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Huberty, T. J. (2012). Anxiety and Depression in Children and Adolescents. Springer.

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Anxiety and Depression in Children and Adolescents

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Although generally considered adult disorders, anxiety and depression are widespread among children and adolescents, affecting academic performance, social development, and long-term outcomes. They are also difficult to treat and, especially when they occur in tandem, tend to fly under the diagnostic radar.Anxiety and Depression in Children and Adolescents offers a developmental psychology perspective for understanding and treating these complex disorders as they manifest in young people. Adding the school environment to well-known developmental contexts such as biology, genetics, social structures, and family, this significant volume provides a rich foundation for study and practice by analyzing the progression of pathology and the critical role of emotion regulation in anxiety disorders, depressive disorders, and in combination. Accurate diagnostic techniques, appropriate intervention methods, and empirically sound prevention strategies are given accessible, clinically relevant coverage. Illustrative case examples and an appendix of forms and checklists help make the book especially useful. Featured in the text: Developmental psychopathology of anxiety, anxiety disorders, depression, and mood disorders. Differential diagnosis of the anxiety and depressive disorders. Assessment measures for specific conditions. Age-appropriate interventions for anxiety and depression, including CBT and pharmacotherapy. Multitier school-based intervention and community programs. Building resilience through prevention.Anxiety and Depression in Children and Adolescents is an essential reference for practitioners, researchers, and graduate students in school and clinical child psychology, mental health and school counseling, family therapy, psychiatry, social work, and education.

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Herskovic, v., Matamala, M. (2020). Somatización, ansiedad y depresión en niños y adolescentes. Elsevier, Vol. 31. Núm. 2. 183-187.

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Somatización, ansiedad y depresión en niños y adolescentes | Revista Médica Clínica Las Condes

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Morales-Muñoz, I., Mallikarjun, PK., Chandan, JS., Thayakaran, R., Upthegrove, R., Marwaha S. (2023). Impact of anxiety and depression across childhood and adolescence on adverse outcomes in young adulthood: a UK birth cohort study. Br J Psychiatry. [Tesis doctoral University of Birmingham]. National library of medicine.

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Isabel Morales-Muñoz, PhD, Pavan K. Mallikarjun, PhD, Joht S. Chandan, PhD, Rasiah Thayakaran, PhD, Rachel Upthegrove, PhD, and Steven Marwaha, PhD

Abstract

Background

Little is still known about the long-term impact of childhood and adolescent persistent depression and anxiety in adulthood.

Aims

To investigate the impact of persistent anxiety, depression, and comorbid anxiety and depression across childhood and adolescence on the development of multiple adverse outcomes in young adulthood.

Method

This study used data from 8122 participants in the Avon Longitudinal Study of Parents and Children cohort. The Development and Well-Being Assessment (DAWBA) examined child anxiety and depression symptomatology. The DAWBA generalised anxiety and mood subscales at 8, 10 and 13 years were selected, and a measure of comorbid anxiety and depression symptoms was created at each time point. Further, several mental and physical health, substance misuse and education/employment problems were assessed at 24 years. Latent class growth analyses were used to detect trajectories of anxiety, depression and comorbid anxiety and depression; and logistic regression to examine how persistent anxiety, depression or both were associated with adverse outcomes at 24 years.

Results

All three classes with persistent anxiety, depression or both were significantly associated with presenting with any mental health problems and any education/employment problem. Persistent high levels of depression and high levels of comorbid anxiety and depression, but not persistent high anxiety, were significantly associated with any physical health problem. High levels of comorbid anxiety and depression was the only DAWBA domain significantly associated with substance misuse; and overall, this was the domain that exerted the greatest negative impact, as it presented the highest odd ratio values.

Conclusions

Children and adolescents with comorbid anxiety and depression are at the highest risk for having more adverse outcomes at 24 years.

Keywords: Anxiety, depression, comorbidity, adverse outcome, longitudinal cohort

Background

Depression and anxiety are the largest contributors to the health burden experienced by children and adolescents.1 According to a meta-analysis, 12.3% meet criteria for anxiety disorder in middle childhood and 11.0% in adolescence,2 and major depression has an estimated prevalence of 4% in school-aged children3 and 7.5% in adolescents.4 Overall, anxiety and depression disorders affect a significant number of children and adolescents worldwide.5 Further, a recent analysis by the Global Burdens of Disease study group found that among young people aged 10-24 years in Europe, anxiety and depressive disorders contributed to a substantial amount of years lived with disability, reporting 655 912 and 626 008 years, respectively.6

Importantly, anxiety and depression are highly comorbid with each other, especially in children and adolescents.7 About 25-50% of youth with depression have comorbid anxiety and about 10-15% of youth with anxiety have depression.8 The presence of comorbid anxiety and depression matters because this has an impact on their treatment and outcomes. For instance, patients with anxious major depressive disorder, compared with patients with non-anxious major depressive disorder, have more severe impairments and more suicidal ideation.9 Similarly, comorbid anxiety and depression predicts worse outcomes.10

Longitudinal studies suggest that when left untreated, anxiety and depression can put children and adolescents at risk for long-term adverse outcomes, including substance misuse, unemployment and/or mental health difficulties.11,12 Early identification and effective treatment of anxiety and depression in children and adolescents are therefore crucial. To date, there is limited longitudinal research investigating how childhood and adolescent anxiety and/or depression may have an impact on long-term outcomes in adulthood. Among the existing evidence, a longitudinal cohort study reported that childhood anxiety disorder was associated with adverse functioning in health, financial and/or interpersonal outcomes in young adulthood.11 The same longitudinal cohort recently reported that childhood and adolescent depression was associated with broad effects on psychiatric problems, substance misuse and functional outcomes in adulthood.13 However, these authors only focused on the longitudinal patterns of anxiety and depression separately, and comorbid anxiety and depression was not explored. Further, their sample size was relatively small (i.e. n = 1420), compared with other currently available longitudinal cohort studies (e.g. Avon Longitudinal Study of Parents and Children (ALSPAC)).

To date, a small number of studies characterising the trajectories of depression and anxiety across childhood and adolescence provide some evidence that there is a group of young people with elevated and persistent anxiety and/or depression levels.14-18 A recent longitudinal cohort study reported that different trajectories of depression throughout childhood and adolescence were associated with worse adult educational and employment outcomes,19 but other areas in adulthood were not explored.

Aims

The current study, therefore, aimed to fill this knowledge gap. The overall aim of this study was to investigate the impact of persistent anxiety and depression across childhood and adolescence on the development of multiple outcomes in young adulthood, including mental and physical health, substance misuse and education/employment problems.

Our objectives were to:

1. examine how anxiety, depression and comorbid anxiety and depression develop over time from 8 to 13 years old;

2. investigate whether and how persistent high levels of anxiety, depression and comorbid anxiety and depression associate with multiple outcomes at 24 years; and

3. examine which of these domains (i.e. anxiety, depression or comorbid anxiety and depression) across childhood and adolescence exert a greater impact on adverse outcomes at 24 years.

We hypothesised that those children presenting comorbid anxiety and depression over time would show more severe adverse outcomes in young adulthood, compared with those children presenting with anxiety or depression alone.

Method

Participants

The ALSPAC is a UK birth cohort study examining the determinants of development, health and disease during childhood and beyond.20 Pregnant women resident in Avon with expected dates of delivery 1 April 1991 to 31 December 1992 were invited to participate. The ALSPAC study website contains details of all the data available ( http://www.bristol.ac.uk/alspac/researchers/our-data/). The initial number of pregnancies enrolled was 14 541. Further details of this cohort appear in Supplementary Appendix 1 (available at https://doi.org/10.1192/bjp.2023.23).

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. All procedures involving human patients were approved by the ALSPAC Law and Ethics Committee and local research ethics committees. Full details of the ALSPAC consent procedures and the corresponding approval numbers at each time point are available on the study website ( http://www.bristol.ac.uk/alspac/researchers/research-ethics/). Written informed consent was obtained from participants (parents and/or the children, when applicable). We used the Strengthening the Reporting of Observational Studies in Epidemiology cohort reporting guidelines.

Anxiety and depression measures

The Development and Well-Being Assessment (DAWBA)21 was administered as a parent-report questionnaire to capture child and adolescent psychopathology. Further details of the DAWBA appear in Supplementary Appendix 2.

To calculate anxiety and depression trajectories across childhood, we focused on the DAWBA generalised anxiety and mood subscales at 8, 10 and 13 years. We selected these time points because (a) these were the assessment points available in ALSPAC for parent-reported DAWBA: and (b) they cover the early adolescence period, which is a critical period for brain maturation and thus the emergence of subsequent psychopathology.

Regarding anxiety, we created a composite measure of generalised anxiety, by calculating the arithmetic mean of: (a) generalised anxieties total score that was calculated using the generalised anxieties subscale; and (b) generalised anxieties symptoms score that was calculated using the generalised anxieties symptoms subscale. To capture depression symptoms trajectories, we used the mood total score, from the mood subscale. Finally, we created a measure of comorbid anxiety and depression (i.e. composite measure of generalised anxiety + the mood total score). This was done at each time point, separately.

A description of each of the items comprising the DAWBA is detailed in Supplementary Table 1).

Outcomes at 24 years

Mental health problems at 22-24 years included presenting psychotic disorder, severe depression, generalised anxiety disorder, social phobia, specific phobia and panic disorder at 24 years, and/or lifetime hypomania at 22-23 years. Psychotic disorder was measured using the semi-structured Psychosis-Like Symptom Interview;22 hypomania using the Hypomania Checklist;23 and severe depression, generalised anxiety disorder, social phobia, specific phobia and panic disorder using a self-administered online version of the Clinical Interview Schedule-Revised.24 Further details of these specific measures are included in Supplementary Table 2).

Physical health problems at 24 years included having any of the following medical conditions for at least 6 months, at 24 years old: diabetes, asthma, arthritis, heart problems, stroke or cancer and/or kidney disease. These conditions were directly asked of participants as follows using a single item by ALSPAC researchers during data collection: do you have any of the following conditions (diabetes, asthma, arthritis, heart problems, stroke or cancer and/or kidney disease)? Further, obesity at 24 years was included using body mass index, which was categorised as obesity (≥30.0 kg/m ²) versus non-obesity (<30.0 kg/m ²), following the World Health Organization guidelines.25 Finally, sleep problems at 24 years were assessed by self-reported questionnaire, with the following item: 'In past month, I had problems getting to sleep or back to sleep'.

Substance misuse at 24 years included presenting alcohol and/or cannabis misuse at 24 years. We decided to focus only on alcohol and cannabis misuse, and not on other additional illicit drugs, as alcohol and cannabis are the most commonly used substances among young adults. Alcohol misuse at 24 years was measured using the DSM-IV tool26 (further description appears in Supplementary Table 3). Cannabis use at 24 years was measured using the Cannabis Abuse Screening Test (CAST) questionnaire,27 and a cut-off score of 4 was selected to detect those individuals with cannabis misuse.

Education/employment status and problems at 24 years were coded as: not in education, employed or in training scheme; difficulty keeping up with coursework/studies; or difficulty keeping up with work; again, these were asked about by a direct question to participants.

Confounders

Multiple early-life family risk factors were assessed using the Family Adversity Index (FAI) during pregnancy, and at the child's 2 and 4 years of life. The FAI comprises 18 mother-reported items on early parenthood, housing conditions, maternal education, financial difficulties, parents' relationship, family size, family major problems, maternal psychopathology, parents' substance misuse, crime records, partner support and social network. Points were summed at each time point for a total FAI score across the three time points. Total FAI score was included as a confound as early-life adversities are associated with an increased risk of depression and anxiety.

Other covariates, which are known to have an impact in youth mental health, were child's gender (male versus female), gestational age (weeks) and ethnicity (White versus Black and minority ethnic), and maternal age when baby was born (years). For the health outcomes at 24 years, we also controlled for parent-reported child's health (i.e. good versus bad) at 4 weeks, and at 8, 10 and 13 years, as poor physical health in childhood associates with a variety of negative health-related outcomes in adulthood.

Statistical analysis

First, latent class growth analyses (LCGA) were conducted using Mplus v8, to detect trajectories of anxiety, depression and comorbid anxiety and depression, separately, across childhood and adolescence. Several models were fitted by increasing the number of classes. The best fitting classification model was chosen according to fit indices (i.e. Bayesian information criteria (BIC) and Vuong-Lo-Mendell-Rubin (VLMR) test). Lower BIC values suggest better model fit. A significant VLMR value suggests that a K-class model fits the data better than a ( K − 1) class model. Entropy was also used to select the best model fit; entropy with values approaching 1 indicates clear delineation of classes. Finally, to decide the optimal class solution, an emphasis was placed on large enough group sizes (i.e. >2% of the sample) and clinically relevant and informative interpretation, according to the previous literature on the topic. Missing values because of attrition were handled by the full-information maximum-likelihood estimation method.

The second stage analysis was conducted in SPSS-v27 to investigate the prospective associations between persistent high levels of anxiety, persistent high levels of depression, and persistent high levels of comorbid anxiety and depression, identified by LCGA and adverse outcomes at 24 years. The derived latent classes from the LCGA were included as predictor (with the class with the highest number of 'cases', as the reference) and adverse outcomes at 24 years as outcome. We conducted logistic regression analysis for each exposure and each outcome, in separate analysis. For each of the analyses, we controlled for FAI, gender, ethnicity, gestational age and maternal age at birth. For the health-related outcomes at 24 years, we also included parent-reported child's health at 4 weeks, and at 8, 10 and 13 years as covariates.

To deal with missingness, which was unlikely to be occurring at random (i.e. our missing data was systematically related to the unobserved data), we conducted logistic regression to identify significant factors associated with attrition, using inverse probability weights. Characteristics associated with attrition at 24 years old were being a boy, younger mother, shorter gestational age, less weight at birth and higher socioeconomic levels (Supplementary Table 4). Using the variables associated with selective dropout as the factors, we fitted a logistic regression model to determine weights for each individual using the inverse probability of response. The regression coefficients from this model were used to determine probability weights for the covariates in the primary analyses.

Results

Data were available on 8122 participants who reported on the DAWBA at 8, 10 and 13 years. A description of the sociodemographic, DAWBA and outcome variables at 24 years old are presented in Tables 1 and ​and2 2 .

Table 1

Variable

8 years old

10 years old

13 years old

24 years old

Health at different agesa

Good (%)

Poor (%)

Gender, boys/girls: n/ n (%/%)

4235/4007

(51.4/48.6)

3938/3869

(50.4/49.6)

3462/3444

(50.1/49.9)

1458/2429

(37.5/62.5)

-

Ethnicity, White/Black and minority ethnic: n/ n (%/%)

7808/145

(98.2/1.8)

7106/125

(98.3/1.7)

6323/104

(98.4/1.6)

3405/78

(97.8/2.2)

Table 2

Adverse outcomes at 24 years old

Yes (%)

No (%)

Latent classes of anxiety, depression, and comorbid anxiety and depression

Table 3 shows VLMR, BIC and entropy for all models assessed (two to six classes), tested for each of the three main DAWBA domains. BIC decreased with the addition of each class indicating a better model fit for more classes. This pattern is typically found in large samples.28 However, decreases in BIC became considerably smaller in the three-classes model compared with the two-classes model, which suggested a better model fit for the two-classes model (see Supplementary Fig 1).

Table 3

DAWBA composite scores of general anxieties

BIC

VLMR, P

Entropy

Further, VLMR showed a statistically significant difference for the two-classes, three-classes, four-classes and five-classes models for DAWBA generalised anxiety and DAWBA depression, and VLMR was statistically significant for two-classes, three-classes and four-classes models for DAWBA anxiety + depression. The six-classes model did not offer a significant difference, for any of the three domains. Importantly, two-classes and three-classes models showed higher significant values for VLMR than the four-classes and five-classes models, suggesting a better model fit for two- or three-classes models, for each of the DAWBA domains.

Finally, the entropy values for the three-classes model for each of the DAWBA domains were the highest, compared with the other n-classes model (and all >0.80), indicating the highest classification accuracy for the three-classes model. Therefore, and overall, the three main fit indices tested (i.e. VLMR, BIC and entropy) suggested that for each of the DAWBA domains, the three-classes model offered the best model fit, followed by the two-classes model. To confirm this optimal three-classes solution, we checked that there were large enough group sizes (i.e. >2% of the sample) in each of the classes, which was the case; and that the trajectories detected were clinically relevant. In fact, the three-classes model was more clinically relevant than the two-classes model, as the two-classes model was not able to detect a group with moderate levels of symptomatology. This was corroborated by the clinical experts in our study (i.e. S.M. and R.U.). Therefore, a three-classes model offered overall the best fit, for each domain. The three derived classes of anxiety from the three-classes model, for each of the three DAWBA domains appear in Fig. 1 .

The three-classes model of DAWBA generalised anxiety included: class 1 ( n = 6331, 72.9%) characterised by persistent and increasing low levels, class 2 ( n = 1882, 21.7%) characterised by persistent and decreasing intermediate levels, and class 3 ( n = 469, 5.4%) characterised by persistent and decreasing high levels.

The three-classes model of DAWBA depression included: class 2 ( n = 8324, 88.2%) characterised by persistent and decreasing low levels, class 1 ( n = 695, 7.4%) characterised by persistent and increasing intermediate levels, and class 3 ( n = 421, 4.5%) characterised by persistent and increasing high levels.

The three-classes model of combined DAWBA generalised anxiety and depression total scores included: class 1 ( n = 11 154, 91.2%) characterised by decreasing low levels, class 2 ( n = 703, 5.8%) characterised by increasing intermediate levels, and class 3 ( n = 369, 3.0%) characterised by increasing high levels.

Associations between persistent anxiety, persistent depression, and persistent comorbid anxiety and depression, with adverse outcomes at 24 years

For the logistic regressions between LCGA three-classes model and the adverse outcomes at 24 years, we focused on class 3, as it represented the individuals at highest risk, in each of the three domains. Our results showed that all three classes with persistent anxiety, depression or both were significantly associated with presenting any mental health problems at 24 years compared with the reference class (anxiety: odds ratio (OR) = 2.09, 95% CI 1.63-2.69, P < 0.001; depression: OR = 2.07, 95% CI 1.50-2.87, P < 0.001; comorbid: OR: 1.99, 95% CI 1.49-2.65, P < 0.001] (see Table 4 ). Further, persistent high levels of depression (OR = 1.27, 95% CI 1.09-1.48, P = 0.002) and high levels of comorbid anxiety and depression (OR = 1.40, 95% CI 1.21-1.62, P < 0.001), but not persistent high anxiety, were significantly associated with any physical health problem at 24 years (see Table 4 ).

Table 4

Outcomne

OR

95% CI

P

Anxiety Class3
2.09 1.63 to 2.69
<0. 001

In relation to substance misuse at 24 years, high levels of comorbid anxiety and depression was the only DAWBA domain significantly associated with this outcome (OR = 1.57, 95% CI 1.15-2.15, P < 0.001; see Table 5 ). Finally, all three classes with persistent anxiety, depression or both were significantly associated with presenting any education/employment problem at 24 years (i.e. anxiety: OR = 1.56, 95% CI 1.20-2.03, P = 0.001; depression: OR = 1.38, 95% CI 1.00-1.91, P = 0.047; comorbid: OR = 1.48, 95% CI 1.07-2.05, P = 0.018; see Table 5 ). Unadjusted logistic regressions (i.e. without covariates) were also reported for each of the main exposure and main outcome measures, which showed similar results to the adjusted models (see Supplementary Table 5).

Table 5

Outcome

OR

95% CI

P

Mood Class1
1.44 1.18 to 1.86
0. 031

We additionally examined the logistic regression with each individual outcome at 24 years. A detailed description of these results can be found in Supplementary Table 6 for individual mental health outcomes; Supplementary Table 7 for individual physical health outcomes; Supplementary Table 8 for sleep problems; Supplementary Table 9 for individual functional outcomes; and Supplementary Table 10 for individual substance misuse outcomes. Briefly, all three classes with persistent anxiety, depression or both were significantly associated with psychotic disorder (highest OR for comorbid anxiety and depression), severe depression (highest OR for comorbid anxiety and depression), generalised anxiety disorder (highest OR for depression) and panic disorder (highest OR for anxiety), all at 24 years.

Concerning individual physical health outcomes at 24 years, persistent high anxiety was associated with diabetes, persistent high depression and high comorbid anxiety and depression symptoms with asthma and arthritis (highest OR for comorbid anxiety and depression, for each outcome), and all three classes with persistent anxiety, depression or both were significantly associated with heart problems (highest OR for comorbid anxiety and depression). Further, high comorbid anxiety and depression symptoms was the only DAWBA domain associated with obesity, sleep problems, alcohol misuse and cannabis misuse at 24 years. Finally, in relation to individual adverse education/employment outcomes at 24 years, all three classes with persistent anxiety, depression or both were significantly associated with not being in education/employed/training (highest OR for comorbid anxiety and depression), and persistent high anxiety was the only DAWBA outcome associated with having difficulties in keeping up with work.

Discussion

Main findings

To our knowledge, this is the first longitudinal study to examine the associations between persistent high levels of depression, anxiety, and comorbid anxiety and depression across childhood and adolescence with several adverse outcomes at 24 years old, including mental health, physical health, substance misuse and education/employment outcomes.

Interpretation of our findings

First, we found different patterns of development over time when we compared the trajectories from each domain (i.e. anxiety, depression, and comorbid anxiety and depression). We found trajectories suggesting that clinical symptoms of generalised anxiety (i.e. DAWBA generalised anxiety) might decrease from childhood to adolescence, whereas the clinical symptoms of depression increase. These findings are consistent with previous work, which supports that anxiety symptoms generally decline from childhood to adolescence,15 whereas depression becomes increasingly more prevalent across adolescence.29 Further, when we examined comorbid anxiety and depression over time we observed that at 8 years, children showed low levels of comorbid anxiety and depression, but at 10 and 13 years there was a clear differentiation, with a small group showing persistent and increasing high levels from 10 to 13 years.

So far, there is no previous evidence on the developmental trajectories of comorbid anxiety and depression across childhood and adolescence. The scarce existing research has focused on the broader concept of internalising symptoms, with some reporting a curvilinear trajectory where internalising symptoms decrease from age 7 to 12 years and then increase into adolescence,14 whereas others have revealed that child internalising symptoms increase from 4 to 10 years.30 As conceived by Achenbach, internalising symptoms refer more generally to problems of withdrawal, somatic complaints and anxiety/depression. Therefore, this is a broader concept than the domain of comorbid anxiety and depression included in our study, which may partially explain the discrepancies. Importantly, in each of the three domains, we detected a group of individuals characterised by high levels of symptomatology over time. This suggests potential chronicity (or persistence) of depression and anxiety, which is clinically relevant, and can develop very early in childhood and adolescence. Chronicity is not only an issue facing adults, but its potential presence in childhood is also likely to be limiting the psychological, academic and social functioning of individuals.

Second, we found that presenting with high levels of anxiety, depression and/or comorbid anxiety and depression from childhood to adolescence is critically important to psychiatry, public health and primary care, given that the persistence of symptoms was associated with a range of adverse outcomes at 24 years. We also reported some differences in the prospective associations in terms of the domains assessed (i.e. anxiety, depression, and comorbid anxiety and depression). More specifically, we found that overall, high levels of comorbid anxiety and depression was the domain that exerted the greatest negative impact at 24 years, especially on mental health and on physical health. For instance, high levels of comorbid anxiety and depression showed the greatest impact on psychotic disorder, depression, asthma, arthritis, heart problems and unemployment at 24 years, compared with persistent high levels of anxiety or depression alone. Further, high levels of comorbid anxiety and depression was the only domain associated with obesity, sleep problems and substance misuse at 24 years. This supports the notion that comorbid anxiety and depression is associated with worse overall outcomes.10 More specifically, comorbid anxiety and depression has been consistently associated with higher illness severity, chronicity and impairments in everyday life, in addition to more disability and alcohol problems.31

There are several potential reasons underlying the risk for adverse outcomes associated with adolescent depression and/or anxiety. For example, chronic elevation of stress hormones or pluripotent genomic vulnerability could lead to risk of physical and mental health conditions in the long term.32 Biological mechanisms such as decreased heart rate variability,33 autonomic nervous system dysregulation34 or higher inflammatory levels35 among individuals with depression and/or anxiety may also lead to increased risk for adverse physical (e.g. cardiovascular diseases, arthritis, diabetes) and mental health outcomes (e.g. psychosis, anxiety, depression). Further, experiencing depression and anxiety since early life might affect the social, cognitive and academic development of the child,36 which subsequently might increase the probabilities of presenting with adverse outcomes in adulthood. Finally, lifestyle risk factors, such as smoking, poor diet or inactivity are more frequent in those with emerging mental health disorders, which could negatively influence physical and mental health.37

Strengths and limitations

Strengths of this study include the large population-based sample and the inclusion of several adverse outcomes covering a wide range of mental health, physical health and education/employment areas. There are also some limitations.

First, other potential contributing factors, such as cognition, social interactions, lifestyle and family factors, and/or obstetric complications were left unexplored. Second, we were unable to use anxiety and depression data in those older than 13 years, thus we cannot comment on future symptomatology trajectory after this age group. Third, the DAWBA measures were parent reported, thus there is a bias associated with parents' perceptions. This parent-reported bias might be especially relevant as children get older (e.g. at 13 years old), as at these ages the parents might not be fully aware of how the child feels. Therefore, future studies should also consider self-reported and/or teacher-reported information. Fourth, the majority of participants were of White ethnicity and they were all residents in the same geographic area in the UK (Avon area), which limits the generalizability of findings to other ethnic groups and ethnic comparisons, and to other geographical areas within and outside the UK, respectively.20 Fifth, as is usual in birth cohort studies, the attrition rate was significant. Although we used procedures to ensure the representativeness of our results, this should be taken into account when interpreting our findings. Sixth, some of the physical health problems at 24 years included very few cases (e.g. stroke/cancer, or kidney diseases), as these are usually rare in young adulthood. Therefore, these specific results should be cautiously interpreted as these may not be representative of this specific age range. Seventh, our data-set did not include information on participants medication. Therefore, we are unaware of any medication that the participants were taking at any of the time points in this study, and which could potentially affect our findings. However, and considering that this is a population-based study, it is likely that only a very small number of participants would be on medication during the study. Finally, adjusted BIC or sample-size adjusted BIC were not used in the selection of the best-class solution, as these are not provided by our software (i.e. Mplus), but we used BIC instead. Nevertheless, there is evidence supporting BIC being an optimal information criterion.³⁸

Implications

In summary, our findings showed that depression, anxiety, and comorbid anxiety and depression from childhood to adolescence present distinct developmental patterns. For each of these domains, we detected a group of individuals characterised by persistent high levels of symptomatology. Further, high levels of anxiety, depression, and comorbid anxiety and depression from 8 to 13 years were all associated with a range of adverse outcomes at 24 years, including mental health, physical health, substance misuse and poor education/employment status.

Among these, high levels of comorbid anxiety and depression exerted the greatest adverse impact at 24 years. These findings highlight the relevance of identifying and treating those children and adolescents presenting with persistent anxiety and depression, and especially the comorbidity of both symptoms, as these would be the individuals at highest risk of having adverse outcomes at 24 years, including health and education/employment problems. Overall, our findings are important to psychiatric practice, public health and primary care, and could help early identification of those at highest risk of a range of adverse outcomes in adulthood: for example, for whom transitional services from child and adolescent mental health services into adult mental health services needs strengthening, or for whom chronicity of depression and anxiety in childhood and adolescence needs more assertive management. Our results suggest that by implementing early intervention programmes targeting chronicity of childhood depression and anxiety there is potential to have an impact on subsequent adverse health and functional outcomes in adulthood. How this could be achieved needs further research.

Acknowledgments

We are extremely grateful to all the families who took part in this study, the midwives for their help in recruiting them, and the whole ALSPAC team, which includes interviewers, computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, receptionists and nurses.

Supplementary material

For supplementary material accompanying this paper visit https://doi.org/10.1192/bjp.2023.23.

Author's contributions

I.M-M., P.K.M. and S.M. conceptualised the research question and developed the analysis plan. I.M-M. analysed the data and drafted the manuscript. J.S.C., R.T. and R.U. reviewed results, and provided guidance on methodology. All authors reviewed and contributed to the manuscript and approved the final version of the manuscript.

Funding

This work was supported by the UK Medical Research Council and Wellcome (Grant ref: 217065/Z/19/Z) and the University of Bristol provide core support for ALSPAC.

Declaration of interest

R.U. is a member of the British Journal of Psychiatry editorial board. We confirm that this author did not take part in the review or decision-making process of this paper. The other authors disclose no conflicts of interest.

References

25. Kivimäki M, Strandberg T, Pentti J, Nyberg ST, Frank P, Jokela M, et al. Body-mass index and risk of obesity-related complex multimorbidity: an observational multicohort study. Lancet Diabetes Endocrinol 2022; 10(4): 253-63. [[ PubMed] PMC free article] [ Google Scholar]

26. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders [(4th edn). American Psychiatric Association, 1994. Google Scholar]

27. Legleye S, Karila L, Beck F, Reynaud M. Validation of the CAST, a general population Cannabis abuse screening test. J Subst Use 2007; 12: 233-42. [ Google Scholar]

37. Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S, Galletly C, et al. The [ Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. Lancet Psychiatry 2019; 6: 675-712. [ PubMed] Google Scholar]

38. Nylund KL, Asparouhov T, Muthén BO. Deciding on the number of classes in latent class analysis and growth mixture modeling: a mnte carlo simulation study. Struct Equ Model A Multidiscip J 2007; 14: 535-69. [ Google Scholar]

Articles from The British Journal of Psychiatry are provided here courtesy of Cambridge University Press

# data[].attributes.attachment_link.title
Impact of anxiety and depression across childhood and adolescence on adverse outcomes in young adulthood: a UK birth cohort study

# data[].attributes.attachment_link.description
Little is still known about the long-term impact of childhood and adolescent persistent depression and anxiety in adulthood.To investigate the impact of persistent anxiety, depression, and comorbid anxiety and depression across childhood and adolescence ...

# data[].attributes.body
Science and Prevention. (2011). Depression in Adolescent Girls. Guilford Publications.

# data[].attributes.body
Garcia, A. (2009). La depresión en Adolescentes. La salud mental de las personas jóvenes en España. Estudios de Juventud. 84, 85-104.

# data[].attributes.body
Tuesta, A. (2020). Estrés y depresión en adolescentes de la Institución Educativa Víctor Raúl Haya de La Torre - Víctor Larco, 2020. [Tesis de Licenciatura, Universidad César Vallejo]. Repositorio Institucional - Universidad César Vallejo. https://repositorio.ucv.edu.pe/bitstream/handle/20.500.12692/45817/Tuesta_AAS-SD.pdf?sequence=1&isAllowed=y

# data[].attributes.body
Briceño, A. M. (2022). Depresión en Adolescentes: Cómo acompañarlos a enfrentar esta enfermedad y las claves para prevenirla. El Mercurio.

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¿Qué es la depresión? ¿Qué hago si sospecho que mi hijo adolescente tiene depresión? ¿Cuáles son sus causas más comunes? ¿Son los fármacos el único tratamiento? ¿Es el suicidio un riesgo real? ¿Se puede prevenir? ¿Cómo podemos ayudarlos a superar este sufrimiento? Son muchas las inquietudes que surgen en los padres frente a esta enfermedad de salud mental que, a veces, los paraliza y no los deja actuar con claridad. A través de un lenguaje directo y práctico, la psiquiatra infanto-juvenil Ana Marina Briceño responde en este libro todas estas preguntas y entrega valiosos consejos que los ayudarán a enfrentar de mejor manera una difícil realidad, cada vez más frecuente en nuestro país. Basándose en ejemplos cotidianos -obtenidos en sus más de veinte años de consulta profesional y en su propia experiencia familiar, ya que su hija fue diagnosticada con depresión a los catorce años-, la autora intenta derribar mitos y borrar los estigmas que conlleva esta enfermedad. Depresión en adolescentes es una guía de acompañamiento para que padres, tutores o profesores, sepan cómo transitar en este duro proceso. Y también es una invitación para aprender a hablar de ella con naturalidad y sin temor, entendiendo que es un trastorno que sí se puede superar.

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¿Qué es la depresión? ¿Qué hago si sospecho que mi hijo adolescente tiene depresión? ¿Cuáles son sus causas más comunes? ¿Son los fármacos el único tratamiento? ¿Es el suicidio un riesgo real? ¿Se puede prevenir? ¿Cómo podemos ayudarlos a superar este sufrimiento?

# data[].attributes.body
Jiménez Noriega, R. E. (2023). Influencia de la ansiedad y depresión en las estrategias de afrontamiento al estrés en adolescentes de Lima Norte. PsiqueMag, 12(1), 45–57. https://doi.org/10.18050/psiquemag.v12i1.2464

# data[].attributes.attachment_link.readable_text
American Academy of Pediatrics (2022). La salud mental durante el COVID-19: señales de que su hijo pudiera necesitar más ayuda. https://www.healthychildren.org/Spanish/health-issues/conditions/COVID-19/Paginas/Signs-your-Teen-May-Need-More-Support.aspx

Apaza, C., Seminario, R. y Santa-Cruz, J. (2020). Factores psicosociales durante el confinamiento por el Covid-19 - Perú. Revista venezolana de Gerencia, 25(90), 402-410. https://www.redalyc.org/articulo.oa?id=29063559022

Arias, F. (2012). El proyecto de investigación. Introducción a la metodología científica (6a ed.). Episteme.

Arroyo, M. y Sádaba, I. (2012). Metodología de la investigación social: técnicas innovadoras y sus aplicaciones. Síntesis.

Beck, A., Emery, G. y Greenberg, R. (1985). Anxiety disorders and phobias: a cognitive perspective. Basic Books.

Berrío, N. y Mazo, R. (2011). Estrés académico. Revista de Psicología de la Universidad de Antioquía, 3(2), 65-82. https://doi.org/10.17533/udea.rp.11369

Caipo, G. y Villar, T. (2017). Relación entre los estilos de afrontamiento y rasgos de personalidad en adolescentes de la I. E. Andrés Avelino Cáceres de Cajamarca [Tesis para obtener el gado de Maestría en Psicología, Universidad Privada Antonio Guillermo Urrelo]. Repositorio Institucional de la Universidad Privada Antonio Guillermo Urrelo. http://repositorio.upagu.edu.pe/bitstream/handle/UPAGU/220/TESIS%202%20C AIPO%20-%20VILLAR.pdf?sequence=1&isAllowed=y

Canessa, B. (2002). Adaptación psicométrica de las Escalas de Afrontamiento para Adolescentes de Frydenberg y Lewis en un grupo de escolares de Lima metropolitana. Persona, (5), 191-233. https://doi.org/10.26439/persona2002.n005.876

Céspedes, (2015). Propiedades psicométricas del inventario de ansiedad estado y ansiedad rasgo en niños y adolescentes de Lima Sur. [Tesis para obtener el grado de Licenciada en Psicología), Universidad Privada Autónoma del Perú]. Repositorio de Universidad Privada Autónoma del Perú. https://repositorio.autonoma.edu.pe/bitstream/handle/20.500.13067/135/CESPEDES%20CONDOMA.pdf?sequence=6&isAllowed=y

Cohen, J. (1992). A Power Primer [Una impresión de poder]. Psychological Bulletin, 112, 155-159. https://journals.sagepub.com/doi/10.1111/1467-8721.ep10768783

Delgado, (2017). Afrontamiento al estrés y síntomas depresivos en adolescentes que padecen acné en instituciones educativas de Chiclayo-2017 [Tesis para obtener el grado de Licenciada en Psicología, Universidad Privada Señor de Sipán]. Repositorio de Universidad Privada Señor de Sipán. https://repositorio.uss.edu.pe/bitstream/handle/20.500.12802/5867/Delgado%20Farro%20Janella%20Solanch.pdf?sequence=1&isAllowed=y

Espinal, I. Gimeno, A. y González, F. (2004). El enfoque sistémico en los estudios sobre la familia. Revista internacional de sistema, 14, 21-34. https://www.uv.es/jugar2/Enfoque%20Sistemico.pdf

Fondo de las Naciones Unidas para la Infancia [UNICEF]. (2020). El impacto del COVID-19 en la salud mental de adolescentes y jóvenes. https://www.unicef.org/lac/el-impacto-del-covid-19-en-la-salud-mental-de-adolescentes-y-j%C3%B3venes

Froxán, M. (2020). Análisis funcional de la conducta humana: Concepto, metodología y aplicaciones. Pirámide.

González, N. y Valdéz, J. (2012). Resiliencia y convivencia escolar en adolescentes mexicanos. Revista de Psicología, 14(2), 194-207. https://sisbib.unmsm.edu.pe/bvrevistas/rev_psicologia_cv/v14_2012_2/pdf/a05v14n2.pdf

González, N. y Valdez, J. (2012). Optimismo-pesimismo y resiliencia en adolescentes de una universidad pública. Ciencia Ergo Sum , 19 (3), 207 214. https://www.redalyc.org/pdf/104/10423895002.pdf

González, P., Martínez, V. (2022). Durante la pandemia COVID-19 las enfermedades mentales se duplicaron en los adolescentes. Evidencias en Pediatría, 18(3), 1-4. https://evidenciasenpediatria.es/files/41-14148-RUTA/AVC_3_COVID_depresion.pdf

González, S., Pineda, A. y Gaxiola, J. (2018). Depresión adolescente: factores de riesgo y apoyo social como factor protector. Universitas Psychologica, 17(3), 1- 11. http://www.scielo.org.co/pdf/rups/v17n3/1657-9267-rups-17-03-00063.pdf

Hernández-Sampieri, R. y Mendoza, C (2018). Metodología de la investigación. Las rutas cuantitativa, cualitativa y mixta. Editorial Mc Graw Hill Education.

https://www3.paho.org/hq/index.php?option=com_content&view=article&id=13102:depression-lets-talk-says-who-as-depression-tops-list-of-causes-of-ill health&Itemid=0&lang=es#:~:text=La%20depresi%C3%B3n%20es%20un%20trastorno,durante%2014%20d%C3%ADas%20o%20m%C3%A1s

Liang, L. y Lee, Y. (2019). Factor structure of the ruminative response scale and measurement invariance across gender and age among Chinese adolescents [Estructura factorial de la escala de respuesta rumiativa e invariancia de medición a través del género y la edad entre los adolescentes chinos]. Advances in Applied Sociology, 9, 193-207. https://doi.org/10.4236/aasoci.2019.96016

Lovibond, S. & Lovibond, P. (1995). Manual for the Depression Anxiety Stress Scales. (2nd. Ed.). Psychology Foundation.

Mella-Norambuena, J., López-Angulo, Y., Sáez-Delgado, Y. y Del Valle, M. (2020). Estrategias de afrontamiento en apoderados durante el confinamiento por la COVID-19. CienciAmérica, 9 (2), 322-333. http://dx.doi.org/10.33210/ca.v9i2.324

Mennin, D., Heimberg, R., Turk, C., & Fresco, D. (2005). Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder [Evidencia preliminar de un modelo de desregulación emocional del trastorno de ansiedad generalizada]. Behaviour Research and Therapy, 43, 1281-1310. https://pubmed.ncbi.nlm.nih.gov/16086981/

Navarro-Loli, J., Moscoso, M. y Calderón-De la Cruz, G. (2017). La investigación de la depresión en adolescentes en el Perú: una revisión sistemática. Liberabit, 23(1), 57-74. https://doi.org/10.24265/liberabit.2017.v23n1.04

OMS (2018). "Depresión: hablemos", dice la OMS, mientras la depresión encabeza la lista de causas de enfermedad.

Palomino-Oré, C. y Huarcaya-Victoria, J. (2020). Trastornos por estrés debido a la cuarentena durante la pandemia por la COVID-19. Horizonte Médico (Lima), 20(4), 1-6. https://doi.org/10.24265/horizmed.2020.v20n4.10

Páramo, M. (2011). Factores de Riesgo y Factores de Protección en la Adolescencia: Análisis de Contenido a través de Grupos de Discusión. Terapia psicológica, 29(1), 85-95. https://dx.doi.org/10.4067/S0718-48082011000100009

Parker, J. S., Haskins, N., Lee, A., Hailemeskel, R., & Adepoju, O. A. (2021). Black adolescents' perceptions of COVID-19: Challenges, coping, and connection to family, religious, and school support [Percepciones de los adolescentes negros sobre el COVID-19: desafíos, afrontamiento y conexión con el apoyo familiar, religioso y escolar]. School psychology, 36(5), 303-312. https://doi.org/10.1037/spq0000462

Pereña, J., y Seidedos, N. (1997). ACS - Escala de Afrontamiento para Adolescentes. Adaptación española Adolescent Coping Scale. TEA Ediciones.

Purisaca, J. y Cajahuanca, A. (2017). Sintomatología depresiva y afrontamiento en escolares de nivel secundario de una institución educativa estatal de la provincia constitucional del Callao. [Tesis de licenciatura, Universidad Católica Sedes Sapientiae]. Repositorio de la Universidad Católica Sedes Sapientiae. https://repositorio.ucss.edu.pe/bitstream/handle/20.500.14095/215/Purisaca_Cajahuanca_tesis_bachiller_2017.pdf?sequence=1&isAllowed=y

Quintero, P., Rodríguez, R., Etchezahar, E. & Gillanders, D. (2020). The Argentinian version of the cognitive fusion questionnaire: Psychometric properties and the role of cognitive fusion as a predictor of pathological worry. Current Psychology: A Journal for Diverse Perspectives on Diverse Psychological Issues. https://doi.org/10.1007/s12144-020-00767-4

Reyes, V., Reséndiz, A., Alcázar, R. y Reidl, L. (2017). Las estrategias de afrontamiento que utilizan los adolescentes ante situaciones que provocan miedo. Psicogente, 20(38), 240-255. https://doi.org/10.17081/psico.20.38.2544

Rojas Camacho, C. y Rivera Tejada, H. (2014). Nivel de estrés y su relación con las estrategias de afrontamiento de las internas de enfermería, Hospital Belén de Trujillo-2013. Cientifi-K, 2(1), 20-25. https://revistas.ucv.edu.pe/index.php/cientifi-k/article/view/1354

Roman, F., Santibañez, P. y Vinet, E. (2016). Uso de las escalas de depresión ansiedad estrés (DASS-21) como instrumento de tamizaje en jóvenes con problemas clínicos, Acta de investigación Psicológica, 6(1), 2325-2336. https://doi.org/10.1016/S2007-4719(16)30053-9

Rude, S. & McCarthy, C. (2003). Emotional functioning in depressed anddepression- vulnerable college students [Funcionamiento emocional en estudiantes universitarios deprimidos o vulnerables a la depresión]. Cognition and Emotion, 17, 799-806.

Salavera, C. y Usán, P. (2017). Repercusión de las estrategias de afrontamiento de estrés en la felicidad de los alumnos de Secundaria. Revista Electrónica Interuniversitaria de Formación del Profesorado, 20(3), 65-77. http://dx.doi.org/10.6018/reifop.20.3.282601

Schwartz, K., Exner-Cortens, D., McMorris, C., Makarenko, E., Arnold, P., Van Bavel, M., Williams, S. & Canfield, R. (2021). COVID-19 and Student Well-Being: Stress and Mental Health during Return-to-School [COVID-19 y el bienestar del estudiante: estrés y salud mental durante el regreso a la escuela]. Canadian journal of school psychology, 36(2), 166-185. https://doi.org/10.1177/08295735211001653

Soler, J., Elices, M. y Carmona, C. (2016). Terapia dialéctica conductual: aplicaciones clínicas y evidencia empírica. Análisis y modificación de conducta, 42, (165- 166), 35-49. http://dx.doi.org/10.33776/amc.v42i165-66.2793

Taha, N., Florenzano, R., Sieverson, C., Aspillaga, C. y Alliende, L. (2011). La espiritualidad y religiosidad como factor protector en mujeres depresivas con riesgo suicida: consenso de expertos. Rev. Chil. Neuro-psiquiat., 49(4), 347- 360. https://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-92272011000400006

Vásquez C., Hervás G., Hernangómez L., Romero N. (2010). Modelos cognitivos de la depresión: una síntesis y nueva propuesta basada en 30 años de investigación. Psicología Conductual, 18 (1), 139-165. https://www.behavioralpsycho.com/wp-content/uploads/2019/08/08.Vazquez_18-1oa-1.pdf

# data[].attributes.attachment_link.title
Influencia de la ansiedad y depresión en las estrategias de afrontamiento al estrés en adolescentes de Lima Norte.

# data[].attributes.attachment_link.description
American Academy of Pediatrics (2022). La salud mental durante el COVID-19: señales de que su hijo pudiera necesitar más ayuda. https://www.healthychildren.org/Spanish/health-issues/conditions/COVID-19/Paginas/Signs-your-Teen-May-Need-More-Support.aspx Apaza, C., Seminario, R. y Santa-Cruz, J. (2020). Factores psicosociales durante el confinamiento por el Covid-19 - Perú. Revista venezolana de Gerencia, 25(90), 402-410. https://www.redalyc.org/articulo.oa?id=29063559022 Arias, F. (2012).

# data[].attributes.body
Monasterio Ontaneda, A. (2019). Depresión en adolescentes de una institución educativa pública de Lima Metropolitana [Tesis de Licenciatura, Universidad San Ignacio de Loyola] Repositorio Institucional – Universidad San Ignacio de Loyola

# data[].attributes.body
García Vera, M. P., Sanz Fernández, J. (2016). Tratamiento de los trastornos depresivos y de ansiedad en niños y adolescentes. Pirámide.

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En este libro se abordan los trastornos de ansiedad y los trastornos depresivos que, en conjunto, son los de mayor prevalencia en la infancia y la adolescencia, y que preocupan tanto a padres como a profesionales, puesto que sus síntomas producen un importante deterioro en la vida del menor y en su entorno familiar, escolar y social. El libro explica de forma pormenorizada en qué consisten esos dos grupos de trastornos y cómo reconocerlos, evaluarlos, realizar un buen diagnóstico y poner en marcha un tratamiento eficaz. Es un texto que integra teoría y práctica y que incluye ejemplos y casos con el objetivo último, tal y como refleja su subtítulo, de trasladar la investigación a la práctica clínica. Así, el libro aúna los conocimientos más actuales con la práctica clínica diaria, los resultados de la investigación más reciente con los conocimientos más asentados, la exposición de los fundamentos y las técnicas de los tratamientos más eficaces con su aplicación concreta en casos clínicos. Sin duda es un manual de referencia completo y muy actualizado para los estudiantes de grado y de posgrado en Psicología, Psicopatología, Psicología Clínica o Psicología General Sanitaria, pero también para estudiantes de grado y posgrado de disciplinas afines de Ciencias de la Salud, como Medicina, Pediatría, Psiquiatría o Enfermería, de Ciencias Sociales, como Trabajo Social, y de Ciencias de la Educación, especialmente de las relacionadas con niños y adolescentes, como Pedagogía, Educación Social o Magisterio. Además, será de utilidad para aquellos profesionales que quieran ponerse al día tanto desde el punto de vista teórico y de las últimas investigaciones, como práctico, en particular, en la aplicación de la metodología de resolución de casos clínicos y de criterios para tomar decisiones sobre qué tratamiento aplicar y de qué modo hacerlo.

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Tratamiento de los trastornos depresivos y de ansiedad en niños y adolescentes

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En este libro se abordan los trastornos de ansiedad y los trastornos depresivos que, en conjunto, son los de mayor prevalencia en la infancia y la adolescencia, y que preocupan tanto a padres como a profesionales, puesto que sus síntomas producen un importante deterioro en la vida del menor y en su entorno familiar, escolar y social.

# data[].attributes.body
Escalera J.P. (2020). Los efectos de un programa de prevención de la ansiedad y la depresión para adolescentes en variables educativas y de bienestar. Elsevier, 25(2) 143-149.

# data[].attributes.body
Núñez C. [Chris Núñez Psicólogo]. (22 de abril de 2019). ¿Cómo Combatir los PENSAMIENTOS de Ansiedad y Depresión? (siguiendo 4 pasos). [Archivo de vídeo]. YouTube. https://www.youtube.com/watch?v=1eZepcg6aC0

# data[].attributes.attachment_link.title
¿Cómo Combatir los PENSAMIENTOS de Ansiedad y Depresión? (siguiendo 4 pasos)

# data[].attributes.body
Diaz, R. S. (2021). La depresión y ansiedad en adolescentes de una universidad de Cajamarca 2021 [Tesis de Licenciatura, Universidad Privada del Norte]. Repositorio Institucional - Universidad Privada del Norte. La depresión y ansiedad en adolescentes de una universidad de Cajamarca 2021 (upn.edu.pe)

# data[].attributes.body
RevistaMSP. (12 de marzo de 2021). Ansiedad y depresión en niños y adolescentes. [Archivo de video]. Youtube. https://www.youtube.com/watch?v=j6IgC6fTI3I

# data[].attributes.attachment_link.title
Ansiedad y depresión en niños y adolescentes

# data[].attributes.body
AMHIM CDMX. (16 de agosto de 2020). Hablemos de Ansiedad y depresión en el adolescente [Archivo de vídeo]. YouTube. https://youtu.be/GYQy7_MC-4M?si=zT82gw5p4SpKs4hJ

# data[].attributes.attachment_link.title
Hablemos de Ansiedad y depresión en el adolescente

# data[].attributes.body
Universidad IEXPRO. (8 de enero de 2024). Depresión y ansiedad adolescente: un problema oculto. [Archivo de vídeo]. YouTube. https://www.youtube.com/watch?v=Xdg0OtOixJA

# data[].attributes.attachment_link.title
+ Salud Mental Para Todos:  Depresión y ansiedad adolescente: un problema oculto

# data[].attributes.body
TEDx Talks. (15 de abril de 2019). ¿Cómo alguien como tú puede tener una depresión? | Ana Ribera | TEDxCiutatVellaDeValencia [Vídeo]. YouTube. https://www.youtube.com/watch?v=9OEo3emh4lQ

# data[].attributes.attachment_link.title
¿Cómo alguien como tú puede tener una depresión? | Ana Ribera | TEDxCiutatVellaDeValencia

# data[].attributes.body
Valencia, C. R., & Escalante, J. C. R. (2020). La depresión (no) existe. Vergara.

# data[].attributes.attachment_link.description
Guía para no causar daño cuando hables con una persona deprimida.

# data[].attributes.body
Marcela, L. (2021) Depresión y Dependencia emocional en estudiantes de psicología de una Universidad particular de Lima, [Tesis de Licenciatura, Universidad Autónoma del Perú]. Repositorio Institucional - Universidad Autónoma del Perú https://repositorio.autonoma.edu.pe/handle/20.500.13067/1865

# data[].attributes.body
Cruz, G. (2012). De la tristeza a la depresión. Revista Electrónica de Psicología Iztacala, 15(4) 5-15.

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DE LA TRISTEZA A LA DEPRESIÓN | Revista Electrónica de Psicología Iztacala

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Es cada vez más frecuente, sobre todo entre los jóvenes, confundir el significado de los términos tristeza y depresión para indicar que el individuo atraviesa por una etapa confusa y dolorosa en su pensar y/o en su actuar, siendo que se trata tan sólo de un episodio de tristeza; mientras que padecer de una depresión, aunque incluye a la tristeza, es algo mucho más complejo que para diagnosticarse como tal, se requiere al menos de un par de semanas de ciertos síntomas y signos claramente identificados y además observa un desequilibrio en los neurotransmisores. En este ensayo se discutirá el concepto de tristeza, comparado con el de depresión y cómo desde su origen hasta su “funcionamiento” operan de manera distinta en el individuo. La tristeza como aflicción, es un sentimiento absolutamente natural, tanto como otros sentimientos básicos que el ser humano posee, mismo que se “mueve” (emociona) por el influjo de sus sentimientos y pensamientos. En cambio la depresión se genera bien por factores exógenos, como algún evento traumático externo, incluida claro está la tristeza, o bien por factores endógenos, esto es, un desequilibrio en los neurotransmisores, provocando alteraciones particularmente en la producción de dopamina, noradrenalina y serotonina. Se concluye entonces que es importante no usar indistintamente ambos términos. Lo anterior obedece a que actualmente existen altos índices de depresión en la sociedad, la que requiere de atención médica y psicológica profesional. Como observa la Organización Mundial de la Salud, menos del 30% de los casos, y en algunos países menos del 10%, obtienen tratamiento efectivo. Y es de destacar que la misma Organización observa que más de 350 millones de personas en el mundo sufren depresión o algún otro trastorno mental. Si se confunde lo que es la depresión, como está sucediendo, se considera a ella como parte intrínseca de nuestra sociedad y no como un acontecimiento clínico, con lo que se corre el peligro de no dimensionar sus efectos y obviar la atención y consecuente tratamiento que requiere.