Early onset substance use and social anxiety are associated with adverse psychosocial outcomes, including impaired academic performance. This study aimed to investigate if problematic substance use is associated with poorer school functioning and if social anxiety is associated with this relationship. Participants (n = 711), aged 8-20, were enrolled in the Texas Youth Depression and Suicide Research Network registry study aiming to characterize youth with depression and/or suicidality. Baseline data from CRAFFT 2.1 + N, MINI-KID, SAS-SR, and PHQ-A were used for multivariate analyses using linear regression to examine the relationship between problematic substance use and school functioning, as well as the interaction between problematic substance use and social anxiety and their association with school functioning. Over 20% of participants met criteria for problematic substance use, with alcohol and marijuana being the two most common reported substances used. Youth with problematic substance use were on average two years older and had significantly greater impairment in school functioning compared to youth without problematic substance use. However, youth with problematic substance use and social anxiety had comparable impairments in school functioning compared to those with problematic substance use that did not have social anxiety. In youth without problematic substance use, having social anxiety was associated with similar levels of impairment in school functioning compared to youth with problematic substance use alone. The significant co-occurrence of problematic substance use, social anxiety, and depression suggests the need for early identification and intervention to prevent and/or mitigate impairment in school functioning. Significant levels of comorbid depression and/or suicidality experienced by our participants may have impacted our findings. Future research comparing youth with and without depression will help elucidate this.

Background The prevalence of Major Depressive Disorder (MDD) is increasing at an alarming rate globally. There is a need for a digital tool that enables continuous and real-time data collection, helps overcome stigma, and improves mental health awareness. Here, we describe mHealth, an open-source, scalable mobile health application (iPhone operating systems, iOS, and Android) and present the details about the pilot phase of the application. Methods We built the mHealth application using Xamarin, an open-source framework. Active data included four questions on mood administered twice daily and were collected as numerical data and mapped onto respective outcomes. Passive data included pedometer, location, device usage (calls, text, application usage), and location networks. Data were updated on the web-based portal and mobile application hourly. Results Of the 199 Texas Resilience Against Depression (T-RAD, observational, longitudinal study) study participants who consented to participate in the mHealth substudy, 113 (110 iOS testers and 3 Android testers) participated in the pilot. During the iOS pilot phase, application usage rates were high for the first three months with 90% engagement. We present detailed descriptive data from a participant to illustrate the types of data that can be extracted from the mobile application and how the data can be integrated into an observational study. Conclusions Our pilot observations highlight opportunities to integrate mHealth into clinical studies. While this work demonstrates technical feasibility and user acceptability, the pilot phase was not powered to evaluate predictive utility. Further research will focus on testing and validating the application in independent cohorts to establish its clinical utility.

BACKGROUND:Adolescent depression is heterogeneous, yet many studies rely on aggregate symptom scores that may obscure meaningful differences in symptom presentation. Latent class analysis (LCA) offers a person-centered approach for identifying symptom subgroups, but few studies have examined depressive symptom classes longitudinally with attention to social determinants of health (SDoH). This study identified depressive symptom classes among youth with depression and/or suicidality, examined demographic, clinical, and socio-ecological correlates of class membership, and evaluated changes in psychological outcomes over 6 months. METHODS:Participants were 1,825 youth ages 8-20 years who screened positive for depression, endorsed suicidal thoughts or behaviors, or were receiving treatment for depression. Baseline Patient Health Questionnaire for Adolescents (PHQ-A) item responses were used to identify latent classes of depressive symptoms. Associations between class membership and sociodemographic characteristics, trauma exposure, health-related social needs, treatment barriers, anxiety, suicidality and resilience were examined using chi-square tests and analyses of variance. Mixed-effect models evaluated changes in clinical symptoms and resilience across 6 months of follow-up. RESULTS:A five-class solution was identified: Somatic Symptoms (15.6%), No Symptoms (12.4%), Mild Symptoms (20.5%), Moderate Symptoms (27.8%), and High Symptoms (23.5%). Classes differed significantly by sex, trauma exposure, interpersonal safety concerns, treatment barriers, anxiety severity, suicidality, and resilience. In contrast, household income and basic resource insecurities did not differ significantly across classes. Longitudinally, depressive symptoms, anxiety, and suicidality showed significant time-by-class interactions; however, within- and between-class effect sizes were generally small. Resilience did not exhibit differential changes across classes. CONCLUSIONS:Depressive symptom classes among youth with depression or suicidality demonstrate distinct clinical and socio-ecological profiles, highlighting meaningful heterogeneity beyond symptom severity alone. Person-centered approaches may improve characterization of adolescent depression and inform more tailored assessment and intervention strategies. Future longitudinal research should examine the stability of these classes and predictors of transitions between symptom classes.

Background: The relationship between social media and mental health, particularly in youth, is an area of concern for researchers, clinicians, and parents. Rising rates of screen time have coincided with an increase in youth mental health issues, emphasizing the need to investigate the prevalence and clinical correlates of problematic social media use. Methods: Our sample is a 489-participant sub-sample of the Texas Youth Depression and Suicide Research Network (TX-YDSRN) Registry, which is comprised of Texas youth receiving care for depression, suicidal ideation and/or suicidal behaviors. Prevalence of problematic social media use was identified, and indicators of mental and physical health were compared in those with or without problematic use. Results: In our sample, 40.3 % of participants reported problematic social media use, and those with problematic use were more likely to report higher amounts of screen time. Relative to non-problematic users, problematic users endorsed more and higher depressive symptoms, anxiety, and suicidal thoughts, as well as poorer wellness factors. Participants with high duration and problematic use had poorer outcomes than those with low duration and non-problematic use. Limitations: The cross-sectional design does not allow for control comparisons and is limited by use of a single time point. Data are mainly derived from self-report measures, and generalizability of the findings may be impacted by overrepresentation of white females in the sample. Conclusions: As use increases, these data contribute to the empirical literature on the complex relationship between social media and mental wellbeing, suggesting problematic use is associated with poor mental health outcomes.

ObjectiveThis report evaluated how self- versus parent/guardian-report of irritability, a common transdiagnostic feature of mental illness in children and adolescents, relate to each other and if there are any differences based on sex.MethodIndividuals (ages 8-17 years) from the ongoing Texas Youth Depression and Suicide Research Network (TX-YDSRN) with data available for self- and parent/guardian-versions of the 5-item irritability domain of Concise Associated Symptom Tracking (CAST-IRR) as a measure were included (N=658). Confirmatory factor analyses (CFA) and item response theory (IRT) analyses evaluated psychometric properties for the full sample and for male and female participants separately. Weighted kappa statistics evaluated the agreement and bifactor analysis evaluated shared versus unique components of the two versions.ResultsBoth self- and parent/guardian-report versions of CAST-IRR had similar psychometric properties in the full sample as well as in male and female participants separately. Slope of each item exceeded 1.0 on IRT analyses suggesting adequate discrimination for each item. There was poor agreement for items of self- and parent/guardian versions (weighted kappa range: 0.07-0.21). Self- and parent/guardian-report versions were significantly correlated to other self- and parent/guardian-report measures of depression and anxiety, respectively. A bifactor model supported the presence of a shared factor as well as unique self- and parent/guardian-specific factors that explained 40.8%, 14.2%, and 45.0% variance, respectively.ConclusionSelf- and parent/guardian-report versions of CAST-IRR have similar psychometric properties in both male and female participants, and measure distinct aspects of irritability in youths. Clinicians may consider using both versions in their practice to comprehensively assess irritability.

Clinicians often utilize a multi-informant approach when assessing depression symptoms in youth; however, reporting discrepancies can arise among informants. Previous work has explored reporting discrepancies of depression symptoms between children and their parents, specifically, and identified several demographic factors that potentially affect parent-child agreement. Findings remained mixed, however, on the extent to which these variables influence parent-child agreement. The present study examined parent-child agreement on a self-report assessment of depression symptoms (Patient Health Questionnaire-9 modified for adolescents; PHQ-A) in 698 parent-child dyads. Additionally, we aimed to characterize the relationship between parent-child agreement and treatment utilization. We found a low level of parent-child agreement overall and no significant differences in agreement when examined as a function of, child’s sex assigned at birth, ethnicity, or parental history of depression. Additionally, children currently receiving psychotherapy had greater agreement with their parents regarding their depression symptoms than children receiving any other types of services (i.e., medication treatment or a combination treatment). These results suggest that clinicians should expect a low level of agreement between parent and child when assessing youth with depression and should consider gathering contextual information from additional sources to generate a comprehensive assessment.

OBJECTIVE:Atypical depression is a depression subtype characterized by atypical and energy-related symptoms such as hypersomnia, weight gain, fatigue, and leaden paralysis. Limited research has examined its clinical characteristics in youth. This study investigates the prevalence, sociodemographic and clinical correlates, and 6-month depression trajectories of atypical depression in a statewide youth depression registry. METHOD:Data from youth 11 to 20 years of age from the Texas Youth Depression and Suicide Research Network (TX-YDSRN), a registry of youth with depression or suicidal ideation, were analyzed. Atypical depression was defined using the Atypical Energy-Related Symptom (AES) Scale (score of ≥6). Sociodemographic data, body mass index (BMI), depression and anxiety severity, suicidality, trauma history, and physical functioning were compared between individuals with atypical and non-atypical depression. Mixed-effects models were used to assess depressive symptom trajectories over 6 months. RESULTS:Of 1,445 participants (mean age = 15.8 years, 72.8% female), 22.4% had atypical depression. Atypical depression was associated with greater baseline depression, anxiety, suicidality, and suicide attempts compared with non-atypical depression. Atypical depression was associated with female sex, trauma history, and obesity. Youth with atypical depression also had poorer physical functioning. Over 6 months, individuals with atypical depression exhibited persistently higher depressive severity compared with those with non-atypical depression. CONCLUSION:Atypical depression in youth is associated with more severe clinical profiles and worse depression trajectories relative to non-atypical depression. Future studies should investigate the temporal relationships between variables such as trauma, obesity, and the onset of atypical depression to better understand how these factors may precede or exacerbate atypical depression. PLAIN LANGUAGE SUMMARY:Data were collected from youth aged 11 to 20 years enrolled in the Texas Youth Depression and Suicide Research Network (TX-YDSRN) registry study. In the sample of 1,445 youth, 22.4% had atypical depression. Experiencing atypical depression in youth was associated with more severe clinical features and worse depression trajectories over 6 months relative to non-atypical depression. Identifying distinct clinical profiles can inform the design of targeted clinical trials for youth with atypical features and potentially lead to improved treatment outcomes.

Objective: This study evaluated whether depressive symptom severity improved early with extended-release naltrexone and bupropion combination (naltrexone bupropion) compared to a placebo in individuals with moderate/severe methamphetamine use disorder and predicted subsequent use of methamphetamine. Methods: This secondary analysis from the Accelerated Development of Additive Pharmacotherapy Treatment for Methamphetamine Use Disorder (ADAPT-2) trial, which was conducted from May 23, 2017-July 25, 2019, included 326 individuals with a 9-item Patient Health Questionnaire (PHQ-9) score ≥5 at baseline. Repeated-measures mixed model analyses evaluated early (baseline-to-week-4) changes in depressive symptom severity with naltrexone-bupropion versus placebo and provided slope estimates for PHQ-9 change. Additional depression outcomes included response (≥50% reduction in PHQ-9 from baseline) and remission (PHQ-9 ≤4). Methamphetamine treatment response was ascribed if 3 out of 4 urine drug screens were negative during weeks 5 and 6. Logistic regression analyses evaluated whether changes in depression predicted methamphetamine treatment response. Covariates included age, sex, race, ethnicity, and baseline PHQ-9. Results: There was a greater reduction in PHQ-9 scores at week 4 with naltrexone-bupropion versus placebo (estimate = -2.52; standard error = 0.81). At week 4, depression response (odds ratio [OR] = 2.54; 95% confidence limit [CL], 1.42-4.55) and remission (OR = 3.04; 95% CL, 1.57-5.87) were more likely with naltrexone-bupropion versus placebo. Greater baseline-to-week 4 reduction in PHQ-9 was associated with a higher likelihood of methamphetamine treatment response (OR = 3.74, 95% CL, 1.28-10.93) and explained 24.8% (95% CI, 6.7%-60.3%) of the effect of naltrexone-bupropion on methamphetamine treatment response. Conclusion: Use of naltrexone bupropion was associated with early reduction in depressive symptom severity compared to a placebo, which was associated with a higher likelihood of reduction in subsequent methamphetamine use. Trial Registration: ClinicalTrials.gov identifier: NCT03078075.

Background: This study assessed the psychometric properties of the 10-item Connor Davidson Resilience Scale (CD-RISC-10), a self-report measure of resilience, in youth receiving treatment and/or screening positive for depression/suicidality in psychiatric outpatient settings. Methods: Data from 908 youth (age 12-20 years) were analyzed. A confirmatory factor analysis (CFA) model was fit to the data, and goodness-of-fit was assessed using indices such as the comparative fit index (CFI). Psychometric analyses were performed through the lenses of classical test theory (CTT) and item response theory (IRT). Measurement invariance of the scale was assessed by classifying the sample by depression severity. Finally, intraclass correlation coefficients (ICC) from test-retest were used to assess the reliability of the scale using data collected at baseline and one-month post-baseline. Results: The scale was unidimensional, representing a single latent trait. CFA demonstrated acceptable model fit (CFI = 0.94). CTT analyses showed good internal consistency (Cronbach's alpha 0.85) and good item discrimination (item-total correlations between 0.38 and 0.66). The scale demonstrated good test-retest reliability over a one-month period (ICC = 0.82). IRT analyses exhibited good item performance on all but the three items related to versatility, humor and persistence. These items were also deterrent to the scale having full scalar invariance. Limitations: Limitations include questionable generalizability beyond the sample and biases inherent in self- report scales. Conclusions: CD-RISC-10 has acceptable reliability and validity. However, depressive symptom severity affected selected item performance. If these findings are confirmed in other independent samples, a seven-item version of the scale may be investigated for depressed samples.

Depression and suicidality are prevalent mental health issues among adolescents in the United States. There are multiple evidence-based practices (EBPs) for depression and/or suicidality, including cognitive behavioural therapy (CBT), dialectical behavioural therapy (DBT) and interpersonal therapy for adolescents (IPT-A), though youth seeking psychotherapeutic treatment in community settings may not consistently receive these EBPs. This study aims to characterize therapy experiences among youth aged 8-20 years with depression and/or suicidal behaviour who were in treatment using the Depression Treatment Experiences Questionnaire (DTEQ), as well as to provide initial construct validity and test-retest reliability of this new measure. Of the first 1000 participants in the Texas Youth Depression and Suicide Research Network (TX-YDSRN), 585 were currently receiving psychotherapy for their depression and/or suicidality. Almost half of the participants engaged in therapy reported receiving some form of CBT (n = 237, 42.4%). The DTEQ showed a two-factor structure, including a 12-item 'Evidence-Based Practice' factor that demonstrated strong internal consistency and test-retest reliability and a two-item 'Parental Involvement' factor that showed acceptable internal consistency and test-retest reliability. Participants receiving psychotherapy generally endorsed being exposed to techniques aligned with EBPs. Additional non-therapeutic elements, such as exercise (n = 276, 47.1%) and changing sleep habits (n = 191, 32.6%), were frequently endorsed as being received by participants in psychotherapy. These results describe the therapy experiences of youth engaged in psychotherapy for depression and/or suicidality and propose a new assessment tool that can be used to characterize these experiences. KEY PRACTITIONER MESSAGES: Youth in psychotherapy for depression or suicidality frequently engage in evidence-based techniques (e.g., problem-solving, cognitive restructuring), yet nearly half are unaware of the type of therapy they are receiving-highlighting a gap in patient-provider communication and psychoeducation. The DTEQ is a promising tool for assessing therapy content and structure and may help practitioners assess that evidence-based components are being implemented and understood by clients. Many adolescents supplement treatment with lifestyle changes like exercise and sleep adjustments-indicating the importance of integrating behavioural health recommendations into therapy for holistic care.

Many youth experience potentially traumatic events and may go on to develop post-traumatic stress disorder (PTSD). For youth who develop PTSD, little research has examined the role of health-related social needs, like housing instability or food insecurity, on its development. The present study aimed to explore the types of traumatic experiences reported at baseline by youth and sought to explore the relationship between post-traumatic stress symptoms and reported health-related social needs. Specifically, it aimed to determine if the effects of health-related social needs differed across demographic variables (e.g., sex assigned at birth, gender, race, ethnicity) and trauma types (i.e., interpersonal and other trauma). Findings demonstrated interpersonal trauma was a significant predictor of PTSD symptoms. While lower interpersonal safety was associated with a greater likelihood of participants reporting interpersonal trauma, it was not related to PTSD symptoms. Our findings highlight the need for clinicians to utilize interventions that specifically target the psychological effects of interpersonal trauma. Furthermore, interventions should consider the wider social context to address factors like interpersonal safety which may play a part in the increased risk of trauma exposure among youth.

Background Anhedonia is a core symptom of major depressive disorder (MDD). We aimed to validate the Dimensional Anhedonia Rating Scale (DARS), explore data-driven subgroups of anhedonia among individuals with depression, and determine associations with anxiety, suicidal ideation, neuroticism, and childhood trauma. Methods Participants with current major depressive episode (n=474) enrolled in the D2K arm of the Texas Resilience Against Depression (T-RAD) study were included in these analyses. Structure and reliability of the DARS were assessed using a factor analysis with a PROMAX rotation and Cronbach’s Alpha. Hierarchical clustering was performed to identify anhedonia-related subtypes using the DARS subscores. To identify the clinical signature that discriminates between anhedonia-based subgroups, discriminant analysis using clinical characteristics (anhedonia, suicidal ideation, anxiety, neuroticism, and childhood trauma) was performed using the Data Integration Analysis for Biomarker discovery using Latent cOmponents (DIABLO, mixOmics package version 6.24.0). Results Factor analysis confirmed the original four-factor structure of DARS, which exhibited excellent internal consistency and reliability (Cronbach’s alpha = 0.94), including the subscales. DARS food and drinks score was associated with early-life physical abuse and anxiety; the social activities score was associated with early-life emotional abuse and neglect, and anxiety was associated with early-life physical abuse. Participants with anhedonia had elevated anxiety, and early-life physical and emotional abuse, compared to those with no anhedonia. Conclusions Anhedonia was associated with elevated anxiety, and early-life physical and emotional abuse, and early-life physical neglect, compared to those with no anhedonia. Clinical Trial Registration D2K was registered with ClinicalTrials.gov (NCT02919280).

This study explored the association between body mass index (BMI), weight and appetite change, the severity of depression and anxiety, and related physical symptoms in youth seeking treatment for depression and/or suicidality. Youth completed self-report surveys and were categorized by BMI into healthy weight, overweight, and obese groups. Findings demonstrated overweight and obese participants were more likely to come from low-income households. Obese youth were more likely to report recent increases in appetite compared to healthy and overweight youth and in perceived weight compared to healthy weight youth. Obese youth had worse depression severity than overweight youth and worse physical function compared to healthy and overweight youth. Appetite and perceived weight changes were generally associated with worse clinical symptoms, with appetite more consistently associated with poorer presentations. These findings suggest high BMI, particularly within the obese range, is of concern for depressed youth, potentially putting them at risk for poorer clinical characteristics.

OBJECTIVE:Depression is a major public health concern with a 19% lifetime prevalence in youth, often precipitating other concerns, including suicidal behavior, poor school performance, and worsened peer relationships. ADHD is also common among youth and frequently presents alongside major depressive disorder (MDD), with this comorbidity associated with increased impairment. More research is needed to elucidate the clinical characteristics of this comorbidity (MDD + ADHD), especially as it relates to youth with MDD and no ADHD (MDD - ADHD). The present study examined the clinical correlates of MDD + ADHD in youth and the presence of an ADHD diagnosis as a moderator of the relationship between depressive symptoms and suicidality, peer relationships, and school functioning, respectively. METHODS:Our sample included 797 youth with MDD ages 8 to 20 years (Mage = 15.5 years) with and without ADHD. RESULTS:Youth with MDD + ADHD experienced more severe depressive symptoms, higher levels of suicidality, impulsivity, and irritability, and worse academic performance compared to those with MDD - ADHD. ADHD diagnosis did not moderate the relationships between depression severity and suicidality, peer relationships, or school functioning, respectively, suggesting that having an ADHD diagnosis may not affect these outcomes in depressed youth in this way. CONCLUSION:Findings shed light on the impact of ADHD in depressed youth, which may allow for earlier and more tailored intervention efforts aimed at identifying and targeting depression, suicidality, peer relationships, and school functioning.

Introduction: Evaluating antidepressant side effects in children and adolescents is important, as side effects can significantly impact treatment adherence and outcomes. While there are tools to assess side effects globally encompassing various body systems, their administration time can be substantial, limiting their practical use in clinical settings. This is especially challenging in pediatric practice, where providers need to collect information from both patients and guardians. The Frequency, Intensity, Burden of Side Effects Rating-Child (FIBSER-C) was developed to address this need and assesses side effect frequency, intensity, and burden; however, its psychometric properties have not been examined in pediatric samples. Methods: The analytic sample included n = 746 youth among the first 1000 participants who completed FIBSER-C and were taking antidepressant medication(s). The construct validity of FIBSER-C was examined by confirmatory factor analysis; internal consistency was evaluated using Cronbach's alpha (α); convergent and divergent validity were assessed by examining its association with depression severity and functioning measures. Results: FIBSER-C showed a single-factor structure, with standardized item loadings of 0.73, 0.83, and 0.89. The scale showed good internal consistency (Cronbach's α = 0.85). The FIBSER-C total score was weakly and positively associated with total PHQ-A, Patient-Reported Outcomes Measurement Information System (PROMIS)-Pain, PROMIS-Pain Severity, and PROMIS-Fatigue and was weakly and inversely associated with PROMIS-Physical Function. Conclusions: The FIBSER-C had has good internal consistency and a single-factor solution. The associations between side effect burden and depression severity, as well as functioning domains, were weak. Further research should explore the consistency and stability of the scale over time.

Treatment decisions for depression are a complex process, influenced by factors such as clinical characteristics, socioeconomic factors, and patient/caregiver preferences. This study examines the characteristics of treatment options during the first month of enrollment among depressed youth. Data for 646 depressed youth were extracted from the Texas Youth Depression and Suicide Research Network study. Participants' treatments during the first month were categorized as no treatment (NT), psychotherapy only (THER), pharmacotherapy only (MED), or a combination of psychotherapy and pharmacotherapy (COMB). Sociodemographic and clinical features were compared across these treatment types. 7% were on NT, 5% on THER, 35% on MED, and 53% on COMB. The MED group was more likely to have low income compared to the COMB group. Compared to the MED group, COMB treatment had higher depression severity and suicidality. The NT group showed higher rates of social risk compared to the group with COMB. Treatment groups did not differ significantly in sex or race. When treatment preferences were examined, 40% of youth on MED expressed a preference for COMB treatment. Treatment options vary with demographic characteristics, depression severity, suicidality, and high-risk social factors. The finding that youth on MED are more likely to have low income compared to COMB treatment, despite a preference for COMB treatment among many, may suggest a potential barrier to accessing comprehensive treatment options. Findings highlight the need to address barriers to combination treatment, which is preferred by youth and caregivers for managing depression.