Smoking exposure trajectories and pulmonary function in early adulthood in a Brazilian cohort

OBJECTIVES

To investigate smoking trajectories and their association with pulmonary function (PF) and respiratory symptoms at age 22.

METHODS

Data from a population-based cohort study of 3350 individuals and their spirometries were analysed. The outcomes were: forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), forced expiratory flow at the mid expiratory phase (FEF25-75 %), FEV1/FVC and FEF25-75/FVC ratio. Smoking data were collected at perinatal follow-up (gestational exposure) and 15, 18 and 22 years. Group-based trajectory model was applied.

RESULTS

Four groups were identified: no exposure (NE), gestational (GE), gestational and adulthood (GAE) and continuous (CE) exposure. Both CE and GAE trajectories were associated with lower values of FEV1/FVC (-1.77pp; p = 0.01 and -1.58 pp; p<0.001 respectively) and FEF25-75/FVC ratio (-7.27pp; p = 0.019 and -6.04pp; p<0.001 respectively) compared to the NE trajectory. Lower FEV1 and FEF25-75 % values were also related to the GAE trajectory (-68 ml; p = 0.03 and -253 ml/s; p<0.001 respectively). Compared to those who never smoked, individuals who smoked 10 or more cigarettes daily presented a reduction in the FEV1/FVC ratio by 1.37pp (p<0.001), FEF25-75 % by 126 ml (p = 0.012) and FEF25-75 %/FVC ratio by 3.62pp (p = 0.011). CE trajectory showed higher odds of wheezing (OR 4.14; p<0.001) and cough (OR 2.39; p = 0.002) compared to the non-exposed group.

CONCLUSIONS

The in-uterus exposure to maternal smoking reduces PF later in life. However, the perpetuation of smoking behaviour throughout adolescence and early adulthood is determinant for PF main reduction and the emergence of respiratory-related symptoms.

The impact of trauma and how to intervene: a narrative review of psychotraumatology over the past 15 years

To mark 15 years of the European Journal of Psychotraumatology, editors reviewed the past 15-year years of research on trauma exposure and its consequences, as well as developments in (early) psychological, pharmacological and complementary interventions. In all sections of this paper, we provide perspectives on sex/gender aspects, life course trends, and cross-cultural/global and systemic societal contexts. Globally, the majority of people experience stressful events that may be characterized as traumatic. However, definitions of what is traumatic are not necessarily straightforward or universal. Traumatic events may have a wide range of transdiagnostic mental and physical health consequences, not limited to posttraumatic stress disorder (PTSD). Research on genetic, molecular, and neurobiological influences show promise for further understanding underlying risk and resilience for trauma-related consequences. Symptom presentation, prevalence, and course, in response to traumatic experiences, differ depending on individuals' age and developmental phase, sex/gender, sociocultural and environmental contexts, and systemic socio-political forces. Early interventions have the potential to prevent acute posttraumatic stress reactions from escalating to a PTSD diagnosis whether delivered in the golden hours or weeks after trauma. However, research on prevention is still scarce compared to treatment research where several evidence-based psychological, pharmacological and complementary/ integrative interventions exist, and novel forms of delivery have become available. Here, we focus on how best to address the range of negative health outcomes following trauma, how to serve individuals across the age spectrum, including the very young and old, and include considerations of sex/gender, ethnicity, and culture in diverse contexts, beyond Western, Educated, Industrialized, Rich, and Democratic (WEIRD) countries. We conclude with providing directions for future research aimed at improving the well-being of all people impacted by trauma around the world. The 15 years EJPT webinar provides a 90-minute summary of this paper and can be downloaded here [http://bit.ly/4jdtx6k].

Epigenome-wide association study of perceived discrimination in the Multi-Ethnic Study of Atherosclerosis (MESA)

Perceived discrimination, recognized as a chronic psychosocial stressor, has adverse consequences on health. DNA methylation (DNAm) may be a potential mechanism by which stressors get embedded into the human body at the molecular level and subsequently affect health outcomes. However, relatively little is known about the effects of perceived discrimination on DNAm. To identify the DNAm sites across the epigenome that are associated with discrimination, we conducted epigenome-wide association analyses (EWAS) of three discrimination measures (everyday discrimination, race-related major discrimination, and non-race-related major discrimination) in 1,151 participants, including 565 non-Hispanic White, 221 African American, and 365 Hispanic individuals, from the Multi-Ethnic Study of Atherosclerosis (MESA). We conducted both race/ethnicity-stratified analyses as well as trans-ancestry meta-analyses. At false discovery rate of 10%, 7 CpGs and 4 differentially methylated regions (DMRs) containing 11 CpGs were associated with perceived discrimination exposures in at least one racial/ethnic group or in meta-analysis. Identified CpGs and/or nearby genes have been implicated in cellular development pathways, transcription factor binding, cancer and multiple autoimmune and/or inflammatory diseases. Of the identified CpGs (7 individual CpGs and 11 within DMRs), two CpGs and one CpG within a DMR were associated with expression of cis genes NDUFS5, AK1RIN1, NCF4 and ADSSL1. Our study demonstrated the potential influence of discrimination on DNAm and subsequent gene expression.

Validation of the International Trauma Interview (ITI) among treatment-seeking people with adverse childhood experiences in South Korea

Background: The International Trauma Interview (ITI) is a clinician-administered assessment that has been newly developed for the International Classification of Diseases (ICD-11) diagnoses of posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD).Objective: The current study evaluated the psychometric properties of the ITI for treatment-seeking people with adverse childhood experiences (ACE) in South Korea, with the aims of verifying the validity and reliability of ITI as well as examining the differentiation of ICD-11 CPTSD and borderline personality disorder (BPD).Methods: In total, data of 103 people were analysed. Clinical psychologists conducted the ITI and the structured interview for BPD. Along with the International Trauma Questionnaire (ITQ), self-report measurements on ACE, adulthood trauma, emotion dysregulation, dissociation, depression, adult attachment, BPD symptoms, self-harm, self-compassion, and quality of life were collected. A confirmatory factor analysis (CFA) was conducted to examine the factorial validity and a structural equation model (SEM) was used to evaluate the convergent and discriminant validity.Results: The CFA supported the second-order two-factor model of ICD-11 CPTSD. However, we determined that the alternatively suggested second-order two-factor model of reexperience avoidance combined PTSD and DSO described the data the best. As was hypothesized, ITI PTSD and DSO showed convergent and discriminant validity, and ITI DSO also showed distinctive features with BPD. Interrater reliability and composite reliability were both found to be acceptable. Agreement and consistency between ITQ and ITI were also fair although tentative.Conclusions: The ITI is determined to be a valid and reliable method for the assessment and diagnosis of ICD-11 PTSD and CPTSD, and it is considered to be promising for the differential diagnosis of BPD in South Korean treatment-seeking people with ACE. Future research should aim to assess the agreement between ITI and ITQ while also seeking alternative criteria for ITI PTSD across variant trauma memory features.

Maximizing expectancy violation and exposure outcomes in patients with PTSD

Background: It has been proposed that maximizing expectancy violation enhances the efficacy of exposure therapy. The clinical utility of expectancy violation remains unclear and it has not yet been studied in PTSD.Objective: We aimed to test whether explicitly focusing on expectancy violation leads to superior exposure outcomes.Method: Adult treatment-seeking patients with PTSD (N = 60) were randomly assigned to one 90-minute exposure session focusing on either expectancy violation or a control condition without an expectancy focus. Assessments occurred before the session and one week later, measuring changes in fear responses during a script-driven imagery task, and PTSD symptoms.Results: Using multilevel analyses, we found no between-condition differences. On average, fear responses to the imagery and PTSD symptoms decreased over time. The expectancy violation condition exhibited a greater decrease in threat appraisal, which appeared to mediate symptom reduction.Conclusions: We found no evidence that explicitly focusing on expectancy violation led to superior immediate effects. However, it may lead to more changes in expectancies which could affect symptom improvement over an extended period. Further research is needed to determine whether emphasizing expectancy violation in exposure therapy for PTSD is advantageous.

Mediated roles of oxidative stress and kidney function to leukocyte telomere length and prognosis in chronic kidney disease

BACKGROUND

Few studies have focused on the correlation between leukocyte telomere length (LTL) and cancer-related mortality or identified potential factors that mediate the relationship between LTL and mortality among chronic kidney disease (CKD) patients. Our study aimed to explore the associations between LTL and all-cause and cause-specific mortality and to identify the underlying mediators.

METHODS

CKD patients were obtained from the National Health and Nutrition Examination Survey (NHANES) 1999-2002. Cox regression analysis and restricted cubic spline analysis were used to explore the associations between LTL and all-cause or specific-cause mortality and their nonlinear connections. Stratified analyses were executed to assess the relationships among the different subgroups. The latent mediated factors were confirmed using mediation analysis. Sensitivity analyses were used to evaluate the robustness of our findings.

RESULTS

Longer LTL associated with the lower risk of all-cause mortality, cardiovascular disease (CVD) and cancer-related mortality, and U-shaped relationships were detected. Patients younger than 65 years with greater LTL or who had hypertension had better prognoses. Age and history of hypertension were associated with LTL and overall mortality. In addition, estimated glomerular filtration rate (eGFR), albumin, and total bilirubin mediated the association, and the proportions of indirect effects were 7.81%, 3.77%, and 2.50%, respectively. Six sensitivity analyses confirmed the robustness of our findings.

CONCLUSIONS

This study revealed that LTL was a protective factor for survival among patients with CKD and emphasized the mediating roles of oxidative stress and kidney function.

Gender differences in early posttraumatic stress disorder symptoms: a network analysis

Background: Despite known gender/sex differences in the prevalence of posttraumatic stress disorder (PTSD), potential differences in the associations among PTSD symptoms between men and women in the early post-trauma period are not well-characterized.Objective: This study utilized network analysis to assess potential differences in the associations among PTSD symptom clusters between men and women during the early post-trauma period.Method: We included n = 475 participants (57.5% self-identified women) who recently (≤2 months) experienced an interpersonal or motor vehicle potential traumatic event in the Netherlands. Past month PTSD symptoms were measured with the PTSD Checklist for DSM-5 (PCL-5) and composited according to the five-node PTSD symptom cluster dysphoric arousal model. We estimated the network as well as indices of centrality (strength and predictability) and assessed the stability of the modelled networks in subsamples of men (n = 202) and women (n = 273). We compared network structures using the Network Comparison Test (NCT).Results: Results largely demonstrated adequate correlation stability for the estimated network structures for women and men. For both men and women, avoidance symptoms were among the strongest nodes with greatest predictability in the networks. In men, anxious arousal additionally showed high strength whereas re-experiencing showed high predictability. In women, re-experiencing symptoms demonstrated both high strength and predictability. The NCT demonstrated nonsignificant differences in global network structure (M = 0.08, p = .054) and strength (S = .073, p = .067). Post hoc comparisons showed an association of re-experiencing symptoms with negative alterations in cognitions and mood in men but not women (E = .038, p = .005).Conclusion: Results demonstrated possible modest gender differences in aspects of network structure although most elements of the network structure were similar across genders. These results help to characterize gender differences in associations among PTSD symptom clusters during the early post-trauma period, which may inform the potential relevance of future gender-sensitive early intervention strategies to ameliorate the risk for long-term PTSD.

Association between renal mean perfusion pressure and prognosis in patients with sepsis-associated acute kidney injury: insights from the MIMIC IV database

OBJECTIVE

To investigate the association between renal mean perfusion pressure (MPP) and prognosis in sepsis-associated acute kidney injury (SA-AKI).

METHODS

Data were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Group-based trajectory modeling (GBTM) was applied to identify dynamic MPP patterns, while restricted cubic spline (RCS) curves were utilized to confirm the non-linear relationship between MPP and mortality. Cox regression analysis assessed the risk of mortality across different MPP levels, adjusting for potential confounders. Subgroup analyses and sensitivity analyses were conducted to ensure the robustness of the findings.

RESULTS

A total of 2318 patients with SA-AKI were stratified into five MPP trajectories by GBTM. Patients in Traj-1 and Traj-2, characterized by consistently low MPP (<60 mmHg), demonstrated markedly higher 90-d mortality (62.86% and 26.98%). RCS curves revealed a non-linear inverse relationship between MPP and 90-d mortality, identifying 60 mmHg as the optimal threshold. Patients with MPP ≤ 60 mmHg exhibited significantly elevated 90-d mortality compared to those with MPP > 60 mmHg (29.81% vs. 20.88%). Cox regression analysis established Traj-1 and Traj-2 as independent risk factors for increased mortality relative to Traj-3 (60-70 mmHg), with hazard ratios (HRs) of 4.67 (95%-CI 3.28-6.67) and 1.45 (95%-CI 1.20-1.76). MPP > 60 mmHg was significantly associated with reduced 90-d mortality (HR 0.65, 95%-CI 0.55-0.77). Subgroup and PSM analyses supported these findings.

CONCLUSIONS

Dynamic MPP trajectory serves as a valuable prognostic biomarker for SA-AKI. Early monitoring of MPP trends offers critical insights into renal perfusion management, potentially improving outcomes in SA-AKI.

Childhood maltreatment and non-suicidal self-injury: the mediating role of mentalization and depression

Background: Childhood maltreatment (CM) is recognized as one of the primary factors increasing the risk of non-suicidal self-injury (NSSI).Objectives: This study aims to further understand the impact of different types of CM on the mechanisms underlying NSSI risk by examining the potential mediating roles of mentalization and depression.Method: A self-report survey was conducted with 1645 Chinese youths (933 males, 712 females; mean age = 18.25, SD = 0.64) to evaluate their experiences of CM, depression, mentalization, and NSSI frequency over the past year. Structural equation modelling was utilized to examine the direct and indirect pathways linking CM to NSSI risk via mentalization and depression.Results: The study found that emotional abuse, physical abuse, mentalization, and depression had significant direct effects on NSSI risk. Moreover, mentalization and depression mediated the relationship between emotional abuse and NSSI risk, while emotional neglect and physical neglect indirectly influenced NSSI risk only through depression. Physical abuse had a significant direct effect on NSSI risk, whereas sexual abuse did not show any direct or indirect effects.Conclusions: The findings suggest that childhood emotional abuse has a markedly different impact compared to other forms of CM. Interventions focused on improving mentalization may be particularly effective in addressing the effects of emotional abuse, mitigating depression, and reducing the risk of NSSI.

Association between early heart rate trajectories in post-PCI STEMI patients and prognosis after hospital discharge

BACKGROUND

Timely percutaneous coronary intervention (PCI) is crucial for restoring myocardial blood supply in ST-segment elevation myocardial infarction (STEMI) patients, with the first 72 h being a critical period for early ventricular remodelling. The association between heart rate trajectories within this period and after hospital discharge outcomes in STEMI patients post-PCI remains unclear.

METHODS

We conducted a retrospective study involving STEMI patients who underwent successful PCI at three tertiary hospitals in Zhejiang Province, China. Heart rate data were collected every 8 h post-PCI through nursing records, along with intraoperative findings and biochemical markers. Using trajectory modelling, we identified heart rate patterns at 24, 48 and 72 h post-PCI, determined the optimal number of trajectory groups using Akaike information criterion (AIC) and Bayesian information criterion (BIC) criteria, and performed a minimum 3-month follow-up. Cox regression analysed the association between early heart rate trajectories and major adverse cardiovascular events (MACEs) post-discharge. The prognostic value of trajectory models was assessed using the area under the curve (AUC).

RESULTS

A total of 1257 patients were included, with an average follow-up duration of 28.72 ± 21.14 months and a mean age of 60.42 ± 14.19 years; 1013 (80.59%) were male. Growth mixture modelling identified four distinct heart rate trajectory groups at 24, 48 and 72 h post-PCI. Higher heart rate trajectories with rates greater than 80 bpm were strongly associated with MACEs, and the 72-hour heart rate trajectory showed a predictive value for MACEs (AUC = 0.745, 95% CI: 0.709-0.781).

CONCLUSIONS

Elevated heart rate trajectories exceeding 80 bpm within 72 h after PCI are associated with an increased risk of MACEs post-discharge. Heart rate management should be further emphasized in post-PCI STEMI patients.

Resveratrol alleviates depressive-like behavior via the activation of SIRT1/NF-κB signaling pathway in microglia

BACKGROUND

Currently, the pathogenesis of depression remains poorly understood, leading to many patients receiving ineffective treatment. Resveratrol has demonstrated beneficial effects in the prevention and treatment of depression. However, it remains unknown whether resveratrol administration can counteract depression-like behaviors by regulating the SIRT1/NF-κB signaling pathway.

METHODOLOGY/PRINCIPAL FINDINGS

Male C57BL/6 mice were randomly assigned to a control group, a depression group, and a resveratrol group. The depression model was established using chronic unpredictable mild stress (CUMS) for 5 weeks. Behavioral tests were conducted to assess depressive-like behaviors. The expression levels of SIRT1 and NF-κB in the hippocampus of mice and BV2 microglial cells were measured. After 5 weeks of modeling, the results indicated that mice in the depression group exhibited significant depressive-like behaviors and inhibited activation of the SIRT1/NF-κB signaling pathway. In contrast, resveratrol administration effectively reversed these changes. Results from in vitro experiments showed that LPS stimulation increased microglial activity and downregulated the SIRT1/NF-κB signaling pathway in microglia; however, resveratrol treatment mitigated these effects.

CONCLUSIONS/SIGNIFICANCE

Our findings suggested that resveratrol can alleviate CUMS-induced depression-like behaviors via the activation of the Sirt1/NF-κB pathway in microglia.

Drought-compounded stress and immune function in Kenyan pastoralist boys and girls occupying contrasting climate zones

BACKGROUND AND AIM

We provide ethnographic, photovoice, and psychosocial stress data (food and water insecurity, potentially traumatic events, stress biomarkers) documenting the joys, hazards, and stressors of adolescents engaging in climate-sensitive pastoralist livelihoods in a global climate change hot spot. We aim to holistically capture socio-environmental relationships characterised by climate sensitive livelihoods and forms of precarity exacerbated by climate change.

SUBJECTS AND METHODS

Qualitative and quantitative methods were integrated to understand the embodied toll of hazards that Samburu pastoralists faced based on a sample of 161 young people. Quantitatively, we tested for associations of psychosocial stressors with both psychological distress and cell-mediated immune function (assessed through differences in IgG antibodies to Epstein-Barr virus).

RESULTS

Qualitatively, young Samburu reported drought, food and water insecurity, wildlife encounters, and war exposure. Girls overall endorsed more posttraumatic stress symptoms, although boys reported relatively more stressors; girls overall and young people in the hotter subregion manifested more immune dysregulation.

CONCLUSION

In spite of important differences between climate subregions, the common elements throughout the Samburu pastoralist leanscape include food and water insecurity and overall precarity exacerbated by drought and climate change. Community-driven interventions are needed to reduce precarity for young people pursuing pastoralist livelihoods.

Validation of a clinician-administered diagnostic measure of ICD-11 PTSD and complex PTSD: the International Trauma Interview in a clinical sample of military veterans

Background: The International Trauma Interview (ITI) is the first clinician-administered diagnostic tool developed to assess posttraumatic stress disorder (PTSD) and Complex PTSD (CPTSD), both recently recognized in the ICD-11. The current study aims to test the construct and discriminant validity of the ITI in a population of treatment-seeking veterans.Method: 124 Danish veterans seeking psychological treatment were interviewed by a group of trained clinicians for ICD-11 PTSD and CPTSD before beginning treatment at the Military Psychological Department in the Danish Defense. A series of confirmatory factor models were estimated in order to identify the extent to which latent variable operationalizations provide potential explanations for the associations between symptoms.Results: Results indicate that symptoms of CPTSD, as measured by the ITI, are best represented by a single higher-order factor. We also found that a bifactor model provided adequate fit to the data. The commonly identified two-factor higher-order model was rejected due to the lack of discriminant validity between PTSD and DSO. The higher order model was found to explain associations between symptoms of CPTSD and symptoms of depression, stress, anxiety, and well-being.Conclusion: The ITI does not fit a two-factor higher-order model in a sample of treatment-seeking Danish veterans. Rather, a single higher order factor shows excellent fit, and is found to explain associations between ITI symptoms and other internalizing symptoms.

Heart failure subphenotypes based on mean arterial pressure trajectory identify patients at increased risk of acute kidney injury

BACKGROUND

Acute kidney injury (AKI) is a common complication in heart failure (HF) patients. Patients with heart failure who experience renal injury tend to have a poor prognosis. The objective of this study is to examine the correlation between the occurrence of AKI in heart failure patients and different mean arterial pressure (MAP) trajectories, with the goal of improving early identification and intervention for AKI.

METHODS

A retrospective study was conducted on patients with heart failure using data from the Medical Information Mart for Intensive Care IV (MIMIC-IV). We utilized the group-based trajectory modeling (GBTM) method to classify the 24-hour MAP change trajectories in heart failure patients. The occurrence of AKI within the first 7 days of intensive care unit (ICU) admission was considered the outcome. The impact of MAP trajectories on AKI occurrence in heart failure patients was analyzed using Cox proportional hazards models, competing risk models, and doubly robust estimation methods.

RESULTS

A cohort of 8,502 HF patients was analyzed, with their 24-hour MAP trajectories categorized into five groups: Low MAP group (Class 1), Medium MAP group (Class 2), Low-medium MAP group (Class 3), High-to-low MAP group (Class 4), and High MAP group (Class 5). The results from the doubly robust analysis revealed that Class 4 exhibited a significantly increased AKI risk than Class 3 (HR 1.284, 95% CI 1.085-1.521, p = 0.003; HR 1.271, 95% CI 1.074-1.505, p = 0.005). Conversely, the risks of Class 2 were significantly lower than those of Class 3 (HR 0.846, 95% CI 0.745-0.960, p = 0.009; HR 0.879, 95% CI 0.774-0.998, p = 0.047).

CONCLUSIONS

The 24-hour MAP trajectory in HF patients influences the risk of AKI. A rapid decrease in MAP (Class 4) is associated with a higher AKI risk, while maintaining MAP at a moderate level (Class 2) significantly reduces this risk. Therefore, closely monitoring MAP changes is crucial for preventing AKI in HF.

Antidepressant activity of flavones from traditional Chinese medicine: a meta-analysis

CONTEXT

Flavones, the key active components in Traditional Chinese Medicine (TCM), have demonstrated antidepressant activity. Given the numerous animal studies conducted, a systematic analysis is essential to provide a valuable reference for future research.

OBJECT

This study investigated the antidepressant activity of flavones based on animal models and summarized the underlying mechanisms.

METHODS

We systematically searched 7 bibliographic Databases as of August 12, 2023, such as Web of Science, PubMed, China National Knowledge Infrastructure, etc. The meta-analysis was performed using either the random or fixed-effect model, supplemented by trial sequential analysis (TSA). The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to assess the quality of evidence.

RESULTS

A total of 25 studies involving 458 mice were included, identifying five flavones (baicalin, baicalein, apigenin, luteolin, vitexin) with antidepressant activity. Compared to the control group, flavones significantly reduced immobility time in forced swimming and tail suspension tests. Flavones also decreased serum and hippocampal levels of interleukin (IL)-1β and tumor necrosis factor-alpha (TNF-α), reduced nuclear factor kappa B (NF-κB) levels, and increased brain-derived neurotrophic factor (BDNF) levels. Relative to the positive group, flavones raised IL-6, sucrose preference rate, and corticosterone (CORT) levels, with no significant differences in other factors. The TSA showed the efficacy of flavones for treating depression with adequate 'information size' for the primary outcome.

CONCLUSIONS

The results demonstrate that flavones exert protective effects against depression in mice, primarily by stimulating neurotrophic factors and modulating inflammatory pathways. These findings emphasize their potential as promising candidates for the development of novel antidepressant therapies.

Insights into depression prediction, likelihood, and associations in children and adolescents: evidence from a 12-years study

Purpose

The severity of depression among young Australians cannot be overstated, as it continues to have a profound impact on their mental health and general wellbeing. This study used machine learning (ML) algorithms to analyse longitudinal data, identifying key features to predict depression, assess future risk, and explore age-specific behaviours that contribute to its progression over time. The results emphasize the significance of early detection to prevent unfavourable consequences and shed light on the alterations in depressive symptoms during various stages of development.

Methods

Three widely regarded ML techniques-random forest (RF), support vector machine (SVM), and logistic regression (LR)-are being applied and compared with a longitudinal data analysis. Additionally, the Apriori algorithm is being utilized to explore potential relationships between health, behaviour, and activity issues with depression among different age groups (10-17).

Results

The analysis results indicate that the RF model is performing exceptionally well in diagnosing depression, with a 94% accuracy rate and weighted precision of 95% for non-depressed and 88% for depressed cases. In addition, the LR model shows promising results, achieving an 89% accuracy rate and 91% weighted precision. Moreover, insights from the Apriori algorithm underscore the significance of early detection by examining potential associations between health, behaviour, and activity problems and depression across diverse age groups.

Conclusion

Combining early screening programs with the RF model and the Apriori algorithm is crucial for understanding depression and developing effective prevention strategies. Emphasizing Apriori's factors and regularly updating strategies with new information will enhance depression management and prevention.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13755-025-00335-9.

Factors influencing premature ovarian insufficiency: a systematic review and meta-analysis

BACKGROUND

Premature ovarian insufficiency (POI) has multiple contributing factors. This study aims to systematically evaluate these factors and their mechanisms, identify high-risk groups, support early intervention, and provide a basis for future research.

METHODS

Following the PRISMA guidelines, a search was conducted across 11 Chinese and English databases, including PubMed, Embase, and the Cochrane Library, up to January 2024. Observational studies on patients with ovarian insufficiency were included. A meta-analysis using Stata 14 was performed to calculate odds ratios (OR) and 95% confidence intervals (CIs) for factors influencing POI.

RESULTS

A total of 38 studies with 4,968 cases and 5,158 controls were included. The following factors were identified as risk factors for POI: abnormal menstruation (OR = 2.707, 95% CI: 1.705-4.299), hair dyeing (OR = 4.725, 95% CI: 2.914-7.660), chemical exposure (OR = 3.314, 95% CI: 2.283-4.811), Type A personality (OR = 6.106, 95% CI: 4.696-7.939), survival stress (OR = 3.292, 95% CI: 2.380-4.555), sleep deprivation (OR = 3.340, 95% CI: 2.363-4.721), bad mood (OR = 4.654, 95% CI: 2.783-7.781), smoking history (OR = 2.748, 95% CI: 1.928-3.917), family history of POI (OR = 4.338, 95% CI: 2.422-7.768), history of mumps (OR = 5.802, 95% CI: 3.460-9.730), number of abortions (OR = 2.292, 95% CI: 1.887-2.785), and history of pelvic surgery (OR = 4.836, 95% CI: 3.066-7.628). Physical exercise (OR = 0.270, 95% CI: 0.106-0.692) and vegetable intake (OR = 0.434, 95% CI: 0.337-0.560) were protective factors. Sensitivity analysis and publication bias tests confirmed robustness.

CONCLUSIONS

POI is related with abnormal menstruation, hair dyeing, chemical exposure, Type A personality, survival stress, sleep deprivation, bad mood, smoking history, family history of POI, history of mumps, number of abortions, and history of pelvic surgery. Physical exercise and vegetable intake may provide protection. These findings inform clinical strategies for early identification and management.

The role of prenatal stress and maternal trauma responses in predicting children's mental health during war

Background: The negative effects of prenatal stress on children's development and the buffering effects of maternal behaviour are well documented. However, specific maternal responses to trauma, particularly among families experiencing cumulative stressors during pregnancy and early childhood, remain less understood.Objective: This study investigated the interplay between prenatal stress in the context of the coronavirus disease 2019 (COVID-19) pandemic and consequent maternal trauma responses and children's difficulties in the context of war-related trauma.Methods: We recruited 318 pregnant women in Israel during the first wave of the COVID-19 pandemic (Time 1). Prenatal depression, anxiety, and COVID-related stress symptoms were assessed. When children were approximately 3.5 years old (SD = 0.02), the mothers were asked to report on parental responses related to the ongoing war and their child's emotional and behavioural difficulties (Time 2). Structural equation modelling was used to examine how maternal trauma responses mediate the association between prenatal stress-related mental health symptoms and children's difficulties during war.Results: Maternal prenatal depressive, anxious, and COVID-19-related stress symptoms predicted maladaptive maternal trauma responses during the war, which in turn were associated with increased emotional and behavioural problems in their children. Among the specific maternal trauma-related responses examined, cognitive avoidance and overprotectiveness were the only behavioural responses during the war significantly associated with children's difficulties.Conclusions: Our study highlights the impact of pandemic-related prenatal stress on maternal responses and children's difficulties during war, emphasizing the importance of identifying at-risk families as well as developing targeted interventions that mitigate negative parenting responses, particularly avoidance and overprotection.

Autism spectrum disorder: difficulties in diagnosis and microRNA biomarkers

We performed a PubMed search for microRNAs in autism spectrum disorder that could serve as diagnostic biomarkers in patients and selected 17 articles published from January 2008 to December 2023, of which 4 studies were performed with whole blood, 4 with blood plasma, 5 with blood serum, 1 with serum neural cell adhesion molecule L1-captured extracellular vesicles, 1 with blood cells, and 2 with peripheral blood mononuclear cells. Most of the studies involved children and the study cohorts were largely males. Many of the studies had performed microRNA sequencing or quantitative polymerase chain reaction assays to measure microRNA expression. Only five studies had used real-time polymerase chain reaction assay to validate microRNA expression in autism spectrum disorder subjects compared to controls. The microRNAs that were validated in these studies may be considered as potential candidate biomarkers for autism spectrum disorder and include miR-500a-5p, -197-5p, -424-5p, -664a-3p, -365a-3p, -619-5p, -664a-3p, -3135a, -328-3p, and -500a-5p in blood plasma and miR-151a-3p, -181b-5p, -320a, -328, -433, -489, -572, -663a, -101-3p, -106b-5p, -19b-3p, -195-5p, and -130a-3p in blood serum of children, and miR-15b-5p and -6126 in whole blood of adults. Several important limitations were identified in the studies reviewed, and need to be taken into account in future studies. Further studies are warranted with children and adults having different levels of autism spectrum disorder severity and consideration should be given to using animal models of autism spectrum disorder to investigate the effects of suppressing or overexpressing specific microRNAs as a novel therapy.

MicroRNAs as potential biomarkers for diagnosis of post-traumatic stress disorder

Post-traumatic stress disorder is a mental disorder caused by exposure to severe traumatic life events. Currently, there are no validated biomarkers or laboratory tests that can distinguish between trauma survivors with and without post-traumatic stress disorder. In addition, the heterogeneity of clinical presentations of post-traumatic stress disorder and the overlap of symptoms with other conditions can lead to misdiagnosis and inappropriate treatment. Evidence suggests that this condition is a multisystem disorder that affects many biological systems, raising the possibility that peripheral markers of disease may be used to diagnose post-traumatic stress disorder. We performed a PubMed search for microRNAs (miRNAs) in post-traumatic stress disorder (PTSD) that could serve as diagnostic biomarkers and found 18 original research articles on studies performed with human patients and published January 2012 to December 2023. These included four studies with whole blood, seven with peripheral blood mononuclear cells, four with plasma extracellular vesicles/exosomes, and one with serum exosomes. One of these studies had also used whole plasma. Two studies were excluded as they did not involve microRNA biomarkers. Most of the studies had collected samples from adult male Veterans who had returned from deployment and been exposed to combat, and only two were from recently traumatized adult subjects. In measuring miRNA expression levels, many of the studies had used microarray miRNA analysis, miRNA Seq analysis, or NanoString panels. Only six studies had used real time polymerase chain reaction assay to determine/validate miRNA expression in PTSD subjects compared to controls. The miRNAs that were found/validated in these studies may be considered as potential candidate biomarkers for PTSD and include miR-3130-5p in whole blood; miR-193a-5p, -7113-5p, -125a, -181c, and -671-5p in peripheral blood mononuclear cells; miR-10b-5p, -203a-3p, -4488, -502-3p, -874-3p, -5100, and -7641 in plasma extracellular vesicles/exosomes; and miR-18a-3p and -7-1-5p in blood plasma. Several important limitations identified in the studies need to be taken into account in future studies. Further studies are warranted with war veterans and recently traumatized children, adolescents, and adults having PTSD and use of animal models subjected to various stressors and the effects of suppressing or overexpressing specific microRNAs.

Systematic review and meta-analysis of early visual processing, social cognition, and functional outcomes in schizophrenia spectrum disorders

Non-affective psychotic disorders are marked by cognitive and sensory processing abnormalities, including in early visual processing and social cognition. Understanding the relationships between these deficits and their impact on daily-life functional outcomes may help to improve outcomes in affected individuals. This systematic review and meta-analysis aimed to summarise the existing evidence on the relationships between early visual processing, social cognition, and functional outcomes, and to assess the evidence regarding the mediating role of social cognition in the association between early visual processing and functional outcomes in individuals with schizophrenia spectrum disorders. A comprehensive search across five databases identified 364 potentially eligible studies, with eight articles meeting all inclusion criteria. Meta-analytic techniques were employed to synthesise effect sizes and assess a meta-mediation model. Three random-effects meta-analyses revealed significant associations between all three domains of interest. Social cognition partially mediated the relationship between early visual processing and functional outcomes. The direct effect of early visual processing on functional outcomes remained significant, albeit with a reduced effect size. The findings suggest that interventions targeting both early visual processing and social cognition concurrently may improve functional outcomes more effectively than focusing on either domain alone.

Influence of binge drinking on the resting state functional connectivity of university Students: A follow-up study

Binge Drinking (BD) is characterized by consuming large amounts of alcohol on one occasion, posing risks to brain function. Nonetheless, it remains the most prevalent consumption pattern among students. Cross-sectional studies have explored the relationship between BD and anomalies in resting-state functional connectivity (RS-FC), but the medium/long-term consequences of BD on RS-FC during developmental periods remain relatively unexplored. In this two-year follow-up study, the impact of sustained BD on RS-FC was investigated in 44 college students (16 binge-drinkers) via two fMRI sessions at ages 18-19 and 20-21. Using a seed-to-voxel approach, RS-FC differences were examined in nodes of the main brain functional networks vulnerable to alcohol misuse, according to previous studies. Group differences in RS-FC were observed in four of the explored brain regions. Binge drinkers, compared to the control group, exhibited, at the second assessment, decreased connectivity between the right SFG (executive control network) and right precentral gyrus, the ACC (salience network) and right postcentral gyrus, and the left amygdala (emotional network) and medial frontal gyrus/dorsal ACC. Conversely, binge drinkers showed increased connectivity between the right Nacc (reward network) and four clusters comprising bilateral middle frontal gyrus (MFG), right middle cingulate cortex, and right MFG extending to SFG. Maintaining a BD pattern during critical neurodevelopmental years impacts RS-FC, indicating mid-to-long-term alterations in functional brain organization. This study provides new insights into the neurotoxic effects of adolescent alcohol misuse, emphasizing the need for longitudinal studies addressing the lasting consequences on brain functional connectivity.

Conductive and flexible gold-coated polylactic acid nanofiber-based electrochemical aptasensor for monitoring cortisol level in sweat and saliva

Conductive nanofibers can exhibit excellent mechanical properties such as flexibility, elasticity, porosity, large surface area-to-volume ratio, etc making them suitable for a wide range of applications including biosensor development. Their large surface area provides more active sites for immobilization of large amount of bioreceptors enabling more interaction sites with the target analytes, enhancing sensitivity and detection capabilities. However, engineering conductive nanofibers with such excellent properties is challenging limiting their effective deployment for intended applications. In this research, we propose a novel approach for easy fabrication of highly conductive and flexible nanofiber leveraging the electrospinning, electroless deposition and have applied it to cortisol monitoring; a common biomarker for stress which is often quantified through enzyme-linked immunoassays using blood or saliva samples. By adopting the nanofiber sheet as a transducer for aptamer immobilization and cortisol sensing our developed biosensor was able to detect cortisol in buffer, artificial saliva, and artificial sweat within five minutes, from 10 pg/mL to 10 µg/mL (27.59 pM to 27.59 µM) with a low detection limit of 1 pg/ml (2.76 pM). The Au-coated PLA nanofiber-based electrochemical biosensor's flexibility allows for compact manufacturing, rendering it an optimal choice for integration into point-of-care testing and wearable systems.

Peripheral mitochondrial DNA as a neuroinflammatory biomarker for major depressive disorder

In the pathogenesis of major depressive disorder, chronic stress-related neuroinflammation hinders favorable prognosis and antidepressant response. Mitochondrial DNA may be an inflammatory trigger, after its release from stress-induced dysfunctional central nervous system mitochondria into peripheral circulation. This evidence supports the potential use of peripheral mitochondrial DNA as a neuroinflammatory biomarker for the diagnosis and treatment of major depressive disorder. Herein, we critically review the neuroinflammation theory in major depressive disorder, providing compelling evidence that mitochondrial DNA release acts as a critical biological substrate, and that it constitutes the neuroinflammatory disease pathway. After its release, mitochondrial DNA can be carried in the exosomes and transported to extracellular spaces in the central nervous system and peripheral circulation. Detectable exosomes render encaged mitochondrial DNA relatively stable. This mitochondrial DNA in peripheral circulation can thus be directly detected in clinical practice. These characteristics illustrate the potential for mitochondrial DNA to serve as an innovative clinical biomarker and molecular treatment target for major depressive disorder. This review also highlights the future potential value of clinical applications combining mitochondrial DNA with a panel of other biomarkers, to improve diagnostic precision in major depressive disorder.

Xenon gas as a potential treatment for opioid use disorder, alcohol use disorder, and related disorders

Xenon gas is considered to be a safe anesthetic and imaging agent. Research on its other potentially beneficial effects suggests that xenon may have broad efficacy for treating health disorders. A number of reviews on xenon applications have been published, but none have focused on substance use disorders. Accordingly, we review xenon effects and targets relevant to the treatment of substance use disorders, with a focus on opioid use disorder and alcohol use disorder. We report that xenon inhaled at subsedative concentrations inhibits conditioned memory reconsolidation and opioid withdrawal symptoms. We review work by others reporting on the antidepressant, anxiolytic, and analgesic properties of xenon, which could diminish negative affective states and pain. We discuss research supporting the possibility that xenon could prevent analgesic- or stress-induced opioid tolerance and, by so doing could reduce the risk of developing opioid use disorder. The rapid kinetics, favorable safety and side effect profiles, and multitargeting capability of xenon suggest that it could be used as an ambulatory on-demand treatment to rapidly attenuate maladaptive memory, physical and affective withdrawal symptoms, and pain drivers of substance use disorders when they occur. Xenon may also have human immunodeficiency virus and oncology applications because its effects relevant to substance use disorders could be exploited to target human immunodeficiency virus reservoirs, human immunodeficiency virus protein-induced abnormalities, and cancers. Although xenon is expensive, low concentrations exert beneficial effects, and gas separation, recovery, and recycling advancements will lower xenon costs, increasing the economic feasibility of its therapeutic use. More research is needed to better understand the remarkable repertoire of effects of xenon and its potential therapeutic applications.

Gender differences in cognitive performance among young adults with first-episode schizophrenia in China

Background

Individuals with schizophrenia exhibit distinctive patterns of cognitive impairments, which pose difficulties in patients' everyday functionality and reduce patients' quality of life. Previous research suggests that many demographic variables, such as gender and age, influence the cognitive performance profiles of schizophrenia patients; however, the gender differences in neurocognitive dysfunction among first-episode schizophrenia (FES) patients remain less clear.

Methods

In this cross-sectional study, we compared the cognitive performance of FES patients to that of healthy controls (HC), with a specific focus on gender differences within the Chinese population aged under 35 years. Cognitive performance was assessed using the raw scores from the MATRICS Consensus Cognitive Battery (MCCB).

Results

FES patients show lower overall cognitive impairment across all MCCB domains compared to HCs. Significant sex effects were observed: females outperformed males in aspects of speed of processing and verbal learning in FES, while males outperformed females in parts of working memory and reasoning and problem solving among HC patients. In both FES and HC groups, females exceeded males in visual learning. Moreover, employing a three-way multivariate analysis of variance (MANOVA) displayed interaction effects between gender and clinical diagnosis in areas of speed of processing and verbal learning.

Conclusions

This suggests that schizophrenia and biological sex may jointly influence performance in these domains, emphasizing the need for early intervention and gender-sensitive approaches to address cognitive deficits in schizophrenia.

Efficacy and neural mechanisms of approach bias modification training in patients with internet gaming disorder: A randomized clinical trial

BACKGROUND

Internet gaming disorder (IGD) is a prevalent behavioral addiction linked to neural alterations and significant negative outcomes. Approach bias modification (ApBM) training aims to correct imbalances in reflective and impulsive systems, reducing cravings and addictions. This study examined the effectiveness of ApBM training in IGD patients and explored the brain response changes associated with the intervention.

METHODS

Fifty-one patients with IGD were randomly assigned to an ApBM group (n = 26) or a sham-ApBM group (n = 25). Resting-state functional magnetic resonance imaging scans and behavioral assessments, including Internet Addiction Test scores, DSM-5 criteria, game craving levels, and automatic approach bias, were conducted before and after a ten-day training with five sessions. An analysis of variance (ANOVA) was employed to assess time (pre- and post-test) × group (ApBM group vs. sham-ApBM group) effects on behavioral measures. Functional connectivity (FC) analyses focused on regions of interest identified through regional homogeneity and degree centrality calculations. Additionally, we analyzed the relationship between neuroimaging variables and intervention outcomes.

RESULTS

Significant group × time interactions were found for automatic approach bias, Internet Addiction Test scores, DSM-5 criteria, and game craving levels. Post-training, these measures significantly decreased in the ApBM group but showed no significant changes in the sham-ApBM group. FC analysis revealed increased connectivity within executive control regions, enhanced connectivity between executive control and reward-related regions, and decreased connectivity within reward-related regions, exclusively in the ApBM group.

CONCLUSIONS

ApBM training effectively reduces gaming cravings in patients with IGD, enhancing executive control and mitigating impulsive behaviors.

Comparing psychiatric symptom networks between individuals in resilience and non-resilience trajectories of adaptation amid the global pandemic

OBJECTIVE

The current study compared symptom networks between individuals exhibiting resilience and non-resilience trajectories of adaptation two years after the COVID-19 outbreak.

METHOD

A population-representative sample (N = 906) reported symptoms of anxiety and depression in February-July 2020 (T1), March-August 2021 (T2), and September 2021-February 2022 (T3), as well as symptoms of post-traumatic stress disorder (PTSD) and adjustment disorder (AD) at T3. After differentiating between individuals with resilience and non-resilience trajectories using growth mixture modeling, network analyses were conducted to investigate group differences in T3 network symptoms (undirected and directed).

RESULTS

Despite non-significant group differences (M = 0.184, p = .380; S = 0.096, p = .681), distinctive qualitative characteristics were observed between networks. Difficulty relaxing was identified as the single root cause in the more diffused resilience network, with anxiety and depressive symptoms as additional starting points in the non-resilience network, which was more interconnected into clusters with clear-cut diagnostic boundaries. Sad mood demonstrated a transdiagnostic communicative role across common mental disorders.

CONCLUSION

Our results contribute to the understanding of anxiety-depression-PTSD-AD symptom networks in resilient and non-resilient individuals by highlighting the consequences of heterogeneity in adaptation capacity in the development of pandemic-related psychopathology.

An association study of depressive symptoms in adult couples over 50 years of age

BACKGROUND

Depression can lead to reduced physical activity, reduced quality of life, and self-sadness or even suicide, resulting in a huge burden of disease and financial loss.

OBJECTIVE

To study the associated factors of depressive symptoms in adult couples over the age of 50.

METHODS

The study collected data from the Survey of Health, Ageing and Retirement in Europe (SHARE) in 2013, 2015, 2017 and 2019/2020, and extracted couples over the age of 50. Logistic regression was used to analyze the associated factors of depressive symptoms in couples.

RESULTS

Binary Logistic regression showed the husbands' age (OR: 1.41, 95%CI: (1.11, 1.80)) and social activities (OR: 0.60, 95%CI: (0.45, 0.79)) were associated with depressive symptoms in wives. Wives' education level (OR: 0.62, 95%CI: (0.46, 0.85)), life satisfaction (OR: 0.57, 95%CI: (0.39, 0.84)) and number of chronic diseases (OR: 1.38, 95%CI: (1.10, 1.73)) were associated with depressive symptoms in husbands. Multinomial logistic regression found that couple's age "≥ 65 years" (OR: 1.45, 95%CI: (1.11, 1.90)), "low" education level (OR: 1.64, 95%CI: (1.07, 2.52)), self-rated health "good" (OR: 0.48, 95%CI: (0.29, 0.80)), life satisfaction "very satisfied" (OR: 0.48, 95%CI: (0.31, 0.75)) and "having" social activities (OR: 0.34, 95%CI: (0.19, 0.60)) were associated with the risk of depressive symptoms in couples. Having "≥ 2" chronic diseases (OR: 1.94, 95%CI: (1.22, 3.10)) was also associated with depressive symptoms in couples.

CONCLUSION

Age, education level, social activities, life satisfaction, self-rated health and number of chronic diseases were associated with depressive symptoms in both individuals and couples.

Emotional stimulated speech-based assisted early diagnosis of depressive disorders using personality-enhanced deep learning

BACKGROUND

Early diagnosis of depression is crucial, and speech-based early diagnosis of depression is promising, but insufficient data and lack of theoretical support make it difficult to be applied. Therefore, it is valuable to combine psychiatric theories, collect speech recognition data for depression, and develop a practicable recognition method for depression.

METHODS

In this study, 24 patients with major depressive disorders (MDDs) and 36 healthy controls (HCs) were recruited to participate in a multi-task speech experiment. Descriptive statistics and tests of variance were used to analyze subjects' personality and speech changes. Subsequently, the speech task with the most depressive cues was explored using the Bidirectional Long - Short Term Memory (Bi-LSTM) algorithm, on which a personality-assisted multitasking deep model, i.e., multi-task attentional temporal convolutional network model (TCN-MTA).

RESULTS

Statistical analyses of speech duration showed that the fable reading, neutral stimulus, and negative stimulus tasks had significant differences on subjects' speech duration, and the negative stimulus task had significant differences between the depressed and control groups (p < 0.001, 0.03, 0.04). Notably, the Big Five personality emotional stability scores were significantly different between the depressed and control groups (0.03). Depression was best identified using Bi-LSTM in negative (Youden index = 0.44) and positive stimulus speech (Youden index = 0.42). Further, the specificity of 0.72 and sensitivity of 0.87 for recognizing depression in negative stimulus speech using our proposed TCN-MTA outperforms existing methods.

LIMITATIONS

The sample size enrolled in this study is higher than the minimum sample size calculated through G-Power 3.1, but the sample size in this study is still small.

CONCLUSION

The proposed deep learning-based personality-assisted multitasking method could accurately recognize major depression, which demonstrated the potential of the method based on the fusion of specialized theories and artificial intelligence.

The impact of childhood emotional abuse and depressive symptoms on sleep macro-architecture and cortical thickness

BACKGROUND

Adverse childhood events and especially emotional abuse (EA) is consistently associated with poor psychiatric outcomes in adulthood, with depressive symptoms being one of the most prevalent. Both EA and depression are frequently associated with poorer sleep quality and cortical structural abnormalities. Interestingly, some individuals who experienced early-life EA are resilient against the development of psychiatric illness in adulthood and are believed to possess distinct neurobiology that confer more effective coping mechanisms.

METHODS

682 subjects from a population-based cohort underwent polysomnography (PSG), whole-body magnetic resonance imaging (MRI) and completed the Childhood Trauma Questionnaire (CTQ) and Patient Health Questionnaire (PHQ-9). Linear regressions were used to model joint EA and depressive symptoms effects with sleep macro-architecture and cortical thickness; and path analyses were used to investigate mediation effects.

RESULTS

Considering depressive symptoms as a product variable with EA (EA×depression), we observed the strongest effect in EA×depression with percentage spent in SWS (%SWS), where %SWS increased with EA in non-depressed subjects. We observed increased thicknesses in three cortical regions in emotionally-abused, non-depressed individuals from structural MRI. Mediation analysis demonstrated that %SWS significantly mediated the association of EA×depression with cortical thickness in two of the three regions.

LIMITATIONS

We are not able to infer any causal role of sleep in our cross-sectional design. Self-report questionnaires are also subject to recall-bias.

CONCLUSIONS

Higher regional cortical thicknesses in emotionally-abused, non-depressed individuals can partially be explained by increased %SWS, suggesting a potentially protective role of SWS against brain volume loss associated with EA and depression.

Esketamine alleviates cognitive impairment signs induced by modified electroconvulsive therapy in a depression rat model via the KLF4/p38 MAPK pathway

BACKGROUND

Depression is a common and serious psychiatric disorder with significant impacts on individuals. Modified electroconvulsive therapy (MECT) is an established treatment for severe and treatment-resistant depression, but its cognitive side effects, particularly memory impairments, limit its use. Esketamine (ESK), an FDA-approved antidepressant, has shown neuroprotective effects. However, its role in mitigating MECT-induced cognitive deficits remains unexplored. This study investigates whether ESK could alleviate MECT-induced signs of cognitive impairments in a rat model of depression and explores the underlying mechanisms.

METHODS

Male Sprague-Dawley rats were exposed to chronic unpredictable mild stress (CUMS) model to induce depressive-like behaviors. Rats were then subjected to MECT, ESK treatment, or both. Depression-like behaviors and cognitive functions were evaluated using various tests. Molecular and cellular assays were performed to assess hippocampal neuronal apoptosis, inflammation, and synaptic plasticity, with a focus on the Krüppel-like factor 4 (KLF4) and p38 MAPK signaling pathways.

RESULTS

MECT treatment significantly alleviated depressive-like symptoms but exacerbated cognitive impairments, hippocampal neuronal apoptosis, and neuroinflammation. ESK co-treatment improved depressive behaviors while reversing MECT-induced cognitive deficits, reducing hippocampal apoptosis, and decreasing inflammatory cytokine levels. Furthermore, ESK enhanced synaptic plasticity and upregulated KLF4 expression, which in turn inhibited the activation of the p38 MAPK pathway. Functionally, knockdown of KLF4 diminished the neuroprotective effects of ESK, confirming its critical role in mediating cognitive protection.

CONCLUSIONS

Esketamine mitigates METC-induced cognitive impairment in the animal model, by upregulating KLF4, which inhibits the p38 MAPK pathway, offering a potential therapeutic strategy for improving cognitive outcomes in patients undergoing ECT.

Prevalence and network structure of depression, anxiety and adverse doctor-patient relationship risks among patients with physical diseases: A cross-sectional study

BACKGROUND

Mental health issues among patients with physical diseases are increasingly common. This study investigated the prevalence of depression, anxiety, and adverse doctor-patient relationship risks (ADRR) among patients with physical diseases, and the central and bridge symptoms of this network structure.

METHODS

A total of 14,344 patients with physical diseases enrolled in this survey. The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Psychological Safety Questionnaire were used to evaluate anxiety, depression, and ADRR. The "qgraph" package in R 4.4.3 was used to construct a network model to identify central and bridge symptoms.

RESULTS

The prevalence rates of depression, anxiety, and ADRR were found to be 9.52 % (95 % confidence interval (CI): 9.04-10.00 %), 19.35 % (95 % CI: 18.71-20.00 %), and 4.29 % (95 % CI: 3.96-4.62 %), respectively. Within the network structure, the central symptoms identified were 'Sad mood,' 'Restlessness,' and 'Excessive worry,' which also served as the bridge symptoms. The flow network analysis revealed that ADRR exhibited the strongest associations with 'Anhedonia', 'Restlessness', and 'Suicidal ideation'. Additionally, 'Suicidal ideation' shows strongest correlations with 'Guilt', 'Concentration', and 'Restlessness'.

LIMITATION

The generalizability of the study's findings is constrained, as the sample consisted exclusively of inpatients, potentially limiting applicability to non-hospitalized individuals with physical illnesses.

CONCLUSION

This study provides novel insights into the comorbidity of depression, anxiety, and ADRR at the symptom level in patients with physical diseases through the application of network analysis. The identification of bridge symptoms highlights potential targets for interventions aimed at addressing the comorbidity among these disorders.

The mediating effect of the striatum-based connectivity on the association between high-sensitivity C-reactive protein and anhedonia in adolescents with depressive disorder

BACKGROUND

The potential pairwise connections among high-sensitivity C-reactive protein (hs-CRP), striatum-based circuits, and anhedonia in adolescents with depressive disorder are not clear. This study aimed to explore whether hs-CRP levels in adolescents with depressive disorder influence anhedonia via alterations of striatum-based functional connectivity (FC).

METHODS

A total of 201 adolescents (92 with depressive episodes with anhedonia (anDE), 58 with DE without anhedonia (non-anDE), and 51 healthy controls (HCs)) underwent resting-state functional magnetic resonance imaging (fMRI) and completed the anhedonia subscale of the Children's Depression Inventory (CDI). hs-CRP levels were measured from peripheral blood samples in all DE patients.

RESULTS

Compared with HCs, the anDE and non-anDE groups showed increased FC between the left dorsal caudate putamen (DCP_L) and bilateral cerebellum crus I, and decreased FC between the left ventral rostral putamen (VRP_L) and right parahippocampal cortex (PHC) (all p < 0.05). Only the non-anDE group exhibited increased FC between the right visual cortex (VC_R) and left cerebellum VI, VC_R and right fusiform gyrus (FG), and the left visual cortex (VC_L) and right inferior temporal gyrus (ITG) compared to HCs (all p < 0.05). Compared to the non-anDE group, the anDE group showed reduced FC between the VC_R and left cerebellum VI and between the DCP_L and right superior frontal gyrus (SFG) (all p < 0.05). Multiple regression analysis revealed that the FC between DCP_L and right SFG negatively predicted anhedonia severity (β = -0.288, p = 0.007) in the anDE group. Although hs-CRP levels had no direct effect for anhedonia, FC between the DCP_L and right SFG fully mediated the relationship between hs-CRP and anhedonia in the anDE group (effect = 0.184, Bootstrapping 95 % CI = 0.0156, 0.436).

CONCLUSION

The findings suggest that hs-CRP influences anhedonia through a fully mediated pathway involving alterations in the frontostriatal network, contributing to a greater understanding of the neurobiological mechanisms underlying anhedonia.

Optimal sexual frequency may exist and help mitigate depression odds in young and middle-aged U.S. citizens: A cross-sectional study

BACKGROUND

While sexual activity is known to benefit physical health, its connection to psychological well-being is less studied. We hypothesized that lower self-reported sexual frequency would be independently associated with higher odds of depression, as assessed by the Patient Health Questionnaire-9 (PHQ-9).

METHODS

We included 15,794 U.S. adults aged 20-59, reporting sexual frequency and complete PHQ-9 scores, from the National Health and Nutrition Examination Survey (2005-2016). Logistic regression models evaluated the independent association between sexual frequency and depression, while restricted cubic spline models explored potential non-linear associations.

RESULTS

The analysis revealed a significant negative association between sexual frequency and the odds of depression. Compared to those engaging in sexual activity less than once per month, participants reporting sexual activity once per month but less than once per week (OR: 0.58; 95 % CI: 0.48-0.70) and at least once per week (OR: 0.6; 95 % CI: 0.51-0.69) had lower odds of depressive symptoms. The restricted cubic spline model indicated a saturation effect (P for nonlinearity = 0.002), suggesting an optimal sexual frequency of 52 to 103 times per year (1-2 times per week) to reduce depression odds.

CONCLUSION

We revealed a significant negative association between self-reported sexual frequency and the odds of depression. A sexual frequency of 1-2 times per week showed the greatest protective effects on psychological well-being and may serve as a reference standard for mental health evaluation and monitoring during depression treatment. Further research is needed to determine directionality, causality, and potential modifiers of this association.

A comparison of objective and subjective measures of physical activity, sedentary and sleep behaviors between persons with and without depressive symptoms

BACKGROUND

Major Depressive Disorder (MDD) is characterized by negative recall biases, which may impact how individuals with depressive symptoms report physical activity (PA), sedentary, and sleep behaviors. Additionally, there are discrepancies between subjective and objective behaviors in MDD. Thus, the current study investigated whether individuals with depressive symptoms differ in their subjective and objective PA, sedentary, and sleep behaviors, and whether the magnitude of these discrepancies differ from those in individuals without depressive symptoms.

METHODS

Participants from the 2011-2014 National Health and Nutrition Examination Survey (N = 8367; Ndepressed = 762) with one-week of passively-collected, wrist worn actigraphy data and self-reported questionnaires assessing PA, sedentary, and sleep behaviors were analyzed.

RESULTS

Three negative binomial models investigated the effects of group, measurement type, and their interaction on PA, sedentary, and sleep behaviors. Individuals with depressive symptoms exhibited lower PA and sleep than individuals without depressive symptoms but did not differ in sedentary behaviors. Measurement type differed across all models: self-reported PA and sleep were lower, and self-reported sedentary behaviors were greater, than objective measurements. The interaction was significant only for PA; whereas objective PA was greater than subjective measurements for all individuals, the difference was far greater for individuals with depressive symptoms.

LIMITATIONS

The absence of a clinically depressed sample and current manner of assessing subjective and objective measures may limit our generalizability and conclusions.

CONCLUSION

Our study highlights discrepancies in objective and subjective reports across domains and emphasizes the importance of incorporating objective measurements to improve psychopathology assessment.

Association between adverse perinatal events and postpartum depressive symptoms in a North American prospective preconception cohort study

BACKGROUND

Identifying risk factors for postpartum depression (PPD) is critical to inform early intervention efforts. This study investigated the impact of adverse perinatal events on PPD.

METHODS

We analyzed data from the Pregnancy Study Online (PRESTO), a North American prospective preconception cohort study. Participants (N = 3559) aged 21-45 years completed questionnaires at preconception, during pregnancy, and postpartum. PPD was assessed at six months postpartum using the Edinburgh Postnatal Depression Scale (EPDS). We fit generalized linear models to estimate risk ratios (RRs) and 95 % confidence intervals (CIs) for the associations of adverse perinatal events (preterm birth; birth size for gestational age; infant birthweight; and NICU admission) with PPD (EPDS score ≥ 13), adjusting for confounders including preconception mental health.

RESULTS

A total of 9.8 % reported PPD. Preterm birth (i.e., <37 weeks gestational age; RR = 1.30; 95 % CI: 0.92, 1.82), particularly spontaneous preterm birth (RR = 1.38; 95 % CI: 0.90, 2.10), very preterm birth (<34 weeks; RR = 1.88; 95 % CI: 1.04, 3.35), very low infant birthweight (i.e., <1500 g; RR = 1.67, 95 % CI: 0.77, 3.60), and NICU admission (RR = 1.15; 95 % CI: 0.86, 1.55) were associated with increased PPD risk. Stratified analyses indicated preterm birth was more strongly associated with PPD among parous participants and participants with a history of mental health diagnoses.

CONCLUSION

Adverse perinatal events were associated with an increased risk of PPD at 6 months postpartum. Early identification and management of depressive symptoms in those who have experienced adverse perinatal events are crucial for improving both parental and infant health outcomes.

Large-scale digital phenotyping: Identifying depression and anxiety indicators in a general UK population with over 10,000 participants

BACKGROUND

Digital phenotyping offers a novel and cost-efficient approach for managing depression and anxiety. Previous studies, often limited to small-to-medium or specific populations, may lack generalizability.

METHODS

We conducted a cross-sectional analysis of data from 10,129 participants recruited from a UK-based general population between June 2020 and August 2022. Participants shared wearable (Fitbit) data and self-reported questionnaires on depression, anxiety, and mood via a study app. We examined correlations between mental health scores and wearable-derived features, demographics, health variables, and mood assessments. Unsupervised clustering was used to identify behavioural patterns associated with depression and anxiety. Furthermore, we employed XGBoost machine learning models to predict depression and anxiety severity and compared the performance using different subsets of features.

RESULTS

We observed significant associations between the severity of depression and anxiety with several factors, including mood, age, gender, BMI, sleep patterns, physical activity, and heart rate. Clustering analysis revealed that participants simultaneously exhibiting lower physical activity levels and higher heart rates reported more severe symptoms. Prediction models incorporating all types of variables achieved the best performance (R2 = 0.41, MAE = 3.42 for depression; R2 = 0.31, MAE = 3.50 for anxiety) compared to those using subsets of variables. Several wearable-derived features were observed to have non-linear relationships with depression and anxiety in the prediction models.

LIMITATIONS

Data collection during the COVID-19 pandemic may introduce biases.

CONCLUSION

This study identified several indicators for depression and anxiety and highlighted the potential of digital phenotyping and machine learning technologies for rapid screening of mental disorders in general populations.

A cross-lagged panel network model on internet gaming disorder and depressive symptoms concerning preferences for game genres

BACKGROUND

Internet gaming disorder (IGD) is a prevalent behavioral addiction that co-occurs with depression. Little is known about how IGD and depression intercorrelate longitudinally at a symptom level. This study aimed to explore the directional relationships between IGD and depressive symptoms and identify the key symptoms in their comorbidity using cross-lagged panel network (CLPN) modeling.

METHODS

A sample of 601 young gamers (mean age = 23.76) in Hong Kong completed the Internet Gaming Disorder Scale - Short Form and Patient Health Questionnaire-9 semi-annually at two-time points. Autoregressive and cross-lagged effects between depressive and IGD symptoms were analyzed via CLPN while controlling gamers' preferences across five game genres in R.

RESULTS

The comorbidity was mainly driven from depressive symptoms to IGD symptoms, with a few weaker associations from IGD to depressive symptoms. 'Anhedonia' (out-/bridge-expected influence = 2.88; 0.03) and 'Motor problems' (out-/bridge-expected influence = 1.24; 0.03) from depression were the central and bridge symptoms to trigger the development of IGD symptoms, whereas 'continue gaming despite harm' (in-expected influence = 1.29) was the most consequent symptom. 'Anhedonia' (r = 0.17) and 'suicidal risk' (r = 0.15) to 'continuation despite harm' were the strongest paths connecting depression and IGD. Gamers who preferred First-Person Shooter games and Massively Multiplayer Online Role-Playing games were more vulnerable to depressive and IGD symptoms.

CONCLUSIONS

Our findings provide empirical support for the comorbidity between IGD and depression and clarify their directional relationships at a symptom level. We identify antecedent bridge symptoms as targets for preventing escalation of co-occurring issues.

Development and application of a machine learning-based antenatal depression prediction model

BACKGROUND

Antenatal depression (AND), occurring during pregnancy, is associated with severe outcomes. However, there is a lack of objective and universally applicable prediction methods for AND in clinical practice. We leveraged sociodemographic and pregnancy-related data to develop and validate a machine learning-based AND prediction model.

METHODS

Data from 20,950 pregnant women form 3 hospitals were used and divided into training and test sets. AND was defined as an EPDS score of 10 or above. Using machine learning, we selected 34 characteristic variables and divided them into three categories based on clinical practice: Base Variables, General Variables, and Obstetric Variables. Based on this classification, we constructed four different AND random forest prediction models: the Base Model, the Base+General Model, the Base+Obstetric Model, and the Full Model.

RESULTS

The AUC range in the test set was 0.687-0.710. The Base+General Model achieved the best performance with an AUC of 0.710 (95 % CI: 0.693-0.710) in predicting AND risk during the late pregnancy period. The AUC of the Base Model was only 0.022 lower than that of the top-performing model, indicating its solid foundation for early AND screening.

LIMITATIONS

We have only analyzed the dataset from two eastern cities, and have not yet validated our models in an external dataset.

CONCLUSIONS

Machine learning-based prediction models offer the capability to anticipate the risk of AND across different pregnancy stages. This enables the earlier and more accurate identification of pregnant women who may be at risk, facilitating timely interventions for improving outcomes for both mothers and their offspring.

Resilience in good outcome patients with fatigue after aneurysmal subarachnoid hemorrhage

Resilience is a psychological process that encompasses various facets of personality traits, behaviour, as well as coping, and it enhances the adjustment to adversities faced. Although a lot of interest has been devoted to the protective effects of resilience in handling affective disorders, little is known about the relationship between resilience and chronic fatigue, which is a common and potentially disabling sequel in survivors of aneurysmal subarachnoid hemorrhage (aSAH). Ninety-six good outcome patients with chronic post-aSAH fatigue answered the Resilience Scale for Adults (RSA) which assesses 6 distinct aspects of resilience. They also answered the Fatigue Severity Scale (FSS), Mental Fatigue Scale (MFS), Beck Depression Inventory (BDI-II), Beck's Anxiety Inventory (BAI), and the Brief COPE. The RSA scores were related to fatigue, emotional burden and coping. The prevailing resilience factor was "Social Resources". Patients with the highest scores for fatigue and emotional symptoms scored significantly lower for the factors "Perception of Self", "Perception of Future" and "Family Cohesion". Patients with clinically significant depression scored low across most RSA factors, with the weakest factors being "Perception of Self" and "Perception of Future". Resilience factors were positively associated with adaptive problem focused coping strategies, and in particular with the emotional coping strategy "Acceptance", whereas they correlated negatively with maladaptive avoidant coping. strategies. There is a close interaction between high resilience, adaptive coping strategies and lower burden of chronic fatigue and emotional symptoms.

Environmental enrichment induces depressive- and anxiety-like behaviors in male Balb/C mice

Depression and anxiety disorders are prevalent neuropsychiatric conditions worldwide that impose substantial economic and social burdens worldwide. Environmental enrichment (EE) has been employed to investigate how the environment can influence these disorders. While EE is known to mitigate depressive and anxiety phenotypes across various mouse strains, the Balb/C strain exhibits greater sensitivity to different environmental stimuli. In this study, we aimed to assess the long-term effects of EE introduced after weaning on emotional behaviors in adulthood. Balb/C mice were weaned on postnatal day (PND) 21 and exposed to chronic EE for 3, 12, or 24 hours daily until PND 66. Depressive- and anxiety-like behaviors were assessed using the open field, elevated plus maze, and tail suspension tests, along with measurements of corticosterone plasma levels. EE exposure induced emotional dysregulation, evidenced by an increase in anxiety- and depressive-like behaviors. Shorter length of EE (3 h) had less impact on these behaviors compared to longer periods (12 and 24 h). These findings highlight the need for caution when employing the Balb/C strain in EE models, particularly in studies exploring emotional behaviors.

Atypical subcortical involvement in emotional face processing in major depressive disorder with and without comorbid social anxiety

Previous research on major depressive disorder (MDD) has largely focused on cognitive biases and abnormalities in cortico-limbic circuitry during emotional face processing. However, it remains unclear whether these abnormalities start at early perceptual stages via subcortical pathways and how comorbid social anxiety influences this process. Here, we investigated subcortical mechanisms in emotional face processing using a psychophysical method that measures monocular advantage (i.e., superior discrimination performance when two stimuli are presented to the same eye than to different eyes). Participants included clinical patients diagnosed with MDD (n = 32), patients with MDD comorbid with social anxiety (comorbid MDD-SAD, n = 32), and a control group of healthy participants (HC, n = 32). We assessed monocular advantage across different emotions (neutral, sad, angry) and among groups. Results indicated that individuals with MDD showed a stronger monocular advantage for sad expressions compared to neutral and angry expressions. In contrast, HC and comorbid MDD-SAD groups showed a greater monocular advantage for neural over negative expressions. Cross-group comparisons revealed that MDD group had a stronger monocular advantage for sad expressions than both HC and comorbid MDD-SAD groups. Additionally, self-reported depressive symptoms were positively correlated with monocular advantage for sad expressions, while social anxiety symptoms were negatively correlated with monocular advantage for negative expressions. These findings suggest atypical early perceptual processing of sadness in individuals with MDD via subcortical mechanisms, with comorbid social anxiety potentially counteracting this effect. This study may inform novel interventions targeting sensory processing and expand beyond cognitive bias modification.

Machine learning-based prediction of illness course in major depression: The relevance of risk factors

BACKGROUND

Major depressive disorder (MDD) comes along with an increased risk of recurrence and poor course of illness. Machine learning has recently shown promise in the prediction of mental illness, yet models aiming to predict MDD course are still rare and do not quantify the predictive value of established MDD recurrence risk factors.

METHODS

We analyzed N = 571 MDD patients from the Marburg-Münster Affective Disorder Cohort Study (MACS). Using random forest classifiers, we predicted i) recurrence of depressive episodes and ii) MDD disease trajectories, within a 2-year interval. Trajectories were identified through latent profile analysis, using a discovery and an internal validation sample. Three distinct models were implemented for predictions: two incorporating only literature-derived MDD recurrence risk factors, and a third incorporating a broader set of explorative features.

RESULTS

Basing predictions on only seven recurrence risk factors, MDD recurrence could be predicted with a balanced accuracy (BACC) of 62.83 % and MDD trajectories were predicted with highest performance achieved for a remitted (BACC = 64.23 %) and a severe MDD trajectory (BACC = 63.17 %). Risk factors included childhood maltreatment, previous depressive episodes, residual symptoms, comorbid anxiety, age of onset, depression severity, and neuroticism. Including a broader feature set only yielded in minor increase of predictive performance.

LIMITATIONS

Lacking external validation, generalizability to other samples remains uncertain.

CONCLUSIONS

MDD recurrence and disease trajectories can be predicted based on literature-derived recurrence risk factors. Model performance must increase to be of use in clinical practice which could be achieved by including multimodal risk factors.

Prediction of health anxiety using resting-state functional near-infrared spectroscopy and machine learning

BACKGROUND

The role of cortical networks in health anxiety remain poorly understood. This study aimed to develop a predictive model for health anxiety, using a machine-learning approach based on resting-state functional connectivity (rsFC) with functional near-infrared spectroscopy (fNIRS).

METHOD

One hundred and four university students experiencing school disclosure due to the Corona Virus Disease 2019 pandemic participated in the study, and the final sample consisted of 90 participants. All participants underwent a 6-min resting-state fNIRS recording session and filled out the Short Health Anxiety Inventory after the data collection. Stratified 10-fold cross-validation was used to train and evaluate the Lasso regression model. Additionally, a bootstrap method was used to determine which features significantly contributed to the prediction of health anxiety.

RESULTS

The contributing rsFC with negative weights was the functional connectivity between right medial superior frontal gyrus and right middle frontal gyrus, with a 99 % confidence interval (CI) of [-1.61, -0.35]. The contributing rsFC with positive weights was the functional connectivity between right supramarginal gyrus and left middle temporal gyrus (99 % CI = [0.02, 1.67]), as well as the functional connectivity between right medial superior frontal gyrus and right supramarginal gyrus (99 % CI = [0.03, 1.41]).

CONCLUSION

The findings reveal a predictive role of intrinsic cortical organization in health anxiety and suggest that health anxiety involves complex interactions between cognitive control, emotion regulation, and sensory processing. The work provides new insights into potential neural mechanisms underlying health anxiety, and implications for neuromodulation research and practice targeting severe health anxiety.

Mental imagery shapes emotions in people's decisions related to risk taking

This research investigates the specific effects of mental imagery on people's emotional responses and risk-taking decisions. We present findings across four studies, including three experiments, that highlight emotions as a mediator between the valence of mental images related to risk and subsequent risk-taking propensity. Our research identifies two key factors that moderate this relationship: the category of cognitive process (analytical thinking vs. visual mental imagery) and the vividness of mental imagery. In Study 1, we found an effect of the valence of mental images on the intensity of emotional reactions, which in turn were linked to risk-taking willingness. Positive imagery corresponded with stronger positive emotions and increased declared risk taking. The experimental Study 2 provided causal evidence for these associations, showing that participants positively imagining risk-related behaviors reported more intense positive feelings and a greater inclination to take risks than those imagining risk taking in a negative manner. Subsequent preregistered experiments (Studies 3 and 4) corroborated our central hypothesis that mental imagery is a distinct driver of emotional responses in risk-related decision making and showed potential boundary conditions for this effect. Study 3 emphasized that decisions influenced by mental imagery had greater emotional strength than those based on analytical reasoning. The final Study 4 demonstrated that vividness of mental imagery further moderates this effect: more vivid images led to stronger emotions, thus affecting risk-taking propensity. These results underscore the significance of emotions in decision making, particularly when decisions are based on mental imagery rather than analysis, and point to the amplifying effect of image vividness on emotional and decision-making processes.

Childhood Adversity and Telomere Length

Purpose: Exposure to adversity during childhood and adolescence is associated with numerous health conditions in adulthood; telomere shortening may be a mechanism through which adversity contributes to poor outcomes. We studied three areas of adversity (parent relational instability, child household instability, and financial instability) occurring during three epochs across childhood and adolescence and their associations with telomere length during adolescence. Methods: Data were obtained from the first wave of a longitudinal cohort study of youth aged 11-17 and their primary caregiver. Caregivers completed demographic and adversity questionnaires; youth provided a saliva sample for DNA extraction for telomere analysis. Results: Of 879 youth, over half experienced some adversity. More than one third experienced parent relational instability in each age epoch, with nearly a quarter experiencing parent relational instability in all age epochs. Youth experienced a similar pattern of financial instability but lower rates of child household instability. Youth experiencing parent relational instability at two or three epochs had shorter telomeres compared to those without any parent relational instability (p < .004). Youth who experienced child household instability in two age epochs had shorter telomeres (p = .003) and youth who experienced financial instability across all three epochs had shorter telomeres (p = .013) compared to youth without these adversities. Conclusion: Continuing exposure to adversity in early childhood may be more likely to affect telomere length. Research is needed to further determine adversities exerting the most effect and to understand if early telomere shortening has long term health effects.

Direct and indirect paths from subclinical symptoms of schizotypal personality to suicidal thinking among non-help-seeking adolescents

Clinical and subclinical symptoms of schizotypal personality predict concurrent and future suicidal ideation. We tested whether relationships of subclinical schizotypal symptoms with ideation operate solely via final common risk pathways for suicidal thinking, or whether there are distinctive ways that the schizotypal-ideation relationships bypass common pathways. Randomly selected 15- to 18-year-old school pupils (n = 177) self-reported on passive and active ideation; subclinical positive, negative, and disorganized symptoms, scored quantitatively; and theoretical final common pathways of thwarted belonging and burden, and of pain and hopelessness. Perceived burden and thwarted belonging, as final common pathways, provided a better account of ideation than pain and hopelessness. The relationships of schizotypal symptoms with passive ideation operated via burden and belonging. However, subclinical schizotypal symptoms had both common and distinctive links with active ideation. Some negative (excessive social anxiety) and positive symptoms (low magical thinking) bypassed burden and belonging to predict active ideation directly; for other schizotypal symptoms, only burden was a final common pathway. Negative symptoms predicted belonging but belonging was not a final common pathway to active ideation. Among adolescents with schizotypal personality, suicidal thinking may not be mitigated by improving belonging but by addressing social anxiety and perceived burden instead.

Positive psychology interventions can improve mental health for chronic pain patients: a systematic review and meta-analysis

OBJECTIVE

This study examines the efficacy of positive psychology interventions (PPIs) for patients with chronic pain through a systematic review and meta-analysis. PPIs are defined as strategies that involve focusing on positive emotions, thoughts, and behaviors that improve mental health by increasing mental well-being and reducing psychological distress.

DESIGN

The search was conducted using the PubMed, Scopus, PsycINFO, and Cochrane Library databases.

MAIN OUTCOME MEASURES

Subjective, psychological, and social well-being were used as indicators of mental well-being, and depression, anxiety, and stress symptoms were used as indicators of psychological distress. Results: Nine studies were included. Eight studies evaluated subjective well-being, seven evaluated depression, and three evaluated anxiety symptoms. No studies examined psychological well-being, social well-being, or stress. PPIs were found to be effective in promoting subjective well-being post-treatment (Hedges' g = 0.40; 95% CI [0.06, 0.73]) and reducing anxiety (Hedges' g = -0.32, 95% CI [-0.59, -0.06]), but no significant results were found for depression (Hedges' g = -0.23, 95% CI [-0.50, 0.04]).

CONCLUSION

The included investigations, while limited, suggest the utility of PPIs in mitigating the psychological consequences of chronic pain. Researchers and practitioners are encouraged to implement PPI practices.