Children's experiences of living with their mental ill-health - a scoping review

PURPOSE

This study aims to identify and summarize existing qualitative empirical research on children's experiences of living with their mental ill-health.

METHODS

A scoping review with a systematic search of the databases PubMed, CINAHL, and PsychINFO was conducted. The search generated 9,864 studies, which were screened by title, abstract, and full text.

RESULTS

Forty articles were included comprising 826 children aged 8-19 years. The key findings were described in four themes: Identifying oneself with mental ill-health, Managing suffering and daily challenges, Seeking supportive and caring relationships and Navigating a complex school environment. Being identified with mental ill-health brought challenges for children's everyday struggles. Their own coping strategies as well as supportive relationships with friends and adults were important. However, the balance between support and stress was complex.

CONCLUSIONS

Children have a desire to manage and comprehend their complex everyday lives of living with mental ill-health and wish for supported yet independent decision-making. Attitudes of friends, adults and professionals are important in providing understanding and non-judgemental support, valuable for children's well-being. Open conversations about mental health and providing accessible, child-centred interventions based on the needs expressed by children are necessary. This study contributes to the literature by emphasizing the central role of children's voices in matters of mental ill-health.

Meta-analysis of age at help-seeking and duration of untreated illness (DUI) in obsessive-compulsive disorder (OCD): The need for early interventions

INTRODUCTION

Obsessive-compulsive disorder (OCD) is a chronic neuropsychiatric disorder that often begins early in childhood. Patients with OCD are known to seek help late after disorder onset, and therefore have a long duration of untreated illness (DUI), which is found to correlate with negative clinical outcomes. No meta-analysis has previously investigated this issue.

METHODS

Our protocol was pre-registered with PROSPERO (CRD42020165226). We followed PRISMA-guidelines and searched for relevant articles in four electronic databases. Meta-analyses of means based on random-effects (Der-Simonian-and-Laird-method) were used to derive the pooled estimates. Subgroup-analyses and meta-regressions were conducted to explore possible factors affecting help-seeking and DUI.

RESULTS

We included N = 31 studies in the quantitative synthesis, with 16 studies proving data for age at help-seeking and 16 studies providing data for duration of untreated illness. The pooled mean age at help-seeking was 28.66 years (95 % CI: 27.34-29.98), while the pooled mean interval between age at disorder onset and help-seeking was 6.97 (95 % CI: 5.69-8.24), and the pooled mean duration of untreated illness was 80.23 months (68.72-91.75), around 6.69 years, all with p < 0.001. Specific OCD-related factors affected help-seeking and duration of untreated illness.

CONCLUSIONS

Patients with OCD seek for help late in the course of the disorder and have a long duration of untreated illness, which is associated with more negative prognosis. This meta-analysis confirms the long duration of untreated illness in OCD and proposes possible factors associated with the length of the help-seeking process and DUI.

Activation differentiates illness trajectories among youth seeking mental health care

BACKGROUND

The clinical profiles of youth presenting to early intervention mental health services are heterogeneous, with various sub-groups proposed and little information about the longitudinal stability of profiles, especially those associated with bipolarity.

METHODS

802 youth aged 12-25-years (Mean = 18.26; 66 % females) accessing primary-care based mental health clinics were assessed at baseline and 417 were re-assessed after 12-months. An exploratory factor analysis of 62 items from six validated rating scales of the severity of mental and physical ill-health was conducted. Seven factors (anxiety, sleep, depression, restlessness, distress, activation, somatic complaints) were derived and modelled using latent profile analysis. Associations between profile membership, clinical outcomes and functioning were examined. Conditional probabilities of shifting to a different profile longitudinally were computed.

RESULTS

Three profiles were revealed which were psychometrically invariant across baseline and follow-up: (1) 'High distress with high activation' (32 % baseline, 25 % follow-up); (2) 'High distress without activation' (31 % baseline, 26 % follow-up); and (3) 'Moderate distress' (37 % baseline, 33 % follow-up). A fourth profile, 'Low distress' (16 %), emerged at follow-up. Profiles did not differ by age at baseline or sex. 'High distress with high activation' was more likely to be impaired longitudinally, and to meet criteria for a full-threshold mental disorder at follow-up. About 39 % of youth retained the same profile longitudinally, while 16 % shifted to lower distress, and 13 % shifted to higher distress.

CONCLUSION

These findings suggest that activation is a marker of poorer clinical and functional outcomes in youth presenting for mental health care.

Manifold functions of Mediator complex in neurodevelopmental disorders

Neurodevelopmental disorders (NDDs) encompass a diverse range of impairments affecting brain development and functions, often presenting as deficits in motor skills, cognitive abilities, language development and neuropsychiatric health. The emergence of next-generation sequencing has unveiled numerous genetic variants linked to NDDs, implicating molecular pathways involved in essential neuronal processes such as synaptic plasticity, neuronal architecture and proteostasis. Central to these processes is the Mediator complex, a highly conserved multi-subunit assembly crucial for RNA polymerase II (Pol II)-dependent transcription. The Mediator functions as a key regulator of gene expression, playing a pivotal role in coordinating cellular processes essential for neuronal differentiation and developmental signaling cascades. Increasingly evidence has shown that its dysfunction is highly associated with the pathogenesis of NDDs. This review aims to comprehensively examine the structural and functional characteristics of individual mediator subunits. We will focus on clinical case reports and recent preclinical studies that highlight the connection between genetic abnormalities in the Mediator complex and specific neurodevelopmental phenotypes, ultimately guiding the development of enhanced diagnostic tools and therapeutic interventions. Furthermore, this review will advance our understanding of the general role transcriptional regulation plays in the etiology of NDDs.

Neurobiological differences in early-onset obsessive-compulsive disorder: A study of the glutamatergic system based on functional magnetic resonance spectroscopy

In this study, the combination of functional state magnetic resonance spectroscopy (fMRS) and cognitive tasks was used to conduct subgroup analyses on early-onset OCD (EO) and non-early-onset OCD (non-EO) and explore differences in the glutamatergic system and cognitive function among OCD subtypes. A total of 70 OCD and 30 healthy controls (HCs) underwent clinical evaluation and were subsequently divided into the EO or non-EO groups. Next, both resting and functional state MRS data were collected, with the anterior cingulate cortex (ACC) serving as the region of interest. Quantitative analysis of MRS data yielded precise neurometabolic concentrations, which were then statistically analyzed alongside inhibitory function, as measured by the Go-nogo task. The final analysis included 92 participants (22 EO-OCD, 41 non-EO OCD, and 29 HCs). EO-OCD patients had significantly higher Glx levels (p = 0.044) and lower GSH levels (p = 0.009) in the functional state compared to the non-EO group. Moreover, in the EO group, correlation analysis revealed a positive correlation between the functional state Glx levels and the average response time for errors in the nogo task (r = 0.526, p = 0.014). Additionally, resting-state GSH levels were positively correlated with total Y-BOCS scores (r = 0.854, p < 0.001). Overall, early-onset OCD may represent a distinct subtype that requires targeted interventions, as evidenced by the imbalance in the glutamatergic system observed in early-onset OCD patients. Additionally, in early-onset patients, Glx concentration during activation was related to cognitive impairment.

Association between cardiovascular comorbidities and psychological anxiety & depression in the elderly

BACKGROUND

Limited research examining the relationship between cardiovascular comorbidities and psychological anxiety & depression in the elderly, and the conclusions are inconsistent. This study aimed to investigate the intricate relationships between them among the pariticipants aged 60 years and above.

METHODS

Utilizing multivariate logistic regression and stratified analysis to analyze the association between cardiovascular comorbidities and psychological anxiety & depression. Trend analysis was performed to evaluate the risk of developing depression and anxiety as the number of diseases increased. Interaction analysis was utilized to explore potential factors underlying the comorbidity of cardiovascular diseases and depression.

RESULTS

Among 11,960 elder participants (mean age 82 years, 46.5 % male), the prevalences of psychological anxiety, depression, and ≥2 types of cardiovascular diseases are 11.7 %, 25.8 %, and 24.7 %, respectively. Compared to subjects without cardiovascular diseases, those with 2, 3, and 4 types of cardiovascular diseases respectively have increased risk of depression, with corresponding ORs (95 % CI) being 1.23 (1.08-1.40), 1.50 (1.24-1.81), and 1.91 (1.42-2.56), respectively. Trend analysis shows that for each additional cardiovascular comorbidity, the risk of depression increases by 15 % (OR 1.15, 95%CI 1.10-1.20). The interaction effect showed that social activities were both additive and multiplicative factors affecting cardiovascular comorbidity and depression. The association between the risk of anxiety and the complexity of cardiovascular comorbidities is not strong (P > 0.05).

CONCLUSION

As the complexity of cardiovascular comorbidity increases, the risk of depression skyrockets among older adults, social activities may serve as a remedy.

Drug-associated hyperprolactinemia: A comprehensive disproportionality analysis based on the FAERS database

Hyperprolactinemia (HPRL) is a clinically significant adverse event that requires careful monitoring. This study aims to identify the medications associated with HPRL using data from the FDA Adverse Event Reporting System (FAERS) between 2004Q1 and 2024Q1. Disproportionality analysis was performed to identify potential drug signals. Sensitivity analysis was conducted to assess the stability and strength of HPRL signals associated with these medications, as well as to examine signal differences by age and gender through stratification. Time-to-onset (TTO) analysis was performed to investigate the factors affecting the onset of HPRL. Disproportionality analyses identified 39 drugs related to HPRL across six main anatomical systems, with the majority (N = 29) affecting the nervous system. Notably, most of these medications belong to psychotropic categories, including atypical antipsychotics (AAPs, N = 13), typical antipsychotics (TAPs, N = 5) and selective serotonin reuptake inhibitors (SSRIs, N = 5). Sensitivity analysis indicated that most signals remained robust, with risperidone exhibiting the strongest signal for HPRL, followed by amisulpride, paliperidone, fluphenazine, and thioridazine. Stratified analysis showed that females had stronger signals for HPRL. Compared to individuals aged 18-44, those aged ≥45 exhibited weaker signals, while the signals in minors varied by drug. TTO analysis revealed that AAP-related HPRL manifested earlier in females, with earlier onset observed in minors using AAPs or SSRIs. In conclusion, we identified and ranked drugs associated with HPRL, primarily psychotropic medications, and observed variations in signal strength and onset time across gender and age. These findings emphasize the importance of individualized HPRL screening based on specific medications, gender, and age.

Disentangling the effects of nicotine versus non-nicotine constituents of tobacco smoke on major depressive disorder: A multivariable Mendelian randomisation study

BACKGROUND AND AIMS

There is growing evidence that tobacco smoking causes depression, but it is unclear which constituents of tobacco smoke (e.g. nicotine, carbon monoxide) may be responsible. We used Mendelian randomisation (MR) to measure the independent effect of nicotine on depression, by adjusting the effect of circulating nicotine exposure [via nicotine metabolite ratio (NMR)] for the overall effect of smoking heaviness [via cigarettes per day (CPD)] to account for the non-nicotine constituents of tobacco smoke.

DESIGN

Univariable MR and multivariable MR (MVMR) were used to measure the total and independent effects of genetic liability to NMR and CPD on major depressive disorder (MDD). Our primary method was inverse variance weighted (IVW) regression, with other methods as sensitivity analyses.

SETTING AND PARTICIPANTS

For the exposures, we used genome-wide association study (GWAS) summary statistics among European ancestry individuals for CPD (n = 143 210) and NMR (n = 5185). For the outcome, a GWAS of MDD stratified by smoking status was conducted using individual-level data from UK Biobank (n = 35 871-194 881).

MEASUREMENTS

Genetic variants associated with NMR (n = 6) and CPD (n = 53).

FINDINGS

Univariable MR-IVW indicated a causal effect of CPD on MDD [odds ratio (OR) = 1.13, 95% confidence interval (CI) = 1.04-1.23, P = 0.003] but no clear evidence for an effect of NMR on MDD (OR = 0.98, 95% CI = 0.97-1.00, P = 0.134). MVMR indicated a causal effect of CPD on MDD when accounting for NMR (IVW: OR = 1.19, 95% CI = 1.03-1.37, P = 0.017; Egger: OR = 1.13, 95% CI = 0.89-1.43, P = 0.300) and weak evidence of a small effect of NMR on MDD when accounting for CPD (IVW: OR = 0.98, 95% CI = 0.96-1.00, P = 0.057; Egger: OR = 0.98, 95% CI = 0.96-1.00, P = 0.038).

CONCLUSIONS

The role of nicotine exposure in risk of depression cannot be entirely dismissed. However, the causal effect of tobacco smoking increasing depression risk appears to be largely independent of circulating nicotine exposure, which implies the role of alternative causal pathways.

What do they look for and what do they find? A coproduced qualitative study on young people's experiences of searching for mental health information online

BACKGROUND

Many young people (YP) struggle with their mental health and look online for help. To capitalise on their digital presence, we need to better understand how and where they seek information online and what they think of what they find.

METHOD

We recruited 24 YP (aged 13-18 years). Online interviews were co-conducted by research team members and trained young researchers. We presented a persona with depression symptoms and asked about potential sources of information/support they might seek. They were also asked to think aloud while searching online and reviewing mental health resources (NHS, Young Minds). We used reflexive thematic analysis.

RESULTS

Analysis generated four themes: (1) the online help-seeking process, showcasing where YP look for information and why; (2) the mismatch between the information YP expected to find and the reality; (3) the strategies YP employed to determine a source's trust and credibility and (4) individual differences that can influence help-seeking.

CONCLUSION

Participants initiated their online search by Googling symptoms. They trusted NHS websites for basic medical information, while charities provided detailed content. Despite scepticism about content, social media offered validation. Online resources should prioritise visual appeal, user-friendliness, age-appropriate and personalised content and peer insights. Codesign is imperative to ensure high-quality, impactful research.

Treatment and long-term outcome of mental disorders: The grim picture from a quasi-epidemiological investigation in 54,826 subjects from 40 countries

INTRODUCTION

This study registered rates of specific treatment options for mental disorders as well as their long-term outcome.

MATERIAL AND METHODS

The history of mental disorders was used as a proxy for diagnosis. The data came from the COMET-G study (40 countries; 54,826 subjects, 64.73 % females, 35.45±13.51 years old). The analysis included descriptive statistics, Risk Ratios, t-tests, and ANCOVA's.

RESULTS

24.14 % reported a history of any mental disorder (depression >12 %, non-affective psychosis and Bipolar disorder 1 % each, >20 % self-injury, >10 % had attempted suicide, 7.17 % illegal substance abuse). Most patients were not under any kind of treatment (59.44 %) and most were not receiving treatment as recommended (e.g. 90 % of Bipolar and 2/3 of psychotic patients). No treatment at all and psychotherapy as monotherapy were consistently related to poorer outcomes. In anxiety or depression, only antidepressant monotherapy and benzodiazepines, in Bipolar disorder only antipsychotic monotherapy in males and antidepressant monotherapy in females and in non-affective psychosis antipsychotics and psychotherapy in females only, were related to good outcomes. No treatment modality was related to a good outcome in those with a history of self-harm, suicidal attempts, or illegal substance use. Only depression and treatment with antidepressants were related to metabolic syndrome.

DISCUSSION

In the community, the overwhelming majority of mental patients do not receive appropriate treatment or, even worse, no treatment at all. The outcome is unfavourable for the majority and only a few selective treatment options seem to make a difference.

Research Review: A review of the past decade of family and genomic studies on adolescent mental health

BACKGROUND

Mental health problems and traits capturing psychopathology are common and often begin during adolescence. Decades of twin studies indicate that genetic factors explain around 50% of individual differences in adolescent psychopathology. In recent years, significant advances, particularly in genomics, have moved this work towards more translational findings.

METHODS

This review provides an overview of the past decade of genetically sensitive studies on adolescent development, covering both family and genomic studies in adolescents aged 10-24 years. We focus on five research themes: (1) co-occurrence or comorbidity between psychopathologies, (2) stability and change over time, (3) intergenerational transmission, (4) gene-environment interplay, and (5) psychological treatment outcomes.

RESULTS

First, research shows that much of the co-occurrence of psychopathologies in adolescence is explained by genetic factors, with widespread pleiotropic influences on many traits. Second, stability in psychopathology across adolescence is largely explained by persistent genetic influences, whereas change is explained by emerging genetic and environmental influences. Third, contemporary twin-family studies suggest that different co-occurring genetic and environmental mechanisms may account for the intergenerational transmission of psychopathology, with some differences across psychopathologies. Fourth, genetic influences on adolescent psychopathology are correlated with a wide range of environmental exposures. However, the extent to which genetic factors interact with the environment remains unclear, as findings from both twin and genomic studies are inconsistent. Finally, a few studies suggest that genetic factors may play a role in psychological treatment response, but these findings have not yet been replicated.

CONCLUSIONS

Genetically sensitive research on adolescent psychopathology has progressed significantly in the past decade, with family and twin findings starting to be replicated at the genomic level. However, important gaps remain in the literature, and we conclude by providing suggestions of research questions that still need to be addressed.

The role of schemas in the experience of distress, burden, and wellbeing in parents and siblings of people with serious mental health difficulties

BACKGROUND

Caregivers of people with serious mental health difficulties (SMHD), such as schizophrenia or bipolar disorder, face various psychological challenges. It is unclear if the mechanisms underlying these challenges differ between different groups of caregivers. This study examined whether the relationship between maladaptive schemas and distress, burden, and reduced wellbeing differed between parents and siblings of people with SMHD.

METHODS

70 parents and 40 siblings completed an online survey that included measures of schemas (Young Schema Questionnaire-Short Form), depressive symptoms (Patient Health Questionnaire-9), anxiety symptoms (Generalised Anxiety Disorder Assessment-7), burden (Experience of Caregiving Inventory), and wellbeing (Ryff Scales of Psychological Wellbeing). Multivariate linear regression models with interaction effects were tested for each outcome of interest.

RESULTS

Compared to parents, siblings reported significantly higher scores in each schema domain, greater distress and burden, and reduced wellbeing. Univariate analyses revealed that Disconnection (β=0.52 [0.17, 0.91], t(100)=2.90, p=.005) and the interaction between Caregiver Group and Disconnection (β=-1.17 [-2.27, -0.13], t(100) =-2.49, p=.014) significantly predicted depressive symptoms. Schema domains predicted anxiety symptoms, burden, and wellbeing; there were no significant interaction effects in these models.

CONCLUSION

Siblings seem to experience greater psychological challenges than parents. Maladaptive schemas were linked to greater psychological challenges in both groups and the relationship between schemas and distress, burden, and wellbeing was similar in parents and siblings. Further research is needed to determine if there are group differences at the individual schema level.

A network approach to personality vulnerability symptom structure across early, middle, and late adolescence: Insights from a large-scale sample

BACKGROUND

The two-polarity model of personality development posits that personality vulnerabilities, specifically dependency and self-criticism, play a critical role in adolescent psychopathology risk. This theoretical framework emphasizes the importance of understanding how these vulnerabilities manifest and develop during adolescence, as adolescents face distinct developmental challenges at different stages. However, existing research overlooks the impact of stage-specific challenges on the development of personality vulnerabilities.

METHOD

This study included 24,946 Chinese adolescents (Mage ± SD = 15.50 ± 2.03; 46.50 % girls) divided into three age groups: early (10-13 years, N = 4652), middle (14-17 years, N = 15,065), and late (18-20 years, N = 5229). We employed network analysis to investigate the symptom structure of self-criticism and dependency through different adolescent stages, focusing on core symptoms (highly connected nodes), bridges (links between dependency and self-criticism), and potential causal relationships.

RESULT

Feelings of disappointing others and loneliness after arguments are consistently central to self-criticism and dependency, respectively. Connections between these vulnerabilities change across stages. Evidence from the directed acyclic graph suggests that self-criticism gradually replaces dependency as the key to triggering experiences of personality vulnerability from early to late adolescence.

CONCLUSION

This study identified the personality vulnerability network structure across three stages of adolescents. The results highlight a developmental shift in the triggering sequences of personality vulnerability, moving from predominantly dependency in early adolescence to increased self-criticism in later stages. These insights underscore the significance of the developmental context in shaping personality vulnerabilities across adolescence and offer crucial directions for stage-specific interventions.

Reproductive health experiences of women and non-binary people with early psychosis: a qualitative study

BACKGROUND AND HYPOTHESIS

Psychosis typically emerges in young adulthood and can impact reproductive health, including risk for suboptimal fertility and unplanned pregnancies. This study aimed to explore the reproductive health experiences of young women and non-binary people with psychosis.

STUDY DESIGN

In this qualitative study, young women and non-binary service users with experience of early psychosis in Toronto, Canada participated in semi-structured interviews about their reproductive health experiences (sexual health experiences analyzed separately). Clinicians providing healthcare for this population also participated in interviews/focus groups. Thematic analysis was used to describe core themes among service users, then understand how clinician perspectives related to these.

STUDY RESULTS

Interviews with service users (n = 19, aged 18-31; cisgender women n = 15, transgender women n = 2, non-binary individuals n = 2) yielded two core themes: (1) Complex reproductive health needs exist irrespective of psychosis, and (2) Psychosis does specifically impact reproductive health priorities and plans. These were discussed across three clinical content areas: contraception, menstruation, and future pregnancy/family planning. A final theme emerged from clinicians (n = 36): (3) Clinicians grapple with clinical complexity, and sometimes have different priorities than their patients (e.g., menstruation was a priority for service users only).

CONCLUSIONS

This study offers insights into the reproductive health experiences of women and non-binary individuals with early psychosis, including complexity that exists irrespective of psychosis, and additional psychosis-related complexity. The study also explored clinicians' perspectives, and identified areas of discordance between service user and clinician perspectives (e.g., related to menstruation). Findings can help shape interventions to improve this population's reproductive health.

Antipsychotic-induced hyperprolactinemia: Toxicologic mechanism and the increased breast cancer risk

Antipsychotic drugs are effective at improving both the positive and negative symptoms of schizophrenia as well as the manic phase of bipolar disorder. Whether an antipsychotic is termed typical or atypical is related to the xenobiotic's propensity to cause extrapyramidal side effects. However, with a few exceptions, drugs of both classes of antipsychotics are known to cause hyperprolactinemia. As many breast cancers are responsive to prolactin concentrations, the persistent increase in prolactin of the antipsychotics has implications for public health and carcinogenesis. The objective of this study was to review the extant literature on hyperprolactinemia due to antipsychotics, and to determine the risk imposed by those drugs on human breast cancer. A summary risk of breast cancer with use of any antipsychotic was found to be 1.19 (95 % confidence interval 1.10-1.30). When limiting usage of antipsychotics to 5 or more years, the summary risk increased to 1.26 (95 % confidence interval 1.12-1.43). And when limited to those studies who evaluated only those medications with the greatest increase in prolactin, the risk increased to 1.59 (95 % confidence interval 1.37-1.85). Given this increased risk of breast cancer, stronger warnings about this increased risk are warranted, and regular monitoring of prolactin levels and breast cancer screening should be part of the management plan for these patients.

The Coproduced Youth Priorities Project: Australian Youth Priorities for Mental Health and Substance Use Prevention Research

BACKGROUND

New approaches to mental health and substance use prevention, that bridge research and diagnostic silos are urgently needed to address rising trends in mental illness amongst young people. Engaging diverse stakeholders, including young people, in setting research priorities could aid the development of innovative responses, enhance research and improve translation. While previous activities have identified priorities for Australian mental health and substance use prevention research, none have centred young people as a primary stakeholder. The current study is a critical next step to understand youth perspectives.

METHODS

This Youth Priorities Project was coproduced with members of The Matilda Centre and PREMISE NHMRC Centre of Research Excellence Youth Advisory Board. The project involved three iterative stages: (1) an online survey; (2) consultations via focus groups and (3) a final consensus workshop to summarise key recommendations for principles, priorities and actions.

RESULTS

A diverse group of young people aged 16-25 were recruited for Stage 1 (n = 653), Stage 2 (n = 7) and Stage 3 (n = 3). Youth participants emphasised the need for increased investment in prevention research targeting a broad range of social determinants and health behaviours and their intersecting effects on youth mental ill health. There were strong calls to government to address economic drivers of mental health, to increase timely access to subsidised mental health support, and to better equip schools to support student wellbeing and mental health.

CONCLUSION

Young people had valuable and unique insights on how research and policy responses regarding youth mental health and substance use could be improved.

PUBLIC CONTRIBUTION

A coproduction Research Team (CPRT) was established, including two youth researchers who guided all stages of the research from conceptualisation, ethics approval, survey and study design, analysis and write-up. A Youth Advisory Board was also consulted.

The health effects of housing instability and its association with congestive heart failure

Housing instability is a critical social determinant of health (SDOH). Prior studies of homelessness and congestive heart failure (CHF) have looked primarily at the association between socioeconomic status and hospitalization. The association between housing instability and the development of CHF has not been fully investigated. We examined data from 4,408 participants with annual household income below $50,000 in the All of Us Research Program, a national cohort study enriched for individuals underrepresented in biomedical research. Within the inceptive survey, participants were asked if they were worried or concerned about not having a place to live in the past 6 months. We assessed the association between this self-reported housing concern and CHF occurrence, finding that individuals with low income and housing instability had a 44 % higher risk of diagnosis of CHF than those with stable housing (HR 1.44; 95 %CI 1.03-2.01). The increased risk remained significant after adjusting for cardiovascular risk factors as potential confounders (HR 1.73; 95 %CI 1.19-2.51) such as cholesterol, history of diabetes, and older age categories aged 55-64 years, 65-74 years, 75 years and older. Compared with men, women in the study were estimated to be at lower risk of CHF diagnosis (HR 0.52; 95 %CI 0.38-0.70) with 5.3 % of men and 2.9 % of women eventually diagnosed. We found that participants with housing instability had a higher risk of diagnosis of CHF compared to those with stable housing, highlighting the potential health impact of this healthcare disparity. Housing instability disrupts the essentials of effective management of cardiovascular risk factors (diabetes, obesity, hypertension) including consistent management, reliable access to care, and access to basic needs like kitchen and bathroom. This exacerbates their severity and increasing the risk of being diagnosed with CHF.

Gut microbiome characteristics in individuals across different stages of schizophrenia spectrum disorders: A systematic review and meta-analysis

Schizophrenia (SCZ) is a complex neuropsychiatric disorder with unclear pathogenesis, limiting advances in early diagnosis and targeted interventions. Increasing evidence suggests that the gut microbiome contributed to SCZ pathophysiology, yet comprehensive characterization across illness stages remains lacking. This meta-analysis aimed to characterize gut microbial alterations across the SCZ spectrum disorder, including individuals at ultra-high risk for psychosis, first-episode psychosis (FEP) and chronic SCZ patients. A systematic search of 10 databases identified 91 case-control studies. Gut microbial outcome measures included relative abundance, alpha and beta diversity. Review Manager and R were used to analyze the data. The results showed that patients with SCZ exhibited significantly reduced alpha diversity, particularly in Shannon, Chao1, Observe and Evenness indices, compared to healthy controls. Beta diversity also differed significantly, with 88.5 % of studies reporting distinct microbial profiles across SCZ stages. Quantitative analysis revealed significantly increased relative abundance of Bacteroides and a decrease abundance of Bifidobacterium and Lactobacilli in FEP patients compared to healthy controls. Qualitative analysis further showed increasing abundance in Lactobacillus, Prevotella and Collinsella, but decreasing abundance in Faecalibacterium, Butyricicoccus, and Blautia in SCZ. Bifidobacterium exhibited stage-specific changes, decreasing in first-episode psychosis but increasing in chronic stages, while Bacteroides followed an opposite trajectory. Notably, Lactobacillus demonstrated an early upward tractor in high-risk individuals, persisting to chronic stages. This meta-analysis identified dynamic and consistent alterations in the gut microbial across the SCZ spectrum. These findings implicated the potentials of gut microbes as early indicators for identification and intervention of SCZ.

Identification of Factors to Predict Transition to Schizophrenia in Subjects with Ultra-high Risk for Psychosis: A Protocol for a Multicenter, Longitudinal Study of Sleep Parameters and Cytokine Levels

Objective

Schizophrenia is a major psychiatric illness which mostly begins in adolescence and leads to impairments of social functioning. Some patients with schizophrenia have been associated with ultra-high risk state for psychosis (UHR), a condition used to operationally represent the prodromal stage of the illness. In previous studies, the UHR and the progression to overt psychosis has been reported to be accompanied with alterations in the quality of sleep and the immune system, as represented by change of blood levels of cytokines. Currently, biomarkers to predict the development of psychosis in persons at UHR have not yet reached a steady consensus. Therefore, we present a study protocol to explore predictors of transitions to psychosis, in the realm of monitoring of sleep condition and cytokine measurement, in subjects with the UHR.

Methods

This is a multicenter, longitudinal cohort study participated by 7 hospitals in Japan. We will recruit 50 UHR people and 30 healthy volunteers as a control group, and measure positive symptom, depressive symptoms, cognitive function, and social function. Blood cytokines levels and sleep indices, as well as actigraphy data will be monitored. After the baseline assessment, clinical symptoms, sleep indices, and cytokine levels will be measured every 12 weeks for 52 weeks. Actigraphy devices will continue to be worn for 52 weeks, while social function will be assessed over 104 weeks. The results of this study are expected to facilitate the development of novel intervention therapies to reduce the risk of psychosis and improve functional outcomes.

The effects of pharmacologic estradiol on anxiety-related behavior in adolescent and adult female mice

Early pubertal onset during adolescence is consistently linked with increased risk of anxiety and depression in girls. Although estradiol tends to have anxiolytic effects on behavior in adulthood, whether estradiol's anxiolytic actions change pre- to post-adolescent development is not clear. Using a rodent model, the current study tested whether anxiety-like responses to estradiol differ before and after adolescence in female mice. Prepubertal and adult C57BL/6 mice were ovariectomized, implanted with vehicle- or estradiol-filled silastic capsules, and behavioral tested 6 days later in the open field and elevated zero maze. A pharmacologic dose of estradiol was administered in silastic capsules (0.72 μg/0.02 mL) to maximize behavioral responses at both ages. In the open field, estradiol implants decreased anxiety-like behavior in adolescent females (relative to vehicle) and had negligible effects on anxiety-related behavior in adult females. These data suggest that adolescence is associated with changes in behavioral responsiveness to estradiol. In the elevated zero maze, adolescent females displayed higher levels of anxiety-like behavior than adults, irrespective of estradiol treatment. These findings demonstrate that substantial changes in anxiety-related behavior occur during adolescence, including an assay-dependent shift in behavioral responsiveness to estradiol.

Association of residential ambient temperature in childhood with mental disorders from childhood into adulthood: A register-based study

BACKGROUND

While many environmental exposures in childhood have been associated with later risk of mental disorders, less is known about whether cumulative early-life exposure to ambient temperature could be relevant to later mental health. We combined high-resolution meteorological data with individual-level data from Finnish nationwide registers to investigate associations of childhood ambient temperature exposure with subsequent mental disorders.

METHODS

The cohort included 578 067 Finnish individuals born in 1990-1999. For each individual, we calculated average daily exposure to ambient temperature from birth to their 10th birthday based on residential history. The individuals were followed from their 10th birthday until a mental disorder diagnosis, death, emigration, or December 2019. Cox proportional hazards models were used to estimate the associations of childhood temperature exposure with subsequent mental disorders while adjusting for individual-level and area-level confounders.

FINDINGS

Childhood exposure to warmer climatic conditions was monotonically associated with a greater subsequent risk of a mental disorder (compared to the median of the 10-year temperature exposure, HR = 1.10 (95% CI, 1.08-1.12) at the 95th percentile, HR = 0.88 (95% CI, 0.86-0.90) at the 5th percentile). In disorder-specific analyses, the associations were evident for mood and anxiety disorders, and to a lesser extent for sleep and substance use disorders. No consistent evidence was observed with psychotic or eating disorders.

INTERPRETATION

Growing up in warmer climatic conditions was associated with subsequent risk of mental disorders. Further studies in populations residing in different latitudes are needed.

Involving Parents in the Management and Treatment of Youth Anxiety

PURPOSE OF REVIEW

Childhood anxiety disorders are impairing and chronic unless addressed early. While cognitive behavioral therapy with exposures has a strong evidence base, many youth continue to experience symptoms posttreatment. Enlisting parents may help improve the management and treatment of childhood anxiety.

RECENT FINDINGS

Parental factors that influence childhood anxiety include family accommodation, parental emotion socialization, parental overcontrol, and parental anxiety. The merits of involving parents in childhood anxiety treatment have been debated. However, when specific, empirically- and theoretically-informed mechanisms are targeted, parental involvement in treatment appears efficacious and holds promise to increase access to care. Clinicians should consider the child's presentation, treatment barriers, and family dynamics to guide decision-making. Researchers and clinicians should also be aware of stressors that parents themselves face, considering ways to help children via supporting parents with their own mental health concerns.

Effects on Multimodal Connectivity Patterns in Female Schizophrenia During 8 Weeks of Antipsychotic Treatment

BACKGROUND AND HYPOTHESIS

Respective abnormal structural connectivity (SC) and functional connectivity (FC) have been reported in individuals with schizophrenia. However, transmodal associations between SC and FC following antipsychotic treatment, especially in female schizophrenia, remain unclear. We hypothesized that increased SC-FC coupling may be found in female schizophrenia, and could be normalized after antipsychotic treatment.

STUDY DESIGN

Sixty-four female drug-naïve patients with first-diagnosed schizophrenia treated with antipsychotic drugs for 8 weeks, and 55 female healthy controls (HCs) were enrolled. Magnetic resonance imaging (MRI) data were collected from HCs at baseline and from patients at baseline and after treatment. SC and FC were analyzed by network-based statistics, calculating nonzero SC-FC coupling of the whole brain and altered connectivity following treatment. Finally, an Elastic-net logistic regression analysis was employed to establish a predictive model for evaluating the clinical efficacy treatment.

STUDY RESULTS

At baseline, female schizophrenia patients exhibited abnormal SC in cortico-cortical, frontal-limbic, frontal-striatal, limbic-striatal, and limbic-cerebellar connectivity compared to HCs, while FC showed no abnormalities. Following treatment, cortico-cortical, frontal-limbic, frontal-striatal, limbic-striatal, temporal-cerebellar, and limbic-cerebellar connectivity were altered in both SC and FC. Additionally, SC-FC coupling of altered connectivity was higher in patients at baseline than in HC, trending toward normalization after treatment. Furthermore, identified FC or/and SC predicted changes in psychopathological symptoms and cognitive impairment among female schizophrenia following treatment.

CONCLUSIONS

SC-FC coupling may be a potential predictive biomarker of treatment response. Cortico-cortical, frontal-limbic, frontal-striatal, limbic-striatal, temporal-cerebellar, and limbic-cerebellar could represent major targets for antipsychotic drugs in female schizophrenia.

Cyberbullying through the lens of trauma: an empirical examination of US youth

BACKGROUND

Scholars have argued that cyberbullying should be characterized as an Adverse Childhood Experience (ACE) given its potential for traumatic impacts on youth development. Considering the current attention surrounding mental health and well-being among adolescents, it seems critical to empirically measure this relationship, and also determine if some types have a stronger negative influence.

METHODS

Data utilized in this study were derived from a survey conducted on a nationally-representative sample in 2023 involving 2,697 English-speaking middle and high school students aged 13 to 17 residing within the United States.

RESULTS

We identified a strong positive relationship between PTSD symptoms and experience with cyberbullying. Surprisingly, exclusion and rejection were just as harmful as overt threats when it comes to inducing trauma. Gossip and malicious comments were as detrimental as targeting someone based on their identity.

CONCLUSION

By becoming more trauma-informed and implementing school-based specific measures, those who work with youth can better safeguard and support them in the face of cyberbullying.

The relationship between neuropsychiatric disorders and aging: A review on telomere length, oxidative stress, and inflammation

Aging is the group of time-independent changes that occur in an organism and that ultimately end in death. The relationship between aging and neuropsychiatric disorders is complex. Not only does the incidence of several neuropsychiatric disorders rise with age, but also these disorders are linked with premature mortality and are even thought to be syndromes of accelerated biological aging. Oxidative stress, inflammation and telomere length are factors commonly used to assess biological aging. The purpose of this review is to sum up the existing information about the state of those factors in schizophrenia, depression, bipolar disorder and anxiety disorders, and to summarize the effects of treatment on telomere length in patients with those neuropsychiatric disorders. The main focus, however, is on telomere length seeing the highly controversial study results on this biomarker in neuropsychiatric disorders. There is no scientific consensus on the state of those factors in the mentioned neuropsychiatric disorders or on the effects of treatment on telomere length, thus further research is needed where confounding variables are controlled. Regarding telomere length, it is highly important to explore whether short telomeres lead to the development of neuropsychiatric disorders or vice versa, as it carries huge clinical potential.

Psychoeducation in the management of menopause symptoms for women living with a serious mental illness: a scoping review

IMPORTANCE AND OBJECTIVE

People living with a serious mental illness (SMI) may require additional management during the menopause transition and may have specific education needs regarding menopause. The aim of this scoping review was to assess the literature on psychoeducation programs that have been developed to address the menopause knowledge needs of people living with a mental illness.

METHODS

A scoping review of the literature was conducted in November 2024, focussing on psychoeducation programs for menopause developed for women living with a SMI using PsycINFO, Medline, Embase, and Google Scholar using the "Population, Concept, and Context" framework. The population considered was individuals with SMI, mental illness, bipolar disorder, schizophrenia, schizoaffective disorder, personality disorder, post-traumatic stress disorder, depression, anxiety disorders, obsessive-compulsive disorder, alcohol use, substance use, and eating disorders. Five studies were found that utilized psychoeducation in the context of cognitive behavior therapy delivered as a treatment of either depression or menopause symptoms. Participants in these studies included women living with depression or bipolar disorder. No studies were identified that delivered any psychoeducation intervention for the majority of conditions assessed. Population groups with no research included schizophrenia or schizoaffective disorder, personality disorder, post-traumatic stress disorder, anxiety disorders, obsessive-compulsive disorder, alcohol use, substance use, and eating disorders.

DISCUSSION AND CONCLUSION

More research is needed to further explore how people living with a mental illness may be best prepared for the menopause transition considering both menopause symptoms and psychiatric symptoms. The development and assessment of psychoeducation programs and materials addressing individual needs should be further considered for those living with a mental illness.

The global, regional, and national burden and trends of anxiety disorders among women of childbearing age from 1990 to 2021: Estimates from the global burden of disease study 2021

BACKGROUND

Anxiety disorders are prevalent, early-onset mental illnesses that have a major negative impact on society and the economy globally. Comprehensive research on the global prevalence and evolving patterns of anxiety disorders in women of childbearing age (WCBA) is lacking.

METHODS

We computed estimated annual percentage changes (EAPCs) to evaluate trends in the incidence and Disability-Adjusted Life Years (DALYs) rates of anxiety disorders using the three primary WCBA indicators for anxiety disorders: prevalence, incidence, and DALYs, which were taken from the Global Burden of Disease (GBD) database from 1990 to 2021.

RESULTS

The number of prevalent cases increased from 120.2 million in 1990 to 224.8 million in 2021. The number of new cases increased from 17.406 million in 1990 to 30.730 million in 2021. Anxiety disorders is more prevalent in women, particularly those of reproductive age (15-49 years). Over the past 32 years, the global changes of Age-standardized incidence rate (ASIR) and Age-standardized prevalence rate (ASPR) were relatively stable. The results of differential smoothing and ARR model fitting showed that the long term risks showed a fluctuating downward trend in the long run, but showed a significant abnormal increase after 2020.

CONCLUSION

The relative increase in the incidence of anxiety disorders and DALYs in the WCBA over 32 years remains high. Our results can help different countries or regions in the world to develop more reasonable prevention and control measures for anxiety disorders, so as to reduce the serious economic and social burden caused by the disease.

Latent Trajectories of Positive, Negative Symptoms and Functioning in Early Intervention Services for First-Episode Psychosis: A 2-Year Follow-Up Study

BACKGROUND

From the first episode (FEP), the course of psychosis is marked by substantial heterogeneity of clinical and functional outcomes which poses significant challenges in providing prognostic guidance to patients and families. To better understand such heterogeneity within the context of early intervention services (EIS), this study aimed to examine latent trajectories of positive and negative symptoms and functioning among FEP individuals undergoing EIS.

STUDY DESIGN

The Prevention and Early Intervention Program for Psychoses (PEPP-Montreal) is a 2-year EIS for FEP that conducted longitudinal assessments of 689 individuals aged 14-35, including sociodemographics, cognition, psychopathology, and functioning. Latent growth mixture modeling was used to identify distinct patterns of clinical and functional trajectories. The inter-relationship between trajectories, and the association of trajectory membership with baseline characteristics and distal outcomes were investigated using the manual 3-step approach.

STUDY RESULTS

Two positive symptom trajectories (Stable-low-32%, Fluctuating-68%,), 3 negative symptom trajectories (Decreasing-41%, Fluctuating-15%, and Stable-high-44%), and 2 functioning trajectories (Increasing-57%, Stable-moderate-43%) were identified. Early treatment response, particularly on negative symptoms, consistently and strongly predicted better outcome trajectories (OR = [3.4-5.5]). Trajectories of higher symptom severity were associated with trajectory of worse functioning (RR = [1.5-2.2]), which exhibited lower rates of clinical and functional remission.

CONCLUSION

These findings offer insights into clinically meaningful subgroups of individuals that could inform the prognosis of FEP and the development of individually tailored EIS. Individuals who do not show early improvement in negative symptoms may benefit from earlier psychosocial interventions specifically targeting actionable factors that contribute to secondary negative symptoms.

Co-occurring psychosocial conditions are associated with increased HIV acquisition and transmission risk among young transgender women in Lima, Peru

In Peru, transgender women (TW) are highly burdened by the HIV epidemic and stigma-related psychosocial conditions. Yet, a dearth of research has assessed co-occurring psychosocial conditions and HIV vulnerability among young TW. From February-July 2022, a community-recruited sample of young TW ages 16-24 years (N = 211) completed a cross-sectional socio-behavioral survey and HIV testing in Lima. Poisson regression models with robust variance estimated the association of indexes of co-occurring psychosocial conditions-childhood (family rejection, bullying, adverse childhood experiences, childhood sexual abuse), violence (psychological, physical, sexual, police violence), mental health (psychological distress, posttraumatic stress disorder, alcohol use disorder, non-injection drug use), and all (range = 0-12)-with past 6-month anal or vaginal condomless sex. Median age was 23 years, the majority were ethno-racial minority (35.1% Indigenous, 34.1% Mestiza, 12.3% Afro-Peruvian), 50.7% reported past 30-day sex work, 33.6% were HIV seropositive, and 42.0% reported past 6-month condomless sex. In separate multivariable sociodemographic-adjusted models, each index was associated with elevated prevalence of past 6-month condomless sex (all p < 0.05). For the overall index, each psychosocial condition increased the prevalence of past 6-month condomless sex by 16% (range = 8-23%). Understanding and intervening on co-occurring psychosocial conditions will be vital to mitigate HIV vulnerability among young TW in this context.

Sex differences in clozapine prescription: Results from an Italian 30-year health records registry

BACKGROUND

Clozapine is the only approved medication for treatment-resistant schizophrenia which is equally prevalent on male and female patients. However, studies showed that clozapine is less frequently prescribed to women compared to men.

AIMS

This study aims to investigate the role of sex in clozapine prescription, taking into account potential sociodemographic and clinical confounding factors.

METHODS

Patients aged 18-65, with a diagnosis of schizophrenia spectrum disorders were selected from the 46,222 individuals who had access to outpatient psychiatric services of Ferrara, Italy, from 1991 to 2021. Sociodemographic and clinical information including clozapine prescription timing and dosage were analyzed.

RESULTS

Among 3901 patients with a schizophrenia spectrum disorders, those who had been prescribed clozapine (189, 4.8%) were significantly more likely to be male (57%), younger at admission to care (30 vs 39.7 years old) and with a schizophrenia diagnosis (77% vs. 49%) compared to those without clozapine prescription. Within patients with a diagnosis of schizophrenia (n = 145), women (n = 60, 41%), compared to men, experienced twice the delay to be prescribed clozapine, both from the prescription of the first antipsychotic to clozapine (mean 1265.7 vs 746.6 days in men, p = 0.03) and from the prescription of the third antipsychotic to clozapine (mean 1214.5 vs 725.8 days in men, p = 0.03). Also, within those diagnosed with schizophrenia, women with a diagnosis of schizophrenia were less likely than men to be prescribed clozapine after the first and third antipsychotic considering both crude (HR = 0.66, p = 0.07; HR = 0.53, p = 0.025) and adjusted hazard ratios (HR = 0.65, p = 0.07; HR = 0.51, p = 0.021).

CONCLUSIONS

This study showed disparities based on sex in both the use and timing of clozapine, which disadvantages women diagnosed with schizophrenia. Further interventions are needed to increase awareness of possible sex-based barriers to clozapine use in clinical practice, measurement of sources of gender specific bias, and quality improvement initiatives to continuously address challenges in providing adequate treatment to this vulnerable population.

Enhancing Behavioral Health Implementation in a Care Coordination Program at a Federally Qualified Health Center: A Case Study Applying Implementation Frameworks

Federally Qualified Health Centers are charged with providing comprehensive health care in traditionally underserved areas, underscoring their importance in caring for and promoting health equity for the large portion of historically marginalized communities in this setting. There is a significant need to ensure Federally Qualified Health Centers are equipped to appropriately address the immense behavioral health needs common among patients served. Care coordination is an evidence-based model that is increasingly utilized in Federally Qualified Health Centers to improve care equity and outcomes. Addressing and supporting behavioral health needs is a key aspect of such care coordination models. Context-specific considerations and programmatic supports, particularly those that address the needs of care coordinators and the complex patients they serve, are needed to ensure such models can appropriately meet and address the behavioral health concerns of the diverse populations served. The goal of this study was to present a mixed-methods case study that systematically applies implementation frameworks to conduct a needs and context assessment to inform the development and testing of evidence-based practice strategies and implementation support as part of a care coordination program within a partnered Federally Qualified Health Center.

Optimal intensity and dose of exercise to improve university students' mental health: a systematic review and network meta-analysis of 48 randomized controlled trials

BACKGROUND

A systematic evaluation and network meta-analysis (NMA) using randomized controlled trials (RCTs) was conducted to investigate the effects of different exercise intensities and dosages on the mental health of college students.

METHODS

A systematic search of eight electronic databases of RCTs involving mental health exercise interventions for college students was conducted, which included data from the inception of the databases through July 2024. Two independent reviewers assessed the quality of the literature. Pairwise, network, and dose‒response meta-analyses were conducted via random-effects models to analyze the effects of exercise on college students' mental health.

RESULTS

A total of 48 RCTs (3951 patients) were included. Light, moderate, and vigorous exercise were all significantly effective at reducing symptoms of depression, anxiety and stress, whereas very light exercise was only effective at reducing symptoms of depression and stress. Surface under the cumulative ranking curve (SUCRA) probability ranking revealed that vigorous exercise had the highest probability of being the best intervention intensity to improve depression and stress symptoms, and the best exercise intensity to improve anxiety symptoms was moderate. The minimum threshold for overall exercise intervention for depressive symptoms was 150 METs-min per week, the benefits provided after doses above 1300 METs-min per week were less pronounced, and the predicted maximum significant response dose was 860 METs-min per week, which was the same as the predicted data for moderate exercise.

CONCLUSION

Very light, light, moderate, and vigorous exercise are all potentially effective exercise intensities for improving the mental health of college students, with no significant difference in effectiveness across the four exercise intensities. SUCRA rankings revealed that vigorous exercise is the most effective intervention for depression and stress and that moderate exercise is the most effective intervention for anxiety. Exercise interventions for depressive symptoms have a low dosage threshold, are simple and easy to administer, and are good treatments for psychological problems in college students.

Children as next of kin's experiences, practices, and voice in everyday life: a systematic review of studies with Norwegian data (2010-2022)

Aims: This systematic review aims to identify and describe how children of parents with mental illness, substance dependence, or severe physical illness/injury, experience and practise their everyday life. Methods: The review followed the four stepwise recommendations of Harden and colleagues when including quantitative and qualitative studies on peoples' experiences and views. In all, 23 studies with data from Norway (2010-2022) have been included. Brown and Clark's thematic analysis was applied. Results: Three themes were constructed from the reviewed articles: (a) Children practice their relational agency by actively doing practical tasks, occasionally jobs to maintain family economy, and organising fun activities with the ill parent. (b) Emotional ambivalence when their own needs were set aside in favour of the parents. They loved their parents but also felt guilt, anger, disappointment, shame, fear of inheriting the illness and longed for a 'normal' everyday life. (c) Supportive contextual factors were, for example, at least one significant adult recognising them, participating in leisure activities, socialising with friends, and talking with other peers who shared similar experiences as next of kin. Obstructive factors were lack of information and recognition as well as silence and lack of dialogue within the family and/or health professional. Conclusions: There is a strong need for more knowledge and competence on the situation and needs of these children when it comes to professionals, parents and the public. Public health initiatives are needed to honour their agency and recognise their contributions in present time to prevent psychosocial problems later in life.

Efficacy of Individual Placement and Support (IPS) on Employment, Education, and Training in Young Adults With Early Psychosis-A Randomized Controlled Trial

OBJECTIVE

To explore the efficiency of IPS on employment, education, and training (EET) outcomes in young adults with early psychosis.

METHODS

Monocenter parallel arm, randomized controlled trial.

INTERVENTION

Individual placement and support (IPS) according to the IPS-Y Fidelity Scale with an add-on of up to eight sessions of adherence therapy.

MAIN OUTCOME MEASURES

EET at least 15 h per week for at least 1 week in the follow-up. Secondary outcomes included EET rates, duration in EET, and total wages. Additionally, subsample analyses were carried out.

RESULTS

A total of 94 young adults (18-35 years) with early psychosis in an outpatient psychiatric service were randomly assigned to 12-month IPS according to program fidelity and standard care versus standard care alone. Four patients were excluded from the analysis because of early dropout after baseline, leaving 90 participants-46 in the IPS group and 44 in the TAU group-for intention to treat (ITT) analysis. EET rate for at least 15 h per week was significantly higher in the IPS group, 78% (36/46) versus 55% (24/44) in the TAU group. The percentage of participants in EET for at least 1 week in the follow-up was 83% (38/46) versus 59% (26/44). The number of weeks in EET was significantly higher in the IPS group (mean = 31.5 weeks, SD = 20.5 versus mean = 18.4 weeks, SD = 21.2), and the total wages were higher in favor of the IPS group (mean = €10,242, SD = 13,437 versus mean = €5217, SE = 7871).

CONCLUSION

IPS integrated into outpatient psychiatric services improves EET in young adults with early psychosis in Germany.

Economic Inequality and Mental Health: Causality, Mechanisms, and Interventions

Almost all countries in the world have witnessed a rapid increase in levels of economic inequality, a measure of the distribution of income and wealth across the population, since the advent of neoliberal economic policies in the 1970s. In this review, we conceptualize inequality as an ecological construct and discuss why it matters for the mental health of populations and for individual clinical outcomes. We then discuss some of the key mechanisms through which economic inequality influences mental health beyond poverty itself: social comparison and social capital. We also consider how the effect might vary across specific vulnerable groups in the population, such as young people and minoritized communities. Finally, we discuss methodological challenges in studying the relationship between inequality and mental health and conclude by outlining future research directions and possible interventions at the governmental, community, and individual levels to mitigate the negative mental health consequences of economic inequality.

Early life adversity is associated with greater similarity in neural representations of ambiguous and threatening stimuli

Exposure to early life adversity (ELA) is hypothesized to sensitize threat-responsive neural circuitry. This may lead individuals to overestimate threat in the face of ambiguity, a cognitive-behavioral phenotype linked to poor mental health. The tendency to process ambiguity as threatening may stem from difficulty distinguishing between ambiguous and threatening stimuli. However, it is unknown how exposure to ELA relates to neural representations of ambiguous and threatening stimuli, or how processing of ambiguity following ELA relates to psychosocial functioning. The current fMRI study examined multivariate representations of threatening and ambiguous social cues in 41 emerging adults (aged 18 to 19 years). Using representational similarity analysis, we assessed neural representations of ambiguous and threatening images within affective neural circuitry and tested whether similarity in these representations varied by ELA exposure. Greater exposure to ELA was associated with greater similarity in neural representations of ambiguous and threatening images. Moreover, individual differences in processing ambiguity related to global functioning, an association that varied as a function of ELA. By evidencing reduced neural differentiation between ambiguous and threatening cues in ELA-exposed emerging adults and linking behavioral responses to ambiguity to psychosocial wellbeing, these findings have important implications for future intervention work in at-risk, ELA-exposed populations.

Coping-strategies as a mediator between emotional disorders and problematic alcohol use

BACKGROUND

Epidemiological studies reveal a high prevalence of alcohol use and comorbidity rates with emotional disorders. This study aims to explore the possible mediational effect of stress-coping strategies on the relationship between symptoms of emotional disorders and problematic alcohol use.

METHODS

The sample included 1014 participants (33.82% male, 66.17% female) aged 18-75 years (M = 33.0, SD = 15.15). Three mediation analyzes were carried out, for depressive, anxious and somatization symptomatology measured with the LSB-50 in which they acted as an independent variable, the coping strategies of the CSQ as a mediating variable and the problematic alcohol use, measured with AUDIT, as a dependent variable. Additionally, sex, age, educational level, and socioeconomic status were entered as covariates.

RESULTS

In all the models, problematic alcohol use was mediated by Problem-Solving Focus and Open Emotional Expression. However, while in depressive symptoms was a fully mediation, in anxious and somatization symptomatology was partially mediated.

CONCLUSIONS

The similarities found may be due to shared variance between emotional disorders. Interventions focused on Problem-Solving Focus could improve the emotional symptoms and the problematic alcohol use.

[Barriers and facilitators to the use of mental health prevention programs among preschool- and elementary school-aged children]

BACKGROUND AND AIMS

Emotional and behavioural problems occur frequently in childhood and are usually associated with burdens on children, families, and society. Preventive interventions could reduce these burdens, but are rarely used despite their availability and effectiveness. The aim was to identify general, individual, structural, and family-related barriers/facilitators to potential and actual participation in prevention programs.

METHODS

As part of a prospective implementation study, n = 3,231 project folders were handed out to parents in 28 paediatric practices in Dresden and surrounding area during routine health check-ups (U9-U11) for children aged 5 to 10 years. In addition to screening for mental health problems, a questionnaire was used to identify potential barriers/facilitators to participation in prevention programs. Of n = 2,844 families agreeing to participate in the study n = 2,122 (74.6 %) completed the questionnaire at least partially. Regression analyses were used to test associations between potential barriers/facilitators and actual participation in (a) a pre-intervention interview (PII; in order to check indications with the program provider) or (b) the prevention program among children with a prevention recommendation.

RESULTS

Of the participating families, 1.8 % reported that they had already participated in a prevention program to improve mental health or had received a recommendation for it before. 59.5 % of the families expressed their general interest in such programs, and 95.7 % would participate if their paediatrician recommended it. At the structural level, a lack of knowledge about mental health prevention programs was identified as a barrier to potential participation; as only 9.2 % of the families were aware of such programs before participating in the study. 65.8 % of all the families considered full reimbursement of the participation fees after paying in advance a prerequisite for their potential program participation, and 56.7 % wanted to receive a voucher from their health insurance fund entitling them to participate without prepayment. At the individual level, the parents' attitude towards the usefulness of prevention programs predicted the actual utilisation of the PII after the paediatrician's recommendation. At the structural level, the acceptance of longer travel times (up to 60 minutes) as well as the assumption/reimbursement of the entire course fees were relevant predictors. Furthermore, male sex (of the children) and higher screening scores were also important predictors at the family-related level. After the PII, the only factor associated with actual participation in prevention programs was efficient public transport accessibility.

DISCUSSION

In order to increase participation in prevention programs, funding to cover participation fees should be secured through health insurance funds. In addition, advertising and educational measures in the public as well as by paediatricians in the context of screening could raise the awareness of and improve attitudes towards useful programs. Implementing the programs in children's environments could reduce structural barriers and create equal opportunities for participation.

GABAB Receptor: Structure, Biological Functions, and Therapy for Diseases

Gamma-aminobutyric acid (GABA) B receptors (GABABRs) that acts slowly and maintains the inhibitory tone are versatile regulators in the complex nervous behaviors and their involvement in various neuropsychiatric disorders, such as anxiety, epilepsy, pain, drug addiction, and Alzheimer's disease. Additional study advances have implied the crucial roles of GABABRs in regulating feeding-related behaviors, yet their therapeutic potential in addressing the neuropsychiatric disorders, binge eating, and feeding-related disorders remains underutilized. This general review summarized the physiological structure and functions of GABABR, explored the regulation in various psychiatric disorders, feeding behaviors, binge eating, and metabolism disorders, and fully discussed the potential of targeting GABABRs and its regulator-binding sites for the treatment of different psychiatric disorders, binge eating and even obesity. While agonists that directly bind to GABABR1 have some negative side effects, positive allosteric modulators (PAMs) that bind to GABABR2 demonstrate excellent therapeutic efficacy and tolerability and have better safety and therapeutic indexes. Moreover, phosphorylation sites of downstream GABABRs regulators may be novel therapeutic targets for psychiatric disorders, binge eating, and obesity. Further studies, clinical trials in particular, will be essential for confirming the therapeutic value of PAMs and other agents targeting the GABABR pathways in a clinical setting.

Multimodal Brain Age Indicators of Internalizing Problems in Early Adolescence: A Longitudinal Investigation

BACKGROUND

Adolescence is a time of increased risk for the onset of internalizing problems, particularly in females. However, how individual differences in brain maturation are related to the increased vulnerability for internalizing problems in adolescence remains poorly understood due to a scarcity of longitudinal studies.

METHODS

Using ABCD (Adolescent Brain Cognitive Development) Study data, we examined longitudinal associations between multimodal brain age and youth internalizing problems. Brain age models were trained, validated, and tested independently on T1-weighted imaging (n = 9523), diffusion tensor imaging (n = 8834), and resting-state functional magnetic resonance imaging (n = 8233) data at baseline (meanage = 9.9 years) and 2-year follow-up (meanage = 11.9 years). Self-reported internalizing problems were measured at 3-year follow-up (meanage = 12.9 years) using the Brief Problem Monitor.

RESULTS

Latent change score models demonstrated that although brain age gap (BAG) at baseline was not related to later internalizing problems, an increase in BAG between time points was positively associated with internalizing problems at 3-year follow-up in females but not males. This association between an increasing BAG and higher internalizing problems was observed in the T1-weighted imaging (β = 0.067, SE = 0.050, false discovery rate [FDR]-corrected p = .020) and resting-state functional magnetic resonance imaging (β = 0.090, SE = 0.025, pFDR = .007) models but not diffusion tensor imaging (β = -0.002, SE = 0.053, pFDR = .932) and remained significant when accounting for earlier internalizing problems.

CONCLUSIONS

A greater increase in BAG in early adolescence may reflect the heightened vulnerability shown by female youth to internalizing problems. Longitudinal research is necessary to understand whether this increasing BAG signifies accelerated brain development and its relationship to the trajectory of internalizing problems throughout adolescence.

Digital Dependence in Aging: Nomophobia as the New Mental Health Threat for Older Adults

Nomophobia, or the fear of being without a mobile phone, is increasingly recognized as an emerging psychological issue, particularly in older adult populations. As technology dependence grows among older adults, the mental health impacts of disconnection from digital devices can manifest in anxiety, cognitive disorientation, and social withdrawal. This geriatric update explores the intersection of aging and digital dependence, emphasizing nomophobia's relevance as a mental health concern for older adults. The article highlights key signs of nomophobia in older adults, including excessive phone use, panic at disconnection, and cognitive decline triggered by technology loss. It also examines effective strategies for early identification and management, including the use of screening tools such as the Nomophobia Questionnaire, adapted for older adult patients. Addressing nomophobia in older adults through a combination of digital literacy, family involvement, and mental health support is critical to mitigating its adverse effects on mental well-being and improving the quality of life for older adults.

Costly avoidance in pediatric anxiety and OCD - The impact of emotional reactivity and reward sensitivity

A central feature of internalizing mental disorders, such as obsessive-compulsive disorder (OCD) and anxiety disorders, is the avoidance of rewarding situations to prevent the risk of experiencing distressing emotions. Previous research has shown that obsessive and anxious individuals avoid situations where rewards come at the cost of aversive experiences, a phenomenon termed costly avoidance. Costly avoidance has not previously been examined in clinical samples of youths with OCD or anxiety disorders, which is an important gap as these disorders typically onset during the first two decades of life. In this study, treatment-seeking youths with OCD (n = 62) and anxiety disorders (n = 43), and a comparison group of youths without mental disorders (n = 47) performed an approach-avoidance conflict task. Participants selected to face either neutral outcomes or to obtain rewards that co-occurred with aversive images and sounds. Results showed more costly avoidance in the OCD and anxiety disorder groups compared to the non-clinical comparison group, but no differences between the two clinical groups emerged. Trait reward sensitivity and subjective negative emotional reactions to aversive sounds and images were the best individual predictors of costly avoidance. The results of our study show that youths with OCD and anxiety disorders display elevated levels of costly avoidance, which is in line with clinical theories and previous findings in adults with anxiety disorders. We also show that these elevated levels of costly avoidance are best explained by individual differences in reward sensitivity and emotional reactivity, suggesting that sensitivity to appetitive and aversive outcomes might underlie differences in maladaptive costly avoidance.

Is there a disparity in osteoporosis referral and treatment among people with affective disorders? A ten-year data linkage study

AIMS

People with affective disorders (AD) are at increased risk of osteoporosis and fractures. Osteoporosis treatment/referral is thus essential in this population. However, it is unclear whether osteoporosis treatment/referral differs between those with and without AD. This retrospective cohort study compared osteoporosis treatment/referral in people with and without AD across linked primary and mental health care data.

METHODS

People with AD (ICD-10 codes F3*) between 1.5.2009-30.11.2019, aged 18+ at first diagnosis, from Lambeth, South London were randomly matched 1:4 to healthy controls based on age band and gender. Outcomes including treatments (prescription of calcium, calcium with vitamin D) and referral (referrals for osteoporosis screening and/or prevention) were analysed using conditional and multivariable logistic regression analyses.

RESULTS

People with AD (n = 23,932) were more likely than controls (n = 76,593) to have a recorded prescription of calcium (odds ratio [OR] = 1.64, 95 % confidence interval [CI] 1.40-1.92) and calcium with vitamin D (OR = 2.25, 95 % CI 2.10-2.41), and be referred for osteoporosis screening (OR = 1.87, 95 % CI 1.76-1.99) within 2 years after the date of the first AD diagnosis in adjusted analyses. Older age, female sex, having an ethnic minority background, Class A analgesics use were significant predictors for all osteoporosis management pathways within AD patients.

CONCLUSION

Findings from the present study suggest that compared to the general population, people with AD are more likely to receive osteoporosis screening/treatments. Whether this increased screening/treatment is sufficient to reduce the burden of osteoporosis and fractures in this population is unclear and warrants further consideration.

The effectiveness of targeted preventive interventions for depression symptoms in children and adolescents: Systematic review and meta-analyses

BACKGROUND

Targeted interventions are needed to prevent depression in at-risk children and adolescents. Children and adolescents are commonly at risk of depression due to subsyndromal depressive symptoms or problems in their social environment.

METHODS

This review was conducted according to the Cochrane guidelines (2023) and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A literature search was done in December 2023 using three electronic databases and a manual search. The methodological quality of all eligible studies was assessed using the Cochrane Collaboration's tool for assessing the risk of bias.

RESULTS

This review includes 77 intervention studies of which 13 are follow-ups. Of the 64 identified main studies (n = 11,808), 19 were selective interventions targeting the problems in a social environment. Of the participants 63.6 % were girls and the mean age ranged between 9 and 17. Most of the studies were conducted in a Western school setting using psychological interventions, with the majority being CBT (cognitive behavioral therapy) based programs. Targeted interventions reduced the symptoms of depression statistically significantly at postintervention (SMD 0.27, 95 % confidence interval 0.16-0.37) and 6-month follow-up (SMD 0.32, 0.18-0.45) compared to any comparator. Intervention effects were not statistically significant at the 12-month follow-up.

CONCLUSION

Indicated and selective interventions targeted to children and adolescents at risk of depression due to their social environment have a small effect on depressive symptoms. Interventions should be delivered by mental health experts.

Restless Leg Syndrome and Pregnancy

OBJECTIVE

The purpose of this assessment of the literature was to evaluate the etiology, incidence, risk factors, diagnosis, management, and recurrent risk in a subsequent pregnancy of restless leg syndrome (RLS) in pregnancy.

METHODS

Electronic databases (PubMed, Embase, and Web of Science) were searched from January 1980-February 2024. The only limitation was that the articles had to be in English. Studies were selected that examined associations among the etiology, prevalence, risk factors, diagnosis and management of RLS during pregnancy.

RESULTS

A total of 498 articles were identified, 47 of which are the basis of this review. RLS is a common occurrence during pregnancy, occurring in up to one-fourth of all pregnancies. The pathophysiology likely involves brain iron deficiency, hormonal changes of pregnancy, mechanical strain from the growing pregnancy, and stress/insomnia. The prevalence of RLS increases in the later trimesters, with increasing parity, and may have regional variations. Risk factors include a history of RLS and underlying hypertension. Criteria for diagnosis have been established by the RLS Study Group. Management involves lifestyle modifications, behavioral strategies, iron and pharmacologic therapy.

CONCLUSIONS

RLS is commonly seen in pregnancy, and the prevalence increases with increasing gestational age. Iron deficiency seems to be a common contributor to RLS. Management involves behavioral/lifestyle modifications, iron therapy, and may involve pharmacological therapy.

Variation in coupling across neural and cardiac systems of regulation is linked to markers of anxiety risk in preschool

Both cortical and parasympathetic systems are believed to regulate emotional arousal in the service of healthy development. Systemic coordination, or coupling, between putative regulatory functions begins in early childhood. Yet the degree of coupling between cortical and parasympathetic systems in young children remains unclear, particularly in relation to the development of typical or atypical emotion function. We tested whether cortical (ERN) and parasympathetic (respiratory sinus arrhythmia [RSA]) markers of regulation were coupled during cognitive challenge in preschoolers (N = 121). We found no main effect of RSA predicting ERN. We then tested children's typical and atypical emotion behavior (context-appropriate/context-inappropriate fear, anxiety symptoms, neuroendocrine reactivity) as moderators of early coupling in an effort to link patterns of coupling to adaptive emotional development. Negative coupling (i.e., smaller ERN, more RSA suppression or larger ERN, less RSA suppression) at age 3 was associated with greater atypical and less typical emotion behaviors, indicative of greater risk. Negative age 3 coupling was also visible for children who had greater Generalized Anxiety Disorder symptoms and blunted cortisol reactivity at age 5. Results suggest that negative coupling may reflect a maladaptive pattern across regulatory systems that is identifiable during the preschool years.

Breast cancer risk of hormone replacement therapy in Japanese women with schizophrenia on antipsychotic treatment: A retrospective cohort study

PURPOSE

This study aimed to identify the risk factors for breast cancer onset in patients with schizophrenia who are receiving antipsychotic treatment. The focus was on understanding how baseline patient characteristics and treatment factors influence breast cancer risk in this population.

METHODS

A retrospective cohort study was conducted using a nationwide claims database in Japan, including 12,479 patients with schizophrenia who were receiving antipsychotic medications. The primary outcome was the development of breast cancer. Multivariate Cox regression analysis was employed to identify independent risk factors, with sensitivity analyses conducted using the jackknife and elastic net methods.

RESULTS

Among the 12,479 patients, 22 developed breast cancer during the follow-up period. Baseline age of 38 years or older (hazard ratio (HR) = 4.87, 95 % confidence interval (CI) = 1.41-16.87, p = 0.013) and the use of progestogens (HR = 4.47, 95 % CI = 1.04-19.18, p = 0.044) were identified as independent risk factors for breast cancer onset. Sensitivity analyses confirmed the robustness of these findings, although the study's limited number of events highlighted potential variability in the HRs.

CONCLUSION

The results suggest that certain treatment factors, particularly the use of progestogens, may increase the risk of breast cancer in patients with schizophrenia who are receiving antipsychotic treatment. Given these findings, careful consideration of treatment plans, including the dosage and duration of hormone replacement therapy and adjustments in antipsychotic treatment, may be warranted. Further research is needed to clarify the interactions between mental disorders, treatment factors, and breast cancer risk.

Please, just talk to me: Self-disclosure mediates the effect of autobiographical memory specificity on adolescent self-harm and depressive symptoms in a UK population-based study

BACKGROUND

Depression and self-harm are two of the most prevalent mental health challenges experienced by adolescents. Sharing their experiences with a parental figure (herein, self-disclosure) can be an important step in getting help, and ultimately, reducing symptoms. Understanding factors that predict self-disclosure can inform public health approaches to support adolescent mental health. We evaluated whether an adolescent's ability to retrieve specific memories of both positive and negative events may be one factor which increases self-disclosure, theorising that having more specific memories would make it easier to describe and share experiences.

METHODS

This pre-registered (https://osf.io/5xdns) analysis evaluated data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK population-based study. We hypothesised that self-disclosure would mediate the relationship between memory specificity, and depressive symptoms, self-harm, and suicide planning. Longitudinal structural equation models evaluated mediation pathways, using three waves of data collected when adolescents (N = 5785) were 13-, 14- and 16-years old. Potential confounds including baseline and cross-sectional depression were considered. Multiple imputation accounted for missing data.

FINDINGS

Significant indirect relationships were observed for our co-primary outcomes of depressive symptoms (b = -0∙13, SE = 0∙005) and self-harm (b = -0∙02, SE = 0∙01). Higher memory specificity at age 13 predicted higher self-disclosure at age 14 (b = 0∙27, SE = 0∙07), which predicted lower depressive symptoms (b = -0∙10, SE = 0∙02) and lower odds of self-harm at age 16 (odds ratio = 0∙87 [95 % CI [0∙78-0∙97]). Models predicting suicide planning were non-significant.

INTERPRETATION

Findings suggest that specific memory retrieval in early adolescence may help to promote self-disclosure to parental figures, and indirectly, reduce poor mental health in later adolescence.

Schizophrenia in women: a review of unique aspects regarding course, management, and challenges across the lifespan

PURPOSE OF REVIEW

This review of the latest literature aims to underscore some unique characteristics of schizophrenia in women and to explore the role of hormonal fluctuations and life-stage stressors in its pathogenesis and management. It summarizes the emerging evidence-based recommendations on biological and psychosocial interventions, with the goal to raise awareness of some gender-specific issues and the ultimate intent to optimize outcomes for this patient population.

RECENT FINDINGS

Schizophrenia affects men and women differently due to gender-specific biological, psychological, social, and cultural factors. Hormonal changes through the woman's reproductive life are associated with differences in disease expression, response to treatment, and treatment adjustments.

SUMMARY

Schizophrenia is a chronic and serious mental illness associated with significant personal and societal burden and with important sexual differences in presentation, course, and management, attributed at least in part to hormonal changes and other factors (e.g. medication compliance, drug interactions, social and cultural characteristics). Periods of high hormonal flux, such as pregnancy, postpartum, and the menopause transition, pose additional challenges concerning psychiatric stability and treatment efficacy and safety. Becoming familiar with important gender-specific characteristics including biological, psychological and sociocultural determinants can lead to adjustments in management and, ultimately, to improved outcomes.