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There is a close association between emotion regulation and mental ill-health but how they influence each other over time is unclear. The close association between the constructs also raises the question of how conceptually distinct or similar they are. We use data from the UK Millennium Cohort Study to investigate temporal and conceptual relationships between emotion regulation and mental health difficulties in childhood.Data from 16,859 children were analysed. The analytic sample included 48.85% female and 51.15% male participants. Ethnic representation was 82.3% White, 3.04% Mixed, 9.4% Asian, and 3.6% as Black or Black British. Study 1 used a cross-lagged model to assess bi-directional effects and temporal sequencing between internalizing and externalizing symptoms and emotion regulation at ages 3, 5, 7 years. We found cascading effects across all ages, whereby emotion dysregulation predicted later mental health difficulties, and externalizing symptoms predicted later emotion dysregulation. Study 2 used a hierarchical bi-factor model, which demonstrated a substantial overlap between the constructs during childhood, with the bi-factor explaining between .52 and .58 of the variance. We also tested the predictive utility of the included factors, of which the bifactor was the best predictor of self-harm and depression symptoms at age 14. Our findings demonstrate a significant overlap between emotion regulation and mental ill-health, which are intrinsically linked with no clear indication of which comes first. Further investigation of this relationship with more comprehensive measures is necessary to reliably inform intervention and prevention efforts.

Evidence-based and person-centred care requires the measurement of treatment outcomes that matter to youth and mental health practitioners. Priorities, however, may vary not just between but also within stakeholder groups. This study used Q-methodology to explore differences in outcome priorities among mental health practitioners from two countries in relation to youth depression. Practitioners from the United Kingdom (UK) (n = 27) and Chile (n = 15) sorted 35 outcome descriptions by importance and completed brief semi-structured interviews about their sorting rationale. By-person principal component analysis (PCA) served to identify distinct priority profiles within each country sample; second-order PCA examined whether these profiles could be further reduced into cross-cultural “super profiles”. We identified three UK outcome priority profiles (Reduced symptoms and enhanced well-being; improved individual coping and self-management; improved family coping and support), and two Chilean profiles (Strengthened identity and enhanced insight; symptom reduction and self-management). These could be further reduced into two cross-cultural super profiles: one prioritized outcomes related to reduced depressive symptoms and enhanced well-being; the other prioritized outcomes related to improved resilience resources within youth and families. A practitioner focus on symptom reduction aligns with a long-standing focus on symptomatic change in youth depression treatment studies, and with recent measurement recommendations. Less data and guidance are available to those practitioners who prioritize resilience outcomes. To raise the chances that such practitioners will engage in evidence-based practice and measurement-based care, measurement guidance for a broader set of outcomes may be needed.

Background: Advancing the field of precision medicine in the treatment of depression in adolescents requires an examination of predictors, moderators and mediators (PMMs) of depression symptom outcome in randomized controlled trials (RCTs). Aims: This scoping review describes findings of PMM analyses in RCTs for the treatment of depression in adolescents. Methods: Databases searched included: MEDLINE, Embase, APA PsycInfo and CINAHL. Included publications tested PMMs of depression symptom outcome (e.g. symptom reduction, remission, etc.) in RCTs pertaining to the treatment of adolescents, ages 13-17. Results were extracted and coded for statistical significance, analytic approach, a priori model development, and adjustment for multiple comparisons. Aggregated results were summarized by PMM variable domain and RCT sample.Results: Eighty-one papers reporting on PMM results across 33 RCTs were identified. Fifty-three variable domains were tested as baseline predictors of depression severity outcome, 41 as moderators, 19 as post-baseline predictors, and 5 as mediators. Most reported results were nonsignificant. For variable domains tested as a PMM in three or more RCTs, only improvements in sleep throughout treatment and early response predicted outcome with complete agreement across relevant studies. The two publications that reported a priori hypotheses and adjustment for multiple comparisons both found that baseline depression symptom severity and family conflict predicted poorer outcomes. Conclusions: Clinicians need to recognize the current limited evidence from RCTs to practice precision medicine principles when treating adolescents with depression. Our findings inform future study design for researchers who wish to incorporate questions about specific PMM variables into their study methods.

The objectives of this review are to determine if the ADRS and the QIDS have sufficient measurement properties according to the COSMIN guidelines, to evaluate the quality of this evidence, and to determine whether these OMIs meet at least minimum COSMIN criteria to support their use in youth with MDD and consideration for inclusion in a COS for this population (i.e., sufficient content validity (any level) AND at least low quality evidence for sufficient internal consistency).

Problem-solving (PS) training is a common ingredient of evidence-based therapies for youth depression that can be delivered as part of broader therapy packages or alone. As a stand-alone treatment, Problem-Solving Therapy (PST) is effective for adult depression. Aims: This scoping review aimed to provide an overview of the evidence concerning PS training for depression in youth aged 14 to 24. We searched five bibliographic databases and the grey literature. We included four randomized control trials (524 participants) comparing PST with waitlist controls or comparator interventions; four secondary analyses of PS-related concepts as predictors, moderators, or mediators of treatment response; 23 clinical practice guidelines (CPGs); and insights from a youth advisory panel. One high-quality study found PST helped with personal problems but was not significantly more effective than the control at reducing emotional symptoms. Exploratory evidence suggests PS training may enhance treatment effectiveness if provided alongside other skills in cognitive behavioural therapy. CPGs do not recommend PST as a first-line treatment for youth depression. Exploratory meta-analysis showed a small effect (Hedges’ g = -0.34; 95% CI: -0.92 to 0.23) with high heterogeneity and a very low quality of the evidence. After removing one study at high risk of bias, effect size and heterogeneity were strongly reduced (g = -0.08; 95% CI: -0.26 to 0.10). High-quality trials of PST alone or with other therapies are needed. As per suggestions by youth advisors, PS training may need to be reworked to ensure it is youth-driven, strengths-based, comprehensive, and personalized.

Measurement of treatment outcomes in childhood depression has traditionally focused on assessing symptoms from the clinician's perspective, without exploring other outcome domains or considering young people's perspectives. This systematic review explored the extent to which multidimensional and multi-informant outcome measurements have been used in clinical research for adolescent depression in the past decade and how patterns have evolved over time.Embase, Medline, and PsycINFO were searched, and studies that were published from 2007 through 2017 and assessed the effectiveness of treatments or service provision for adolescent depression were included. Of 7,483 studies screened, 95 met the inclusion criteria and were included for data extraction and analysis.Ten outcomes domains were identified, 2 of which were assessed on average using 4 outcome measures. Most studies (94%) measured symptoms, followed by functioning (52%). Other domains such as personal growth, relationships, quality of life, and service satisfaction were each considered by less than 1 in 10 studies. Youth self-report was considered by 54% but tended to focus on secondary outcomes. Multidimensional and multi-informant measurements were more frequent in studies published since 2015.Recent clinical research continues to prioritize symptoms measurement based on clinician report and has not yet fully embraced multidimensional and multi-informant approaches. In the context of significant policy shifts toward patient-centered and evidence-based care, measuring what matters most to patients has become a priority, but this is not yet widely reflected in clinical research.