Real-World Affect and Social Context as Predictors of Treatment Response in Child and Adolescent Depression and Anxiety: An Ecological Momentary Assessment Study

Abstract

Objective: Response to treatment in child and adolescent affective disorders is variable, with limited ability of any one treatment to improve outcome across patients. Unfortunately, we know little about the factors that explain this variability in treatment response. Individual differences in the social and affective dynamics of daily life could help to elucidate the characteristics of youth who respond to treatment. Methods: We used ecological momentary assessment of negative affect, positive affect, and companions in natural settings over 4 days in a sample of young people with depressive and anxiety disorders who participated in an 8-week open trial of cognitive behavioral therapy (CBT), selective serotonin reuptake inhibitors (SSRIs), or a combination of the two. Clinicians rated participants' clinical severity at five time points, and participants reported their symptoms before and after treatment. Latent growth curve models were used to predict rate of change in clinical severity from pretreatment affect in natural settings. Results: Participants with high positive affect (PA), low negative affect (NA), and a high PA:NA ratio at baseline had lower severity, depressive symptoms, and anxiety symptoms at the end of treatment. Lower posttreatment symptoms were associated with spending more time with fathers and less time with peers before treatment. Although baseline affect was not associated with initial symptom severity, high NA and low PA:NA at baseline were related to slower rate of decline of severity during treatment. When baseline symptoms were included in models, NA and PA:NA predicted rate of decline in severity during treatment, whereas self-reported depressive and anxiety symptoms at baseline did not. Conclusion: A more typical profile of baseline affective functioning in natural settings-that is, lower NA and higher PAand time with fathers, could provide a foundation for treatment response in children and adolescents. Affective and social dynamics in natural settings could ultimately help investigate which young people might benefit from current treatments.

Childhood Depression As Emerging Public Health Problem: A Systematic Review

“…Family-focused interventions also have the advantage of approaching critical issues of the child's context, emerging as a promising strategy in recent years, especially in young children [11,211,212]. Spending time with caring family members or peers could serve as a protective factor by supporting healthy affective experience and promoting response to treatment [193].…”

“…From a psychological perspective, parents play critical roles in their children's emotional and social development and provide the crucible within which developmental skills unfold [191]. A close father-child relationship could provide a unique kind of support for improvement and response to treatment in young people [193]. Additionally, when parents (caregivers) themselves respond to a child's distress, they function as interpersonal regulatory agents [191].…”

“…Affective characteristics such as high positive affect or low negative affect could have relevance for response to treatment in children and adolescents with depression, because these characteristics could indicate a more adaptive pattern of affective style that could promote improvement in response to treatment [193,220]. Therefore, according to koVacS et al [191], the explanatory paradigm of a developmentally sensitive intervention should address how parents impact the skill that is being targeted or else, account for the role of the parents in those areas of the young patient's functioning that are relevant to treatment targets.…”

“…Depressive symptoms include cognitive and vegetative features in addition to affective features [193].…”

Childhood depression in family narratives

“…[15] In this sense, the family use healthcare services in an attempt to understand the disease so that describe the everyday practices when living with the child, and gives a glimpse of true access codes to the disease and the reality of the facts. [16] Therefore it is necessary to consider that family narratives insist on the idea of understanding the truth of the communicative situation, reflected in the desire of listening.…”