The need for a behavioural science focus in research on mental health and mental disorders

Personality changes related to presence and treatment of substance use (disorders): a systematic review

Heavy substance use (SU) and substance use disorders (SUD) have complex etiologies and often severe consequences. Certain personality traits have been associated with an increased risk for SU(D), but far less is known about personality changes related to SU(D). This review aims to synthesize the existing literature on this research question. A systematic literature search was conducted from November 2022 to February 2023 in PubMed, EbscoHost, and Web of Science. Peer-reviewed original papers on SU(D)-related personality changes were included. Of 55 included studies, 38 were observational population-based studies and 17 were intervention studies. Overall, personality and SU measures, samples, study designs, and statistical approaches were highly heterogenous. In observational studies, higher SU was most consistently related to increases in impulsivity-related traits and (less so) neuroticism, while interventions in the context of SU(D) were mostly associated with increases in conscientiousness and self-efficacy and lasting decreases in neuroticism. Findings for traits related to extraversion, openness, conscientiousness, and agreeableness were mixed and depended on SU measure and age. Studies on bidirectional associations suggest that personality and SU(D) both influence each other over time. Due to their strong association with SU(D), impulsivity-related traits may be important target points for interventions. Future work may investigate the mechanisms underlying personality changes related to SU(D), distinguishing substance-specific effects from general SU(D)-related processes like withdrawal, craving, and loss of control. Furthermore, more research is needed to examine whether SU(D)-related personality changes vary by developmental stage and clinical features (e.g. initial use, onset, remission, and relapse).

Study protocol: the pragmatic, exploratory DELTA-JU trial of the group-based multimodal DELTA intervention for abstinent adolescents with substance use disorders living in youth welfare institutions

Background

The DELTA intervention contains 16 weekly group sessions plus additional individual sessions and educational session for parents. It aims to reduce substance use and related problems such as substance use disorders (SUD) in adolescents. Recent results indicated positive effects in psychiatric outpatients. Conducting DELTA in youth welfare settings seems feasible, however, organizational and content adjustments such as smoking cessation elements should be added in order to reduce relapse risks and to prevent negative health consequences.

Methods/design

The pre-registered DELTA-JU study (German Clinical Trials Register, DRKS00027913) is separated into three stages: In the adjustment stage during months 1-4, we will revise the DELTA manual based on semi-structured interviews (n = 10) with personnel from youth welfare institutions specialized in serving adolescents with SUD in the study region, analyzed with content analysis. In the sampling stage during months 5-22, participants qualifying for a SUD and willing to regularly participate in the 16 weekly DELTA-JU group sessions will be enrolled to either one of two arms (cluster randomization: immediate intervention, waitlist with subsequent intervention 16 weeks later). Adolescents will be assessed at baseline and follow-up (16 weeks after first group session) with an additional pre-assessment (16 weeks before intervention starts) for the waitlist group. Assessment procedures include questionnaires and clinical interviews among others. At the same time, institutional personnel will receive a 1-day workshop on SUD-relevant topics based on the DELTA parental education group and on feedback from the qualitative interviews. Personnel will also be assessed twice with questionnaires. In the dissemination stage during months 23-24, final study evaluation results will be prepared and submitted for publication.

Discussion

This study will create a setting-specific manual for vulnerable adolescents suffering from SUDs, and, in many cases, from co-occurring mental disorders. If shown to be effective, DELTA-JU can be disseminated within other institutions of youth welfare.

The use of integrated behavioural z-scoring in behavioural neuroscience - A perspective article

Complex pathophysiology in psychiatric disorders results in difficulties interpreting pre-clinical data. Guilloux et al. (2011b), proposed an integrated behavioural z-scoring procedure to improve the predictive validity of animal models by converging evidence similarly used to diagnose mental health conditions in humans. Here, I set out to give a brief review of the current methodology and literature using integrated behavioural z-scoring. Secondly, I will discuss the benefits and downfalls of integrated behavioural z-scoring and its potential future applications. Integrated behavioural z-scoring is a methodology used most frequently within animal models of depression and anxiety. Here, I am suggesting broadening the application of integrated behavioural z-scoring beyond the field of depression and anxiety to a three-step methodology to obtain disease-specific behavioural z-scores (i.e Schizophrenia index, Alzheimer's disease index) to aid translatability and interpretation of data. Lastly, I suggest integrating not only behaviour but also biological variables to create converging psychological and physiological evidence to sustain face and construct validity, while improving predict validity.

A potential biomarker for treatment stratification in psychosis: evaluation of an [18F] FDOPA PET imaging approach

[¹⁸F]FDOPA PET imaging has shown dopaminergic function indexed as K_i^cer differs between antipsychotic treatment responders and non-responders. However, the theragnostic potential of this biomarker to identify non-responders has yet to be evaluated. In view of this, we aimed to evaluate this as a theragnostic test using linear and non-linear machine-learning (i.e., Bernoulli, support vector, random forest and Gaussian processes) analyses and to develop and evaluate a simplified approach, standardised uptake value ratio (SUVRc). Both [¹⁸F]FDOPA PET approaches had good test-rest reproducibility across striatal regions (K_i^cer ICC: 0.68-0.94, SUVRc ICC: 0.76-0.91). Both our linear and non-linear classification models showed good predictive power to distinguish responders from non-responders (receiver operating curve area under the curve for region-of-interest approach: K_i^cer = 0.80, SUVRc = 0.79; for voxel-wise approach using a linear support vector machine: 0.88) and similar sensitivity for identifying treatment non-responders with 100% specificity (K_i^cer: ~50%, SUVRc: 40-60%). Although the findings were replicated in two independent datasets, given the total sample size (n = 84) and single setting, they warrant testing in other samples and settings. Preliminary economic analysis of [¹⁸F]FDOPA PET to fast-track treatment-resistant patients with schizophrenia to clozapine indicated a potential healthcare cost saving of ~£3400 (equivalent to $4232 USD) per patient. These findings indicate [¹⁸F]FDOPA PET dopamine imaging has potential as biomarker to guide treatment choice.

Longitudinal changes of anxiety and depressive symptoms during the COVID-19 pandemic in Germany: The role of pre-existing anxiety, depressive, and other mental disorders

Especially individuals with mental disorders might experience an escalation of psychopathological symptoms during the COVID-19 pandemic. Therefore, we investigated the role of anxiety, depressive, and other mental disorders for levels and longitudinal changes of COVID-19-related fear, anxiety and depressive symptoms during the first months of the COVID-19 pandemic in Germany. In a longitudinal observational design with four assessment waves from March, 27th until June, 15th 2020, a total of 6,551 adults from Germany was assessed. 4,175 individuals participated in one, 1,070 in two, 803 in three, and 503 in all four waves of data collection. Multilevel analyses revealed that across all assessment waves, COVID-19-related fear, anxiety, and depressive symptoms were significantly higher in individuals with vs. without anxiety, depressive, and other mental disorders. All symptoms decreased on average over time, and this decrease was significantly stronger in individuals with vs. without anxiety disorders, and particularly driven by individuals with generalized anxiety disorder. Our findings suggest that individuals with mental disorders, especially anxiety disorders - and in particular those with a generalized anxiety disorder - seem to be vulnerable to experience psychological strain in the context of the pandemic, might likely overestimate potential threat, and should be targeted by preventive and therapeutic interventions.

Elevated costly avoidance in anxiety disorders: Patients show little downregulation of acquired avoidance in face of competing rewards for approach

BACKGROUND

Pathological avoidance is a transdiagnostic characteristic of anxiety disorders. Avoidance conditioning re-emerged as a translational model to examine mechanisms and treatment of avoidance. However, its validity for anxiety disorders remains unclear.

METHODS

This study tested for altered avoidance in patients with anxiety disorders compared to matched controls (n = 40/group) using instrumental conditioning assessing low-cost avoidance (avoiding a single aversive outcome) and costly avoidance (avoidance conflicted with gaining rewards). Autonomic arousal and threat expectancy were assessed as indicators of conditioned fear. Associations with dimensional symptom severity were examined.

RESULTS

Patients and controls showed frequent low-cost avoidance without group differences. Controls subsequently inhibited avoidance to gain rewards, which was amplified when aversive outcomes discontinued. In contrast, patients failed to reduce avoidance when aversive and positive outcomes competed (elevated costly avoidance) and showed limited reduction when aversive outcomes discontinued (persistent costly avoidance). Interestingly, elevated costly avoidance was not linked to higher conditioned fear in patients. Moreover, individual data revealed a bimodal distribution of costly avoidance: Some patients showed persistent avoidance, others showed little to no avoidance. Persistent versus low avoiders did not differ in other task-related variables, response to gains and losses in absence of threat, sociodemographic data, or clinical characteristics.

CONCLUSIONS

Findings suggest that anxious psychopathology is associated with a deficit to inhibit avoidance in presence of competing positive outcomes. This offers novel perspectives for research on mechanisms and treatment of anxiety disorders.

Incentive-based, instructed, and social observational extinction of avoidance: Fear-opposite actions and their influence on fear extinction

Avoidance is a transdiagnostic symptom of clinical anxiety and its reduction a major focus of cognitive-behavioral treatments. This study examined the instrumental extinction of goal-directed avoidance by means of incentives, verbal instruction, and social observation and their influence on fear extinction. Participants acquired conditioned fear and instrumental avoidance responses (N = 160). In four randomized groups, the reduction of avoidance by incentives for non-avoidance, instructions to refrain from avoidance, and social observation of non-avoidance was compared to no intervention before removing the aversive outcome. Conditioned fear when avoidance became unavailable subsequently was tested. Incentives, instruction, and observation all reduced avoidance better than no intervention, however, with different degrees and influence on conditioned fear. Incentives and instructions strongly reduced avoidance despite high levels of fear (i.e., fear-opposite actions). This initiated fear extinction, thereby reducing conditioned fear when avoidance became unavailable. Social observation directly reduced conditioned fear, presumably because it conveyed additional information about the absence of the aversive outcome. However, observation only moderately reduced avoidance and resulted in higher fear when avoidance became unavailable. The effects of social observation may depend on the nuances of the demonstrator's behavior. The clear effects of incentive and instructions provide support for clinical interventions to reduce avoidance during exposure therapy and can serve as experimental models for their controlled investigation.

How to Improve Behavioral Parent and Teacher Training for Children with ADHD: Integrating Empirical Research on Learning and Motivation into Treatment

Attention deficit hyperactivity disorder [ADHD] is one of the most common psychiatric disorders of childhood with poor prognosis if not treated effectively. Recommended psychosocial evidence-based treatment for preschool and school-aged children is behavioral parent and teacher training [BPT]. The core elements of BPT are instrumental learning principles, i.e., reinforcement of adaptive and the ignoring or punishment of non-adaptive behaviors together with stimulus control techniques. BPT is moderately effective in reducing oppositional behavior and improving parenting practices; however, it does not reduce blinded ratings of ADHD symptoms. Also after training effects dissipate. This practitioner review proposes steps that can be taken to improve BPT outcomes for ADHD, based on purported causal processes underlying ADHD. The focus is on altered motivational processes (reward and punishment sensitivity), as they closely link to the instrumental processes used in BPT. Following a critical analysis of current behavioral treatments for ADHD, we selectively review motivational reinforcement-based theories of ADHD, including the empirical evidence for the behavioral predictions arising from these theories. This includes consideration of children's emotional reactions to expected and unexpected outcomes. Next we translate this evidence into potential ADHD-specific adjustments designed to enhance the immediate and long-term effectiveness of BPT programs in addressing the needs of children with ADHD. This includes the use of remediation strategies for proposed deficits in learning not commonly used in BPT programs and cautions regarding the use of punishment. Finally, we address how these recommendations can be effectively transferred to clinical practice.

Four Actionable Bottlenecks and Potential Solutions to Translating Psychiatric Genetics Research: An Expert Review

BACKGROUND

Psychiatric genetics has had limited success in translational efforts. A thorough understanding of the present state of translation in this field will be useful in the facilitation and assessment of future translational progress.

PURPOSE

A narrative literature review was conducted. Combinations of 3 groups of terms were searched in EBSCOhost, Google Scholar, and PubMed. The review occurred in multiple steps, including abstract collection, inclusion/exclusion criteria review, coding, and analysis of included papers.

RESULTS

One hundred and fourteen articles were analyzed for the narrative review. Across those, 4 bottlenecks were noted that, if addressed, may provide insights and help improve and increase translation in the field of psychiatric genetics. These 4 bottlenecks are emphasizing linear translational frameworks, relying on molecular genomic findings, prioritizing certain psychiatric disorders, and publishing more reviews than experiments.

CONCLUSIONS

These entwined bottlenecks are examined with one another. Awareness of these bottlenecks can inform stakeholders who work to translate and/or utilize psychiatric genetic information. Potential solutions include utilizing nonlinear translational frameworks as well as a wider array of psychiatric genetic information (e.g., family history and gene-environment interplay) in this area of research, expanding which psychiatric disorders are considered for translation, and when possible, conducting original research. Researchers are urged to consider how their research is translational in the context of the frameworks, genetic information, and psychiatric disorders discussed in this review. At a broader level, these efforts should be supported with translational efforts in funding and policy shifts.

Assessing Stakeholder Perceptions of the Utility of Genetic Information for the Clinical Care of Mental Health Disorders: We Have a Will but Need to See the Way

Academic stakeholders' (primarily mental health researchers and clinicians) practices and attitudes related to the translation of genetic information into mental health care were assessed. A three-part survey was administered at two large, urban universities. Response frequencies were calculated. Participants (N = 64) reported moderate levels of translational practice, adequate levels of genetic knowledge, and variable levels of genetic competence. They held positive attitudes toward translating genetic information about mental health broadly but negative attitudes about the impact that such information would have on specific aspects of care. The current study lays the groundwork for further inquiry into translating genetic information to mental health care.

Mental Health and Well-Being of University Students: A Bibliometric Mapping of the Literature

The purpose of this study is to map the literature on mental health and well-being of university students using metadata extracted from 5,561 journal articles indexed in the Web of Science database for the period 1975-2020. More specifically, this study uses bibliometric procedures to describe and visually represent the available literature on mental health and well-being in university students in terms of the growth trajectory, productivity, social structure, intellectual structure, and conceptual structure of the field over 45 years. Key findings of the study are that research on mental health and well-being in university students: (a) has experienced a steady growth over the last decades, especially since 2010; (b) is disseminated in a wide range of journals, mainly in the fields of psychology, psychiatry, and education research; (c) is published by scholars with diverse geographical background, although more than half of the publications are produced in the United States; (d) lies on a fragmented research community composed by multiple research groups with little interactions between them; (e) is relatively interdisciplinary and emerges from the convergence of research conducted in the behavioral and biomedical sciences; (f) tends to emphasize pathogenic approaches to mental health (i.e., mental illness); and (g) has mainly addressed seven research topics over the last 45 years: positive mental health, mental disorders, substance abuse, counseling, stigma, stress, and mental health measurement. The findings are discussed, and the implications for the future development of the field are highlighted.

The Behavior and Mind Health (BeMIND) study: Methods, design and baseline sample characteristics of a cohort study among adolescents and young adults

OBJECTIVES

The Behavior and Mind Health (BeMIND) study is a population-based cohort study of adolescents and young adults from Dresden, Germany. The aim is to investigate psychological and behavioral factors linked to a range of mental disorders and health behaviors and their interaction with social-environmental and genetic/biologic factors.

METHODS

A random sample of 14-21 year olds was drawn from the population registry in 2015. The baseline investigation was completed 11/2015-12/2016 (N = 1,180). Assessments include standardized diagnostic interview, cognitive-affective tasks, questionnaires, biosamples, and ecologic momentary assessment in real life with combined actigraphic/geographic monitoring. In the family study component, parents completed similar assessments and provided information on child's early development.

RESULTS

The participation rate (minimum response proportion) was 21.7%; the cooperation rate was 43.4%. Acceptance and completion of study components were high. General health data indicate that more than 80% reported no or only mild impairment due to mental or somatic health problems in the past year; about 20% ever sought treatment for mental health problems or chronic somatic illnesses, respectively.

CONCLUSIONS

Data from BeMIND baseline and follow-up investigations will provide novel insights into contributors to health and disease as adolescents grow into adulthood.

European mental health research resources: Picture and recommendations of the ROAMER project

As part of the Roamer project, we sought to have a picture of the available mental health research (MHR) funding, capacity-building and infrastructures resources and to establish consensus-based recommendations that would allow an increase of European MHR resources and enable better use and accessibility to them. The methods fell into three sections (i) a review of the literature, (ii) a mental health-related keywords search within the Cordis^®, On-Course^® and Meril^® databases which contain information on European research funding, training and infrastructures. These reviews provided an overview that was presented to (iii) two experts workshops with 28 participants drawn from academic which identified gaps and produced recommendations. The literature review illustrates the debates in the scientific community on funding, training and infrastructures. The database searches estimated the fraction of health research resources available for mental health. Eight overarching goals for MHR resources were identified by the workshops; each of them was carried out with several practical recommendations. Resources for MHR are scarce considering the burden of mental disorders, the high rate of return of MHR and the under-investment of the field. The recommendations are urgently warranted to increase resources and their optimal access and use.

Anxiety disorders

Anxiety disorders constitute the largest group of mental disorders in most western societies and are a leading cause of disability. The essential features of anxiety disorders are excessive and enduring fear, anxiety or avoidance of perceived threats, and can also include panic attacks. Although the neurobiology of individual anxiety disorders is largely unknown, some generalizations have been identified for most disorders, such as alterations in the limbic system, dysfunction of the hypothalamic-pituitary-adrenal axis and genetic factors. In addition, general risk factors for anxiety disorders include female sex and a family history of anxiety, although disorder-specific risk factors have also been identified. The diagnostic criteria for anxiety disorders varies for the individual disorders, but are generally similar across the two most common classification systems: the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the International Classification of Diseases, Tenth Edition (ICD-10). Despite their public health significance, the vast majority of anxiety disorders remain undetected and untreated by health care systems, even in economically advanced countries. If untreated, these disorders are usually chronic with waxing and waning symptoms. Impairments associated with anxiety disorders range from limitations in role functioning to severe disabilities, such as the patient being unable to leave their home.

Coping strategies and distress reduction in psychological well-being? A structural equation modelling analysis using a national population sample

BACKGROUND

Little is understood about of the role of coping strategies in psychological well-being (PWB) and distress for the general population and different physical and psychiatric disease groups. A thorough examination of these relationships may provide evidence for the implementation of public mental health promotion and psychiatric disease prevention strategies aimed at improving the use of positive coping approaches or addressing the causes and maintainers of distress. The present study using a structural equation modelling (SEM) approach and nationally representative data on the Canadian population investigates the relationships among PWB, distress and coping strategies and identifies major factors related to PWB for both the general population and diverse-specific disease groups.

METHODS

Data examined were from the Canadian Community Health Survey of Mental Health and Well-being (CCHS 1.2), a large national survey (n = 36 984). We applied exploratory factor analysis (EFA), confirmatory factor analysis and SEM to build structural relationships among PWB, distress and coping strategies in the general population.

RESULTS

Both SEM measurement and structure models provided a good fit. Distress was positively related to negative coping and negatively related to positive coping. Positive coping indicated a higher level of PWB, whereas negative coping was associated with a lower level of PWB. PWB was negatively related to distress. These same relationships were also found in the population subgroups. For the population with diseases (both physical and psychiatric diseases, except agoraphobia), distress was the more important factor determining subjective PWB than the person's coping strategies, whereas, negative coping had a major impact on distress in the general population. Strengths and limitations were also discussed.

CONCLUSIONS

Our findings have practical implications for public psychiatric disease intervention and mental health promotion. As previously noted positive/adaptive coping increased the level of PWB, whereas negative/maladaptive coping was positively related to distress and negatively related to PWB. Distress decreased the level of PWB. Our findings identified major correlates of PWB in both the general population and population subgroups. Our results provide evidence for the differential use of intervention tactics among different target audiences. In order to improve the mental health of the general population public mental health promotion should focus on strategies that reduce negative coping at a population level, whereas clinicians treating individual clients should make the reduction of distress their primary target to maintain or improve patients' PWB.

Incorporating Natural Products, Pharmaceutical Drugs, Self-Care and Digital/Mobile Health Technologies into Molecular-Behavioral Combination Therapies for Chronic Diseases

Merging pharmaceutical and digital (mobile health, mHealth) ingredients to create new therapies for chronic diseases offers unique opportunities for natural products such as omega-3 polyunsaturated fatty acids (n-3 PUFA), curcumin, resveratrol, theanine, or α-lipoic acid. These compounds, when combined with pharmaceutical drugs, show improved efficacy and safety in preclinical and clinical studies of epilepsy, neuropathic pain, osteoarthritis, depression, schizophrenia, diabetes and cancer. Their additional clinical benefits include reducing levels of TNFα and other inflammatory cytokines. We describe how pleiotropic natural products can be developed as bioactive incentives within the network pharmacology together with pharmaceutical drugs and self-care interventions. Since approximately 50% of chronically-ill patients do not take pharmaceutical drugs as prescribed, psychobehavioral incentives may appeal to patients at risk for medication non-adherence. For epilepsy, the incentive-based network therapy comprises anticonvulsant drugs, antiseizure natural products (n-3 PUFA, curcumin or/and resveratrol) coupled with disease-specific behavioral interventions delivered by mobile medical apps. The add-on combination of antiseizure natural products and mHealth supports patient empowerment and intrinsic motivation by having a choice in self-care behaviors. The incentivized therapies offer opportunities: (1) to improve clinical efficacy and safety of existing drugs, (2) to catalyze patient-centered, disease self-management and behavior-changing habits, also improving health-related quality-of-life after reaching remission, and (3) merging copyrighted mHealth software with natural products, thus establishing an intellectual property protection of medical treatments comprising the natural products existing in public domain and currently promoted as dietary supplements. Taken together, clinical research on synergies between existing drugs and pleiotropic natural products, and their integration with self-care, music and mHealth, expands precision/personalized medicine strategies for chronic diseases via pharmacological-behavioral combination therapies.

Contribution of the Nordic School of Public Health to the public mental health research field: a selection of research initiatives, 2007-2014

The field of public mental health has been defined by an expert group convened by the Nordic School of Public Health (NHV) as encompassing the experience, occurrence, distribution and trajectories of positive mental health and mental health problems and their determinants; mental health promotion and prevention of mental disorders; as well as mental health system policies, governance and organization. The mental health priorities of the Nordic Council of Ministers in 2010 signalled a mutual Nordic exchange of knowledge in the following thematic areas: child and adolescent mental health; working life and mental health; mental health in older people; strengthening the role of primary care in mental health service provision; stronger involvement of users and carers; and reduction of use of coercion in psychiatric care. Efforts to realize these priorities included commissioning the Nordic Research Academy for Mental Health, an NHV-based network of research institutions with a common interest in mental health research across the Nordic countries, to develop, organize and follow-up projects on public mental health. The research initiatives included mental health policy analysis, register-based research and research focused on the users' perspective in a Nordic context, as well as EU-level research policy analysis. The public mental health research conducted at the NHV highlighted the complexity of mental health and emphasized that the broad determinants of mental health need to be increasingly addressed in both public health research and practice. For example, health promotion actions, improved access to health care, a healthy alcohol policy and prevention of suicides and violence are all needed to reduce the life expectancy gap - a red flag indicator of public health inequalities. By exchanging knowledge and best practice, the collaboration between the Nordic countries contributes to the welfare of the region. The expertise and traditions developed at the NHV are of significant importance in this work.

Predictors of the course of anxiety disorders in adolescents and young adults

Anxiety disorders belong to the most frequent mental disorders and are often characterized by an early onset and a progressive, persistent/chronic, or recurrent course. Several individual, familial, and environmental risk factors for adverse course characteristics of anxiety disorders (including higher persistence, lower probability of remission, and increased risk of recurrence) have been identified, and previous research suggests that clinical features of anxiety (e.g., higher severity, duration, and avoidance) as well as comorbid other mental disorders are particularly useful for predicting an unfavorable course of anxiety disorders. However, additional studies are needed to identify risk factors for individual course trajectories of anxiety disorders in general as well as specific diagnoses. Doing so is essential in order to more precisely identify individuals with anxiety disorders who are at increased risk for adverse long-term outcomes and might thus particularly profit from targeted early interventions.

Validity and clinical interpretability of Overall Anxiety Severity And Impairment Scale (OASIS)

BACKGROUND

The Overall Anxiety Severity and Impairment Scale is a brief generic measure for anxiety that encompasses frequency and intensity as well as behavioral and functional aspects of anxiety. This study was conducted to elucidate aspects of reliability, validity, and interpretability, such as equivalence of factor loadings across non-clinical and clinical populations, convergence and discriminance of related variables, and performance of detecting diagnostic and medical status of anxiety disorders.

METHODS

Non-clinical and clinical Japanese populations were taken from a panelist pool registered with an internet survey company (total n=2830; 619 panic disorder, 576 for social anxiety disorder, 645 for obsessive-compulsive disorder, a 619 for major depressive disorder, and 371 for non-disorder panelists). Conventional measures of anxiety, depression, mental health and measures for discriminant validity were administered in addition to OASIS.

RESULTS

Exploratory and confirmatory factor analyses indicated good fit to data for the one-factor model of OASIS. Multi-group confirmatory factor analysis showed the equivalence of the factor loadings between those of non-clinical and clinical subsamples. The OASIS reliability was confirmed by internal consistency and test-retest coefficients. Receiver operating characteristic curve analyses showed that OASIS and conventional anxiety measures have fair performance for detecting diagnostic and medical status as anxiety disorders.

LIMITATIONS

Participants were limited to a Japanese population of people who had registered themselves at an internet survey company.

CONCLUSIONS

Along with useful information to interpret OASIS, the results suggest the reliability and validity of OASIS in Japanese populations. These results also suggest cross-cultural validity.

Horizon 2020 priorities in clinical mental health research: results of a consensus-based ROAMER expert survey

Within the ROAMER project, which aims to provide a Roadmap for Mental Health Research in Europe, a two-stage Delphi survey among 86 European experts was conducted in order to identify research priorities in clinical mental health research. Expert consensus existed with regard to the importance of three challenges in the field of clinical mental health research: (1) the development of new, safe and effective interventions for mental disorders; (2) understanding the mechanisms of disease in order to be able to develop such new interventions; and (3) defining outcomes (an improved set of outcomes, including alternative outcomes) to use for clinical mental health research evaluation. Proposed actions involved increasing the utilization of tailored approaches (personalized medicine), developing blended eHealth/mHealth decision aids/guidance tools that help the clinician to choose between various treatment modalities, developing specific treatments in order to better target comorbidity and (further) development of biological, psychological and psychopharmacological interventions. The experts indicated that addressing these priorities will result in increased efficacy and impact across Europe; with a high probability of success, given that Europe has important strengths, such as skilled academics and a long research history. Finally, the experts stressed the importance of creating funding and coordinated networking as essential action needed in order to target the variety of challenges in clinical mental health research.

Towards Horizon 2020: challenges and advances for clinical mental health research - outcome of an expert survey

BACKGROUND

The size and increasing burden of disease due to mental disorders in Europe poses substantial challenges to its population and to the health policy of the European Union. This warrants a specific research agenda concerning clinical mental health research as one of the cornerstones of sustainable mental health research and health policy in Europe. The aim of this research was to identify the top priorities needed to address the main challenges in clinical research for mental disorders.

METHODS

The research was conducted as an expert survey and expert panel discussion during a scientific workshop.

RESULTS

Eighty-nine experts in clinical research and representing most European countries participated in this survey. Identified top priorities were the need for new intervention studies, understanding the diagnostic and therapeutic implications of mechanisms of disease, and research in the field of somatic-psychiatric comorbidity. The "subjectivity gap" between basic neuroscience research and clinical reality for patients with mental disorders is considered the main challenge in psychiatric research, suggesting that a shift in research paradigms is required.

CONCLUSION

Innovations in clinical mental health research should bridge the gap between mechanisms underlying novel therapeutic interventions and the patient experience of mental disorder and, if present, somatic comorbidity. Clinical mental health research is relatively underfunded and should receive specific attention in Horizon 2020 funding programs.

The psychological perspective on mental health and mental disorder research: introduction to the ROAMER work package 5 consensus document

This paper provides an overview of the theoretical framework of the Psychological Sciences' reviews and describes how improved psychological research can foster our understanding of mental health and mental disorders in a complementary way to biomedical research. Core definitions of the field and of psychological interventions and treatment in particular are provided. The work group's consensus regarding strength and weaknesses of European Union (EU) research in critical areas is summarized, highlighting the potential of a broader comprehensive "Behaviour Science programme" in forthcoming programmatic EU funding programmes.

ROAMER: roadmap for mental health research in Europe

Despite the high impact of mental disorders in society, European mental health research is at a critical situation with a relatively low level of funding, and few advances been achieved during the last decade. The development of coordinated research policies and integrated research networks in mental health is lagging behind other disciplines in Europe, resulting in lower degree of cooperation and scientific impact. To reduce more efficiently the burden of mental disorders in Europe, a concerted new research agenda is necessary. The ROAMER (Roadmap for Mental Health Research in Europe) project, funded under the European Commission's Seventh Framework Programme, aims to develop a comprehensive and integrated mental health research agenda within the perspective of the European Union (EU) Horizon 2020 programme, with a translational goal, covering basic, clinical and public health research. ROAMER covers six major domains: infrastructures and capacity building, biomedicine, psychological research and treatments, social and economic issues, public health and well-being. Within each of them, state-of-the-art and strength, weakness and gap analyses were conducted before building consensus on future research priorities. The process is inclusive and participatory, incorporating a wide diversity of European expert researchers as well as the views of service users, carers, professionals and policy and funding institutions.

Advancing psychotherapy and evidence-based psychological interventions

Psychological models of mental disorders guide research into psychological and environmental factors that elicit and maintain mental disorders as well as interventions to reduce them. This paper addresses four areas. (1) Psychological models of mental disorders have become increasingly transdiagnostic, focusing on core cognitive endophenotypes of psychopathology from an integrative cognitive psychology perspective rather than offering explanations for unitary mental disorders. It is argued that psychological interventions for mental disorders will increasingly target specific cognitive dysfunctions rather than symptom-based mental disorders as a result. (2) Psychotherapy research still lacks a comprehensive conceptual framework that brings together the wide variety of findings, models and perspectives. Analysing the state-of-the-art in psychotherapy treatment research, "component analyses" aiming at an optimal identification of core ingredients and the mechanisms of change is highlighted as the core need towards improved efficacy and effectiveness of psychotherapy, and improved translation to routine care. (3) In order to provide more effective psychological interventions to children and adolescents, there is a need to develop new and/or improved psychotherapeutic interventions on the basis of developmental psychopathology research taking into account knowledge of mediators and moderators. Developmental neuroscience research might be instrumental to uncover associated aberrant brain processes in children and adolescents with mental health problems and to better examine mechanisms of their correction by means of psychotherapy and psychological interventions. (4) Psychotherapy research needs to broaden in terms of adoption of large-scale public health strategies and treatments that can be applied to more patients in a simpler and cost-effective way. Increased research on efficacy and moderators of Internet-based treatments and e-mental health tools (e.g. to support "real time" clinical decision-making to prevent treatment failure or relapse) might be one promising way forward.