPs elicited from the SRET over time in healthy, female adolescents (n = 31). At baseline, participants were administered a diagnostic interview and a self-report measure of depression severity. In addition, they completed the SRET while 128-channel ERP data were recorded to examine early (P1) and late (late positive potential [LPP]) ERPs. Three months later, participants were readministered the depression self-report measure and the SRET in conjunction with ERPs. Results revealed that healthy adolescents endorsed, recalled, and recognized more positive and fewer negative words at each assessment, and these effects were stable over time (rs = .44-.83). Similarly, they reported a faster reaction time when endorsing self-relevant positive words, as opposed to negative words, at both the initial and follow-up assessment (r = .82). Second, ERP responses, specifically potentiated P1 and late LPP positivity to positive versus negative words, were consistent over time (rs = .56-.83), and the internal reliability of ERPs were robust at each time point (rs = .52-.80). As a whole, these medium-to-large effects suggest that the SRET is a reliable behavioral and neural probe of self-referential processing.

19 Article Depression risk and electrocortical reactivity during self-referential emotional processing in 8 to 14 year-old girls. 2016

Speed, Brittany C / Nelson, Brady D / Auerbach, Randy P / Klein, Daniel N / Hajcak, Greg. ·Department of Psychology, Stony Brook University. · Department of Psychiatry, Harvard Medical School. ·J Abnorm Psychol · Pubmed #27175985.

ABSTRACT: Cognitive vulnerabilities, such as a negative self-referential processing bias, have been theorized to play a causal role in the development of depression. Indeed, depression is associated with the endorsement and recall of more negative and fewer positive emotional words (i.e., recall biases) in the self-referential encoding task (SRET). In addition, currently depressed adults and adolescents, compared to healthy controls, show an enhanced late positive potential (LPP), an event-related potential (ERP) component that reflects sustained attentional engagement, during the processing of negative relative to positive words in the SRET. However, it is unclear whether these behavioral and neural measures in the SRET are indicators of risk for depression, or are concomitants of the disorder. The present study included 121 8 to 14 year-old girls with no lifetime history of depression, and examined the association between maternal history of depression (i.e., risk) and both behavioral and ERP measures while viewing positive and negative adjectives during the SRET. Lifetime history of major depressive disorder and/or dysthymia in the biological mother was assessed via a semistructured diagnostic interview. Results indicated that participants with maternal history of depression, compared with those with no maternal history of depression, demonstrated an enhanced LPP to negative words. There were no group differences in the LPP to positive words. Maternal history of depression was also related to faster response time when rejecting negative words. Participant's current depression symptoms were associated with increased negative recall bias and decreased positive recall bias. The present study provides novel evidence that abnormal electrocortical reactivity to negative self-referential words indexes vulnerability for depression in 8 to 14 year-old girls. (PsycINFO Database Record

20 Article PSYCHOLOGICAL TREATMENT OF DEPRESSION IN COLLEGE STUDENTS: A METAANALYSIS. 2016

Cuijpers, Pim / Cristea, Ioana A / Ebert, David D / Koot, Hans M / Auerbach, Randy P / Bruffaerts, Ronny / Kessler, Ronald C. ·Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. · EMGO Institute for Health and Care Research, Amsterdam, The Netherlands. · Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania. · Clinical Psychology Branch, Department of Surgical, Medical, Molecular, and Critical Pathology, University of Pisa, Pisa, Italy. · Department of Psychology, Clinical Psychology and Psychotherapy, Friedrich-Alexander University Nuremberg-Erlangen, Erlangen, Germany. · Department of Psychiatry, Harvard Medical School, Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, Massachusetts. · Universitair Psychiatrisch Centrum - KU Leuven, Kortenberg, Belgium. · Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts. ·Depress Anxiety · Pubmed #26682536.

ABSTRACT: BACKGROUND: Expanded efforts to detect and treat depression among college students, a peak period of onset, have the potential to bear high human capital value from a societal perspective because depression increases college withdrawal rates. However, it is not clear whether evidence-based depression therapies are as effective in college students as in other adult populations. The higher levels of cognitive functioning and IQ and higher proportions of first-onset cases might lead to treatment effects being different among college students relative to the larger adult population. METHODS: We conducted a metaanalysis of randomized trials comparing psychological treatments of depressed college students relative to control groups and compared effect sizes in these studies to those in trials carried out in unselected populations of depressed adults. RESULTS: The 15 trials on college students satisfying study inclusion criteria included 997 participants. The pooled effect size of therapy versus control was g = 0.89 (95% CI: 0.66∼1.11; NNT = 2.13) with moderate heterogeneity (I(2) = 57; 95% CI: 23∼72). None of these trials had low risk of bias. Effect sizes were significantly larger when students were not remunerated (e.g. money, credit), received individual versus group therapy, and were in trials that included a waiting list control group. No significant difference emerged in comparing effect sizes among college students versus adults either in simple mean comparisons or in multivariate metaregression analyses. CONCLUSIONS: This metaanalysis of trials examining psychological treatments of depression in college students suggests that these therapies are effective and have effect sizes comparable to trials carried out among depressed adults.

21 Article 'Weakest Link' as a Cognitive Vulnerability Within the Hopelessness Theory of Depression in Chinese University Students. 2016

Xiao, Jing / Qiu, Yu / He, Yini / Cui, Lixia / Auerbach, Randy P / McWhinnie, Chad M / Yao, Shuqiao. ·Beijing Key Laboratory of Learning and Cognition and Department of Psychology, Capital Normal University, Beijing, China. · Harvard Medical School, Boston, MA, USA. · Medical Psychological Research Center, Second Xiangya Hospital, Central South University, Changsha, China. · Hunan Province Technology, Institute of Psychiatry, Changsha, Hunan, China. ·Stress Health · Pubmed #24639362.

ABSTRACT: The current study tested the cognitive vulnerability-stress component of hopelessness theory using a 'weakest link' approach (e.g. an individual is as cognitively vulnerable to depression as his or her most depressogenic attributional style makes him or her) in a sample of Chinese university students. Participants included 520 students in Changsha. During an initial assessment, participants completed measures assessing weakest link, depressive symptoms and occurrence of negative events once a month for 6 months. Results from hierarchical linear modelling analyses showed that higher levels of weakest link scores were associated with greater increases in depressive symptoms following the occurrence of negative events. Higher weakest link level was associated with greater increases in depressive symptoms over time. These results provide support for the applicability of the 'weakest link' approach to the hopelessness theory to Chinese university students.

22 Article Predicting suicide attempts in depressed adolescents: Clarifying the role of disinhibition and childhood sexual abuse. 2015

Stewart, Jeremy G / Kim, Judy C / Esposito, Erika C / Gold, Joseph / Nock, Matthew K / Auerbach, Randy P. ·Department of Psychiatry, Harvard Medical School; McLean Hospital, Center for Depression, Anxiety and Stress Research, Belmont, MA, USA. Electronic address: jstewart@mclean.harvard.edu. · Department of Psychiatry, Harvard Medical School; McLean Hospital, Center for Depression, Anxiety and Stress Research, Belmont, MA, USA. · Harvard University, Department of Psychology, Cambridge, MA, USA. ·J Affect Disord · Pubmed #26318268.

ABSTRACT: BACKGROUND: Suicide is the second leading cause of death among adolescents, and depressed youth are six times more likely to make suicide attempts as compared to non-depressed adolescents. The present study examined the unique and interactive effects of two well-established correlates of suicidality - childhood sexual abuse (CSA) and disinhibition - in predicting suicide attempts among depressed adolescents. METHOD: Participants were 163 adolescents (125 females) aged 13-18 (M=15.60, SD=1.27) diagnosed with Major Depressive Disorder (n=95, 58.3%) and/or Dysthymia (n=69, 42.3%) recruited from an acute residential treatment service. Participants completed interviews assessing psychopathology and suicidality, self-report measures of depressive symptoms and CSA, and a computerized disinhibition task. RESULTS: Consistent with hypotheses, CSA moderated the association between disinhibition and adolescents' report of their past year and lifetime suicide attempts. Specifically, higher disinhibition was associated with a greater likelihood of having made a suicide attempt among adolescents with a history of CSA, but not among those without. The same pattern of results held in analyses of suicide attempt frequency. LIMITATIONS: Primary findings were based on observational, cross-sectional data, and therefore, causal relationships cannot be inferred. The gender imbalance in the sample precluded stratifying our analyses by gender. CSA was ascertained by self-report; replication of the results with more objective measures is warranted. CONCLUSIONS: Our findings indicate that CSA and disinhibition may work together to predict elevated suicide risk, and these results have implications for early identification efforts in youth at high risk for suicide.

23 Article Identifying differences between depressed adolescent suicide ideators and attempters. 2015

Auerbach, Randy P / Millner, Alexander J / Stewart, Jeremy G / Esposito, Erika C. ·Department of Psychiatry, Harvard Medical School, Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA. Electronic address: rauerbach@mclean.harvard.edu. · Department of Psychiatry, Harvard Medical School, Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA; Department of Psychology, Harvard University, Cambridge, MA, USA. · Department of Psychiatry, Harvard Medical School, Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA. ·J Affect Disord · Pubmed #26233323.

ABSTRACT: BACKGROUND: Adolescent depression and suicide are pressing public health concerns, and identifying key differences among suicide ideators and attempters is critical. The goal of the current study is to test whether depressed adolescent suicide attempters report greater anhedonia severity and exhibit aberrant effort-cost computations in the face of uncertainty. METHODS: Depressed adolescents (n=101) ages 13-19 years were administered structured clinical interviews to assess current mental health disorders and a history of suicidality (suicide ideators=55, suicide attempters=46). Then, participants completed self-report instruments assessing symptoms of suicidal ideation, depression, anhedonia, and anxiety as well as a computerized effort-cost computation task. RESULTS: Compared with depressed adolescent suicide ideators, attempters report greater anhedonia severity, even after concurrently controlling for symptoms of suicidal ideation, depression, and anxiety. Additionally, when completing the effort-cost computation task, suicide attempters are less likely to pursue the difficult, high value option when outcomes are uncertain. Follow-up, trial-level analyses of effort-cost computations suggest that receipt of reward does not influence future decision-making among suicide attempters, however, suicide ideators exhibit a win-stay approach when receiving rewards on previous trials. LIMITATIONS: Findings should be considered in light of limitations including a modest sample size, which limits generalizability, and the cross-sectional design. CONCLUSIONS: Depressed adolescent suicide attempters are characterized by greater anhedonia severity, which may impair the ability to integrate previous rewarding experiences to inform future decisions. Taken together, this may generate a feeling of powerlessness that contributes to increased suicidality and a needless loss of life.

24 Article EMOTION-PROCESSING BIASES AND RESTING EEG ACTIVITY IN DEPRESSED ADOLESCENTS. 2015

Auerbach, Randy P / Stewart, Jeremy G / Stanton, Colin H / Mueller, Erik M / Pizzagalli, Diego A. ·Department of Psychiatry, Center for Depression, Anxiety and Stress Research, McLean Hospital, Harvard Medical School, Belmont, Massachusetts. · Abteilung Klinische Psychologie & Psychotherapie, Justus-Liebig-Universität Gießen, Gießen, Germany. ·Depress Anxiety · Pubmed #26032684.

ABSTRACT: BACKGROUND: Although theorists have posited that adolescent depression is characterized by emotion-processing biases (greater propensity to identify sad than happy facial expressions), findings have been mixed. Additionally, the neural correlates associated with putative emotion-processing biases remain largely unknown. Our aim was to identify emotion-processing biases in depressed adolescents and examine neural abnormalities related to these biases using high-density resting EEG and source localization. METHODS: Healthy (n = 36) and depressed (n = 23) female adolescents, aged 13-18 years, completed a facial recognition task in which they identified happy, sad, fear, and angry expressions across intensities from 10% (low) to 100% (high). Additionally, 128-channel resting (i.e., task-free) EEG was recorded and analyzed using a distributed source localization technique (low-resolution electromagnetic tomography (LORETA)). Given research implicating the dorsolateral prefrontal cortex (DLPFC) in depression and emotion processing, analyses focused on this region. RESULTS: Relative to healthy youth, depressed adolescents were more accurate for sad and less accurate for happy, particularly low-intensity happy faces. No differences emerged for fearful or angry facial expressions. Further, LORETA analyses revealed greater theta and alpha current density (i.e., reduced brain activity) in depressed versus healthy adolescents, particularly in the left DLPFC (BA9/BA46). Theta and alpha current density were positively correlated, and greater current density predicted reduced accuracy for happy faces. CONCLUSION: Depressed female adolescents were characterized by emotion-processing biases in favor of sad emotions and reduced recognition of happiness, especially when cues of happiness were subtle. Blunted recognition of happy was associated with left DLPFC resting hypoactivity.

25 Article Self-referential processing in depressed adolescents: A high-density event-related potential study. 2015

Auerbach, Randy P / Stanton, Colin H / Proudfit, Greg Hajcak / Pizzagalli, Diego A. ·Department of Psychiatry, Harvard Medical School. · Department of Psychology, Stony Brook University. ·J Abnorm Psychol · Pubmed #25643205.

ABSTRACT: Despite the alarming increase in the prevalence of depression during adolescence, particularly among female adolescents, the pathophysiology of depression in adolescents remains largely unknown. Event-related potentials (ERPs) provide an ideal approach to investigate cognitive-affective processes associated with depression in adolescents, especially in the context of negative self-referential processing biases. In this study, healthy (n = 30) and depressed (n = 22) female adolescents completed a self-referential encoding task while ERP data were recorded. To examine cognitive-affective processes associated with self-referential processing, P1, P2, and late positive potential (LPP) responses to negative and positive words were investigated, and intracortical sources of scalp effects were probed using low-resolution electromagnetic tomography (LORETA). Additionally, we tested whether key cognitive processes (e.g., maladaptive self-view, self-criticism) previously implicated in depression related to ERP components. Relative to healthy female subjects, depressed females endorsed more negative and fewer positive words, and free recalled and recognized fewer positive words. With respect to ERPs, compared with healthy female adolescents, depressed adolescents exhibited greater P1 amplitudes following negative words, which was associated with a more maladaptive self-view and self-criticism. In both early and late LPP responses, depressed females showed greater activity following negative versus positive words, whereas healthy females demonstrated the opposite pattern. For both P1 and LPP, LORETA revealed reduced inferior frontal gyrus activity in response to negative words in depressed versus healthy female adolescents. Collectively, these findings suggest that the P1 and LPP reflect biased self-referential processing in female adolescents with depression. Potential treatment implications are discussed. (PsycINFO Database Record

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