Wider, faster, more: Re-envisioning the treatment and research of depression to address its public health burden in the United States

Depression and other internalizing disorder symptoms are leading causes of disability in theUnited States. Although there are effective interventions, the burden of disability attributableto internalizing disorder symptoms is not decreasing. I review clinical and epidemiological datato identify solutions to the public health burden of internalizing disorder symptoms. Contemporary research efforts have a focus on treatment development and the identification of biomarkers of response. However, these solutions are not scalable because internalizing disorders are much more common than usually appreciated and there are substantial disparities in access to mental health care. Improving the dissemination of individual interventions may also be of limited value given data suggesting that high rates of symptom remission can only be achieved with multiple (e.g., 4-10) treatment steps. The logic of stepped care approaches for internalizing disorders is well-supported by these data, but initial treatments likely should be low-intensity and “stepping up” should occur more quickly than usually done in most trials. Efforts that promise to make an impact in the public health burden of internalizing disorder symptoms need to consider their high prevalence and heterogeneity in the level of care as well as in the mechanisms that treatments may need to engage.

Acceptability and outcomes of transdiagnostic guided self-help bibliotherapy for internalizing disorder symptoms in adults: Results of a fully remote nationwide open trial

Doing What Matters in Times of Stress (DWM) is a transdiagnostic five-module guided self-help (GSH) intervention developed by the World Health Organization. %The original DWM included group guidance in-person. %It appeared efficacious in pilot trials and a cluster randomized-controlled trial. In a sample of individuals recruited from across the United States, we studied the feasibility and acceptability of an adaptation of DWM in which guidance was provided individually and remotely. We assessed internalizing symptoms, psychological well-being, work and social functioning, usability of the intervention, and emotion regulation over the course of six weeks. A total of 344 individuals started our baseline screening, and 215 completed it. Of those screened, 74% (n=159) qualified for the intervention. We reached most participants who qualified (67%, n=107) via phone to schedule a GSH session. Most of those scheduled attended a study session (84%, n=90), and most of those who attended a session completed more than half the treatment (83%, n = 75). Retention rates were comparable to meta-analytic estimates of dropout rates in GSH-CBT. Participants showed improvement on the K6, WHO5, WSAS, and ERQ subscales. Baseline acceptability on the SUS was high but did not improve over time. DWM is a freely available, seemingly efficacious transdiagnostic intervention for internalizing disorder symptoms.

A Person-Centered Approach in Investigating a Mindfulness-Based Program for Adolescents with Autism Spectrum Disorder

Objectives Adolescents with autism often experience comorbid internalizing disorders such as anxiety disorders or depression but the available evidence-based treatments to support the mental health of adolescents with autism are limited. The aim of this study was to investigate if and how MYmind, a mindfulness-based program (MBP) for youth with autism, could benefit adolescents with comorbid internalizing disorder(s). Methods A person-centered approach with a multiple baseline design was used to investigate the effects of MYmind. Five adolescents with autism and an internalizing disorder took part in the 9-week MYmind program. The adolescents and their parents completed a daily questionnaire on their personal goals during a baseline phase, the intervention, a 2-month follow-up phase, and a 1-year follow-up phase. We analyzed the effects on their personal goals using visual inspection and statistical analysis for single-case designs. Also, we investigated potential processes of change by analyzing how changes were related over time. Results Findings indicated that most, but not all, adolescents benefitted from the MBP. Four out of five adolescents showed medium-sized improvement in some of their personal goals. However, one adolescent reported a deterioration during the intervention and 2-month follow-up phase. Decreased worry preceded behavioral improvements in two adolescents, whereas other potential mechanisms of change showed inconclusive results. Conclusion The findings indicated that most of the adolescents with autism and a comorbid internalizing disorder partially benefitted from the MBP.

Adolescent Gender Identity, Sexual Orientation, and Cannabis Use: Potential Mediations by Internalizing Disorder Risk

Background/Aims Adolescents who identify as nonbinary gender or as not heterosexual report higher levels of mental illness than their counterparts. Cannabis use is a commonly employed strategy to cope with mental illness symptoms among adolescents; however, cannabis use can have many deleterious health consequences for youth. Within the frame of minority stress theory, this study investigates the relationships between gender identity and sexual orientation, internalizing disorder symptoms, and cannabis use among adolescents. Method A national cross-sectional survey of a generalizable sample of high school students in Canada from the 2017 wave ( N = 15,191) of the Cancer Risk Assessment in Youth Survey was analyzed in spring 2019. Mediation analyses were completed to examine risk of internalizing disorder symptoms as a potential mediator of the association between (1) gender identity and (2) sexual orientation, and cannabis use. Results Indirect effects in all models show significantly higher levels of reported internalizing disorder symptoms for female (OR = 3.44, 95% CI [2.84, 4.18]) and nonbinary gender (OR = 3.75, 95% CI [2.16, 6.51]) compared with male students. Sexual minority adolescents had higher odds of internalizing disorder risk relative to non–sexual minority adolescents (OR = 3.13, 95% CI [2.63, 3.74]). Students who reported higher rates of internalizing disorder symptoms were more likely to have ever used cannabis. Patterns of partial mediation are also present among all groups. Discussion/Conclusions Findings can be used to better inform mental health interventions for adolescents. Future study should explore specific mental health stressors of vulnerable adolescent groups with respect to cannabis use as a coping mechanism.

Parental internalizing disorder and the developmental trajectory of infant self-regulation: The moderating role of positive parental behaviors

Child self-regulation (SR), a key indicator for later optimal developmental outcomes, may be compromised in the presence of parental mental disorders, especially those characterized by affective dysregulation. However, positive parental behaviors have been shown to buffer against such negative effects, especially during infancy when SR shows great plasticity to environmental inputs. The current study investigated the effect of maternal and paternal lifetime and current internalizing disorders on the developmental trajectory of infant SR from 3 to 24 months, and the potential moderating role of positive parental behaviors. A latent growth model revealed that SR increased overall from 3 to 24 months. Mothers’ positive parental behaviors demonstrated significant moderation effects, such that maternal lifetime internalizing disorder was associated with higher SR intercept only among those with low levels of positive parental behavior. Mothers’ lifetime internalizing disorder was also associated with a lower linear slope in SR development with a moderate effect size. Fathers’ current internalizing disorder was significantly associated with a higher intercept and lower linear slope of the SR trajectory. The current study expands the infant SR literature by describing its early developmental trajectory as well as early risk and protective factors within the parent–infant environment, taking into consideration developmental inputs from both parents.