Links between depression and executive function impairments in adolescents

描述(申请人提供)：严重抑郁障碍(MDD)是最常见的精神疾病之一，大约六分之一的美国人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MDD的成年人在执行功能(EF)方面存在缺陷，EF是一种认知能力，使我们能够灵活地对环境做出反应，因此对于我们几乎所有的日常活动都是必不可少的。然而，尚不清楚EF缺陷是否(A)先于抑郁症，且是抑郁症的危险因素，(B)抑郁症的后果，还是(C)两者都有，建立了一个正反馈循环，导致复发的抑郁症和日益严重的功能障碍。绝大多数关于EF在抑郁症中的研究使用了横断面设计，并对已经经历过一次或多次抑郁症发作的成年人进行了测试；因此，以前的文献无法解决EF障碍是否为抑郁症的危险因素或影响。此外，对成年人的关注错过了抑郁症易感性和EF发展的关键年龄阶段：青春期。这项拟议的研究旨在通过测试EF与青少年抑郁之间的时间关系来做出创新贡献。这项拟议的研究使用纵向设计来调查青少年抑郁和EF之间的联系方向，并探索这些联系可能如何与压力和情绪特征风险因素以及对情绪的偏向关注相互作用。参与者将是青少年，赞助商已经从他们那里收集了关于抑郁症和抑郁症风险因素的多项评估。在之前的这些会议中没有对EF进行评估。因此，在拟议的研究中，这些青少年将完成两个额外的疗程，相隔12个月，评估EF和目前的抑郁症。这种设计比以前的研究有很大的优势，因为它能够通过确定EF缺陷是继续还是跟随抑郁症的发生来检验方向性假说。了解这些模型中的哪一种(例如，EF作为MDD的危险因素或影响)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缺陷是抑郁症的风险因素，那么容易患抑郁症的青少年(例如，由于父母患有MDD)可能会从早期干预中受益，以训练EF或传授补偿策略，以减轻EF缺陷的影响。因此，这项拟议的研究对未来预防有抑郁风险的青少年的方法的研究具有重要意义。

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.