Links between depression and executive function impairments in adolescents

重度抑郁症（MDD）是最常见的精神疾病之一，大约每六个美国人中就有一个在他们的生活中受到影响，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MDD的成年人在执行功能（EF）方面存在缺陷，这种认知能力使我们能够灵活地对环境做出反应，因此对于成功地驾驭我们几乎所有的日常活动至关重要。然而，目前尚不清楚EF缺陷是否（a）先于抑郁症的发展，并且是抑郁症的风险因素，（B）是抑郁症的后果，或（c）两者兼而有之，建立正反馈回路，导致复发性抑郁症和增加功能障碍。绝大多数关于抑郁症EF的研究都使用了横断面设计，并测试了已经经历过一次或多次抑郁发作的成年人;因此，以前的文献无法解决EF损伤是否是抑郁症的风险因素或影响。此外，对成年人的关注错过了抑郁脆弱性和EF发展的关键年龄段：青春期。该研究旨在通过测试青少年EF和抑郁症之间的时间关系做出创新性贡献。该研究采用纵向设计，探讨青少年抑郁和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注意相互作用。参与者将是青少年，申办者已经从他们那里收集了抑郁症和抑郁症风险因素的多项评估。在之前的会议中未评估EF。因此，对于拟议的研究，这些青少年将完成两个额外的会议，间隔12个月，评估EF和当前的抑郁症。这种设计比以前的研究有很大的优势，因为它可以通过确定EF缺陷是否继续或跟随抑郁症的发作来测试方向性假设。了解这些模型（例如EF作为风险因素或MDD的影响）中的哪一个最能解释与抑郁症相关的EF缺陷，对于制定预防和补救策略至关重要。例如，如果EF缺陷是抑郁症的风险因素，那么容易患抑郁症的青少年（例如，由于父母有MDD病史）可能会从早期干预中受益，以训练EF或教授补偿策略来减轻EF损伤的影响。因此，拟议的研究对未来研究青少年抑郁症的预防方法具有影响。

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.