Rationale, Methods, Feasibility, and Preliminary Outcomes of a Transdiagnostic Prevention Program for At-Risk College Students

The default mode network is associated with changes in internalizing and externalizing problems differently in adolescent boys and girls

Internalizing and externalizing problems that emerge during adolescence differentially increase boys' and girls' risk for developing psychiatric disorders. It is not clear, however, whether there are sex differences in the intrinsic functional architecture of the brain that underlie changes in the severity of internalizing and externalizing problems in adolescents. Using resting-state fMRI data and self-reports of behavioral problems obtained from 128 adolescents (73 females; 9-14 years old) at two timepoints, we conducted multivoxel pattern analysis to identify resting-state functional connectivity markers at baseline that predict changes in the severity of internalizing and externalizing problems in boys and girls 2 years later. We found sex-differentiated involvement of the default mode network in changes in internalizing and externalizing problems. Whereas changes in internalizing problems were associated with the dorsal medial subsystem in boys and with the medial temporal subsystem in girls, changes in externalizing problems were predicted by hyperconnectivity between core nodes of the DMN and frontoparietal network in boys and hypoconnectivity between the DMN and affective networks in girls. Our results suggest that different neural mechanisms predict changes in internalizing and externalizing problems in adolescent boys and girls and offer insights concerning mechanisms that underlie sex differences in the expression of psychopathology in adolescence.

Changes in responses of the amygdala and hippocampus during fear conditioning are associated with persecutory beliefs

The persecutory delusion is the most common symptom of psychosis, yet its underlying neurobiological mechanisms are poorly understood. Prior studies have suggested that abnormalities in medial temporal lobe-dependent associative learning may contribute to this symptom. In the current study, this hypothesis was tested in a non-clinical sample of young adults without histories of psychiatric treatment (n = 64), who underwent classical Pavlovian fear conditioning while fMRI data were collected. During the fear conditioning procedure, participants viewed images of faces which were paired (the CS+) or not paired (the CS-) with an aversive stimulus (a mild electrical shock). Fear conditioning-related neural responses were measured in two medial temporal lobe regions, the amygdala and hippocampus, and in other closely connected brain regions of the salience and default networks. The participants without persecutory beliefs (n = 43) showed greater responses to the CS- compared to the CS+ in the right amygdala and hippocampus, while the participants with persecutory beliefs (n = 21) failed to exhibit this response. These between-group differences were not accounted for by symptoms of depression, anxiety or a psychosis risk syndrome. However, the severity of subclinical psychotic symptoms overall was correlated with the level of this aberrant response in the amygdala (p = .013) and hippocampus (p = .033). Thus, these findings provide evidence for a disruption of medial temporal lobe-dependent associative learning in young people with subclinical psychotic symptoms, specifically persecutory thinking.

Association between Depressive Symptoms and Adherence to the Mediterranean Diet in Nursing Students

With university admission, there are major changes in students' daily habits that can lead to mental health problems. In this respect, adherence to a healthy diet, such as the Mediterranean diet (MD), can be very beneficial. The present study examines the associations between adherence to the MD and mental health among Spanish nursing students (n = 289). Sociodemographic data and life habits were collected electronically using a self-administered questionnaire. The participants also completed the Mediterranean Diet Adherence Screener (MEDAS-14) and the Goldberg Anxiety and Depression Scale (GADS). The percentage of anxiety and depression symptoms was high: 45.3% (n = 131) and 46.4% (n = 134), respectively. Only 35.6% reported good adherence to the MD (score ≥ 9). The statistical analysis showed poor adherence to the MD to be significantly and positively associated with depressive symptoms (p = 0.013) and the total score on the GADS (p = 0.039). A multivariable regression model analysis identified the depression subscale score as a predictor variable, with a mean risk of low adherence to the MD being 0.803 times (95%CI: 0.666-0.968, p = 0.021) among participants with greater depressive symptoms. These results support the implementation of prevention programs in universities focused on health and mental health issues.

Efficacy of a transdiagnostic, prevention-focused program for at-risk young adults: a waitlist-controlled trial

BACKGROUND

Prevention programs that are 'transdiagnostic' may be more cost-effective and beneficial, in terms of reducing levels of psychopathology in the general population, than those focused on a specific disorder. This randomized controlled study evaluated the efficacy of one such intervention program called Resilience Training (RT).

METHODS

College students who reported mildly elevated depressive or subclinical psychotic symptoms ('psychotic experiences' (PEs)) (n = 107) were randomized to receiving RT (n = 54) or to a waitlist control condition (n = 53). RT consists of a four-session intervention focused on improving resilience through the acquisition of mindfulness, self-compassion, and mentalization skills. Measures of symptoms and these resilience-enhancing skills were collected before and after the 4-week RT/waitlist period, with a follow-up assessment 12-months later.

RESULTS

Compared to the waitlist control group, RT participants reported significantly greater reductions in PEs, distress associated with PEs, depression, and anxiety, as well as significantly greater improvements in resilience, mindfulness, self-compassion, and positive affect, following the 4-week RT/waitlist period (all p < 0.03). Moreover, improvements in resilience-promoting skills were significantly correlated with symptom reductions (all p < 0.05). Lastly, the RT-related reductions in PEs and associated distress were maintained at the 12-month follow-up assessment.

CONCLUSIONS

RT is a brief, group-based intervention associated with improved resilience and reduced symptoms of psychopathology, with sustained effects on PEs, in transdiagnostically at-risk young adults. Follow-up studies can further assess the efficacy of RT relative to other interventions and test whether it can reduce the likelihood of developing a serious mental illness.

Mothering from the Inside Out: Results of a community-based randomized efficacy trial testing a mentalization-based parenting intervention for mothers with addictions

Mothering from the Inside Out (MIO) is a mentalization-based parenting intervention developed to address challenges common among mothers experiencing substance use disorders (SUDs) and previously deemed effective when delivered by research clinicians. This randomized clinical trial was designed to test the efficacy of MIO when delivered by community-based addiction counselors in Connecticut, USA. Ninety-four mothers [M(SD)age = 31.01(4.01) years; 75.53% White] caring for a child 11-60 months of age were randomly assigned to participate in 12 sessions of either MIO or psychoeducation. Caregiving, psychiatric, and substance use outcomes were assessed repeatedly from baseline through 12-week follow-up. Mothers who participated in MIO showed decreased certainty about their child's mental states, and decreased depression; their children demonstrated increased clarity of cues. Participation in MIO was not associated with the same degree of improvement that was observed in prior trials where MIO was delivered by research clinicians. However, when delivered by community-based clinicians, MIO may be protective against a deterioration in caregiving over time often seen in mothers with addictions. The drop in efficacy of MIO in this trial raises questions about intervention-intervenor fit. Research should examine factors influencing MIO effectiveness to close the science-to-service gap common in the dissemination of empirically validated interventions.

[Initial mental disorders in patients with psychotic of schizophrenia in adolescent]

OBJECTIVE

Clarification of the phenomenology and dynamics of initial mental disorders in patients with psychotic pubertal forms of schizophrenia, identification of the features of these disorders depending on sex.

MATERIAL AND METHODS

The study material was adolescent patients with psychotic forms of schizophrenia. Forty-three people were examined (women 44.2%, median age 14.3 [13.0; 16.8] years). Clinical-anamnestic, clinical-psychopathological, clinical-statistical methods were used.

RESULTS

The duration of the initial stage of the disease ranged from several hours to 5 years (median 0.8 [0.5; 1.7]. The structure of initial disorders was dominated by nonspecific mental disorders characterized by a combination of symptoms of non-psychotic and subpsychotic levels (20 patients - 43.5%; including 12 males - 26% and 8 females - 24.1% ). If behavioral disorders and episodes of psychoactive substance use were significantly more often detected in boys, then dysmorphic phenomena were detected in girls (p<0.05). In accordance with the dynamics of development, acute (n=14 - 32%), subacute (n=21 - 49%), fluctuating (n=8 - 19%) variants of initial disorders are distinguished. Young men turned to a psychiatrist in a more timely manner (already at the stage of prodrome), while girls sought psychiatric help only at the stage of development of psychotic disorders.

CONCLUSION

A psychotic episode in adolescents suffering from schizophrenia developed acutely in a third of cases. In the vast majority of cases, the initial mental disorders that appeared on the eve of acute psychosis was subacute, or differed in a fluctuating course, characterized by clinical polymorphism and multidirectionality. Differences were revealed in the preference for the occurrence of a number of initial disorders in boys and girls, as well as in the timeliness of seeking psychiatric help.

Cross-Sectional Analysis of Mental Health among University Students: Do Sex and Academic Level Matter?

University students' mental health and well-being is a growing public health concern. There is a lack of studies assessing a broad range of mental health domains by sex and academic level of study. This cross-sectional online survey of BSc, MSc, and PhD students (n = 3353, 67% female) enrolled at one university in Germany assessed a wide scope of mental health domains, covering positive (i.e., self-rated health, self-esteem, student engagement) and negative aspects (i.e., perceived stress, irritation, and screening positive for depression, anxiety, comorbidity, and psychological distress). We evaluated differences in mental health by sex and academic level. Overall, although self-rated health did not differ by sex and academic level, females and lower academic level were associated with less favorable mental health. Males reported higher prevalence of high self-esteem, and higher engagement (all p ≤ 0.04). Conversely, mean perceived stress and cognitive/emotional irritation were higher among females, as were rates for positive screenings for anxiety, anxiety and depression comorbidity, and psychological distress (p < 0.001 for all). Likewise, lower academic level (BSc) was associated with lower rates of high self-esteem (p ≤ 0.001), increased perceived stress (p < 0.001), and higher prevalence of positive screening for depression, anxiety, comorbidity, and psychological distress (p ≤ 0.002 for all), while higher academic level (PhD) was linked to increased student engagement (p < 0.001 for all). Although the effect sizes of sex and academic level on student mental health were modest, these findings support a need for action to establish and expand early detection and prevention programs, on-campus advisory services, and peer counseling that focus on the sex-specific and academic-study-level-specific factors, as well as mental health and career development resources for students. Academics and policy makers need to consider multipronged intervention strategies to boost confidence of students and their academic career.

Personal space increases during the COVID-19 pandemic in response to real and virtual humans

Personal space is the distance that people tend to maintain from others during daily life in a largely unconscious manner. For humans, personal space-related behaviors represent one form of non-verbal social communication, similar to facial expressions and eye contact. Given that the changes in social behavior and experiences that occurred during the COVID-19 pandemic, including "social distancing" and widespread social isolation, may have altered personal space preferences, we investigated this possibility in two independent samples. First, we compared the size of personal space measured before the onset of the pandemic to its size during the pandemic in separate groups of subjects. Personal space size was significantly larger in those assessed during (compared to those assessed before) the onset of the pandemic (all d > 0.613, all p < 0.007). In an additional cohort, we measured personal space size, and discomfort in response to intrusions into personal space, longitudinally before and during the pandemic, using both conventional and virtual reality-based techniques. Within these subjects, we found that measurements of personal space size with respect to real versus virtual humans were significantly correlated with one another (r = 0.625-0.958) and similar in magnitude. Moreover, the size of personal space, as well as levels of discomfort during personal space intrusions, increased significantly during (compared to before) the COVID-19 pandemic in response to both real and virtual humans (all d > 0.842, all p < 0.01). Lastly, we found that the practice of social distancing and perceived (but not actual) risk of being infected with COVID-19 were linked to this personal space enlargement during the pandemic (all p < 0.038). Taken together, these findings suggest that personal space boundaries expanded during the COVID-19 pandemic independent of actual infection risk level. As the day-to-day effects of the pandemic subside, personal space preferences may provide one index of recovery from the psychological effects of this crisis.

A Review of Self-Compassion as an Active Ingredient in the Prevention and Treatment of Anxiety and Depression in Young People

Previous meta-analyses have found higher self-compassion is associated with lower anxiety and depression. The aim of this study was to investigate the efficacy of self-compassion as an active ingredient in the treatment and prevention of anxiety and depression in youth. This was conducted through (i) a systematic review of the literature and (ii) qualitative consultation with young people and researchers in self-compassion. Fifty studies met our inclusion criteria. Eight studies evaluated self-compassion interventions among youth aged 14-24, and the remaining studies measured the association between self-compassion and anxiety, and/or depression among this age group. Qualitative interviews were conducted with four self-compassion researchers. Interviews were also conducted in two rounds of consultation with 20 young people (M age = 18.85 years, age range 14-24 years). Higher self-compassion was related to lower symptoms of anxiety, r =  - 0.49, 95% CI (- 0.57, - 0.42), and depression, r =  - 0.50, 95% CI (- 0.53, - 0.47). There was evidence for self-compassion interventions in decreasing anxiety and depression in young people. Consultation with young people indicated they were interested in self-compassion interventions; however, treatment should be available in a range of formats and tailored to address diversity. Self-compassion experts emphasised the importance of decreasing self-criticism as a reason why self-compassion interventions work. The importance of targeting self-criticism is supported by the preferences of young people who said they would be more likely to engage in a treatment reducing self-criticism than increasing self-kindness. Future research is required to add to the emerging evidence for self-compassion interventions decreasing symptoms of anxiety and depression in young people.

Clinical and cost-effectiveness of social recovery therapy for the prevention and treatment of long-term social disability among young people with emerging severe mental illness (PRODIGY): randomised controlled trial

BACKGROUND

Young people with social disability and severe and complex mental health problems have poor outcomes, frequently struggling with treatment access and engagement. Outcomes may be improved by enhancing care and providing targeted psychological or psychosocial intervention.

AIMS

We aimed to test the hypothesis that adding social recovery therapy (SRT) to enhanced standard care (ESC) would improve social recovery compared with ESC alone.

METHOD

A pragmatic, assessor-masked, randomised controlled trial (PRODIGY: ISRCTN47998710) was conducted in three UK centres. Participants (n = 270) were aged 16-25 years, with persistent social disability, defined as under 30 hours of structured activity per week, social impairment for at least 6 months and severe and complex mental health problems. Participants were randomised to ESC alone or SRT plus ESC. SRT was an individual psychosocial therapy delivered over 9 months. The primary outcome was time spent in structured activity 15 months post-randomisation.

RESULTS

We randomised 132 participants to SRT plus ESC and 138 to ESC alone. Mean weekly hours in structured activity at 15 months increased by 11.1 h for SRT plus ESC (mean 22.4, s.d. = 21.4) and 16.6 h for ESC alone (mean 27.7, s.d. = 26.5). There was no significant difference between arms; treatment effect was -4.44 (95% CI -10.19 to 1.31, P = 0.13). Missingness was consistently greater in the ESC alone arm.

CONCLUSIONS

We found no evidence for the superiority of SRT as an adjunct to ESC. Participants in both arms made large, clinically significant improvements on all outcomes. When providing comprehensive evidence-based standard care, there are no additional gains by providing specialised SRT. Optimising standard care to ensure targeted delivery of existing interventions may further improve outcomes.

Promoting resilience in healthcare workers during the COVID-19 pandemic with a brief online intervention

INTRODUCTION

The psychological wellbeing of healthcare workers has been impacted by the high levels of stress many have experienced during the Coronavirus Disease 2019 (COVID-19) pandemic. This study aimed to examine the feasibility and acceptability of a brief online course focused on introducing evidence-based skills that could increase resilience and decreases emotional distress in healthcare workers during the pandemic.

MATERIALS AND METHODS

Employees of a large healthcare system completed a mental health survey at baseline, and then one month and two months after some employees participated in an online resilience-enhancement course consisting of three 12-19 min videos focused on mindfulness, mentalization, and self-compassion.

RESULTS

A total of 554 participants completed the baseline survey, endorsing moderate to high levels of emotional distress. Of those who completed all three assessments and participated in the course (n = 38), significant improvements in resilience and reductions in emotional distress were found one and two months later, in comparison to those who did not participate in the course (n = 110).

DISCUSSION

These findings suggest that a brief, online intervention can improve the mental health of healthcare workers during a crisis such as the COVID-19 pandemic.

Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies

Promotion of good mental health, prevention, and early intervention before/at the onset of mental disorders improve outcomes. However, the range and peak ages at onset for mental disorders are not fully established. To provide robust, global epidemiological estimates of age at onset for mental disorders, we conducted a PRISMA/MOOSE-compliant systematic review with meta-analysis of birth cohort/cross-sectional/cohort studies, representative of the general population, reporting age at onset for any ICD/DSM-mental disorders, identified in PubMed/Web of Science (up to 16/05/2020) (PROSPERO:CRD42019143015). Co-primary outcomes were the proportion of individuals with onset of mental disorders before age 14, 18, 25, and peak age at onset, for any mental disorder and across International Classification of Diseases 11 diagnostic blocks. Median age at onset of specific disorders was additionally investigated. Across 192 studies (n = 708,561) included, the proportion of individuals with onset of any mental disorders before the ages of 14, 18, 25 were 34.6%, 48.4%, 62.5%, and peak age was 14.5 years (k = 14, median = 18, interquartile range (IQR) = 11-34). For diagnostic blocks, the proportion of individuals with onset of disorder before the age of 14, 18, 25 and peak age were as follows: neurodevelopmental disorders: 61.5%, 83.2%, 95.8%, 5.5 years (k = 21, median=12, IQR = 7-16), anxiety/fear-related disorders: 38.1%, 51.8%, 73.3%, 5.5 years (k = 73, median = 17, IQR = 9-25), obsessive-compulsive/related disorders: 24.6%, 45.1%, 64.0%, 14.5 years (k = 20, median = 19, IQR = 14-29), feeding/eating disorders/problems: 15.8%, 48.1%, 82.4%, 15.5 years (k = 11, median = 18, IQR = 15-23), conditions specifically associated with stress disorders: 16.9%, 27.6%, 43.1%, 15.5 years (k = 16, median = 30, IQR = 17-48), substance use disorders/addictive behaviours: 2.9%, 15.2%, 48.8%, 19.5 years (k = 58, median = 25, IQR = 20-41), schizophrenia-spectrum disorders/primary psychotic states: 3%, 12.3%, 47.8%, 20.5 years (k = 36, median = 25, IQR = 20-34), personality disorders/related traits: 1.9%, 9.6%, 47.7%, 20.5 years (k = 6, median = 25, IQR = 20-33), and mood disorders: 2.5%, 11.5%, 34.5%, 20.5 years (k = 79, median = 31, IQR = 21-46). No significant difference emerged by sex, or definition of age of onset. Median age at onset for specific mental disorders mapped on a time continuum, from phobias/separation anxiety/autism spectrum disorder/attention deficit hyperactivity disorder/social anxiety (8-13 years) to anorexia nervosa/bulimia nervosa/obsessive-compulsive/binge eating/cannabis use disorders (17-22 years), followed by schizophrenia, personality, panic and alcohol use disorders (25-27 years), and finally post-traumatic/depressive/generalized anxiety/bipolar/acute and transient psychotic disorders (30-35 years), with overlap among groups and no significant clustering. These results inform the timing of good mental health promotion/preventive/early intervention, updating the current mental health system structured around a child/adult service schism at age 18.

Depression Predicts Global Functional Outcomes in Individuals at Clinical High Risk for Psychosis

Objectives

While co-morbid depression is associated with poor functional outcome among patients with schizophrenia, whether depression similarly predicts poorer outcomes in individuals at clinical high-risk for psychosis (CHR-P) is not clear. The present study aimed to examine depressive symptoms in relation to long-term global functional outcomes in the North American Prodrome Longitudinal Study cohort (NAPLS2).

Methods

CHR individuals were evaluated clinically at baseline and at 12- and 24-month follow-ups for depressive and prodromal symptom severity as well as general functioning. Regression models were built to investigate whether baseline positive and depressive symptom scores predicted longitudinal improvement in global functioning.

Results

A total of 406 CHR individuals completed the 12-month follow-up assessment and 259 CHR individuals completed the 24-month assessment. Baseline depressive symptoms in the CHR-P population were found to predict better global functional outcomes at 2 years. Furthermore, the degree of recovery of depressive symptoms in the first year following baseline completely mediated the association between depressive symptoms at baseline and functional improvement at 2 years.

Conclusions

Presence of affective symptoms within the CHR-P population has different implications for prognosis compared with patients with schizophrenia. The present findings support the view that among those at risk for psychosis, depressive symptoms at baseline predict a more favorable course of functional recovery, and highlight the potential importance of treating co-occurring depressive symptoms at an early stage of psychosis risk.

Structure can predict function in the human brain: a graph neural network deep learning model of functional connectivity and centrality based on structural connectivity

Although functional connectivity and associated graph theory measures (e.g., centrality; how centrally important to the network a region is) are widely used in brain research, the full extent to which these functional measures are related to the underlying structural connectivity is not yet fully understood. Graph neural network deep learning methods have not yet been applied for this purpose, and offer an ideal model architecture for working with connectivity data given their ability to capture and maintain inherent network structure. Here, we applied this model to predict functional connectivity from structural connectivity in a sample of 998 participants from the Human Connectome Project. Our results showed that the graph neural network accounted for 89% of the variance in mean functional connectivity, 56% of the variance in individual-level functional connectivity, 99% of the variance in mean functional centrality, and 81% of the variance in individual-level functional centrality. These results represent an important finding that functional centrality can be robustly predicted from structural connectivity. Regions of particular importance to the model's performance as determined through lesioning are discussed, whereby regions with higher centrality have a higher impact on model performance. Future research on models of patient, demographic, or behavioural data can also benefit from this graph neural network method as it is ideally-suited for depicting connectivity and centrality in brain networks. These results have set a new benchmark for prediction of functional connectivity from structural connectivity, and models like this may ultimately lead to a way to predict functional connectivity in individuals who are unable to do fMRI tasks (e.g., non-responsive patients).

Predicting Negative and Positive Affect During COVID-19: A Daily Diary Study in Youths

The COVID-19 pandemic has the potential to profoundly affect youths' mental health. Understanding predictors of affective responding to the pandemic is critical for prevention and intervention efforts. This study examines emotion regulation as an important predictor of youth's changes in positive and negative affect. The present study of 115 participants (62 girls, M_age  = 11.77) explores the relation between pre-existing emotion regulation strategies, as measured by multi-week daily diaries pre-COVID, and youths' mean positive and negative affect levels and variability during a 28-day period amidst the pandemic, while including COVID-related worries and isolation as important moderators. The findings provide important insight into interactions between pre-existing vulnerabilities and COVID-related stressors in predicting affective adjustment in youth.

The multidimensional construct of resilience across the psychosis spectrum: Evidence of alterations in people with early and prolonged psychosis

OBJECTIVE

Research has demonstrated that resilience impacts functional outcomes and is often reduced among those with prolonged psychosis. However, little work has examined when during the course of psychosis resilience declines and whether resilience impacts symptoms and functioning similarly in different illness phases. This study examined whether overall resilience (a) differed between those with early compared to relatively prolonged psychosis, (b) differed between the psychosis groups and nonclinical controls, and (c) differentially related to symptoms and functioning in the psychosis groups.

METHOD

Participants with early (n = 30) and prolonged psychosis (n = 64) and nonclinical controls (n = 58) completed the Resilience Scale. Psychosis participants also completed clinician-rated functioning and symptom measures. Analyses of Variance were used to compare group resilience levels. Pearson's correlations identified relationships between resilience, symptoms, and functioning.

RESULTS

Overall resilience levels did not significantly differ between the psychosis groups, but both psychosis groups had lower resilience than nonclinical controls. Higher overall resilience was significantly associated with lower negative symptoms in the early psychosis group and lower mood symptoms in the prolonged psychosis group; greater resilience was significantly associated with higher functioning in both psychosis groups.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Resilience may be reduced throughout the course of psychosis but may differentially impact symptom domains in different illness phases. Targeting resilience with psychosocial interventions may be important throughout the course of psychosis and may lead to improvements in functioning as well as negative symptoms and mood symptoms (in early and prolonged psychosis, respectively). (PsycInfo Database Record (c) 2020 APA, all rights reserved).