Why do anxious children become depressed teenagers? The role of social evaluative threat and reward processing

Background Depression is a leading cause of worldwide disability. Adolescence represents a key developmental window in which rates of this disorder increase markedly. Children with an anxiety disorder show a particular risk of developing depression during adolescence. Method We present and review evidence for a developmental model that considers the intersection of two vulnerabilities relevant to the trajectory from anxiety to depression: difficulties in response to potential social evaluation and changes in reward processing at puberty. Results Evidence suggests that these vulnerabilities ( a ) have been associated with depression, ( b ) are likely to be problematic in many, but not all, anxious youth, and ( c ) may be exacerbated by maturational processes that occur around pubertal development in ways that can create a negative spiral into a depressive disorder. Conclusions We discuss the possibility that early intervention strategies targeting key aspects of these vulnerabilities could alter the trajectory away from depression for many anxious youth.