Depression is costly and has detrimental effects on disease course in physically ill populations. This proposal takes a novel multi-dimensional approach to assess the neurobiological basis of depression in chronic pediatric physical illness using inflammatory bowel disease (IBD) as a model. It also evaluates the efficacy of a modified cognitive behavioral therapy (CBT) on emotional well-being, physical health, economic costs, and neurobiological outcomes. These results will provide key building blocks for a paradigm shift within medicine by integrating behavioral health into the comprehensive medical care of physical illnesses. Little is known about how the brain and body interact to increase depressive vulnerability, particularly during key developmental periods during childhood and adolescence. Adult studies identify disruptions in limbic and prefrontal brain activity in the pathophysiology of depression. Cytokines secondary to inflammation and exogenous treatment with steroids can cause mood and cognitive changes in these same brain regions. It is important to understand the neuropsychiatric effects of IBD and its treatment on underlying brain structures during adolescence, a critical developmental period for brain maturation underlying emotional regulation and cognitive processing. More importantly, neuronal plasticity during adolescence may still allow reversibility of disease-related brain effects through teaching coping strategies for life-long illness management that could change developmental trajectories and reduce vulnerability in adulthood. Using translational neuroscience approaches, this proposal will examine: 1) brain regions that underlie emotional and cognitive processing in youth with active IBD and depression using brain functional magnetic resonance imaging compared to youth with IBD and no depression, and normal controls;and 2) the efficacy of a combined CBT-physical illness narrative intervention targeting emotional and cognitive processing compared to supportive non-directive therapy at: (a) improving emotional well being;(b) alleviating physical symptoms; and (c) reducing health care costs.
| Keerthy, Divya; Youk, Ada; Srinath, Arvind I et al. (2016) Effect of Psychotherapy on Health Care Utilization in Children With Inflammatory Bowel Disease and Depression. J Pediatr Gastroenterol Nutr 63:658-664 |
| Szigethy, Eva; Youk, Ada O; Gonzalez-Heydrich, Joseph et al. (2015) Effect of 2 psychotherapies on depression and disease activity in pediatric Crohn's disease. Inflamm Bowel Dis 21:1321-8 |
| Srinath, Arvind I; Goyal, Alka; Zimmerman, Lori A et al. (2014) Predictors of abdominal pain in depressed pediatric inflammatory bowel disease patients. Inflamm Bowel Dis 20:1329-40 |
| Szigethy, Eva M; Youk, Ada O; Benhayon, David et al. (2014) Depression subtypes in pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr 58:574-81 |
| Clark, Jeffrey G; Srinath, Arvind I; Youk, Ada O et al. (2014) Predictors of depression in youth with Crohn disease. J Pediatr Gastroenterol Nutr 58:569-73 |
| Srinath, Arvind; Young, Erin; Szigethy, Eva (2014) Pain management in patients with inflammatory bowel disease: translational approaches from bench to bedside. Inflamm Bowel Dis 20:2433-49 |
| Mackner, Laura M; Greenley, Rachel Neff; Szigethy, Eva et al. (2013) Psychosocial issues in pediatric inflammatory bowel disease: report of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 56:449-58 |
| Jones, Neil P; Siegle, Greg J; Proud, Lindsay et al. (2011) Impact of inflammatory bowel disease and high-dose steroid exposure on pupillary responses to negative information in pediatric depression. Psychosom Med 73:151-7 |
| Thompson, Rachel D; Delaney, Patty; Flores, Inti et al. (2011) Cognitive-behavioral therapy for children with comorbid physical illness. Child Adolesc Psychiatr Clin N Am 20:329-48 |
| Szigethy, Eva; McLafferty, Laura; Goyal, Alka (2010) Inflammatory bowel disease. Child Adolesc Psychiatr Clin N Am 19:301-18, ix |
