In a recent article published in Psychological Medicine, researchers examine affective and neural responses to parental feedback in adolescents with depression.
Background
Depression, characterised by negative self-perception and low self-esteem, is a serious mental health problem that currently affects an estimated 280 million people worldwide.
Several different regions of the brain are differentially affected by depression. For example, brain regions related to social salience, the subgenual ACC (sgACC) and the anterior insula (AI), elicit greater neural reactivity to negative stimuli in adults and adolescents with depression.
In comparison, criticism leads to increased neural activity in the AI, ACC and social cognition-related brain regions, including the dorsomedial prefrontal cortex (PFC), temporal poles and inferior frontal gyrus in adolescents.
In healthy individuals, feedback elicits mood responses depending on its valence and consistency with self-views. For example, criticism that is inconsistent with self-views can elicit a negative mood in these individuals. However, compared to healthy individuals, adolescents with depression, who are often more sensitive to rejection, feel worse after criticism regardless of their self-views.
Depression also leads to negative biases in cognitive processes such as attention, memory and interpretation. For example, adolescents with depression may be more blunt in their response to parental criticism, especially if it is inconsistent with how they see themselves.
About the study
The Relations and Emotions in Parent-Adolescent Interaction Research (RE-PAIR) study examined the interplay between parent-adolescent interactions by comparing adolescents aged 11-17 years with dysthymia (DEP) or major depressive disorder (MDD) to healthy controls.
Criteria for the diagnosis of MDD or DEP were based on the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL). Other inclusion criteria included adolescents who had recently started secondary school, lived with their parents and were fluent in Dutch.
Families with adolescents with DEP or MDD were recruited for the current study through mental health clinics and social media. After enrolment, these families took part in a laboratory session, completed a 14-day ecological momentary assessment, and then underwent magnetic resonance imaging (MRI).
During the laboratory session, adolescents and their parents rated 49 feedback words from very negative to neutral to very positive. These words were also rated for their applicability to the adolescent’s personality, with a score of one indicating ‘not at all applicable’ to a score of five or ‘very applicable’.
After hearing each feedback word, adolescents rated their current mood during the MRI session from one or ‘very negative’ to seven or ‘very positive’. Before and after these tasks, the adolescents also completed visual analogue scales (VAS) to rate their levels of self-esteem, sadness, relaxation and irritability.
The researchers also looked at whether adolescents with depression showed blunted or enhanced negative mood in response to parental criticism and abnormal neural activity in brain regions involved in the salience network, including the AI and sgACC, and those involved in social cognition, such as the temporoparietal junction (TPJ).
Study results
A total of 63 healthy and 22 depressed adolescents took part in the study. Depressed adolescents who received parental criticism showed increased activity in the temporal pole, which is involved in extracting social knowledge.
Increased activity was also observed in the hippocampus, fusiform gyrus and parahippocampal gyrus, all regions of the brain that are important for encoding episodic memory. In comparison, receiving parental praise was associated with reduced activity in the right visual cortex in adolescents with depression compared to healthy controls.
In both study groups, mood increased when praise was more applicable, but applicability did not modulate neural responses. When criticism was more applicable, adolescents with depression showed smaller increases in mood. Notably, parents of depressed adolescents viewed their children less positively.
Depressed adolescents also recalled more negative than positive feedback words, suggesting that parental criticism affected these individuals more than healthy controls. This is consistent with previous observations suggesting negative memory and attentional biases in adolescents with depression.
Regardless of depression status, parental praise improved mood in adolescents to a greater extent when it was consistent with the child’s self-perception. Thus, identifying the personality traits that adolescents value in themselves may help to identify interventions to improve their mood. In addition, providing psychoeducation about the effects and neural states of adolescents with depression may also help parents better interpret the possible causes of certain behaviours.
Adolescents could also learn to adapt and communicate their thoughts and feelings to their parents. Parents could work on providing constructive criticism in order to reduce its negative effects and promote a positive family environment.
Conclusions
Adolescents with DEP and MDD appear to be particularly vulnerable to parental criticism, as these individuals showed increased sgACC and hippocampal activity after hearing parental criticism and longer recall of critical feedback. Unfortunately, these children also experienced less positive effects from parental praise.
Parents and clinicians should be made more aware of the alert profile of DEP or MDD adolescents through psychoeducation. Parents should also be encouraged to actively identify, acknowledge and value characteristics in their children that may facilitate the development of a positive self-image. Early intervention may also attenuate depressive symptoms at onset.
Future longitudinal studies are needed to assess individuals from early childhood for neural susceptibility to depression and other neuropsychiatric conditions.
