2013 › Trails



Depression: Chronicity of depressive problems and the cortisol response to psychosocial stress in adolescents. The TRAILS study

Authors: Booij S.H., Bouma EMC, de Jonge P, Ormel H, Oldehinkel AJ

Clinical and epidemiological studies, further supported by meta-analytic studies, indicate a possible association between chronicity (i.e., persistence or recurrence) of depression and hypothalamic-pituitary-adrenal (HPA) axis responsiveness to psychosocial stress. In the present study we examined whether and how chronicity of depressive problems predicts cortisol responses to a standardized social stress test in adolescents. Data were collected in a high-risk focus sample (n = 351) of the Tracking Adolescents’ Individual Lives Survey (TRAILS) cohort, a large prospective population study with bi- to triennial measurements. Depressive problems were assessed around age 11, 13.5 and 16. Cortisol levels were measured in saliva, sampled before, during, and after the Groningen Social Stress Test (GSST), to determine the cortisol response to psychosocial stress. The area under the curve with respect to the increase (i.e. change from baseline) of the cortisol response was used as a measure of HPA axis response. By means of linear regression analysis and repeated-measures General Linear Modeling it was examined whether chronicity of depressive problems predicted the cortisol response to the GSST around the age of 16. Chronicity of depressive problems was significantly associated with cortisol stress responses. The relationship was curvilinear, with recent-onset depressive problems predicting an increased cortisol response, and more chronic depressive problems a blunted response. The results of this study suggest that depressive problems initially increase cortisol responses to stress, but that this pattern reverses when depressive problems persist over prolonged periods of time.

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Depression: Life changes and depressive symptoms: the effects of valence and amount of change

Authors: Bennik E.C., Ormel J., Oldehinkel A.J.

Background. Only few studies have focused on the effects of positive life changes on depression, and the ones that did demonstrated inconsistent findings. The aim of the present study was to obtain a better understanding of the influence of positive life changes on depressive symptoms by decomposing life changes into a valence and an amount of change component. Methods. Using hierarchical multiple regression, we examined the unique effects of valence (pleasantness/unpleasantness) and amount of change on depressive symptoms in 2230 adolescents (M age: 16.28 years) from the TRAILS study. Results. Adjusted for age, gender and pre-event depressive symptoms, the amount of life change was positively associated with depressive symptoms. A small excess of positive life changes predicted fewer symptoms, but experiencing a large excess of positive life changes did not have any additional beneficial effects, rather the opposite. Valence was more strongly associated with cognitive-affective than with neurovegetative-somatic symptoms. Conclusions. More positive life changes relative to negative life changes can protect against depressive symptoms, yet only when the amount of change is limited. This study encourages examination of the effects of life changes on specific symptom clusters instead of total numbers of depressive symptoms, which is the current standard.

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Depression: Physical activity and onset of depression in adolescents: A prospective study in the general population cohort TRAILS

Authors: Stavrakakis N, Roest AM, Verhulst FC, Ormel J, De Jonge P, Oldehinkel AJ

Although it has often been suggested that physical activity and depression are intertwined, only few studies have investigated whether specific aspects of physical activity predict the incidence of major depression in adolescents from the general population. Therefore the aim of this study was to investigate the effects of nature, frequency, duration and intensity of physical activity during early adolescence on the onset of a major depressive episode in early adulthood. In a population sample of adolescents (N = 1396), various aspects of physical activity were assessed at early adolescence (mean age 13.02, SD = 0.61). Major depressive episode onset was assessed using the Composite International Diagnostic Interview. A Cox regression model was performed to investigate whether physical activity characteristics and their interactions with gender predicted a major depressive episode onset up until mean age 18.5 (SD = 0.61). The individual characteristics of physical activity (nature, frequency, duration and intensity) or their interactions with gender did not predict a major depressive episode onset (p values >0.05). So far, there is no prospective evidence that physical activity protects against the development of adolescent depressive episodes in either boys or girls.

Copyright © 2013 Elsevier Ltd. All rights reserved.

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Depression: Child Behavior Checklist - Mania Scale (CBCL-MS): Development and evaluation of a population-based screening scale for bipolar disorder

Authors: Papachristou S, Ormel J, Oldehinkel AJ, Kyriakopoulos M, Reinares M, Reichenberg A, Frangou S


Early identification of Bipolar Disorder (BD) remains poor despite the high levels of disability associated with the disorder.


We developed and evaluated a new DSM orientated scale for the identification of young people at risk for BD based on the Child Behavior Checklist (CBCL) and compared its performance against the CBCL-Pediatric Bipolar Disorder (CBCL-PBD) and the CBCL-Externalizing Scale, the two most widely used scales.

Methods. The new scale, CBCL-Mania Scale (CBCL-MS), comprises 19 CBCL items that directly correspond to operational criteria for mania. We tested the reliability, longitudinal stability and diagnostic accuracy of the CBCL-MS on data from the TRacking Adolescents' Individual Lives Survey (TRAILS), a prospective epidemiological cohort study of 2230 Dutch youths assessed with the CBCL at ages 11, 13 and 16. At age 19 lifetime psychiatric diagnoses were ascertained with the Composite International Diagnostic Interview. We compared the predictive ability of the CBCL-MS against the CBCL-Externalising Scale and the CBCL-PBD in the TRAILS sample. Results. The CBCL-MS had high internal consistency and satisfactory accuracy (area under the curve = 0.64) in this general population sample. Principal Component Analyses, followed by parallel analyses and confirmatory factor analyses, identified four factors corresponding to distractibility/disinhibition, psychosis, increased libido and disrupted sleep. This factor structure remained stable across all assessment ages. Logistic regression analyses showed that the CBCL-MS had significantly higher predictive ability than both the other scales. Conclusions. Our data demonstrate that the CBCL-MS is a promising screening instrument for BD. The factor structure of the CBCL-MS showed remarkable temporal stability between late childhood and early adulthood suggesting that it maps on to meaningful developmental dimensions of liability to BD.

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Depression: Plasticity genes do not modify associations between physical activity and depressive symptoms

Authors: Stavrakakis N, Oldehinkel A.J., Ormel J., Verhulst F.C., OudeVoshaar R., Nederhof E., de Jonge P.

Objective: Physical activity is inversely associated with depression in adolescents but the overall associations are fairly weak, suggesting individual differences in the strength of the associations. The aim of this study was to investigate whether plasticity genes modify the reciprocal prospective associations between physical activity and depressive symptoms found previously. Methods: In a prospective population-based study (N=1196), physical activity and depressive symptoms were assessed three times, around the ages of 11, 13.5 and 16. Structural Equation Modeling was used to examine reciprocal effects of physical activity and depressive symptoms over time. The plasticity genes examined were 5-HTTLPR, DRD2, DRD4, MAOA, TPH1, 5-HTR2A, COMT, and BDNF. A cumulative gene plasticity index consisting of three groups (low, intermediate and high) according to the number of plasticity alleles carried by the adolescents was created. Using a multi-group approach we examined if the associations between physical activity and depressive symptoms differed between the three cumulative plasticity groups as well as between the individual polymorphisms. Results: We found significant cross-sectional and cross-lagged paths from physical activity to depressive symptoms and vice versa. Neither the cumulative plasticity index nor the individual polymorphisms modified the strengths of these associations. Conclusion: Associations between adolescents’ physical activity and depressive symptoms are not modified by plasticity genes.

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Depression: Cortisol in the morning and dimensions of anxiety, depression, and aggression in children from a general population and clinic-referred cohort: An integrated analysis. The TRAILS study

Authors: Dietrich A., Ormel J, Buitelaar JK, Minderaa RB, Verhulst FC, Hoekstra PJ, Hartman CA

Anxiety and depressive problems have often been related to higher hypothalamic— pituitary—adrenal (HPA)-axis activity (basal morning cortisol levels and cortisol awakening response [CAR]) and externalizing problems to lower HPA-axis activity. However, associations appear weaker and more inconsistent than initially assumed. Previous studies from the Tracking Adolescents Individual Lives Study (TRAILS) suggested sex-differences in these relationships and differential associations with specific dimensions of depressive problems in a general population sample of children (10—12 years). Using the TRAILS population sample (n = 1604), we tested hypotheses on the association between single day cortisol (basal morning levels and CAR) and specifically constructed dimensions of anxiety (cognitive versus somatic), depressive (cognitive-affective versus somatic), and externalizing problems (reactive versus proactive aggression), and explored the modifying role of sex. Moreover, we repeated analyses in an independent same-aged clinic-referred sample (n = 357). Structural Equation Modeling was used to investigate the association between cortisol and higher- and lower-order (thus, broad and specific) problem dimensions based on self-reports in an integrated model. Overall, findings were consistent across the population and clinic-referred samples, as well as with the existing literature. Most support was found for higher cortisol (mainly CAR) in relation to depressive problems. However, in general, associations were weak in both samples. Therefore, the present results shed doubt on the relevance of single day cortisol measurements for problem behaviors in the milder range. Associations may be stronger in more severe or persistent psychopathology.

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