A new study published in Journal of Affective Disorders Evidence suggests that while depression in early adolescence is initially associated with a variety of cognitive problems, many of these issues do not persist as adolescents grow older. The exception is inattention, which develops a reciprocal relationship where poor attention worsens depression and vice versa. These findings suggest that addressing attentional problems at school may help youth who struggle with their mental health.
Depression is a major mental health concern that affects about eight percent of young people worldwide. As teens move through middle and high school, depression can negatively affect their relationships, physical health, and academic performance. Scientists recognize that depression in adults often comes with cognitive impairment, meaning problems with thinking, remembering and concentrating.
When looking at youth, previous studies have provided mixed results on whether depression causes similar cognitive problems. Most previous research on youth has been cross-sectional. A cross-sectional study looks at one moment in time. Because of this design, previous studies have not been able to determine whether depression causes cognitive problems or whether pre-existing cognitive struggles make a young person more likely to develop depression.
“Although research in adults has shown a strong relationship between depression and cognitive impairment, studies of adolescents have primarily looked at only one point in time and the findings have been mixed. We wanted to examine the relationship between depression and cognition over time, to better understand whether one precedes the other. This information will directly contribute to improving mental health and cognitive education. School-aged children,” study author Daphne J. Korczak, director of the Department of Children and Youth. said director of clinical psychiatry, director of the Pediatric Integrated Mood and Body Depression Program, and an associate professor at the University of Toronto.
The scientists used data from the Young Brain Cognitive Development Study. This is a large, long-term project tracking the health and brain development of adolescents in the United States. The present study included a precise sample size of 10,552 participants. At the start of the study, the children were on average 9.9 years old. About 48 percent of this group were women.
The researchers examined the participants at three different points in time. This included a baseline assessment, two-year follow-up, and four-year follow-up. Caregivers completed questionnaires about their children to measure the severity of depressive symptoms.
In addition, professionals conducted clinical interviews with both children and their caregivers. This helped determine whether a participant met the criteria for a formal depression diagnosis. Of the total sample, 1,122 participants had a clinical diagnosis of depression.
To ensure accuracy, scientists have controlled for many extraneous factors. They accounted for participant age, sex at birth, ethnicity, caregiver education, annual household income, and the presence of other mental health conditions. Controlling for these variables ensures that the final results are actually due to depression and not an isolated demographic factor.
To measure cognitive performance, participants completed a series of standardized tests using digital tablets. These tests test five specific areas of brain function. The scientists measured long-term memory, working memory, attention, language, and executive function.
Working memory refers to the ability to hold and manipulate information in the mind for a short period of time. Executive functioning involves higher level skills such as planning, impulse control, and following complex instructions. Long-term memory involves storing information over a long period of time, while language assessment measures vocabulary skills.
During the baseline assessment, the scientists found that depression was widely associated with poor mental performance. Higher depressive symptoms and a formal diagnosis of depression were associated with significantly lower scores on attention, long-term memory, working memory, and executive function. These preliminary results are consistent with previous research showing that depressed children often experience cognitive difficulties.
However, long-term findings painted a different picture. During the four-year follow-up period, most of the initial cognitive deficits disappeared. By the two-year and four-year marks, working memory issues, long-term memory, and executive functioning were no longer similarly significantly associated with depression.
“Our study suggests that there are developmental changes in the way depressive symptoms are present in later childhood and early adolescence; cognitive symptoms may be more prominent in younger children,” Korczak told PsyPost.
Scientists suggest that this change may occur because the nature of depression changes as children become teenagers. In early adolescence, depression often manifests as physical and mental fatigue, which directly affects test performance.
As adolescents grow older, their depression shifts toward emotional and social issues. They may struggle more with identity development or have problems with peer relationships. This shift toward emotional concerns may explain why direct effects on memory and planning fade over time.
Despite many cognitive deficits disappearing, researchers found a consistent and reciprocal relationship between depression and attention. Higher depressive symptoms at baseline predicted poorer caregiving two years later. In turn, significantly lower levels of depression at the two-year mark predicted higher depressive symptoms at the four-year mark.
“The findings suggest that depression and attention deficits may enhance each other over time, contributing to an overall pattern that can impair academic performance and daily functioning,” said Korzak.
A depressed teen may struggle to concentrate in class, which can lead to poor grades. Academic failure can result in teenagers feeling bad about themselves, ultimately increasing their depressive symptoms.
In an unexpected twist, the researchers also found that higher depressive symptoms predicted better language skills over time. Scientists suspect that this may be related to rumination, which is the habit of repeatedly thinking about negative emotions. Teens who think they might develop a larger vocabulary to describe their emotional pain.
Alternatively, their improved language skills may simply make their parents more aware of their struggles. Young people who can clearly describe their depression may encourage their caregivers to report higher levels of depression on questionnaires. Future studies are needed to fully explain this unique relationship between vocabulary and mood.
“Our findings have both educational and clinical implications,” explained Korczak. “In educational settings, these results highlight the importance of considering the etiological role of depression when inattention is identified, as teachers may pay more attention to attention problems than to symptoms of depression. In clinical settings, the results of our study suggest that children and adolescents who are referred for depression or attention problems should be evaluated for both problems in order to receive appropriate and appropriate psychological treatment.”
While this study provides a detailed look at youth mental health, it has some limitations. Research relies heavily on caregiver reports to measure depressive symptoms. Parents may not always know exactly what their children are feeling internally. Future studies should include self-reported data directly from youth. This will help to get a complete picture of their emotional state.
Participants also came from the general community and generally had low levels of depression. “More research is needed to see if these patterns are similar to more severe depression in young people,” Korczak said.
The study, “Depression and Cognition in Youth: A Comparison of Cross-Sectional and Longitudinal Effects,” was authored by Sarah Kaburi, Annette Schumacher, Eric Tu, and Daphne J. Korzak.
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