4 101 Neural and affective responses to prolonged eye contact with parents and unfamiliar others in depressed and non-depressed adolescents showed diminished neural activation in left IFG and left secondary visual cortex compared to HCs, suggesting blunted neural responses in these regions that may indicate a lack of social engagement. Lastly, depressed adolescents showed decreased neural activation over time in left SFG, while this region was not associated with eye contact duration in HCs. Consistent with findings in adults (Wever et al., 2022), prolonged eye contact (versus averted gaze) induced a better mood and feelings of connectedness in adolescents and substantial overlap in brain regions related to the processing of eye contact with others versus the self (i.e., left TPJ, right IFG, right FG, precentral gyrus, and left MOG). These are all brain regions that have been consistently found in socio-emotional processing and mentalizing (Herlin et al., 2021; Senju & Johnson, 2009), and have been linked to the communicative intent of eye contact (Cavallo et al., 2015). In addition, adolescents’ affective responses were strongest when they were presented with their own parent versus unfamiliar others, while they did not distinguish between the sight of an unfamiliar peer or adult. This aligns with research showing that parents are still subjectively perceived by the child as important advisors and continue to be important for their mental health and well-being (Baumrind, 1991; Steinberg & Silk, 2002; Yap et al., 2014). Remarkably, we did not find evidence for the engagement of a specific neural network in adolescents when presented with videos of their own parent versus others, indicating that this enhanced sensitivity to their parent was not reflected in their neural responses. Although the reason for this discrepancy is unclear, this is in contrast to what we found in parents who showed enhanced affective responses and decreased deactivation in left middle/inferior occipital gyrus and right IFG to the sight of their own child versus others (Wever et al., 2022). The finding that depressed adolescents (versus HCs) reported a lower mood and diminished feelings of connectedness in response to the sight of their parent versus unknown others point towards a less positive perception of the parent in depressed adolescents. This is in line with numerous studies indicating that adolescent depression is associated with a lower parent-child relationship quality, (Branje et al., 2010; Restifo & Bögels, 2009; Sheeber et al., 2001; Yap et al., 2014) and with a lower level of self-reported parental care in depressed versus non-depressed adolescents in this study (see Table 4.1). Several studies suggest that the directionality of this effect may go in both ways: Negative parenting behaviors, such as a lack of warmth and more critical parenting, are associated with increased depressive symptoms in adolescents over time, but adolescent’ depressive symptoms are also related to a lower perceived relationship quality with their parents (Branje et al., 2010; Heaven et al., 2004; Pavlidis & McCauley, 2001; Sheeber et al., 1997). As such, this emphasizes the importance of also considering how adolescents perceive the relationship with their parents, especially when developing interventions to improve the parent-child relationship in families with a depressed adolescent.
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