Links between depression and executive function impairments in adolescents

描述（由申请人提供）：重度抑郁症（MDD）是最常见的精神疾病之一，大约六分之一的美国人一生中都会受到影响，许多人在青春期经历了第一次抑郁发作。有强有力的证据表明，患有重度抑郁症的成年人存在执行功能（EF）缺陷，这种认知能力使我们能够灵活地应对环境，因此对于成功完成几乎所有日常活动至关重要。然而，目前尚不清楚 EF 缺陷是否 (a) 先于抑郁症并成为抑郁症的危险因素，(b) 是抑郁症的结果，还是 (c) 两者都存在，从而建立一个正反馈循环，导致抑郁症复发并增加功能障碍。绝大多数关于 EF 治疗抑郁症的研究都采用横断面设计，并测试了已经经历过一次或多次抑郁发作的成年人；因此，之前的文献无法解决 EF 损伤是否是抑郁症的危险因素或影响。此外，对成年人的关注忽略了抑郁症易感性和 EF 发展的关键年龄阶段：青春期。拟议的研究旨在通过测试青少年 EF 和抑郁症之间的时间关系来做出创新贡献。拟议的研究采用纵向设计来调查青少年抑郁症和 EF 之间的联系方向，并探讨这些联系如何与压力和情绪特质风险因素以及对情绪的偏见关注相互作用。参与者将是申办者已经收集了抑郁症和抑郁症风险因素的多项评估的青少年。在之前的会议中未对 EF 进行评估。因此，对于拟议的研究，这些青少年将完成两次额外的课程，相隔 12 个月，评估 EF 和当前抑郁症。与之前的研究相比，这种设计具有很大的优势，因为它可以通过确定 EF 缺陷是继续发生还是在抑郁症发作后出现来检验定向假设。了解哪些模型（例如 EF 作为危险因素或 MDD 的影响）最能解释与抑郁症相关的 EF 缺陷，对于制定预防和治疗策略至关重要。例如，如果 EF 缺陷是抑郁症的一个危险因素，那么容易患抑郁症的青少年（例如，由于父母患有重度抑郁症）可能会受益于早期干预，以训练 EF 或教授补偿策略，以减轻 EF 损伤的影响。因此，拟议的研究对未来针对有抑郁症风险的青少年的预防方法研究具有重要意义。

DESCRIPTION (provided by applicant): Major depressive disorder (MDD) is one of the most common mental illnesses, affecting approximately one out of every six Americans during their life, with many individuals experiencing their first depressive episode during adolescence. There is strong evidence that adults with MDD experience deficits in executive function (EF), the cognitive ability that allows us to respond flexibly to the environment and is thus essential for successfully navigating nearly all of our daily activities. However, it is unknown whether EF deficits (a) precede, and are a risk factor for, developing depression, (b) are a consequence of depression, or (c) both, setting up a positive- feedback loop leading to recurrent depression and increasing functional impairments. The vast majority of research on EF in depression has used cross-sectional designs and tested adults who have already experience one, or often multiple, episodes of depression; therefore the previous literature cannot address whether EF impairments are a risk factor for, or effect of, depression. In addition, a focus on adults misses key age period for both depression vulnerability and EF development: adolescence. The proposed research aims to make an innovative contribution by testing the temporal relations between EF and depression in adolescents. The proposed study uses a longitudinal design to investigate the direction of links between depression and EF in adolescents, and explore how those links may interact with stress and emotional trait risk factors and with biased attention to emotion. Participants will be adolescents from whom the sponsor has already collected multiple assessments of depression and depression risk factors. EF was not assessed in these previous sessions. Thus, for the proposed study, these adolescents will complete two additional sessions, 12 months apart, assessing EF and current depression. This design has a strong advantage over previous research because it enables directional hypotheses to be tested, by determining whether EF deficits proceed or follow the onset of depression. Understanding which of these models (e.g. EF as risk factor or effect of MDD) best accounts for EF deficits associated with depression will be critical for developing strategies for prevention and remediation. For example, if EF deficits are a risk factor for depression, adolescents who are vulnerable to depression (e.g. due to parental history of MDD) might benefit from early intervention to train EF or teach compensatory strategies to mitigate the effects of EF impairments. The proposed research thus has implications for future research on prevention approaches for adolescents at risk for depression.