In Focus: The Auerbach Laboratory
Dr. Randy P. Auerbach’s research is committed to improving our understanding of depression and suicide in adolescents. Approximately 20% of adolescents will experience a major depressive disorder (MDD) by the age of 18, and presently, suicide is the second leading cause of death among adolescents. These alarming statistics underscore the critical need of elucidating behavioral and biological markers that confer risk for depression and suicide during a pivotal period of development. Towards achieving this goal, Dr. Auerbach’s research has resulted in over 150 published scientific papers and book chapters, and this work has been funded by grants from the National Institute of Mental Health (NIMH), the Klingenstein Third Generation Foundation, the Dana Foundation: Clinical Neuroscience Research Grant, and several private foundations.
Dr. Auerbach began his work at Columbia University’s Department of Psychiatry in January 2018 after spending 8 years with Harvard Medical School. At Columbia, he is an Associate Professor and Co-Director of the Center for the Prevention and Treatment of Depression, and his scholarly pursuits are aimed at identifying psychosocial, behavioral, and neurobiological factors that render certain children, adolescents, and young adults vulnerable to depression and suicide. His research utilizes a multimodal approach for assessment (e.g., laboratory-based experiments, passive sensor monitoring, electrophysiology, and neuroimaging) to determine why depressive symptoms unfold, how self-injurious and suicidal behaviors develop, and what changes occur in the brain during treatment. Dr. Auerbach and his collaborators have published several influential findings. We highlight a few specific examples of his team’s recent contributions to the literature.
Neuroimaging Approaches to Chart the Trajectory of Adolescent Symptoms
Dr. Auerbach has published extensively on anhedonia, the reduced ability to experience pleasure. Anhedonia is of particular interest, as it often is a precursor to mental illness and a risk factor for suicidal behavior. In “Neuroanatomical Prediction of Anhedonia in Adolescents,” which appeared in the journal Neuropsychopharmacology, Auerbach and his colleagues found that smaller volume of the dorsal striatum—and the putamen in particular—predicted anhedonia symptoms during the 3-month follow-up period. This was an important expansion of prior research which had exclusively tested this relationship in cross-sectional designs with adults samples. Further, by testing healthy adolescents with no lifetime history of mental disorders, the results suggest that these structural abberations may be a potential cause of anhedonia onset, which then may lead to the manifestation of depression and related disorders.
Building on this work, Dr. Auerbach and colleagues recently published an article in the Journal of the American Academy of Child & Adolescent Psychiatry, “Brain Volume Abnormalities in Youth at High Risk for Depression: Adolescent Brain and Cognitive Development Study.” Data were analyzed from over 7,000 children aged 9-10 years, and results indicated that high-risk youth (by virtue of a parental history of depression) reported smaller right putamen volumes relative low-risk youth. This finding is notable, as brain abnormalities in children may be present prior to the onset of depression, and for some, may increase risk for depression during adolescence.
Improving College Mental Health
Dr. Auerbach is the Co-Director of the WHO World Mental Health International College Student Initiative, and in late 2018, the American Psychological Association’s Journal of Abnormal Psychology published “WHO World Mental Health Surveys International College Student Project: Prevalence and Distribution of Mental Disorders.” Dr. Auerbach’s publication received significant press (e.g., NPR, CNBC, and U.S. News & World Report), as it reported that one-third of college students from 8 countries (Australia, Belgium, Germany, Mexico, Northern Ireland, South Africa, Spain and the United States) screened positive for at least one of six mental health disorders. The most common mental illness was major depressive disorder, with 21.2 percent of respondents experiencing an episode in their lifetime, followed by general anxiety disorder, which was reported by 18.6 percent of students.
These findings exposed a key global mental health issue and raised questions about appropriate screening and intervention. "Only a minority of students are seeking out treatment, creating a conundrum on campus," Dr. Auerbach said to NPR. "Lots of administrators everywhere are scrambling to find innovative ways to reach students in need." In a EuerkAlert press release, Dr. Auerbach suggested that, “Internet-based clinical tools may be helpful in providing treatment to students who are less inclined to pursue services on campus or are waiting to be seen… It is incumbent on us to think of innovative ways to reduce stigma and increase access to tools that may help students better manage stress."
Identifying Suicide Risk in Adolescents
Dr. Auerbach has identified a range of risk factors for adolescent suicide ranging from anhedonia (and associated behavioral processes) to specific stressful events. With regards to the latter, Dr. Auerbach recently published a study, “Life Stress and Suicide in Adolescents” (Journal of Abnormal Child Psychology), which showed that interpersonal loss was associated with adolescent suicide attempts. Specifically, relative to suicide ideators, suicide attempters showed markedly greater interpersonal loss in the 6-months prior to an attempt, suggesting that this may be a key risk factor that may precede suicide attempts.
A signature feature of Dr. Auerbach’s work is his desire to translate lab-based work into clinical settings. For example, in a recently initiated NIMH-supported study—Mobile Assessment for the Prediction of Suicide (MAPS)—that was highlighted in the Wall Street Journal and on BBC radio, Dr. Auerbach is using real time monitoring to identify when an adolescent may be at risk to suicide. The project seeks to “track” many of the risk factors identified within Dr. Auerbach’s lab by leveraging smartphone technology—information ranging from words used in texts and posting (through natural language processing) to teens’ activity (accelerometer) to patterns of movement (geolocation). This multisite project includes the University of Oregon (Dr. Nicholas Allen) and the University of Pittsburgh Medical Center (Dr. David Brent) and follows actively suicidal teens for 6-months with the aim of elucidating short-term predictors of suicidal behaviors. Identifying these markers could be game-changing, as it would allow clinicians to intervene when patients may be most at risk to hurt themselves.
Looking Forward
Dr. Auerbach’s multimodal approach—ranging from neuroimaging to passive sensor technology—is setting the stage for immense change in the adolescent mental health arena. With an ever-present focus on translating findings to everyday life, his research provides the promise of developing novel approaches to deliver more effective preventative-interventions for adolescents and families in need.