Behavioral activation (BA) has been shown to be an effective treatment for depression, especially for severe and/or chronic depression; however, there is little empirical guidance on how BA can be effectively utilized to treat chronic Major Depressive Disorder (MDD) in the context of complicated grief, low socioeconomic status, and ethnic minority status. This case study focuses on the treatment of Ms. X, a 51-year-old African American woman with chronic depression that was exacerbated by complicated grief. This case describes an effective course of a standard BA protocol for MDD in the context of complicated grief, low socioeconomic status, and ethnic minority status and illustrates how a BA protocol can be applied while incorporating important cultural considerations.

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Purpose Low maternal socioeconomic position (SEP) has been associated with adverse neonatal outcomes including preterm birth, low birth weight, intrauterine growth restriction, and infant mortality. A key biological mechanism that has been proposed to explain this association is hypothalamic-pituitary-adrenal (HPA) activity, yet the association between SEP and HPA activity in pregnancy has received little attention. In this study we aimed to examine the association between SEP and two forms of maternal cortisol regulation: diurnal slope and wakening response across pregnancy. Furthermore, we aimed to assess if this association differed by the sex of the fetus. Methods 217 pregnant women aged 18–40 with singleton pregnancies participated. Women were excluded from participating if they were < 18 or > 40 years old, and if they were at risk for maternal or obstetric complications. Women provided information on socioeconomic characteristics of adults contributing to the participants’ household to compute a Hollingshead score of SEP. Women provided salivary cortisol samples upon awakening, 30 minutes after wake-up, and at bedtime at three times over pregnancy and once 30 days postpartum to calculate the diurnal slope and cortisol awakening response (CAR). Using linear regression analyses, we examined the relations between maternal SEP and maternal diurnal slope and CAR. We explored the relations between maternal SEP and cortisol by fetal sex using linear regression analyses. We also explored links between maternal SEP, maternal cortisol, and infant birth outcomes. Findings Women of lower SEP displayed smaller awakening responses and less change over the day compared to women of higher SEP. SEP was significantly associated with attenuated diurnal slope only among women carrying female fetuses, while for CAR, the association between SEP and attenuated CAR was significant only for women carrying male fetuses. Lower SEP was associated with decreased birth weight, and this association was partially explained by maternal HPA activity in pregnancy. Implications Women of low SEP displayed attenuated HPA activity across the perinatal period, and patterns varied by fetal sex and cortisol metric. Findings are in need of replication. More research is needed to understand links between SEP, HPA activity, and neonatal health.

We investigated the association between adolescent depressive symptoms and components of executive functioning (EF), including planning (Tower of London), set-shifting (Wisconsin Card Sorting Task), and inhibition (Stop Signal Task) in a community sample of 12–14 year olds. Further, EF was tested as a moderator of motivation (as operationalized by revised Reinforcement Sensitivity Theory) effects on depressive symptoms. Results suggested that planning ability was associated with depressive symptoms. Furthermore, planning ability moderated the relationship between motivation (fight-flight- freeze system; FFFS) and depressive symptoms, such that among adolescents with poor planning ability the FFFS positively predicted depressive symptoms, but among adolescents with strong planning ability the FFFS negatively predicts depressive symptoms. Neither set-shifting nor inhibition was associated with depressive symptoms. Findings highlight the need to consider multiple components of EF and to integrate motivational and executive dysfunction models to the study of depression.

Results from this pilot study provide preliminary evidence for understanding mechanisms explaining increased risk for preterm birth among childhood maltreatment victims.