Low Emotional Awareness and Altered Frontostriatal Functional Connectivity During Reward Processing Prospectively Predict Depressive Symptoms in At-Risk Youth

Abstract

Objective:

To examine how emotional awareness (the ability to understand and identify one’s own emotions) and neural reward circuitry, processes that are associated with depression and undergo significant maturation during adolescence, prospectively predict depressive symptoms in a community sample of youth at varying risk for affective disorders.

Method:

Youth aged 13–19 years (N = 84), risk-enriched for depression (66% with familial history of affective disorders), completed self-report assessments of emotional awareness and depressive symptoms at baseline. Depressive symptoms were also assessed at 1-year follow-up. Neural reward function, as indexed by functional connectivity of the dorsomedial prefrontal cortex (dmPFC) and nucleus accumbens (NAcc), was assessed via a functional magnetic resonance imaging task of winning versus losing monetary rewards at baseline. Controlling for age, biological sex, familial risk status, and baseline depression, linear regressions examined the interaction of emotional awareness and dmPFC–NAcc functional connectivity to predict changes in depressive symptoms over 1 year.

Results:

Low emotional awareness at baseline predicted more severe depressive symptoms at 1-year follow-up, particularly among youth demonstrating heightened positive dmPFC–NAcc functional connectivity, a pattern potentially indicating over-regulation of reward responding.

Discussion:

Low emotional awareness and stronger frontostriatal functional connectivity during processing of reward relative to loss are relevant early-emerging risk factors that could jointly lead to future depression. Interventions targeting emotional regulation skills and reward processing may mitigate the onset and course of adolescent depressive symptoms.