102 Chapter 4 Another remarkable finding in depressed versus non-depressed adolescents is the overall blunted BOLD-activity in left IFG and secondary visual cortex in response to all task conditions. The IFG has been consistently linked to human’s capacity to build and maintain attachment and the perception of shared internal states with others (Feldman, 2017), and suggests that depressed adolescents might feel more alienated from others and themselves. The secondary visual cortex has been found in relation to experiences of social exclusion in 7-10 year old children in a meta-analysis of three distinct samples (van der Meulen et al., 2017). Together, this might reflect a lack of social engagement characteristic of adolescent depression, and even a feeling of being excluded whilst making eye contact (Arce et al., 2009; Jankowski et al., 2018; Joiner et al., 2002). It is of note to emphasize that depressed and non-depressed adolescents did not differ in their eye gaze patterns, indicating that they made equivalent eye contact with the targets. Hence, the blunted neural responses of depressed adolescents did not reflect a greater avoidance of eye contact in depressed versus non-depressed adolescents. This study contributes to our understanding of adolescents’ responses to making eye contact with their parent and unknown others and how this may differ between depressed and nondepressed adolescents. We used personally tailored stimuli including adolescents’ own parent and assessed a combination of subjective, gaze, and fMRI data. Nevertheless, this study is not without limitations. The task did not include a familiar peer or adult condition and therefore we cannot rule out novelty effects introduced by the unfamiliar peer and adult conditions. However, presenting videos of a familiar peer might have introduced new complexities, such as variations in friendship quality. Lastly, our sample size of depressed adolescents was relatively small (n = 19) due to difficulties persuading depressed adolescents and their parents to participate in an extensive fMRI study and the recruitment period coinciding with COVID-19. Future studies including larger sample sizes are necessary to replicate our findings. Our findings indicate that depressed adolescents do not benefit as much from the moodboosting and connectedness-inducing effects of eye contact and have a less positive perception of the relationship with their parents compared to HCs. Moreover, they reported a lower mood and diminished neural responses in brain regions related to attachment and social exclusion compared to HCs, suggesting a sense of alienation from others and self in depressed adolescents. Together these results contribute to our understanding of interpersonal difficulties in adolescents with depression, especially towards their parents, and highlight the importance of including adolescents’ perception (among other perspectives) in interventions focusing on improvement of the parent-child bond in families with a depressed adolescent.
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