Leveraging population level data to inform prevention and treatment of adolescent depression following social adversities

University Of California, San Francisco, San Francisco CA

Investigators

Abstract

PROJECT SUMMARY Adverse Childhood Experiences (ACEs) are among the strongest predictors of adolescent depression and are estimated to account for 44% of depression cases. The pervasive impact of ACEs on health has galvanized policy makers, resulting in federal and state-wide efforts to screen for ACEs with the goal of providing preventive services to those with high levels of ACEs. However, with 15% percent of children experiencing 4 or more ACEs, meeting the needs of all these individuals is simply not possible given mental health care shortages. The primary rationale for this study is that the precision and efficacy of ACEs-focused programs and policies could be dramatically improved with better insight into what factors increase risk for, and resilience to, depression symptoms following ACEs. The overarching hypothesis for this study is that there is significant heterogeneity in the association between ACEs and adolescent depression symptoms that is due to interactions between a broad range of factors. Prior investigations into such heterogeneity, however, have faced a conceptual gap between the theories that inform adolescent depression research, which highlight interacting, developmentally specific sources of vulnerability and resilience, and the predominant statistical approach of testing one or two risk or promotive factors at a time. We advance ACEs and depression science in two foundational ways: 1) we draw on empirical work and theories across disciplines to identify an inclusive yet concise list of factors mostly likely to promote resilience or increase vulnerability to depression following ACEs, and 2) we identify the combination of these a priori defined characteristics that most affect the ACEs- adolescent depression symptoms association using a robust, well-powered, data driven approach (Aim 1a). Our innovative analytic pipeline includes 10-fold replication of our primary findings, as well as replication using alternative algorithms (Aim 1b). We also explore novel, understudied effect modifiers to generate new hypotheses (Exploratory Aim 2). We use the longitudinal Adolescent Brain and Cognitive Development (ABCD) study (release 6.0, available Spring 2025), which will include data on approximately 10,000 socioeconomically and racially diverse children from 21 sites across the country with yearly data collection from age 9-10 through age 14-15. We model effect modifiers of the association between ACEs (parent and child report) and change in depression symptoms (assessed using the Child Behavior Checklist) between ages 9-10 and 14-15, thereby accounting for baseline depression symptoms. A priori identified effect modifiers include sociodemographic characteristics, family and peer relationships, media use, and pubertal timing. The proposed work will yield robust insights about adolescents in the United States right now with implications for ACEs focused programs and policies. Future research will replicate results in other pediatric studies, expand inquiry to adult depression outcomes, and inform new collaborations with interventionists to design clinical trials powered to detect heterogeneity in the effectiveness of ACEs focused treatment.