BACKGROUND AND OBJECTIVES:The COVID-19 pandemic was marked by global uncertainty, fluctuating safety measures, and major changes to daily living. For those high in intolerance of uncertainty (IU), depressive symptoms emerged or worsened. We examined whether perceived stress mediated the relationship between impacts of the COVID-19 pandemic on symptoms of depression over time, and whether IU moderated these associations. METHODS:207 adults living in Quebec, Canada, completed an online questionnaire battery at three timepoints, each three months apart, between May 2020 and January 2021. RESULTS:Occupation-related impacts of the pandemic (e.g., changes in income, lay-offs) at time 1 positively predicted perceived stress at time 2, in turn positively predicting depressive symptoms at time 3. Surprisingly, the indirect effect was significant for individuals with low and medium IU, who were sensitive to the actual occupational impacts of the pandemic experienced, but not for those with high IU. Levels of perceived stress were highest overall among individuals with high IU and not significantly predicted by pandemic-related occupational impacts. CONCLUSIONS:Results highlight that there may be a higher susceptibility to perceived stress and depressive symptoms in persons with high intolerance of uncertainty, irrespective of the extent of actual occupational impacts endured during the pandemic.

Intranasal administration of oxytocin has been shown to enhance social cognition and reduce stress reactivity in healthy individuals, suggesting therapeutic potential for mental disorders. However, clinical trials have produced mixed results. Following a systematic search, data were extracted from 42 double-blind, randomized controlled trials comparing symptoms following intranasal oxytocin versus placebo in autism spectrum disorder, schizophrenia spectrum disorders, substance use disorders, and other mental disorders. Random effects meta-analysis of the pooled sample (N = 1922) revealed a small, non-significant overall treatment effect with substantial between-trial heterogeneity (g = 0.17, 95% CI [-0.05, 0.38], I² = 77.4%). Removing two outlier studies with very large treatment effects in substance use disorders reduced the pooled estimate and eliminated heterogeneity (g = 0.05, 95% CI [-0.03, 0.12], I² = 0.0%). Analyzing mental disorder subgroups separately revealed a small, significant effect in schizophrenia spectrum disorders (g = 0.12, 95% CI [0.01, 0.23]). Removing outliers uncovered moderation by biological sex, whereby studies with more females showed greater effects (b = 0.0043, p = .02). No significant moderation by dose, number of administrations, psychosocial interventions, or participant age was detected. Findings demonstrate a promising signal in schizophrenia spectrum disorders and potentially important sex differences. However, trial methods seldom aligned with optimal protocols. Future trials should systematically examine dose-response relations, optimize psychosocial interventions, address female underrepresentation, and report individual participant data to enable future meta-analyses to investigate individual differences in treatment response.

The offspring of parents with bipolar disorder (OBD) are at high risk for developing affective disorders. Low levels of organization and consistency in the home (parenting structure) is associated with increased behavioral problems and hypothalamic-pituitary-adrenal (HPA) reactivity in the OBD and thus may be an important developmental risk factor. We also examined whether the cortisol response following awakening (CAR) is increased in the OBD who developed an affective disorder relative to OBD with no affective disorder. The sample (19.3 ± 3.4 years) consisted of 68 OBD and 64 offspring (61 female) of parents with no affective disorder (controls). As predicted, offspring who developed an affective disorder had higher CAR than OBD who did not have an affective disorder (Cohen's d= 0.423) and controls (Cohen's d= 0.468). Bootstrapping serial mediation analyses revealed that parenting structure in middle childhood and the CAR in offspring significantly mediated the relationship between risk status and offspring depressive and anxiety symptoms 12 years later (CI:.01,.66). Low parenting structure in the OBD leads to changes in the HPA axis that increases the risk of developing symptoms of an affective disorder. Suboptimal childrearing may have enduring consequences on mental health outcomes in the OBD.

Despite high recurrence rates in major depressive disorder (MDD), little is known about the factors influencing recurrence. Understanding the changes that occur between major depressive episodes (MDEs) is imperative. It is possible that being fearful of experiencing another MDE may lead to cognitive and behavioural changes that increase MDD recurrence risk. There are no available tools designed to capture these fears. This study developed and validated a self-report questionnaire measuring fears of depression recurrence (FoDR). 552 participants remitted from MDD (75% female; Age 18-73, Mage = 29.5, SD = 9.2) participated. Separate samples were used for the exploratory factor analysis (n = 200) and confirmatory factor analysis (n = 352). Test-retest reliability was assessed (n = 244). The results supported the retention of a 24-item scale, the Fear of Depression Recurrence Questionnaire (FoDRQ), loading onto three factors (severity, content, triggers). The FoDRQ demonstrated excellent internal consistency and composite reliability, and acceptable test-retest reliability. The scale showed strong convergent and divergent validity across other validated measures. FoDRQ scores significantly predicted measures of experiential avoidance and mental health self-management. The FoDRQ has excellent psychometric properties and can be used to understand how FoDR may influence MDD outcomes, recurrence risk, and illness-related coping.

BackgroundMajor Depressive Disorder (MDD) is a prevalent psychiatric condition and the largest contributor to disability worldwide. MDD is highly recurrent, yet little is known about the mechanisms that occur following a Major Depressive Episode (MDE) and underlie recurrence. We explored the concept of fear of depression recurrence (FoDR) and its impact on daily functioning among individuals in remission from MDD.Methods30 participants (83% female; 37% White; Mage = 27.7, SD = 8.96) underwent semi-structured qualitative interviews. The interviews explored participants' experiences of FoDR including the frequency, severity, content, triggers, and impact of fears and associated coping strategies. We used content analysis to analyze the transcriptions.ResultsMost participants (73%) reported having FoDR, with varying frequency, severity, and duration of fears. The triggers and content of participants' fears often mirrored the symptoms (e.g., low mood, anhedonia) and consequences (e.g., job loss, social withdrawal) endured during past MDEs. Some participants reported a minimal impact of FoDR on daily functioning, whereas others reported a positive (e.g., personal growth) or negative (e.g., increased anxiety) influence.LimitationsOur sample size did not allow for explorations of differences in FoDR across unique MDD subtypes or sociocultural factors.ConclusionsThe concept of FoDR may present a window into understanding the unique cognitive and behavioural changes that occur following MDD remission and underlie depression recurrence. Future research should aim to identify underlying individual differences and characteristics of the disorder that may influence the presence and impact of FoDR. Finally, a FoDR measure should be developed so that associations between FoDR and recurrence risk, depressive symptoms, and other indices of functioning can be determined.

Background: The home environment of offspring of parents with bipolar disorder (OBD) has been characterized by high levels of stress and disorganization, which may impact development of the hypothalamic-pituitaryadrenal (HPA) axis and their subsequent risk for affective disorders. The present study examined the effects of a family-based preventative intervention on the OBD's HPA axis functioning and whether intervention-related changes in the home environment might have driven change in the HPA axis. Methods: Fifty-five children (6-11 years) were recruited from families having a parent with bipolar disorder (n=26) or families having two parents with no current mental disorders (n=29). Only those families with a parent having bipolar disorder participated in the preventative intervention. Both groups completed assessments at baseline, post-prevention, 3-, and 6-months post-prevention. At each assessment, family organization, control, cohesion, conflict, and expressiveness, in addition to childhood internalizing problems, were measured, and offspring saliva samples were collected across two consecutive days. Results: Hierarchical Linear Modelling found no significant differences in HPA axis functioning between groups at baseline or across time. Improvements in family organization, however, were associated with elevations in participants' cortisol awakening response (CAR; p =.004) and total daily output (p =.023), and a steepening of their diurnal slope (p =.003) across time. Similar findings were obtained for family cohesion with respect to CAR (p <.001) and, to a lesser degree, diurnal slope (p =.064). Discussion: HPA axis functioning did not differ between the OBD and healthy controls at baseline or in response to the preventative intervention. However, intervention-related improvements in family organization and, to a lesser degree, cohesion, were associated with adaptive changes in HPA functioning over time.

Because the offspring of parents with an affective disorder (OAD) are at high risk for developing mental disorders, and persons with an affective disorder (AD) show dysfunctional hypothalamic–pituitary–adrenal (HPA) axis activity, changes in HPA functioning in OAD might be an etiological risk factor that precedes the development of ADs. The primary aim of the meta-analysis was to quantitatively summarize the existing data on different indices of diurnal cortisol in the OAD. The secondary aim was to explore potential moderators of this relation. Following PRISMA guidelines, we included 26 studies (3052 offspring) on diurnal cortisol in our meta-analysis after an initial screening of 3408 articles. Intercept-only and meta-regression models were computed using the robust variance estimation method. Analyses examining mean cortisol levels at discrete timepoints, total cortisol output, and the cortisol rise in response to awakening (CAR) were conducted separately. The results demonstrated that the OAD had higher mean levels of cortisol at different timepoints throughout the day compared to controls (Hedge’s g = 0.21). There was evidence of publication bias in studies examining CAR, such that effect sizes were positively biased. The present findings are consistent with a meta-analysis showing elevated cortisol in youth having an AD. Notable limitations across studies include the method of cortisol measurement and assessment of ADs. Altogether, these results highlight the fact that increased cortisol levels may act as a potential neuroendocrine antecedent and/or risk factor for the development of ADs among high risk youth.

Background Although both pharmacotherapy and psychological treatments are considered to be efficacious in the treatment of major depressive disorder (MDD), one third of patients do not respond to treatment and many experience residual symptoms post-treatment. In this double-blind placebo-controlled randomized control trial (RCT), we assessed whether intranasal oxytocin (OT) augments the therapeutic efficacy of psychotherapy for MDD and improves the therapeutic alliance. Methods Twenty-three volunteers (12 female) with MDD underwent 16 sessions of interpersonal therapy. Prior to each session, volunteers self-administered 24 International Units of intranasal OT (n = 12; Syntocinon) or placebo (n = 11). Depressive symptoms were assessed with the Inventory of Depressive Symptomatology at pre- and post-treatment, and at a six month follow-up. Results Multilevel modeling found a significant effect of OT on the negative slope of depressive symptoms over time (p < 0.05), with medium-large effect sizes at post-treatment (Cohen's d = 0.75) and follow-up (Cohen's d = 0.82). Drug intervention also predicted the intercept when examining the weekly ratings of the therapeutic alliance (p < 0.05), such that volunteers receiving OT, relative to placebo, reported improved therapeutic alliance at session 1. The agreement of goals between therapists and participants, a facet of the therapeutic alliance, mediated the relationship between drug intervention and clinical outcome. Conclusion In this pilot study, the administration of intranasal OT, relative to placebo, improved the therapeutic alliance at the beginning of therapy and therapeutic efficacy of psychotherapy in persons with MDD. Future RCTs should attempt to replicate these findings in larger samples with different therapeutic modalities (ClinicalTrials.gov: NCT02405715).

BackgroundOffspring of parents with affective disorders (OAD) are at risk of developing a wide range of mental disorders. Deficits in the rearing environment and high levels of stress are well‐known risk factors for negative outcomes in OAD. Building on prior research, we aim to examine the longitudinal relationships between family dysfunction, stressful life events, and mental health in OAD and control offspring of parents with no affective disorder. In the present study, we hypothesized that high levels of family dysfunction would be associated with more internalizing and externalizing problems across time in OAD than in controls, and that family dysfunction would mediate the relationship between stressful life events in adolescence and poor mental health in adulthood, particularly in OAD.MethodsAs part of the TRacking Adolescents' Lives Survey (TRAILS), 2230 participants (51% female, Mage = 11.1 years, SD = 0.6, at baseline) and their parents completed measures across six time points, spanning 15 years. Mental health, family dysfunction, and stressful life events were assessed with the Youth and Adult Self‐Report, Family Assessment Device, and an in‐house measure, respectively.ResultsMulti‐group structured equation modeling revealed that family dysfunction was linked to internalizing and externalizing problems in OAD, but not controls, across time. Risk status did not moderate family dysfunction's mediation of the relationship between stressful life events and negative outcomes in adulthood.ConclusionsOAD show high sensitivity to dysfunction in the rearing environment across childhood and adolescence, which supports the use of family based interventions to prevent the development of mental disorders in high‐risk youth.

BackgroundThe offspring of parents with bipolar disorder (OBD) are at higher risk of developing psychopathology than the offspring of parents with no affective disorder (control). In addition to genetic predisposition, childhood adversity and a stressful family environment are important risk factors for the OBD. Protective factors in parents, such as social support and coping strategies, may buffer the effects of stress on at-risk children. This study tested whether parents' social support and coping style attenuated the link between risk status (OBD vs. control) and psychopathology in offspring.MethodsDuring offspring's middle childhood, parents underwent a diagnostic interview and completed social support and coping style questionnaires. Sixty-nine OBD (39 female) and 69 control (29 female) offspring between ages 13 and 29 completed a diagnostic interview approximately 10 years later.ResultsParents' social support satisfaction moderated the link between offspring risk status and their development of substance use disorder (SUD) symptoms (F(1,131) = 5.90, p = .017). Parents' social network size moderated the link between offspring risk status and their development of anxiety and depression symptoms in an unexpected direction (F(1,131) = 5.07, p = .026). No effects of parents' coping style were found.ConclusionsAmong the OBD, having parents with greater social support satisfaction and, unexpectedly, a smaller social network buffered their development of SUD and depression and anxiety symptoms by early adulthood. Parents' social support may thus have a protective function for children in these high-risk families.

Offspring of parents with affective disorders (OAD) are at risk of developing a wide range of mental disorders. Deficits in the rearing environment and high levels of stress are well-known risk factors for negative outcomes in OAD. Building on prior research, we aim to examine the longitudinal relationships between family dysfunction, stressful life events, and mental health in OAD and control offspring of parents with no affective disorder. In the present study, we hypothesized that high levels of family dysfunction would be associated with more internalizing and externalizing problems across time in OAD than in controls, and that family dysfunction would mediate the relationship between stressful life events in adolescence and poor mental health in adulthood, particularly in OAD. As part of the TRacking Adolescents' Lives Survey (TRAILS), 2230 participants (51% female, M age  = 11.1 years, SD  = 0.6, at baseline) and their parents completed measures across six time points, spanning 15 years. Mental health, family dysfunction, and stressful life events were assessed with the Youth and Adult Self-Report , Family Assessment Device , and an in-house measure, respectively. Multi-group structured equation modeling revealed that family dysfunction was linked to internalizing and externalizing problems in OAD, but not controls, across time. Risk status did not moderate family dysfunction's mediation of the relationship between stressful life events and negative outcomes in adulthood. OAD show high sensitivity to dysfunction in the rearing environment across childhood and adolescence, which supports the use of family based interventions to prevent the development of mental disorders in high-risk youth.

Offspring of parents with bipolar disorder (OBD) are at risk for developing mental disorders, and the literature suggests that parenting stress may represent an important risk factor linking parental psychopathology to offspring psychopathology. We aimed to investigate whether improvements in parenting stress mediated the relationship between participation in a prevention program and offspring internalizing and externalizing symptoms at follow-up. Families having a parent with BD (N = 25) underwent a 12-week prevention program. Assessments were conducted at pre-intervention, post-intervention, and at 3- and 6-month follow-ups. Families of parents with no affective disorders (i.e., control families) served as a comparison sample (N = 28). The Reducing Unwanted Stress in the Home (RUSH) program aimed to teach communication, problem-solving, and organization skills to improve the rearing environment. Measures included the Parenting Stress Index—4th Edition, the Behaviour Assessment Scales for Children—2nd Edition, and the UCLA Life Stress Interview. Families having a parent with BD reported more parenting stress at pre-intervention, and more change across time, than control families. Improvements in parenting stress mediated the relationship between participation in the intervention and reduced offspring internalizing and externalizing symptoms. While families having a parent with BD reported more chronic interpersonal stress at pre-intervention, no intervention effects were found. The findings demonstrate that a preventative intervention targeting parenting stress in families may serve to prevent the development of mental disorders in at-risk children.

Oxytocin promotes social affiliation across various species, in part by altering social cognition to facilitate approach behaviour. However, the effects of intranasal oxytocin on human social cognition are mixed, perhaps because its effects are context dependent and subject to inter-individual differences. Few studies have included explicit manipulations of social context to test this supposition. We examined oxytocin’s effects on autobiographical memory recall in two contexts, with and without social contact, and evaluated whether these effects were moderated by depressive symptoms. Two non-clinical samples (Study 1, n = 48; Study 2, n = 63) completed randomised, placebo-controlled, within-subject experiments. We assessed autobiographical memory recall across two sessions (intranasal oxytocin or placebo) and two contexts (memories elicited by an experimenter or by computer). Overall, intranasal oxytocin increased ratings of the vividness of recalled memories during the social context only. Individuals with elevated depressive symptoms also recalled memories that were more negative following oxytocin relative to placebo only in the non-social context across the two studies. Findings highlight the negative consequences of increasing oxytocin bioavailability in vulnerable persons in the absence of social contact. Contextual factors such as social isolation among depressed populations may complicate the clinical use of oxytocin.

Intranasal oxytocin (OT) can enhance emotion recognition, perhaps by promoting increased attention to social cues. Some studies indicate that individuals with difficulties processing social information, including those with psychopathology, show more pronounced effects in response to OT. As such, there is interest in the potential therapeutic use of OT in populations with deficits in social cognition. The present study examined the effects of intranasal OT on the processing of facial features and selective attention to emotional facial expressions, as well as whether individual differences in depressive symptom severity predict sensitivity to intranasal OT. In a double-blind placebo-controlled within-subject design, eye tracking was used to measure attention to facial features in an emotional expression appraisal task, and attention to emotional expressions in a free-viewing task with a quadrant of multiple faces. OT facilitated the processing of positive cues, enhancing the maintenance of attention to the mouth region of happy faces and to happy faces within a quadrant, with similar effect sizes, despite the latter effect not being statistically significant. Further, persons with depressive symptoms, and particularly males, were sensitive to OT's effects. For males only, OT, relative to placebo, increased attentional focus to the mouth region of all faces. Individuals with depressive symptoms showed less attentional focus on angry (males only) and sad facial expressions, and more attention to happy faces (particularly for males). Results indicate increased sensitivity to OT in males and persons at risk for depression, with OT administration promoting a positive bias in selective attention to social stimuli.

Correction to: Journal of Abnormal Child Psychology

Psychological disorders such as major depressive disorder are characterised by interpersonal difficulties and anhedonia. A cognitive mechanism proposed to contribute to the maintenance of these problems is a diminished ability to generate positive mental imagery, especially regarding social interactions. The current study examined whether the effects of social imagery training on social activity and anhedonia could be enhanced with the addition of intranasal oxytocin, and whether these effects might be augmented in persons with a high propensity to engage socially (i.e., high extraversion). University students (N = 111) were randomised to self-administer intranasal oxytocin or placebo, followed by a single session of positive social or non-social imagery training that required participants to imagine 64 positive scenarios occurring in either a social or non-social context, respectively. There were no main effects of imagery type and drug, and no interaction effect on anhedonia and social activity, measured respectively via self-report and a behavioural task. Individuals low in extraversion, trust-altruism, and openness to experience reported significantly more anhedonia after receiving oxytocin relative to placebo, but only following imagery training of positive social outcomes. Results highlight the negative consequences of increasing oxytocin bioavailability after priming social contact in more withdrawn individuals.