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Background: Depression is common and increasing in young people, who seem especially vulnerable, both in the probability of developing depression, and in the resulting negative consequences across the lifespan. Unfortunately, available treatments rarely lead to full remission and even in cases of remission relapse rates are high. Different explanatory models have been proposed, and research indicates a multifaceted etiology. The descriptive DSM-5 has low diagnostic validity in this age-group, especially for depressive disorders, and limited attention has been given to young people’s own experiences of becoming depressed. Hence, there is a risk of missing clinical information that is important for the therapeutic alliance and treatment.

Objective: This study aimed to explore young people’s experiences of becoming depressed.

Method: A qualitative study was performed. Six participants with clinical depression, currently in treatment at child and adolescent psychiatric outpatient clinics in northern Sweden were recruited. Interviews followed a semi-structured manual, and data was analyzed with inductive qualitative content analysis.

Results: Participants described different reasons for their depression, and from their stories four categories were identified: “Being subjected to violence”, “Suffering separation and loss”, “Feeling abandoned”, and “Feeling burdened and vulnerable”. These categories were interpreted in the theme: “Dealing with an overwhelming life situation”.

Conclusions: The participants presented mainly stressful external and relational events preceding their depression. A combination of overwhelming stressors, lack of support and lack of time for recovery was described. This points to the importance of validating the narratives of young patients with depression and to offer trauma-informed treatment approaches in mental health care.

The objective of the current study was to investigate, for the first time, the association between individual-level residential greenspace and redemption of antidepressant drugs in a longitudinal nationwide population-based sample in Sweden. A nationwide population-based sample of adults residing in Sweden was studied during 2013–2016 (Nindividuals = 108716; Nobservations = 324378). Residential greenspace land cover was assessed via high resolution geographic information systems, at 50, 100, 300, and 500 m buffers around individual residences. Antidepressant redemptions were assessed through the Swedish National Prescribed Drug Register. Greenspace-antidepressant associations were analyzed using generalized estimating equations (GEE), adjusting for demographic, socioeconomic and urban factors. Higher greenspace within 50–500 m residential buffer zones was associated with lower levels of prevalent antidepressant redemptions (50 m, odds ratio [OR] 0.878; 100 m, OR 0.891; 300 m, OR 0.873; 500 m, OR 0.899), while only greenspace in the 50 m buffer was associated with incident antidepressant redemptions (OR 0.853), in covariate-adjusted models. In conclusion, residential greenspace is associated with statistically significantly lower prevalent and incident antidepressant medication redemptions. The association is particularly salient for greenspace in the closest buffer zone around the residence. The results underscore the importance of green infrastructure and greenspace in the immediate residential-surrounding environment for mental health, and further point towards the need for an environmental psychiatry framework, and the importance of integrating health and environmental policies, urban planning and greening.

Introduction: Depression constitutes one of our largest global health concerns and current treatment strategies lack convincing evidence of effectiveness in youth. We suggest that this is partly due to inherent limitations of the present diagnostic paradigm that may group fundamentally different conditions together without sufficient consideration of etiology, developmental aspects, or context. Alternatives that complement the diagnostic system are available yet understudied. The Power Threat and Meaning Framework (PTMF) is one option, developed for explanatory and practical purposes. While based on scientific evidence, empirical research on the framework itself is still lacking. This qualitative study was performed to explore the experiences of adolescents and young adults with depression from the perspective of the PTMF.

Methods: We conducted semi-structured interviews with 11 Swedish individuals aged 15– 22 years, mainly female, currently enrolled in a clinical trial for major depressive disorder. Interviews were transcribed verbatim and analyzed with framework analysis informed by the PTMF.

Results: A complex multitude of adversities preceding the onset of depression was described, with a rich variety of effects, interpretations, and reactions. In total, 17 themes were identified in the four dimensions of the PTMF, highlighting the explanatory power of the framework in this context. Not all participants were able to formulate coherent narratives.

Discussion: The PTMF provides a framework for understanding the complexities, common themes, and lived experiences of young individuals with depression. This may be essential for the development of new interventions with increased precision and effectiveness in the young.

Background: Depression is a top-ranking global health concern increasing in magnitude. Available treatments for adolescents and young adults are not convincingly effective and relapse rates remain high. Training for Awareness, Resilience and Action (TARA) is a group treatment program targeting specific pathophysiological mechanisms of depression in young people. TARA is feasible, acceptable, preliminarily efficacious in depressed American adolescents, and it affects postulated brain-circuitry.

Methods: As an initial step of a multicenter randomized controlled trial (RCT) we performed a single-arm multicenter pilot-study on TARA. Thirty-five depressed individuals (15–21 years old, 28 females) received TARA for 12 weeks face-to-face or online. Data was collected before (T0), during, and after the intervention (T1). The trial was pre-registered at clinicaltrials.gov, NCT Registration: identifier [NCT04747340]. Feasibility outcomes included recruitment, attendance rates, and session ratings. Adverse events were recorded weekly and extracted from medical records at the end of the trial. Primary effectiveness outcome was self-rated depression severity on Reynolds Adolescent Depression scale 2nd ed. at T1. Secondary outcomes were Children’s Depression Rating Scale-revised (CDRS-R) and Multidimensional Anxiety Scale for Children (MASC) at T1.

Results: TARA was feasible and safe in the present trial. No significant RADS-2-change was seen (adjusted mean difference –3.26, 95 % CI –8.35 to 1.83; p= 0.20), however a significant decrease in CDRS-R scores is reported (adjusted mean difference –9.99, 95% CI –14.76 to –5.22; p < 0.001). MASC-scores did not change significantly (adjusted mean difference 1.98, 95% CI –0.96 to 4.91; p=0.18). Additional feasibility aspects are presented and discussed.

Discussion: Limitations include substantial loss-to-follow-up, no randomization to control, and that some participants received concomitant treatment(s). The Coronavirus pandemic complicated both implementation and interpretation of the trial. In conclusion TARA was feasible and safe in depressed adolescents and young adults. Preliminary signs of effectiveness were seen. The initiated RCT will be important and worthwhile to conduct, and several improvements to the design are suggested based on the present results.