Podcast
Questions and Answers
Which of the following is NOT typically considered a disorder with peak onset during childhood or adolescence?
Which of the following is NOT typically considered a disorder with peak onset during childhood or adolescence?
- Mood disorders
- Impulse control disorders
- Late-onset Alzheimer's disease (correct)
- Substance use disorders
According to the DSM-5 criteria for major depression, which of the following is required for diagnosis?
According to the DSM-5 criteria for major depression, which of the following is required for diagnosis?
- Symptoms lasting at least one week
- Persistent depressed mood or irritability in young people (correct)
- Presence of psychotic symptoms, such as hallucinations
- Experiencing at least one manic episode
In the Berkshire CAMHS study, what was the most prevalent symptom reported by young people referred for depressive symptomatology?
In the Berkshire CAMHS study, what was the most prevalent symptom reported by young people referred for depressive symptomatology?
- Eating disorders
- Suicidal ideation
- Low mood/irritability (correct)
- Anhedonia
According to Loades (2022), which depressive subtype is characterized by lower rates of depressed mood, suicidal ideation, and worthlessness, but high rates of sleep disturbance and decreased concentration?
According to Loades (2022), which depressive subtype is characterized by lower rates of depressed mood, suicidal ideation, and worthlessness, but high rates of sleep disturbance and decreased concentration?
Which of the following is considered the gold-standard method for diagnosing anxiety disorders in research settings?
Which of the following is considered the gold-standard method for diagnosing anxiety disorders in research settings?
Which of the following is a limitation of using questionnaire measures for assessing depression and anxiety in young people?
Which of the following is a limitation of using questionnaire measures for assessing depression and anxiety in young people?
In the context of parental understanding of child depression, what was observed regarding the correlation between parent and child responses on the Mood and Feelings Questionnaire?
In the context of parental understanding of child depression, what was observed regarding the correlation between parent and child responses on the Mood and Feelings Questionnaire?
Which of the following is NOT identified as a risk factor for the development of anxiety and depression in youth?
Which of the following is NOT identified as a risk factor for the development of anxiety and depression in youth?
According to the Intergenerational Model of Anxiety, which parental behavior contributes to childhood anxiety through anxiogenic modeling and information transfer?
According to the Intergenerational Model of Anxiety, which parental behavior contributes to childhood anxiety through anxiogenic modeling and information transfer?
In Orchard, Creswell, and Cooper's (2017) study, what was the relationship between maternal anxiety and expectations of their child's coping behaviors?
In Orchard, Creswell, and Cooper's (2017) study, what was the relationship between maternal anxiety and expectations of their child's coping behaviors?
In the ALSPAC study, which aspect of sleep was NOT found to be a significant predictor of future anxiety and depression in adolescents?
In the ALSPAC study, which aspect of sleep was NOT found to be a significant predictor of future anxiety and depression in adolescents?
What is the average delay between young people experiencing their first symptoms of mental health issues and receiving help?
What is the average delay between young people experiencing their first symptoms of mental health issues and receiving help?
Which of the following is a major barrier to parents accessing mental health treatments for their children?
Which of the following is a major barrier to parents accessing mental health treatments for their children?
What is the most commonly used and recommended treatment approach for both childhood and adolescent anxiety disorders?
What is the most commonly used and recommended treatment approach for both childhood and adolescent anxiety disorders?
According to the IMPACT study (Goodyer et al., 2017), how did self-reported symptoms differ between patients receiving CBT and short-term psychoanalysis therapy?
According to the IMPACT study (Goodyer et al., 2017), how did self-reported symptoms differ between patients receiving CBT and short-term psychoanalysis therapy?
In the meta-analysis by Echshtain (2020), which type of therapy demonstrated larger effects compared to CBT for youth depression?
In the meta-analysis by Echshtain (2020), which type of therapy demonstrated larger effects compared to CBT for youth depression?
Which of the following approaches is NOT typically considered a 'next step' for improving anxiety treatment for young people?
Which of the following approaches is NOT typically considered a 'next step' for improving anxiety treatment for young people?
In the study treating maternal anxiety alongside child CBT, what was the outcome of combining child CBT with maternal CBT?
In the study treating maternal anxiety alongside child CBT, what was the outcome of combining child CBT with maternal CBT?
In the RCT examining guided parent-delivered CBT for childhood anxiety, what percentage of children had recovered after treatment?
In the RCT examining guided parent-delivered CBT for childhood anxiety, what percentage of children had recovered after treatment?
What was the outcome of delivering guided parent-delivered CBT online compared to face-to-face sessions?
What was the outcome of delivering guided parent-delivered CBT online compared to face-to-face sessions?
What is the general effect of psychological treatments for sleep disturbances on depression symptoms?
What is the general effect of psychological treatments for sleep disturbances on depression symptoms?
What range of effect have trials examining the effect on anxiety symptoms using psychological treatments for sleep disturbances shown?
What range of effect have trials examining the effect on anxiety symptoms using psychological treatments for sleep disturbances shown?
What was the focus of the iBLISS study conducted in secondary schools?
What was the focus of the iBLISS study conducted in secondary schools?
A researcher aims to study the prospective relationship between sleep quality and anxiety in adolescents. Which study design would be most appropriate?
A researcher aims to study the prospective relationship between sleep quality and anxiety in adolescents. Which study design would be most appropriate?
A clinician wants to use a brief measure to assess anxiety symptoms in children in primary care. Which of the following factors should be prioritized when selecting a questionnaire?
A clinician wants to use a brief measure to assess anxiety symptoms in children in primary care. Which of the following factors should be prioritized when selecting a questionnaire?
Flashcards
Why are childhood and adolescence important for mental health?
Why are childhood and adolescence important for mental health?
Critical period for mental health; peak onset for many disorders occurs during this time.
DSM-5 Criteria for Major Depression
DSM-5 Criteria for Major Depression
Persistent depressed mood or irritability AND/OR marked loss of interest, plus at least 5 symptoms lasting 2+ weeks causing impairment.
Most Prevalent Depressive Symptoms in Youth
Most Prevalent Depressive Symptoms in Youth
Low mood/irritability, suicidal ideation, sleep disturbances, negative self-perceptions.
Methods for Measuring Depression & Anxiety
Methods for Measuring Depression & Anxiety
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Pros and Cons of Measurement Methods
Pros and Cons of Measurement Methods
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Risk Factors for Depression and Anxiety
Risk Factors for Depression and Anxiety
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Protective Factors Against Depression and Anxiety
Protective Factors Against Depression and Anxiety
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Intergenerational Model of Anxiety
Intergenerational Model of Anxiety
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Parent Anxiety & Interpretation Bias
Parent Anxiety & Interpretation Bias
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What evidence do we need to prove causal role for sleep?
What evidence do we need to prove causal role for sleep?
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Sleep and Mental Health
Sleep and Mental Health
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Access to Mental Health Treatment
Access to Mental Health Treatment
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Barriers to Accessing Mental Health Treatment
Barriers to Accessing Mental Health Treatment
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Common Treatment Approaches for Anxiety & Depression
Common Treatment Approaches for Anxiety & Depression
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Meta-analysis of Depression Treatment
Meta-analysis of Depression Treatment
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Next Steps for Improving Anxiety Treatment
Next Steps for Improving Anxiety Treatment
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Next Steps for Improving Depression Treatment
Next Steps for Improving Depression Treatment
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CBT for Insomnia
CBT for Insomnia
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Study Notes
- Mental health disorders often peak during childhood and adolescence, including:
- Impulse control disorders
- Substance use disorders
- Anxiety disorders
- Mood disorders
- Schizophrenia
Anxiety Disorders (DSM-5)
- Types include:
- Generalized anxiety disorder
- Specific phobia
- Panic disorder (with or without agoraphobia)
- Separation anxiety disorder
Major Depression (DSM-5)
- Characterized by:
- Persistent depressed mood or irritability
- Marked loss of interest
- Requires at least 5 symptoms for a minimum of 2 weeks, causing significant impairment.
- Symptoms:
- Significant weight or appetite changes
- Insomnia or hypersomnia
- Psychomotor agitation or retardation
- Fatigue or loss of energy
- Feelings of worthlessness or guilt
- Impaired concentration or indecisiveness
- Recurring thoughts of death or suicide
Depressive Symptomatology Study
- Study of 100 young people referred to Berkshire CAMHS:
- Ages 12-17 years
- 75% female
- 89% White British
- Most prevalent symptoms:
- Low mood/irritability (100%)
- Suicidal ideation (86%)
- Sleep disturbances (71%)
- Eating disorders (60%)
- Cognitive disturbances (70%)
- Anhedonia (50%)
- Fatigue (43%)
- Negative self-perceptions (86%)
- Psychomotor changes (19%)
Depression Symptom Clusters (Loades, 2022)
- Studied 465 young people with moderate to severe depression, identifying 3 subtypes:
- Severe: High prevalence of all symptoms.
- Moderate: Fewer symptoms and lower rates of suicidal ideation.
- Somatic: Lower rates of depressed mood, suicidal ideation, and worthlessness but high rates of sleep disturbance and decreased concentration.
- Severe and moderate groups reported more self-harm.
- No differences in therapeutic working alliance or daily functioning across groups.
Measuring Depression & Anxiety
- Questionnaire measures of symptomatology:
- Revised Child Anxiety and Depression Scale (RCADS)
- Mood and Feelings Questionnaire
- Diagnostic interviews (gold standard for research):
- Anxiety Disorder Interview Schedule (ADIS) for anxiety
- Schedule for Affective Disorders and Schizophrenia in School Age Children (Kiddie-SADS) for depression
- Considerations:
- Questionnaires may not fully capture the experience.
- Interviews capture more experience.
- Gender differences in presentation may affect assessment.
- Questionnaires might be easier for anxious young people to answer
Parental Understanding
- Parents often score below the threshold on mood questionnaires.
- There is often no association between parent and child responses, indicating that parents may not fully perceive the severity of their child’s depression
Risk Factors for Depression and Anxiety
- Multiple interacting risk factors:
- Genes
- Temperament
- Stress/life events
- Individual characteristics (e.g., sleep habits)
- Co-morbid anxiety or depressive disorders
- Parental psychopathology
- Parental responses
- Cognitive biases
Protective Factors
- Parent connectedness
- Academic achievement
- Awareness of and access to local services
- Neighborhood safety
- Overall resilience
- Closeness to caring friends
- School safety
- Connections to non-parental adults
Intergenerational Model of Anxiety (Murray, Creswell & Cooper, 2009)
- Parental anxiety can lead to child anxiety through:
- Child biological/genetic vulnerability
- Life events/lifestyle/socialization
- Anxiogenic modeling and information transfer, including parental overinvolvement
- This results in child anxiety, information processing biases, avoidance, and distress
Parental Anxiety and Interpretation Bias (Orchard, Creswell & Cooper, 2017)
- Study: Anxious mothers have negative expectations of their child’s coping behaviors.
- Mothers’ self-referent interpretations mediate this relationship
Causal Role for Sleep
- Evidence needed:
- Association between sleep and mental health
- Prospective relationship
- Effects of sleep manipulation on mental health
- Pathways to change
Avon Longitudinal Study of Parents and Children (ALSPAC)
- Study: Less sleep time on school nights predicts future anxiety and depression
- Daytime sleepiness, nighttime waking, and perception of insufficient sleep predict future anxiety and depression
Treatment Access
- Poor access rates globally
- Average 10-year delay between first symptoms and receiving help
- 2/3 of children with anxiety disorders do not access professional help
- GPs feel ill-equipped to manage and support childhood anxiety disorders
- Barriers & Facilitators for parents accessing treatments :
- Knowledge and understanding of MH problems
- Knowledge and understanding of help-seeking process
- Views and attitudes towards services and treatments (stigma)
- Family circumstances
- Improve access:
- Readily available tools to identify clinical significant anxiety in children
- Guidance on help-seeking process and available support for families and professionals
Treatment Approaches
- CBT is commonly used and recommended for both anxiety and depression.
- CBT has highlighted effectiveness for childhood and adolescent anxiety
- Depression is less promising - small effect sizes/cognitive treatments no better than non-cognitive
- Medication is sometimes advised in addition to CBT for depression
IMPACT Study (2017)
- RCT comparing short-term psychodynamic psychotherapy, CBT, and specialist clinical care for young people with depression:
- 30-40% still had depression diagnosis
- No difference in self-reported symptoms between CBT and short-term psychoanalysis therapy.
Meta-Analysis (Eckshtain, 2020)
- Effects are larger for interpersonal therapy than CBT.
- Effects are larger for youth self-reported outcomes than parent reports.
- Effects are larger when compared with inactive control conditions.
Improving Treatment
- Anxiety:
- Prevention/early intervention
- Improved access
- Focus on the role of parents
- Disorder-specific treatments
- Depression:
- Adapt current approaches
- Develop new approaches
Treating Maternal Anxiety
- Combining child CBT with maternal CBT did not outperform individual child CBT
Guided Parent-Delivered CBT
- Effective in treating anxiety disorders in children.
- Online delivery was non-inferior to face to face delivery
CBT for Insomnia
- For depression:
- Small to moderate effect on depression
- For anxiety:
- Small to moderate effect on anxiety
- Limited research on adolescents
iBLISS study
- Group sleep workshops in secondary schools, delivering CBT-informed interventions
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