Elsevier

Clinical Psychology Review

Volume 71, July 2019, Pages 63-77
Clinical Psychology Review

Review
Cognitive and attentional vulnerability to depression in youth: A review

https://doi.org/10.1016/j.cpr.2019.01.004Get rights and content

Highlights

  • There is a need to better understand the development and maintenance of depression in youth.

  • This review synthesizes research on cognitive and neurobiological factors in youth depression.

  • Consistent with the model, attentional impairments appear greatest for negative information.

  • There is limited evidence that attentional deficits are associated with rumination in youth.

  • Other model predictions have mixed support or require additional study.

Abstract

Although depressive disorders are among the most common disorders in youth, highly efficacious treatments for childhood affective disorders are lacking. There is significant need to better understand the factors that contribute to the development and maintenance of depression in youth so that treatments can be targeted at optimal mechanisms. The aim of the current paper was to synthesize research on cognitive and neurobiological factors associated with youth depression, guided by De Raedt and Koster's model (2010) for vulnerability to depression in adults. Consistent with model predictions, there is evidence that attentional impairments are greatest in the context of negative information, relative to positive or neutral information, and some evidence that attentional deficits are associated with rumination in depressed youth. However, we found little evidence for the model's assumption that attentional bias is an etiological and maintenance factor for depression. There are several other model predictions that require additional study as current data are lacking. Overall, De Raedt and Koster's (2010) integrative cognitive and biological framework has tremendous potential to move the field forward in understanding the development of depression in youth. Additional longitudinal studies incorporating measures across biological and cognitive levels of analysis are needed.

Section snippets

Depression prevalence, course, and associated outcomes in youth

Clinically significant depression in youth emerges as young as age three (Luby et al., 2003; Luby, Belden, Pautsch, Si, & Spitznagel, 2009) and increases in prevalence across development. Approximately 2% of children and 12.5% of adolescents reported a major depressive disorder (MDD) in a one-year period (Center for Behavioral Health Statistics and Quality, 2016; Costello et al., 2002). Rates of MDD increase steadily through adolescence, rising from 5.4% at age 12 to 15% at age 17 (Center for

Development of attentional control and attentional bias

Because attentional control deficits are central to De Raedt and Koster's (2010) model of depression, applying a downward extension of the model to children should be informed in part by understanding how attentional control develops normatively. The terms executive function, cognitive control, and attentional control are at times used interchangeably in the literature. Attentional control includes a set of higher-order processes that guide and regulate lower-order processes to maintain

Literature review

The focus of the review was on identifying literature relevant to the core predictions of De Raedt and Koster's (2010) model in youth. The search was restricted to youth between preschool age and early adulthood. The search was conducted between February and November 30th of 2017 in PSYCINFO and was limited to peer-reviewed articles published in English. Studies that included special diagnostic populations (e.g., youth with bipolar disorder or comorbid developmental delays and depression) were

Activation of negative schema in response to stress

De Raedt and Koster's (2010) integrated framework expands upon Beck's cognitive schema theory to include neurobiological cognitive processes that contribute to depression. Specifically, stressors are thought to activate both latent schemas and the HPA axis. Thus, schemas are activated when stressors arise. These schemas, paired with dysregulated biological stress response, attentional deficits, and rumination are thought to contribute to depression.

Schemas are cognitive structures that help to

Summary

Depression is one of the most common mental health conditions in children and adolescents and is characterized by a relapsing and remitting course that often begins in youth (e.g., Center for Behavioral Health Statistics and Quality, 2016; Costello et al., 2002). Therefore, it is critically important to identify factors early in development that may explain an increasing vulnerability for depression over the lifespan. The current review was designed to integrate the literature on cognitive and

Clinical implications

The findings of the current review suggest that clinical intervention studies designed to target both cognitive and biological (i.e., stress reactivity) variables in youth may be especially helpful in decreasing vulnerability to depression. Delivering cognitive interventions during an early developmental window may take advantage of high levels of natural neuroplasticity given that attentional abilities are still developing throughout adolescence and trait-like rumination has not yet stabilized

Limitations and future directions

There are several important areas for future research. First, much of the research included in this review is cross-sectional and therefore unable to address questions about the effects of depression on normative development of attentional control and vice versa. Therefore, it is not clear if cognitive control deficits represent a causal vulnerability factor to the development of depression, as predicted by De Raedt and Koster's model (2010), or if the associated deficits are the result of

Declarations of interest

None.

Sarah J. Kertz is an associate professor in psychology at Southern Illinois University-Carbondale.

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  • Cited by (0)

    Sarah J. Kertz is an associate professor in psychology at Southern Illinois University-Carbondale.

    Devin R. Petersen is a graduate student in the doctoral program in clinical psychology at Southern Illinois University-Carbondale.

    Kimberly T. Stevens is a graduate of the doctoral program in clinical psychology at Southern Illinois University-Carbondale. She is currently completing her postdoctoral fellowship at the Institute of Living in Hartford, CT.

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