Teen brains with depression show heightened sensitivity to parental criticism

In a recent article published in Psychological Medicine, researchers examine affective and neural responses to parental feedback in adolescents with depression.

Study: Sticky criticism? Affective and neural responses to parental criticism and praise in adolescents with depression. Image Credit: fizkes / Shutterstock.com

Background

Depression, which is characterized by negative self-views and low self-esteem, is a serious mental health issue that is currently estimated to affect 280 million people worldwide.

Several different regions within the brain are differentially affected by depression. For example, social saliency-related brain regions, subgenual ACC (sgACC), and anterior insula (AI) trigger greater neural reactivity to negative stimuli in adults and adolescents with depression.

Comparatively, criticism leads to increased neural activity in 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 valence and consistency with self-views. For example, criticism 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. Thus, adolescents with depression react to parental criticism more bluntly, especially when it does not match their self-views.

About the study

The Relations and Emotions in Parent-Adolescent Interaction Research (RE-PAIR) study investigated the interplay between parent-adolescent interactions by comparing adolescents between 11 and 17 years of age with dysthymia (DEP) or major depressive disorder (MDD) to healthy controls.

The criteria for MDD or DEP diagnosis was based on the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL). Other inclusion criteria included adolescents who recently started secondary school, lived with their parents and spoke Dutch fluently. 

Families with DEP or MDD adolescents were recruited for the current study through mental health clinics and social media. After enrollment, these families participated in a laboratory session, completed an ecological momentary assessment for 14 days, and subsequently underwent magnetic resonance imaging (MRI).

During the lab session, adolescents and their parents rated 49 feedback words from very negative to neutral to very positive. These words were also rated on their applicability to the adolescent’s personality, in which a score of one indicated ‘not at all applicable’ to a score of five or ‘very much applicable.’

After hearing each feedback word, adolescents rated their current mood from one or ‘very negative’ to seven or ‘very positive’ during the MRI session. Before and after these tasks, adolescents also completed visual analog scales (VAS) to rate their self-esteem, sadness, relaxation, and irritability levels.

The researchers also determined whether adolescents with depression exhibited blunted or potentiated negative mood to parental criticism and abnormal neural activity in brain regions of the salience network, including AI and sgACC, as well as those involved in social cognition, such as the temporoparietal junction (TPJ).

Study findings

A total of 63 healthy and 22 depressed adolescents participated in the current study. Depressed adolescents receiving parental criticism exhibited 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 of which are brain regions critical for encoding episodic memory. Comparatively, receiving parental praise was associated with decreased activity in the right visual cortex in adolescents with depression as compared to healthy controls.

In both study groups, mood increased when praise was more applicable; however, applicability did not modulate neural responses. When criticism was more applicable, adolescents with depression exhibited smaller increases in mood. Notably, parents of depressed adolescents viewed their children less positively.

Depressed adolescents also recalled more negative than positive feedback words, thus suggesting that parental criticism more strongly affected these individuals than healthy controls. This is consistent with previous observations, thus suggesting negative memory and attention biases in adolescents with depression.

Regardless of depression status, parental praise enhanced adolescents’ mood to a greater extent when it was consistent with the child’s self-views. Thus, identifying personality characteristics that adolescents value about themselves may help discover interventions to improve their mood. Furthermore, providing psycho-education regarding the effects and neural states of adolescents with depression may also help parents better interpret the potential causes of certain behaviors. 

Adolescents could also learn to adapt and communicate their thoughts and feelings to their parents. Parents could work towards delivering constructive criticism in an effort to reduce its negative effect and foster a positive family environment. 

Conclusions

Adolescents with DEP and MDD appear to be particularly vulnerable to parental criticism, as these individuals exhibited increased sgACC and hippocampus activity after hearing parental criticism and recalled critical feedback longer afterward. Unfortunately, these children also experienced a less positive impact of parental praise. 

Parents and clinicians should become more aware of the vigilant profile of DEP or MDD adolescents through psycho-education. Furthermore, parents are advised to actively identify, acknowledge, and value child characteristics that could facilitate the development of a positive self-view. Early intervention could also attenuate depressive symptoms at disease onset.

Future longitudinal studies are needed to evaluate individuals from early childhood for neural sensitivity to depression and other neuropsychiatric conditions.