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，大约每六个美国人中就有一个在他们的一生中受到影响，许多人在青春期经历了他们的第一次抑郁发作。有强有力的证据表明，患有重度抑郁症的成年人在执行功能（EF）方面存在缺陷，EF是一种认知能力，它使我们能够灵活地对环境做出反应，因此对我们几乎所有的日常活动都是必不可少的。然而，目前尚不清楚EF缺陷是(a)先于抑郁症并成为抑郁症的危险因素，(b)是抑郁症的后果，还是(c)两者兼而有之，建立了一个导致抑郁症复发和功能障碍增加的正反馈循环。绝大多数关于抑郁症中EF的研究都采用了横断面设计，测试的是已经经历过一次或多次抑郁症发作的成年人；因此，先前的文献无法解决EF障碍是否是抑郁症的风险因素或影响。此外，对成年人的关注忽略了抑郁易感性和EF发展的关键时期：青春期。本研究旨在通过测试青少年EF与抑郁之间的时间关系，做出创新性的贡献。本研究采用纵向设计来探讨青少年抑郁与EF之间的联系，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向性关注相互作用。参与者将是青少年，发起者已经从他们那里收集了多项抑郁和抑郁风险因素的评估。在之前的会议中没有评估EF。因此，在拟议的研究中，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。与以往的研究相比，这种设计有很强的优势，因为它可以通过确定EF缺陷是在抑郁症发生之前还是之后来测试定向假设。了解哪一种模型（例如EF作为风险因素或MDD的影响）最能解释与抑郁症相关的EF缺陷，对于制定预防和补救策略至关重要。例如，如果EF缺陷是抑郁症的一个危险因素，那么易患抑郁症的青少年（例如由于父母有重度抑郁症病史）可能会从早期干预中受益，以培训EF或教授补偿策略来减轻EF缺陷的影响。因此，拟议的研究对未来关于青少年抑郁风险预防方法的研究具有启示意义。

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.