The Reward Positivity As a Predictor of First-Lifetime Onsets of Depression, Anxiety, and Suicidal Ideation in High-Risk Adolescents

Abstract

Background: Reduced reward positivity (RewP), an electroencephalography marker elicited by feedback indicating reward, has been associated with an increased risk for depression during adolescence. However, the ability of the RewP to predict the first-lifetime onset of depressive disorders, as opposed to anxiety and suicidal ideation in high-risk populations, has not been thoroughly investigated. In this study, we examined whether the RewP predicts the first-lifetime onset of depression, anxiety, and suicidal ideation over 18 months in familial high-risk adolescents.

Methods: The sample included 145 adolescents (64.8% female), ages 11 to 17 years, who had at least 1 parent with a history of mood or anxiety disorders and completed baseline and at least 1 follow-up measurement. At baseline, the RewP was measured using a simple gambling task; current internalizing symptoms were assessed using self-report questionnaires; and the adolescent's psychiatric diagnoses were evaluated with diagnostic interviews. The same interview was administered to the adolescents again 9 months and 18 months later.

Results: Logistic regression models showed that higher RewP scores significantly predicted a lower likelihood of developing a first onset of major depressive disorder over 18 months, even after controlling for sex, age, and baseline internalizing symptoms. In contrast, the RewP did not significantly predict the first onset of anxiety disorders or suicidal ideation.

Conclusions: A reduced RewP precedes the first onset of depression in high-risk adolescents, highlighting the RewP's predictive capability for depression risk in predisposed populations. A blunted RewP could complement self-reported symptoms in screening and prevention.

Keywords: Adolescence; Anxiety; Event-related potential; Familial high risk; Major Depressive Disorder; Reward Positivity.