In Search of bio-psycho-social markers for the recurrence of adolescent depression

Children and Young People's PhD Scholarship 2018 (2): Section of Clinical Psychology, School of Health in Social Science, University of Edinburgh.

Supervisor: Dr Stella Chan

Summary:

Half of depression cases emerge in youth. Adolescent depression is notoriously difficult to treat and highly recurrent. Once an individual has had one episode of illness, the chance of developing a second episode is 60%; after two and three episodes, the chances rise up to 70% and 90% respectively. We urgently need to develop more effective treatments on the early stage of illness, before it develops into a recurrent pattern. This PhD will therefore focus on young people who have recovered from depression. The key hypothesis is that the experience of depression may result in biological and psychosocial changes (‘scar effects’) that make the individual more at risk for developing future episodes of illness. This PhD will examine these features, focusing on three areas:

i. Emotional processing – the way we attend to, interpret, and remember emotional information;

ii. Reactivity to stress – both in terms of biological functions indicated by cortisol levels (the ‘stress hormone’), quality of sleep, and psychological strategies of emotional regulation;

iii. Psychological scar effects – the way individuals cope with the sense of shame and stigma that are often associated with mental health difficulties.

This project consists of three studies using both quantitative and qualitative methods with longitudinal follow-up assessments to examine short- and long-term outcomes. Qualitative interviews will help capturing the lived experience of adolescent depression and identify factors that are subjectively important. The ultimate goal is to inform the development of better treatment and preventative strategies that can transform the quality of life across the life span.

Research Student: Niamh MacSweeney

Hello! My name is Niamh and I am due to start my PhD in Clinical Psychology at the University of Edinburgh in January 2019.

I have just completed a joint-honours degree in Psychology with English Literature at Trinity College Dublin, where I graduated with first-class honours. My final year dissertation leveraged a novel behavioural assay of coping and investigated its relationship with depressive symptom severity in female adolescents. For the past year, I have been working as a part-time research assistant at the Trinity College Institute of Neuroscience on a Brain and Behaviour Research Foundation funded project investigating the neural correlates of coping and emotion regulation in adolescent depression.

Throughout my undergraduate studies, my research pursuits have become increasingly focused on youth mental health and I am very excited to be pursuing a PhD in this field. Outside of research, I volunteer on a weekly basis with ISPCC Childline. I look forward to working with Dr Stella Chan and colleagues in Edinburgh and would like to thank Mental Health Research UK for this great opportunity.

Start Date: September 2018

Scientific Goal:

Half of depression cases emerge by the age of 25 [1]. Adolescent depression is typically a more severe form of the disorder and is notoriously difficult to treat [2, 3]. Notably, risk for recurrence increases with each episode of illness. Following one episode, 60% suffer another episode; after two and three episodes, the probabilities rise to 70% and 90% respectively [4, 5]. Hence, the experience of depression may itself have a causative influence on further clinical outcome. The overarching hypothesis is that ‘scar effects’ from previous depressive episode(s) contribute to further vulnerability. The scientific goal of this proposed PhD is to identify these scar effects by examining which features follow a first depressive episode in adolescent individuals and which act as vulnerability markers predicting future recurrence of illness.
Based on a developmental perspective, this PhD will target the period immediately following the first depressive episode in adolescence, to examine the dynamic change of risk and resilience mechanisms over this critical time. This is built upon our two current Wellcome Trust funded studies (led by the applicant) examining how biological and psychosocial risk mechanisms emerge in adolescence prior to illness onset. Together, our findings will make a significant scientific contribution regarding the mechanisms that underpin the occurrence and recurrence of adolescent depression, a question that has been identified by patients, carers, and mental health professionals as the top priority of depression research [6].We will also take an interdisciplinary approach, examining across biological, neural-cognitive and psychosocial mechanisms. This holistic approach, supported by an interdisciplinary supervision team situated in the unique multidisciplinary environment at the University of Edinburgh, is important in bridging the gaps in knowledge due to traditional unhelpful disciplinary divides. This study will have an impact on the development of better treatments that can build long term resilience against recurrence of illness, improving quality of life from a young age.

Progress Report Year 1, 2019

Since beginning my doctoral studies in January 2019, I have had a busy couple of months to say the least! I spent the first few weeks settling into life in Edinburgh and was really impressed by the level of support offered by the university for new PhD students, from a comprehensive induction week to an array of research training courses. This made the adjustment from undergraduate to postgraduate study that bit smoother. I enrolled on a variety of courses on research methods and training, which was a great aid when writing my literature review — the focus of my PhD work for the first couple of months. This review helped shape and finalise my PhD protocol, which I submitted as my 10-week review, a requisite for all first-year doctoral students at the University of Edinburgh. While this required a significant amount of time and effort, I found the exercise to be incredibly helpful as it clarified my research questions and laid out a clear plan for the project going forward.

Moreover, this review laid a strong foundation upon which to start my ethics application. “Ethics” is a term that often strikes fear into the hearts of many PhD students and researchers, and although I was initially daunted by the prospect of completing this lengthy application, it was thankfully easier than I anticipated. Due to the fact that I will be working with a vulnerable population (young people with depression) during my PhD, it was necessary to submit the highest level of ethics clearance, which involved a lot of contingency and safeguarding plans! Thankfully, I am putting the final touches to the application and I am due to submit it to the Ethics Committee by the end of July 2019. Following ethics approval, I will begin recruitment and data collection in September 2019, which will keep me busy for the next few months… or years! Given that my project involves a follow-up at various time points over a two-year period, there is some pressure to start data collection as soon as possible but thankfully, our timeline is on target so far.

Outside of my PhD project, I have immersed myself in the University’s vibrant public engagement scene. Over the (gloriously sunny!) Easter weekend, I participated in this year’s Edinburgh Science Festival with Edinburgh Neuroscience at the National Museum. I spent the weekend chatting to families about the wonderful world of brain research, which involved dissecting lamb brains in a rather hot seminar room! Further to this activity, in June another PhD student and I were awarded a Royal Society STEM Partnership Grant to the value of £3000. This funding will allow us to undertake a year-long STEM project entitled, "Does our biology influence our mood?", in partnership with Musselburgh Grammar school. The project will provide a better understanding of psychiatric genetic research through a series of practical workshops as well as a student-led research project. The project will run during the 2019-20 school year, so I will certainly be kept busy for the next while.

Although only in the first year of my PhD, I managed to find myself in the university final of the 3-Minute Thesis competition, which was held at the end of June. I took part in the School heat back in April for fun as they were looking for more sign-ups so to have made it all the way to the final was a real bonus!  Explaining one’s research in a comprehensive, yet engaging, manner to a lay-audience in three minutes is no easy task. However, I feel that my science communication skills have greatly developed from the experience and I would really encourage all PhD students to enter if the opportunity presents itself. 

You can check out a video of my presentation here: https://www.youtube.com/watch?v=gnlJ1gT-UeA

Between data collection and public engagement activities, I have a busy year ahead but a full-plate is a happy plate, right? Thanks to MHRUK again for enabling all these research activities. I look forward to seeing the team at our next Scholars’ Day.