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2. A systematic review of the association between biological markers and environmental stress risk factors for adolescent depression

Author

Zajkowska, Zuzanna, Walsh, Annabel, Zonca, Valentina, Gullet, Nancy, Pedersen, Gloria, Kieling, Christian Costa, Swartz, Johnna, Karmacharya, Rakesh, Fisher, Helen L., Kohrt, Brandon A., and Mondelli, Valeria

Subjects
MDD, Inflammation, Youth, Fatores de risco, Depression, Hidrocortisona, Brain, Maus-tratos infantis, Major depressive disorder, Cortisol, Adolescence, Inflamação, Biomarcadores, Risk factors, Encéfalo, Transtorno depressivo maior, Young people, Depressão, Early life adversity, Adolescente, Biomarkers, MRI, Child mal treatment
Abstract

Introduction Although the aetiology and pathophysiology of depression are multifactorial, to date most studies have examined either biological or environmental mechanisms without looking at the integration of both; with most studies conducted in high-income countries (HICs). Therefore, we conducted a systematic review of worldwide studies investigating the relationship between biological and environmental stress risk factors for major depressive disorder (MDD) in adolescence. Methods We searched MEDLINE (via Ovid), PsycINFO, Cochrane Database of Systematic Reviews, Web of Science (Core Collection), Lilacs, African Journals Online and Global Health for prospective and cross-sectional studies that examined the association between biological markers and environmental stress risk factors in MDD during adolescence. Findings Of 11,089 articles identified, 21 were included, with only two from middle-income countries. Increased inflammation, telomere length and brain abnormalities, including blunted reward-related activity, white matter disruptions, and altered volume of limbic brain regions, were associated with increased risk for MDD mainly in the context of early life adversity. There is little evidence suggesting that the neurobiological changes investigated were associated with MDD in the context of recent life stress. Interpretation The developmental trajectory of depression appears to start with early life adversities and occurs in the context of immune and brain abnormalities. Understanding these biopsychosocial processes will help to improve our ability to detect individuals at risk of developing depression in adolescence. However, generalizability is limited by few studies examining both biological and environmental stress risk factors and a lack of studies on adolescents and young adults in low-and-middle-income countries (LMICs).

Published
2021

3. Cortisol and development of depression in adolescence and young adulthood – a systematic review and meta-analysis.

Author

Zajkowska, Zuzanna, Gullett, Nancy, Walsh, Annabel, Zonca, Valentina, Pedersen, Gloria A., Souza, Laila, Kieling, Christian, Fisher, Helen L., Kohrt, Brandon A., and Mondelli, Valeria

Subjects
*DEPRESSION in adolescence, *YOUNG adults, *MENTAL depression, *MORNINGNESS-Eveningness Questionnaire, *HYDROCORTISONE, *HYPOTHALAMIC-pituitary-adrenal axis
Abstract

Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been implicated in the development of major depressive disorder (MDD) in adulthood. Less work has focused on the role of the HPA axis in depression in adolescence and young adulthood globally. The aim of this study was to conduct a systematic review and meta-analysis of worldwide research investigating the relationship between cortisol, a measure of HPA axis activity, and MDD in adolescence and young adulthood. We searched MEDLINE, PsycINFO, Cochrane Database of Systematic Reviews, Web of Science, Lilacs, African Journals Online, and Global Health for studies which examined the relationship between cortisol and MDD in global youth (10–24 years old). Twenty-six studies were included in the systematic review and 14 were eligible for the meta-analysis, but only one study included young adults in their sample. Results from the meta-analysis demonstrated that elevated morning, but not evening, cortisol levels was prospectively associated with later MDD development in adolescence and young adulthood. However, morning cortisol levels did not significantly differ between healthy controls and individuals with MDD in cross-sectional studies. Afternoon cortisol and cortisol stress response also did not differ between adolescents with MDD and healthy controls. Qualitative synthesis of the three studies examining nocturnal cortisol showed higher nocturnal cortisol was both longitudinally and cross-sectionally associated with MDD in adolescence. Our findings suggest elevated morning cortisol precedes depression in adolescence. Despite this, we did not find any differences in other cortisol measures in association with MDD in cross-sectional studies. Taken together, these findings suggest that elevated morning and nocturnal cortisol are risk factors for depression in adolescence rather than a biomarker of existing MDD. This supports a role for the hyperactivity of the HPA axis in the development of MDD in adolescence. Most of the studies were from high-income-countries (HICs) and thus further work would need to be conducted in low- and middle-income countries (LMICs) to understand if our findings are generalisable also to these populations. • Higher morning cortisol is associated with later MDD development in adolescence. • Morning cortisol is not associated with adolescent MDD in cross-sectional studies. • Morning and nocturnal cortisol are risk factors for depression in adolescence. [ABSTRACT FROM AUTHOR]

Published
2022
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