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.

Psychometric evaluation of a novel measure of trauma-related cannabis use to cope

Background: Posttraumatic stress disorder (PTSD) and cannabis use disorder (CUD) are commonly comorbid and are associated with many negative public health outcomes. One plausible explanation for this comorbidity comes from a self-medication framework, which suggests people use cannabis to cope with PTSD symptoms. Despite theoretical and empirical evidence for PTSD-related cannabis use to cope, no measure of this construct exists.Objective: We sought to address this gap by developing and validating a novel measure of PTSD-specific cannabis self-medication, which we have termed the Trauma-Related Cannabis Use to Cope (TRCU) questionnaire.Method: The psychometric properties of the TRCU and how it relates to relevant constructs were examined among a diverse sample of 345 trauma-exposed undergraduate cannabis users (Mage = 22.19, SD = 6.45; 46.7% White; 79.7% woman-identifying) using structural equation modelling in Mplus.Results: Study findings indicate that the TRCU is a more precise and targeted measure of cannabis use to cope with PTSD symptomology, as compared to existing measures of cannabis coping motives. Furthermore, our data support the use of the TRCU as a four-factor scale, assessing cannabis use to cope with the four DSM-5 PTSD symptom clusters (χ2(164) = 257.83, p < .001; CFI = .969; TLI = .965; RMSEA = .041). We also found strong evidence supporting the construct and criterion validity of the TRCU, specifically in relation to PTSD symptoms, cannabis use, and cannabis-related issues and dependence.Conclusions: Results support the use of the TRCU in future self-medication research and as a clinically useful screening tool for identifying individuals with PTSD who are at risk for developing CUD.

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.

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.

Making trauma ecological momentary assessment studies FAIR: review of design considerations and data procedures

Background: Ecological momentary assessment (EMA) involves collecting data from people in their everyday lives one or more times per day over the course of days, weeks, or months. EMA has been used in the traumatic stress field to better understand how trauma-relevant symptoms, experiences, and behaviours occur under naturalistic conditions and in relation to one another. The FAIR principles specify that data should be Findable, Accessible, Interoperable, and Reusable to maximise the knowledge gained from individual research studies. However, it is unclear how EMA design decisions and data procedures might affect the implementation of these principles.Objective: We articulate key design considerations and data procedures when performing trauma EMA research and outline some challenges and recommendations for implementing the FAIR data principles in trauma EMA research.Method and Results: Using examples from existing trauma EMA studies, we discuss the decisions made when preparing a trauma EMA study; data processing and analytic procedures performed following data collection; and challenges that exist for their implementation, as well as practices that trauma EMA researchers can incorporate into their research to promote FAIR data.Conclusions: Implementing the FAIR data principles in trauma EMA research is critical to advancing scientific knowledge. Researchers should deposit their data in reputable repositories and include documentation detailing design decisions and the steps taken to clean and prepare data. Many challenges remain for the implementation of these practices including balancing privacy concerns and efforts to make trauma EMA data readily shareable.

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.

Investigation of the relationship between salivary nitrate levels and perinatal anxiety and postpartum depression

BACKGROUND

Postpartum depression (PPD) is a common psychological condition affecting 10-20% of postpartum women, characterized by emotional instability, anxiety, and, in severe cases, hallucinations or suicidal ideation. Growing evidence suggests a link between oxidative stress and depression, with nitrite-a key metabolite of nitric oxide (NO)-emerging as a potential biomarker. This study explores the association between salivary nitrite levels, perinatal anxiety, and PPD, aiming to identify predictive factors for early intervention.

METHODS

A prospective clinical study was conducted involving 220 naturally delivered women. Saliva samples were collected at three time points: before labor analgesia, one hour post-analgesia, and on the discharge day. PPD was assessed using the Edinburgh Postnatal Depression Scale (EPDS) at 28 and 42 days postpartum. Logistic regression was applied to analyze the relationship between salivary nitrite levels and PPD risk (EPDS ≥ 9). Anxiety, information needs, and fear were evaluated as additional predictors.

RESULTS

Of 220 participants, 194 completed the study. The incidence of PPD was 10.82% at 28 days and 15.98% at 42 days postpartum. Higher pre-analgesia salivary nitrite levels were significantly associated with increased PPD risk at 28 days (OR = 1.017, p < 0.05) and 42 days (OR = 1.008, p < 0.05), with a stronger effect at 28 days. Preoperative anxiety was a strong predictor at 28 days (OR = 1.76, p = 0.019), while preoperative information needs were significant at 42 days (OR = 1.22, p = 0.043). Salivary nitrite levels significantly decreased after labor analgesia and remained low at discharge.

CONCLUSION

This study is the first to demonstrate a significant association between salivary nitrite levels and the occurrence of postpartum depression (PPD), with this association being particularly pronounced at 28 days postpartum. Perinatal anxiety and information needs were also identified as important predictors of PPD. This research provides a new perspective for the early screening and intervention of PPD and points the way for future studies to further explore its mechanisms and predictive factors.

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.

Effects of home-based integrated sensory stimulation program to preterm infants on parents' depression and anxiety: a randomized controlled trial

BACKGROUND

Preterm parents face higher risks of postpartum depression and anxiety, affecting bonding and infant development. Sensory stimulation shows promise, but its long-term impact on parental mental health needs further study.

OBJECTIVES

This study aimed to evaluate whether a home-based integrated sensory stimulation program, administered to preterm infants by their parents, could alleviate parental mental health issues and enhance maternal bonding and parenting competence.

METHODS

The program, including tactile, auditory, visual, gustatory, and olfactory stimuli, was assessed in a block-randomized controlled trial from November 2018 to January 2020. A total of 200 parents of preterm infants were recruited, and the intervention continued at home until the infants reached six months corrected age. Parents' depression and anxiety were assessed using validated scales at baseline, and at first, third, and sixth month follow-ups.

RESULTS

The intervention group included 98 parents, and the control group comprised 102 parents. At the six-month follow-up, the intervention group demonstrated significant improvements in maternal depression, state anxiety, and trait anxiety compared to the control group. In the mixed linear model, the intervention was associated with reductions in maternal trait anxiety (d =-2.18; 95% CI: -4.30, -0.06), paternal trait anxiety (d =-3.37; 95% CI: -5.62, -1.11) and state anxiety (d =-4.63; 95% CI: -7.00, -2.26).

CONCLUSION

The home-based integrated sensory stimulation program, when provided by parents to preterm infants, was effective in improving parents' mental health and can serve as an alternative treatment for postpartum depression and anxiety in parents of preterm infants at home.

Effectiveness of immersive VR therapy in reducing stress-associated symptoms in Ukraine

Background: The ongoing conflict in Ukraine has led to a rise in stress-related symptoms, including anxiety and depression, among veterans, necessitating accessible and effective mental health interventions. Traditional rehabilitation resources are often limited, prompting exploration into alternative therapies.Objective: This paper aims to assess the effectiveness of immersive 360° video-based Virtual Reality (VR) therapy as an enhancement to standard rehabilitation programmes for Ukrainian veterans experiencing anxiety and depression.Method: A randomised controlled trial (RCT) was conducted with 69 participants, who were randomly assigned to either the experimental group (n = 34), receiving daily VR sessions alongside standard rehabilitation, or the control group (n = 35), following standard rehabilitation alone. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS) both at baseline and post-intervention. Additionally, momentary changes in anxiety and mood were measured immediately before and after each VR session to evaluate the immediate effects. The VR intervention was designed with veteran and expert feedback to enhance emotional regulation and stress resilience, integrating evidence-based psychotherapeutic techniques.Results: Results demonstrate significant rapid improvement in mood and reduction in anxiety following each session, along with significant reductions in anxiety (up to 14.5%) and depression (up to 12.3%) upon programme completion. Consistent results across all study iterations confirmed the reliability and scalability of 360-VR therapy as a short-term rehabilitation tool.Conclusions: Immersive VR therapy presents an effective, accessible solution for managing the psychological impact of war, particularly within the limitations of Ukraine's healthcare system.

The genetic basis of male and female infertility

This review provides a comprehensive overview of the genetic factors underlying male and female infertility. Infertility affects an estimated one in six couples worldwide, with both male and female factors contributing equally to its prevalence. Approximately, 50% of infertility cases are attributed to genetic causes. We explore three main categories of genetic causes: chromosomal abnormalities, monogenic disorders, and syndromic conditions. Chromosomal causes, including numerical and structural aberrations, are discussed with a focus on their impact on gametogenesis and reproductive outcomes. We review key monogenic causes of infertility, highlighting recent discoveries in genes critical for gonadal development, gametogenesis, and hormonal regulation. Syndromic conditions affecting fertility are examined, highlighting their impact on reproductive function. Throughout the review, we address the challenges in identifying genetic mechanisms of infertility, particularly focusing on the intricate processes involved in oogenesis and spermatogenesis. We also discuss how advancements in genetic testing, such as next-generation sequencing (NGS) and genome-wide association studies (GWAS), have significantly enhanced our understanding of idiopathic infertility and promise further insights in the future. We also discuss the clinical implications of genetic diagnoses, including the role of preimplantation genetic testing (PGT) and genetic counseling in reproductive medicine. This review synthesizes current knowledge on the genetic basis of infertility, providing a comprehensive overview of chromosomal, monogenic, and syndromic causes. It aims to offer readers a solid foundation for understanding the complex genetic factors underlying reproductive disorders.

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.

Living under threat: adolescents' continuous traumatic stress reactions in relation to violence exposure

Background: Adolescents exposed to violence are at a higher risk for mental health problems than their peers. Exposure to ongoing violence can potentially lead to Continuous Traumatic Stress (CTS). CTS reactions have never been studied in relation to violence exposure in adolescent samples.Objective: We aimed to validate the Lithuanian version of the Continuous Traumatic Stress Response (CTSR) scale in the adolescent sample, to explore the adolescents' CTS reactions using the person-oriented approach, and to study the relationship between different types of violence and CTS reactions.Method: In total, 321 adolescents (M(SD)age = 14.19 (1.26)) from Lithuania were included in the current study, of which 181 (56.4%) were female, 135 (42.1%) were male, and 54.5% (n = 175) were continuously exposed to violence over their lifetime. Confirmatory factor analysis (CFA) with measurement invariance across genders and age groups was used to test the structural validity of the CTSR scale. A latent class-analysis approach was used to explore the patterns of CTS reactions.Results: The results showed good structural, convergent, and differential validity of the CTSR scale. Exhaustion/Detachment, Rage/Betrayal, and Fear/Helplessness were more profound in continuous violence exposure versus non-exposure groups, with even higher CTS reactions when recently exposed to violence. Three groups of adolescents with low, moderate, and high CTS reactions were distinguished with the suggested cut-off sum score of CTSR ≥18 for severe CTS reactions. The intensity of exposure to neglect, psychological abuse, physical abuse, and sexual abuse positively predicted Continuous traumatic stress (CTS) response group membership.Conclusions: These results stress the need for psychological support when exposed to continuous interpersonal violence in adolescence.

Utilization of lactate trajectory models for predicting acute kidney injury and mortality in patients with hyperlactatemia: insights across three independent cohorts

This study aims to investigate the association between lactate trajectories and the risk of acute kidney injury (AKI) and hospital mortality in patients with hyperlactatemia. We conducted a multicenter retrospective study using data from three independent cohorts. By the lactate levels during the first 48 h of ICU admission, patients were classified into distinct lactate trajectories using group-based trajectory modeling (GBTM) method. The primary outcomes were AKI incidence and hospital mortality. Logistic regression analysis assessed the association between lactate trajectories and clinical outcomes, with adjusting potential confounders. Patients were divided into three trajectories: mild hyperlactatemia with rapid recovery (Traj-1), severe hyperlactatemia with gradual recovery (Traj-2), and severe hyperlactatemia with persistence (Traj-3). Traj-3 was an independent risk factor of both hospital mortality (all p < 0.001) and AKI development (all p < 0.001). Notably, Traj-2 was also associated with increased risk of mortality and AKI development (all p < 0.05) using Traj-1 as reference, except for the result in the Tianjin Medical University General Hospital (TMUGH) cohort for mortality in adjusted model (p = 0.123). Our finding was still robust in subgroup and sensitivity analysis. In the combination cohort, both Traj-2 and Traj-3 were considered as independent risk factor for hospital mortality and AKI development (all p < 0.001). When compared with the Traj-3, Traj-2 was only significantly associated with the decreased risk of hospital mortality (OR 0.17, 95% CI 0.14-0.20, p < 0.001), but no with the likelihood of AKI development (OR 0.90, 95% CI 0.77-1.05, p = 0.172). Lactate trajectories provide valuable information for predicting AKI and mortality in critically ill 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.

Dualistic perspectives on illness coping experiences of individuals with depression and their spouses: a qualitative study

PURPOSE

Dyadic coping interventions alleviate emotional problems in patients and families with a variety of chronic illnesses. Current coping research on depression focuses mainly on the individual level. This study examined the experiences of people with depression and their spouses, using a dyadic coping perspective to support the implementation of a targeted dyadic intervention.

METHOD

Semi-structured, in-depth interviews were conducted with patients with depression and their spouses. The data were organized and analysed using Colaizzi's seven-step method.

RESULTS

The experiences of individuals with depression and their spouses were categorized into four themes and 12 subthemes: delays in medical care (delays in medical decision-making, delays in in-hospital care), spousal maladjustment (perceived stress of the illness, role conflict, negative emotions), coexistence of positive and negative dyadic coping strategies (shared coping, positive communication, emotional support, negative communication, overprotectiveness), and confusion and needs (fear of illness prognosis, desire for continuity of care).

CONCLUSION

Healthcare professionals should promote positive dyadic coping among individuals with depression and their spouses while caring for depressive illnesses. They should strengthen individuals' knowledge of the disease, attend to spouses' physical and mental health, explore couple-centred dyadic intervention strategies, and improve continuity in the healthcare system.

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.

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.

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.

Does the impact of economic inequality on maternal and child health inequality exhibit a threshold effect? Evidence from China

When the economy (economic inequality) develops to a certain level, does the impact of economic inequality on health inequality change? Through threshold regression, this study analyses the impact of city-level economic inequality on the absolute and economic-related inequality in under-5 child mortality rate (U5MR) (2001-2012) and maternal mortality rate (MMR) (2001-2015), along with the threshold values for economic development stages and economic inequality. Findings show: For the relationship between economic inequality and absolute inequality in U5MR, as well as economic-related inequality, there exists an economic development threshold effect. For the relationship between economic inequality and absolute inequality in MMR, an economic inequality threshold effect is illustrated. The improvement of economic conditions contributes to alleviating inequality in U5MR. Economic development inequality has a significant impact on the equality of maternal health development, but for enhancing the equality of women's health, health promotion policies may be more feasible.

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.

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.

Life-course socioeconomic position and the gut microbiome in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Socioeconomic position (SEP) in childhood and beyond may influence the gut microbiome, with implications for disease risk. Studies evaluating the relationship between life-course SEP and the gut microbiome are sparse, particularly among Hispanic/Latino individuals, who have a high prevalence of low SEP. We use the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a population-based cohort study conducted in four field centers in the United States (U.S.), to evaluate the association between life-course SEP and gut microbiome composition. Life-course SEP indicators included parental education (proxy of childhood SEP), current SEP (n = 2174), and childhood (n = 988) and current economic hardship (n = 994). Shotgun sequencing was performed on stool samples. Analysis of Compositions of Microbiomes was used to identify associations of life-course SEP indicators with gut microbiome species and functions. Parental education and current SEP were associated with the overall gut microbiome composition; however, parental education and current education explained more the gut microbiome variance than the current SEP. A lower parental education and current SEP were associated with a lower abundance of species from genus Bacteroides. In stratified analysis by nativity, we found similar findings mainly among foreign-born participants. Early-life SEP may have long-term effects on gut microbiome composition underscoring another biological mechanism linking early childhood factors to adult disease.

The complex interaction between oestrogen receptor genes, oestradiol, and perinatal mood

INTRODUCTION

Genetic variations in oestrogen receptor (ER) genes are associated with inter-individual differences in the sensitivity of ER-α, ER-β and G protein-coupled oestrogen receptor (GPER). These sensitivity differences may modulate susceptibility to mood changes during phases of endogenous oestrogen fluctuations, thereby explaining individual vulnerability. This study examined the association between ER gene variations, oestradiol and perinatal mood disturbances.

METHODS

A total of 159 women were observed during the perinatal period, providing saliva samples for oestradiol assessment and completing self-report measures of depressive and anxiety symptoms at five time points. Polymorphisms in ER genes were determined from dried blood spots. The associations were analysed using linear mixed models.

RESULTS

The ER-α gene haplotypes were associated with perinatal mood disturbances. The CG haplotype was associated with perinatal depressive (p = 0.0162, F-test) and anxiety symptoms (p = 2.396e-05, F-test), whereas the TA haplotype was associated with perinatal anxiety symptoms (p = 0.004, F-test). The interaction between ER gene variations, oestradiol and perinatal mood disturbances was not significant.

CONCLUSIONS

ER-α gene variations are associated with an increased susceptibility to perinatal mood disturbances. Sensitivity differences in ER-α appear to play a more important role for emotional processes than those in ER-β and GPER, independently of oestradiol levels. This might be explained by ER-α's more dominant expression in the hypothalamus and amygdala.

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.

Lying behavior in adolescents with conduct disorder: An experimental study of the role of executive functioning

Children with conduct disorder (CD) are often reported to engage in higher rates of lying compared to their typically developing (TD) peers. However, there is a paucity of experimental evidence exploring the specific characteristics and underlying mechanisms driving the propensity for lying in this population. To address these gaps, this study aimed to investigate the relationship between executive functioning (EF) and lying behavior in adolescents with CD compared to TD adolescents. To assess spontaneous lying for personal gain, we used a spot-the-differences task with adolescents aged 13 to 16 (N = 115). EF abilities-including cognitive flexibility, inhibitory control, and working memory-were measured using the Trail Making Test, Color-Word Stroop Task, and Digit Span Test, respectively. We hypothesized that CD adolescents would lie more frequently for personal gain than TD adolescents. Additionally, we expected EF to negatively correlate with lying frequency in TD adolescents but positively correlate with lying frequency in CD adolescents. The results partially supported these hypotheses. While adolescents with CD did not lie significantly more often than TD adolescents, EF was differently related to lying frequency. Specifically, cognitive flexibility was positively associated with lying frequency in CD adolescents but was not significantly related to lying frequency in TD adolescents. Additionally, better inhibitory control was associated with less frequent lying across both groups. These findings provide new insights into the role of EF in adolescent dishonesty and suggest that EF may influence lying behavior differently in CD and TD populations.

Exposure to vaping and smoking prohibitions and nicotine and cannabis vaping in a California-based sample of young adults: An ecological momentary assessment study

BACKGROUND

Localities have extended smoke-free policies to prohibit use of combustible and vaping products for nicotine/tobacco and cannabis (THC), but little is known about how this affects vaping behavior. We used Ecological Momentary Assessment to examine perceived exposure to smoking- and vaping-specific prohibitions and nicotine and THC vaping.

METHODS

Young adults (n = 178; age 25; 55 % male; 47 % Hispanic, 21 % Asian, 21 % White) in California who endorsed past-month use of nicotine and/or THC vaping products were recruited from an existing longitudinal study. In 2023, individuals completed up to five brief surveys each day over 21 days to assess vaping behavior and momentary context (e.g., vaping/smoking prohibitions) of vaping and non-use (random prompt) events. Multilevel generalized linear mixed models assessed associations between exposure to prohibitions and likelihood of vaping nicotine or THC (vs. non-use events).

RESULTS

Young adults showed reduced likelihood of vaping nicotine (aOR = 0.60, 95 % CI 0.42 - 0.85; p = 0.004) and THC (aOR = 0.48, 95 % CI 0.33 - 0.69; p < 0.0001) in settings where vaping and smoking were prohibited compared to settings in which vaping and smoking were allowed. Exposure to settings in which only smoking was prohibited (vaping allowed) was associated with increased likelihood of vaping nicotine (aOR = 2.13, 95 % CI 1.34 - 3.39; p = 0.002), but unrelated to vaping THC (aOR = 0.87, 95 % CI 0.53 - 1.44; p = 0.59).

CONCLUSIONS

Efforts to increase young people's awareness of and compliance with vaping prohibitions may help reduce both nicotine and THC vaping in real-world settings.

Rates and correlates of simultaneous use and mixing of alcohol, tobacco, and cannabis among adults who currently use alcohol and tobacco

BACKGROUND

Little research exists on simultaneous use of multiple substances that pose additive risk for negative health outcomes. We examine rates and sociodemographic and state cannabis legalization status correlates of simultaneous use (i.e., use > 1 substance on the same occasion) and mixing (e.g., co-administration of substances) of tobacco, alcohol, and cannabis among a U.S sample of adults who currently use alcohol and combustible tobacco products.

METHODS

Using a survey panel, we recruited 1,300 U.S. adults who reported past 30-day use of alcohol and combustible tobacco between June to July 2021. We fit logistic regression models to examine associations between sociodemographic characteristics and cannabis legalization status with use of alcohol, tobacco, and cannabis.

RESULTS

The majority (67%) of participants reported simultaneous alcohol and tobacco use. Over half (55.5%) of tobacco and alcohol co-users reported past 30-day cannabis use, 42.1% reported simultaneous tobacco and cannabis use, and 45% reported mixing tobacco and cannabis in the form of a blunt. Additionally, 36.5% reported simultaneous alcohol and cannabis use, and 33.1% reported simultaneous alcohol and blunt use. Age, race, gender, and income level were associated with simultaneous use of some substances. State cannabis legalization status was not significantly associated with outcomes.

CONCLUSIONS

Overall, the prevalence of simultaneous use was high among this U.S. purposive sample of adults who reported current co-use of alcohol and tobacco products. Researchers should consider measuring simultaneous use of substances in samples of co-users, which may inform the efficacy of interventions focused on cessation or harm reduction of substance use.

Prevalences and differences of depressive symptomology among first-episode of depression and recurrent depression: An analysis of data from NSSD

BACKGROUND

The study was designed to fully map and display the hierarchy of depressive symptomology among first-episode and recurrent major depressive disorder (MDD) patients.

METHODS

This cross-sectional study included 3249 MDD patients from the National Survey on Symptomatology of Depression (NSSD). The prevalences of 64 sets of depressive symptoms in first-episode and recurrent MMD were fully described and compared. Logistic regression and random forest models were used to assess the relative importance of the symptoms in distinguishing first-episode MDD from recurrent MDD.

RESULTS

The prevalences of the total 64 sets of the symptoms ranged from 5.7 % to 80.0 %, and depressed mood (80.0 %), pleasure loss (76.0 %), interest loss (72.0 %), low energy (72.0 %), later insomnia (65.0 %) were the top 5 symptoms. 24 symptoms that had a significantly higher prevalence in recurrent MDD patients than those of first-episode MDD patients were identified, especially memory loss (59.0 % vs. 49 %, p < 0.001), suicide history (17.9 % vs. 8.9 %), sense of decreased ability (69.7 % vs. 60.8 %, p < 0.001). The results from logistic regression and random forest analyses consistently indicated that the differences in the prevalences of suicidal behavior, memory loss, and late insomnia may be the most important distinguishing characteristics between first-episode and recurrent MDD.

CONCLUSION

The findings may help develop screening tools for MDD in clinics and provide clues for further mechanistic studies for the recurrence of MDD.

LIMITATIONS

Because of the study's cross-sectional design, causal conclusions could not be drawn between the differences in the prevalences of symptoms and recurrence of MDD.

Exploring relationships among smoking cessation app use, smoking behavioral outcomes, and pharmacotherapy utilization among individuals who smoke cigarettes

INTRODUCTION

Most individuals who smoke cigarettes are interested in quitting, but many are unable to quit. Fewer than one-third of individuals who smoke cigarettes attempt to quit using FDA-approved cessation methods, such as nicotine replacement therapy (NRT) and prescription medications. Smoking cessation apps (SCAs) provide individuals with personalized quit plans, information about smoking cessation treatments, craving management strategies, and other features. However, their relationship to NRT/prescription medication utilization and quit attempts is understudied.

METHODS

We conducted a longitudinal secondary data analysis using a subset of adults who smoked at least 100 cigarettes in their lifetime, currently smoked every day or some days, and planned to quit within a year. This subset was drawn from the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative cohort study. We utilized Generalizing Estimating Equation models to examine the longitudinal associations between SCA use initiation and the following outcomes across 2014-2019: NRT, prescription medications, and quit attempts.

RESULTS

SCA use initiation was associated with greater odds of prescription medication utilization (AOR = 2.43, 95 % CI: 1.63, 3.64; p < 0.05). Likewise, SCA use initiation was associated with greater odds of making a quit attempt (AOR = 1.38, 95 % CI: 1.09, 1.76; p < 0.01), but not NRT utilization.

CONCLUSION

Among adults who regularly smoked cigarettes and had plans to quit, SCA use initiation was associated with prescription medication utilization and quit attempts but not NRT utilization. SCAs may have utility as a population-level intervention but specific features needed to be studied further.

ABBREVIATIONS

SCA, Smoking Cessation App; NRT, Nicotine Replacement Therapy.

Risk factors for suicidality among college students: A systematic review and meta-analysis

BACKGROUND

Suicide is a leading cause of death among college students, but inconsistent data and a lack of meta-analysis make it difficult to identify and recognize the risk factors for suicidal ideation, planning, and attempts in this group. To gain a comprehensive understanding of previous research, this study summarized risk factors for suicidal ideation, planning, and attempts among college students through a review and meta-analysis.

METHODS

We systematically searched six electronic databases from inception to May 18, 2024, to identify longitudinal studies of factors associated with suicidal ideation, planning, and attempts among college students. The effect sizes of the risk factors were pooled using a random effects model. Based on the results of the meta-analysis, we developed a risk prediction model for suicidal ideation among college students.

RESULTS

Thirty-three studies involving 193,517 college students were included. This study identified 18 risk factors, such as sexual orientation and traumatic experiences, and identified two protective factors, namely, social support and positive coping. Suicidal ideation is considered an important precursor to suicide. This study developed a predictive model for suicidal ideation with the results of the meta-analysis.

CONCLUSIONS

This review demonstrated the importance of several risk and protective factors for suicidal ideation, planning, and attempts among college students. A predictive model was developed based on the results of this meta-analysis, thus providing novel insights for translating evidence into clinical practice.

Randomized controlled trial for the Attempted Suicide Short Intervention Program (ASSIP): An independent non-replication study

Following the call for rigorous replication practices in crisis intervention and suicide prevention research, this study re-evaluated the efficacy of a brief intervention (ASSIP - Attempted Suicide Short Intervention Program) for patients with a recent suicide attempt in reducing repeated suicidal behavior. In this open-label, randomized, controlled parallel-group trial, 92 patients were assigned to treatment as usual (TAU) or TAU plus ASSIP. The primary outcome was suicidal behavior (suicide attempts and suicide deaths) during a 12-month observation period. Secondary outcomes included the number of suicide attempts and psychiatric inpatient admissions. Twelve patients in the intervention group and six patients in the control group engaged in suicidal behavior, including one suicide death in each group. The intention-to-treat (ITT) analysis found no significant effect of ASSIP in reducing suicidal behavior or admission to psychiatric hospitals. Surprisingly, the per-protocol (PP) analysis revealed a significantly higher incidence rate of suicide re-attempts in the intervention group. Contrary to the original findings, this non-replication study suggests that ASSIP combined with TAU does not significantly reduce suicidal behavior compared to TAU alone. Further research is needed to refine indications for ASSIP therapy and enhance its effectiveness.

Dimensional foundations toward a novel nosology addressing comorbidity: Preadolescent syndrome profiles

OBJECTIVE

Traditional categorical systems for diagnosing psychopathological symptoms, such as the DSM-5, face limitations including high comorbidity rates and insufficient support for transdiagnostic treatment protocols. Dimensional, person-centered approaches can address these limitations by focusing on cross-cutting psychiatric symptoms.

METHOD

This study leverages data from the Adolescent Brain Cognitive Development℠ Study (ABCD Study®) to develop dimensional models of preadolescent psychopathology, focusing on a large, diverse sample of youths aged 9-10. We used latent profile analysis (LPA) on Child Behavior Checklist (CBCL) syndrome scales collected from an elevated symptomatology subsample to delineate subgroups for targeted interventions.

RESULTS

Four distinct profiles emerged: "Mildly Elevated" and "Highly Elevated" (on both internalizing and externalizing), "Moderately Elevated - Rule-Breaking," and "Moderately Elevated - Internalizing & Thought Problems." These profiles differed significantly across sociodemographic, neurocognitive, and life experience characteristics. The "Highly Elevated" group showed the highest levels of risk, including greater trauma exposure and higher rates of parental psychopathology. In contrast, the "Mildly Elevated" group demonstrated lower levels of risk factors and higher fluid intelligence compared to the other groups. The two Moderately Elevated profiles were largely similar across most risk indicators, though the Internalizing & Thought Problems group had a slightly higher proportion of parents with a college education.

CONCLUSIONS

These profiles offer the beginnings of a foundation for classifying symptom co-occurrence and highlight the need for developmentally specific nosologies to improve risk detection and intervention strategies. Future research should further validate these profiles and explore their stability across developmental stages to inform targeted interventions.

Prediction of first attempt of suicide in early adolescence using machine learning

BACKGROUND

Suicide is the second leading cause of death among early adolescents, yet the first onset of suicide attempts during this critical developmental period remains poorly understood. This study aimed to identify key characteristics associated with the first suicide attempt in early adolescence and to develop a predictive model for assessing individual risk.

METHODS

We used data from the Adolescent Brain Cognitive Development Study, a longitudinal, population-based study in the US. The analysis focused on a cohort of 4,238 early adolescents (aged 11-12 years) who had no prior history of suicide attempts. To predict the onset of a first suicide attempt over the subsequent two years (2020-2022), we developed an extremely randomized tree model, incorporating 87 potential predictors from diverse bio-psycho-social domains pertinent to adolescent development.

RESULTS

Among the 4,238 adolescents, 163 (3.8%) reported their first suicide attempt within the subsequent two years. Our predictive model demonstrated good discriminative ability, achieving an AUC of 0.82 (95% CI [0.79, 0.85]), with a sensitivity of 0.82 and a specificity of 0.69 at the optimized threshold. Key predictors included sex assigned at birth, sexual orientation, negative affect, internalizing and attention problems, and lifetime suicidal ideation, along with other significant factors from multiple domains.

CONCLUSIONS

These findings highlight the utility of machine learning algorithms in identifying predictors of suicide attempts among early adolescents. The insights gained from this study may contribute to the development of tailored screening tools and preventive interventions aimed at mitigating suicide risk in this vulnerable population.

Decreases in smartphone overuse and moderators among adults in general after the COVID-19 outbreak: A three-year prospective study

The outbreak of the coronavirus disease 2019 (COVID-19) led many individuals to utilize digital devices, including smartphones, to minimize in-person activities. How the pandemic brought about a long-term impact on smartphone overuse is still unclear owing to mixed results of previous studies. This prospective study investigated whether levels of smartphone overuse increased over three years after the COVID-19 outbreak. Recruited through a research marketing company, 86,827 Japanese adults were deemed eligible to take part in this study and responded to three outcome measures of smartphone overuse and other measures related to smartphone use and COVID-19. Data collection occurred before the outbreak in December 2019 and at six subsequent time points between the first outbreak in Japan and December 2022. Contrary to the hypothesis, a growth model analysis (GMA) revealed downward trajectories in all three smartphone overuse measures: the Smartphone Addiction Scale, Short Version, GMA d = -0.13; smartphone overuse, GMA d = -0.14; and negative consequences from overuse, GMA d = -0.23. A complete case analysis suggested the robustness of these effect sizes. Moderators of the declines in all three outcome measures included spending less money on purchasing new apps and stronger beliefs about not having contracted COVID-19. As individuals turned to online platforms during the COVID-19 outbreak, high reliance on digital technologies, once perceived as overuse before the pandemic, may have become necessary preventive measures against the pandemic, resulting in diminished smartphone overuse.

Self-guided virtual reality therapy for anxiety: A systematic review

BACKGROUND

Virtual reality (VR) technology can be used to treat anxiety symptoms and disorders. However, most VR interventions for anxiety have been therapist guided rather than self-guided.

OBJECTIVE

This systematic review aimed to examine the effectiveness and user experience (i.e., usability, acceptability, safety, and attrition rates) of self-guided VR therapy interventions in people with any anxiety condition as well as provide future research directions.

METHOD

Peer-reviewed journal articles reporting on self-guided VR interventions for anxiety were sought from the Cochrane Library, IEEE Explore Digital Library, PsycINFO, PubMED, Scopus, and Web of Science databases. Study data from the eligible articles were extracted, tabulated, and addressed with a narrative synthesis.

RESULTS

A total of 21 articles met the inclusion criteria. The findings revealed that self-guided VR interventions for anxiety can provide an effective treatment of social anxiety disorder, public speaking anxiety, and specific phobias. User experience outcomes of safety, usability, and acceptability were generally positive, and the average attrition rate was low. However, there was a lack of standardised assessments to measure user experiences.

CONCLUSION

Self-guided VR for anxiety can provide an engaging approach for effectively and safely treating common anxiety conditions. Nevertheless, more experimental studies are required to examine their use in underrepresented anxiety populations, assess their long-term treatment effects beyond 12 months, and compare their effectiveness against other self-help interventions for anxiety (e.g., internet interventions and bibliotherapy).

Identification of mitochondrial-related causal genes for major depression disorder via integrating multi-omics

CONTEXT

Mitochondria dysfunction plays a pivotal role in major depressive disorder (MDD), but the causal link between mitochondria dysfunction and MDD remains unclear.

AIMS

This study aimed to explore the causal effects of mitochondrial-related genes (MRGs) on MDD by integrating multi-omics data.

METHODS

Summary statistics of DNA methylation, gene expression, and protein for MRGs were obtained from the corresponding quantitative trait loci in European ancestry individuals. GWAS summary statistics for MDD were sourced from the Psychiatric Genomics Consortium (PGC, discovery) and FinnGen R10 study (replication). Summary-data-based Mendelian Randomization (SMR) was performed to assess the association between DNA methylation, gene expression, and protein abundances of MRGs with the risk of MDD. Colocalization analysis was employed to assess the potential shared genetic variants between MRGs and MDD. Two-sample MR was conducted to assess the sensitivity of the SMR results. Single-nucleus RNA-sequencing (snRNA-seq) and bulk RNA-seq data were used to explore the candidate MRG expression.

RESULTS

We identified methylation levels of PPTC7 (cg08752433) and methylation levels of VRS2 (cg07945879, cg14935711, cg00244776, cg15848685, cg12457901, cg16958594) associated with a decreased risk of MDD. Conversely, the methylation levels of VRS2 (cg26784891, cg05853013, cg04966294) and MRPL46 (cg00200755) were associated with increased risk of MDD. High expression of COQ8A and TRMT10C were associated with an increased risk of MDD. Notably, COQ8A was predominantly expressed in both inhibitory and excitatory neurons in MDD patients.

CONCLUSION

This study established a causal relationship between mitochondrial dysfunction and MDD, identifying candidate MRGs, and providing potential diagnostic and therapeutic targets for MDD.

C-reactive protein-to-albumin ratio is associated with increased depression: An exploratory cross-sectional analysis

BACKGROUND

Depression, prevalent globally, significantly impacts psychological and physical health. As a burgeoning biomarker, C-reactive protein-to-albumin ratio (CAR) offers insights into metabolism-immune status and disease diagnosis. This exploratory investigation seeks to elucidate the relationship between CAR and depression.

METHODS

This cross-sectional investigation utilized data from the National Health and Nutrition Examination Survey (NHANES). Depression was assessed using the PHQ-9 questionnaire. To examine the relationship between CAR and depression risk, we employed a multivariable logistic regression analysis and a restricted cubic spline (RCS) approach. Furthermore, subgroup analyses were performed to validate the consistency of the findings across specific populations.

RESULTS

This investigation enrolled 13,159 adult participants, comprising 8.15 % with depression. Compared with participants without depression, those diagnosed with depression showed a significantly higher CAR level. Each one - unit increase in log10-transformed CAR (log-CAR) was associated with an 58 % increase in the incidence of depression (Odds Ratio = 1.58, 95 % Confidence Interval: 1.33-1.88). A non-linear dose-response relationship was detected between CAR and depression risk (non-linear p < 0.001). Furthermore, the strength of this association persisted undiminished throughout multiple subgroup analyses. Notably, among individuals with a prior history of metabolic diseases, the observed association remained consistent.

CONCLUSIONS

A distinct positive correlation was observed between CAR and depression in U.S. adults. Further large-scale, well-controlled studies are needed to validate the reliability and establish the generalizability of these findings.

Using machine learning approach to predict suicide ideation and suicide attempts among Chinese adolescents: A cross-sectional study

BACKGROUND

Screening for suicide ideation and suicide attempts is crucial for adolescents, yet accurately predicting these outcomes remains a significant challenge. The relationship between non-suicidal self-injury and suicide ideation and attempts is complex. Therefore, this study employs machine learning techniques to explore and address these challenges.

METHODS

Using cross-sectional data, this study used stratified cluster sampling to recruit 2123 adolescents aged 10 to 15 from Fuyang, Anhui Province. Five psychological scale scores and six sociodemographic parameters were collected and included in eight machine learning models for factor selection and prediction of suicide ideation and suicide attempts.

RESULTS

The XGBoost model achieved an impressive AUC of 0.89 for suicide ideation and 0.92 for suicide attempts. Feature importance analysis revealed that suicide attempts are the most critical feature influencing suicide ideation, with an importance score of 0.73. Conversely, suicide ideation was identified as a significant predictor of suicide attempts, with an importance score of 0.86. Furthermore, non-suicidal self-injury was also found to significantly impact both outcomes. Notably, the relationship between the frequency of non-suicidal self-injury and both suicide ideation and attempts are nonlinear.

LIMITATION

A key limitation is that this cross-sectional study somewhat restricts the ability to establish causal relationships.

CONCLUSION

This study applied machine learning techniques to identify critical factors influencing adolescent suicide ideation and attempts, uncover the intricate relationship between non-suicidal self-injury and these outcomes, enhance risk prediction accuracy, and support early screening and intervention efforts.

Dysregulation of peripheral oxidative stress and the Nrf2 antioxidant system in Major Depressive Disorder

BACKGROUND

Oxidative stress and inflammation have been found to be involved in the development of major depressive disorder (MDD). The aim of this study was to investigate the peripheral levels of oxidative stress and the nuclear factor erythroid 2-related factor 2 (Nrf2) antioxidant system markers in patients with MDD and to evaluate the changes in these markers after 12 weeks of antidepressant treatment.

METHODS

We consecutively enrolled 104 drug-naïve or drug-free patients with an acute episode of MDD and 50 healthy controls (HCs). Plasma levels of Nrf2, phospho-Nrf2 (p-Nrf2), heme oxygenase-1 (HO-1), superoxide dismutase (SOD), malondialdehyde (MDA), phospholipase A2 (PLA2) and cyclooxygenase-2 (COX-2), were measured with the enzyme-linked immunosorbent assay.

RESULTS

Patients with MDD exhibited lower levels of the antioxidant system Nrf2, p-Nrf2, HO-1, SOD and higher levels of oxidative stress markers COX-2, PLA2, MDA compared to HCs (all p < 0.001). HO-1 levels differed significantly among melancholic, anxious, and atypical depression (p = 0.002). In addition, we found a negative correlation between somatic symptoms in HAMA scores and Nrf2 levels in MDD group (p = 0.04). At 12 weeks, COX-2 levels significantly increased in the non-remission group compared to baseline (p = 0.039), whereas no significant changes were observed in the remission group.

CONCLUSIONS

Peripheral oxidative stress and the Nrf2 antioxidant system were found to be dysregulated in patients with MDD. The Nrf2 antioxidant system might be a protective factor for somatic symptoms in MDD, whereas COX-2 might be a risk factor for poor antidepressant efficacy.

Transdiagnostic relationships between childhood adversity and cortical thickness of the rostral anterior cingulate cortex

Childhood adversity (CA) is the leading preventable risk factor for mental illness. While CA can exacerbate affective symptoms across various psychiatric disorders, its impact on brain morphology, particularly the rostral anterior cingulate cortex (rACC), has mainly been studied in specific stress-related psychiatric disorders, such as depression and anxiety disorders. Therefore, we set out to disentangle the relationships between CA, psychopathology and brain structure across a broader range of psychiatric disorders. We studied 227 patients with stress-related and/or neurodevelopmental disorders and 95 healthy controls. We focused on the rACC, as this region is highly impacted by CA and has a pivotal role in affective functions across psychiatric disorders. The presence of CA was associated with decreased left rACC thickness across the whole sample, independent of psychopathology. Additionally, the contralateral right rACC was associated with psychopathology, with psychiatric patients having a thinner rACC compared to healthy controls, which was most pronounced in the stress-related disorders group. While left rACC thickness negatively correlated with social anxiety-related concerns, right rACC thickness negatively correlated with various core symptoms of stress-related and neurodevelopmental disorders. Finally, our exploratory analyses across cortical regions did not reveal any robust effects that survived multiple comparison correction. Taken together, our results suggest that within the stress-related disorders group, the CA-related thinning of the left rACC may compound the effects of the affected right rACC. This 'double hit' in stress-related disorders may contribute to the well-established phenomenon that CA leads to a worse illness trajectory in these disorders.

Validation of the state-brief-penn state worry questionnaire

Intensive longitudinal designs, made possible due to the ubiquitous nature of smartphones, improve the ability to measure state and trait components of psychological processes like anxious arousal simultaneously. To maximize the potential of these designs, reliable and valid measures must be developed. We report the psychometric properties of a state version of the Brief Penn State Worry Questionnaire (SB-PSWQ) in 90 participants (M age = 29.14, SD = 12.21; 61.1 % Female). Participants completed a diagnostic interview and a battery of self-report questionnaires in one session, a series of cognitive tasks while hooked up to EEG equipment in another session and then participants completed two weeks of surveys sent five times per day to their smartphone. During these daily surveys, participants were asked to report current anxious apprehension, anxious arousal, and stressful life events. Using confirmatory factor analysis (CFA), we found that a one-factor solution showed acceptable fit for the SB-PSWQ at both within- and between-persons levels. Further, between-person SB-PSWQ scores were positively associated with anxious arousal and anxious apprehension, but not symptoms of an alcohol use disorder, all measured at baseline. In addition, within-person SB-PSWQ scores were positively associated with within-person anxious arousal scores. The present study provides initial evidence for the validation of a brief measure of anxious apprehension to be used in intensive longitudinal designs.

AI-driven analyzes of open-ended responses to assess outcomes of internet-based cognitive behavioral therapy (ICBT) in adolescents with anxiety and depression comorbidity

OBJECTIVE

Although patients prefer describing their problems using words, mental health interventions are commonly evaluated using rating scales. Fortunately, recent advances in natural language processing (i.e., AI-methods) yield new opportunities to quantify people's own mental health descriptions. Our aim was to explore whether responses to open-ended questions, quantified using AI, provide additional value in measuring intervention outcomes compared to traditional rating scales.

METHOD

Swedish adolescents (N = 44) who received Internet-based Cognitive Behavioral Therapy (ICBT) for eight weeks completed (pre/post) scales measuring anxiety and depression and three open-ended questions (related to depression, anxiety and general mental health). The language responses were quantified using a large language model and quantitative methods to predict mental health as measured by rating scales, valence (i.e., words' positive/negative affectivity), and semantic content (i.e., meaning).

RESULTS

Similar to the rating scales, language measures revealed statistically significant health improvements between pre and post measures such as reduced depression and anxiety symptoms and an increase in the use of words conveying positive emotions and different meanings (e.g., pre-intervention: "anxious", depressed; post-intervention: "happy", "the future"). Notably, the health changes identified through semantic content measures remained statistically significant even after accounting for the changes captured by the rating scales.

CONCLUSION

Language responses analyzed using AI-methods assessed outcomes with fewer items, demonstrating effectiveness and accuracy comparable to traditional rating scales. Additionally, this approach provided valuable insights into patients' well-being beyond mere symptom reduction, thus highlighting areas of improvement that rating scales often overlook. Since patients often prefer using natural language to express their mental health, this method could complement, and address comprehension issues associated fixed-item questionnaires.

Association between ketogenic diets and depression: A cross-sectional analysis of the NHANES 2005-2023 August

BACKGROUND

The ketogenic diet (KD) is widely used for epilepsy and neurodegenerative diseases. Glutamate, the excitatory neurotransmitter in the body, has been found to be significantly elevated in the brains of some patients with depression. Ketone bodies, the main products of KD, may negatively regulate the metabolic activity of glutamate, which suggests a potential role in the onset and progression of depression. However, the relationship between KD and depression risk remains uncertain.

METHODS

This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and August 2023 to investigate the association between the ketogenic diet ratio (KDR) and depression risk. Multiple logistic regression analysis was employed to examine this association, whereas nonlinear relationships were assessed using restricted cubic splines. Stratification analysis was employed to examine the association between KDR and depression severity. Subgroup analyses were also performed.

RESULTS

In a fully adjusted model accounting for confounding variables, KDR was significantly associated with depression risk. Two-piecewise linear regression analysis better fitted the association (KDR < 0.35, OR: 0.11; 95%CI: 0.03-0.35; P < 0.001). Subgroup analyses indicated that this association between KDR and depression was particularly pronounced in certain specific populations. We further observed a significant correlation between KDR and depression severity (P < 0.001).

CONCLUSION

Higher KDR was associated with a reduced risk of depression, with potentially greater efficacy observed in specific populations. Additionally, KDR has been found to be significantly associated with the severity of depression. Further study could investigate their potential mechanism.