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

INTRODUCTION

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

MATERIAL AND METHODS

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

RESULTS

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

DISCUSSION

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

Psychological distress among Israelis during crisis: A comparison between COVID-19 and the Iron Swords War

This study aimed to compare stress reactions and coping resources among the Jewish population in Israel during two different crises: the COVID-19 pandemic and the current Iron Swords War. The study included 421 respondents during the COVID-19 period and 604 respondents during the Iron Swords War. Participants completed self-report questionnaires designed to evaluate sense of coherence, hope, and Community resilience as indicators of coping resources and the Brief Symptom Inventory as a measure of psychological distress. Overall, the mental state of the entire population was more severe during the Iron Swords War than it was during the COVID-19 period (p0.001> (. Sense of coherence and hope were both strongly negatively correlated with psychological distress (p<.001). Moreover, hope, sense of coherence, gender, and age were significant predictors of psychological distress (p< .01). These findings indicate the importance of personal coping resources, such as sense of coherence, during times of crisis. This is particularly important for vulnerable groups. Policymakers should prioritize mental-health services and targeted interventions in emergency response plans.

Recent advances in biomimetic nanodelivery systems for the treatment of depression

Depression and cognitive disorders remain major challenges in healthcare, with conventional treatments often facing limitations such as slow onset, side effects, and poor drug delivery to the brain. Biomimetic nanodelivery systems, including nanozymes, cell membrane-based systems, and exosomes, have emerged as promising solutions to these issues. These systems leverage natural biological processes to enhance drug targeting, improve bioavailability, and regulate complex biological pathways. Nanoenzymes, with their catalytic properties, offer antioxidant and anti-inflammatory benefits, while cell membranes and exosomes provide efficient targeting and immune evasion. However, challenges remain, including the immaturity of large-scale production techniques, stability concerns, and incomplete understanding of their mechanisms of action. Moreover, the long-term safety, pharmacokinetics, and toxicity of these systems require further investigation. Despite these obstacles, the potential of biomimetic nanodelivery systems to revolutionize depression treatment is significant. Future research should focus on optimizing their preparation, improving drug targeting and release, and ensuring clinical safety. Multidisciplinary collaboration will be essential for advancing these systems from the laboratory to clinical practice, offering new therapeutic avenues for depression and other neurological disorders.

IL-17 enhanced the susceptibility to fluoxetine resistance in depression via the JAK1-STAT6 signaling pathway

AIMS

This study aims to investigate the role of IL-17 in fluoxetine resistance in depression.

METHODS

The Weighted Gene Coexpression Network Analysis (WGCNA) was utilized to analyze differentially expressed genes between response to antidepressant (GRA) group and the resistance to antidepressant (AR) group. Furthermore, a treatment resistance model of depression was established in Chronic unpredictable mild stress (CUMS) mice administrated with fluoxetine (widely used clinical medication for the treatment of depression) according to sucrose preference rate. Depression-like behaviors in mice were detected in Control group, CUMS group, GRA group, AR group, and SR1001 (Th17 differentiation inhibitor) group. Subsequently, HT22 cells were exposed to IL-17 secreted by Th17 differentiation. Transcriptome sequencing from the Control and IL-17 group was used to screen differential genes. HT22 cells were then transfected with si-JAK1 or si-STAT6. Th17 differentiation, the integrity of the blood-brain barrier (BBB), JAK1-STAT6 signaling pathway related proteins were detected by western blot, immunocytochemistry, flow cytometric analysis, ELISA experiments, immunofluorescence, and PCR.

RESULT

The WGCNA showed that Th17 differentiation played an important role in the treatment resistance of depression. The results of the following animal experiments showed that fluoxetine resistance resulted in a reduction in total distance and average speed in the Open Field Test (OFT), an increase in immobility time during the Forced Swim Test (FST) and Tail Suspension Test (TST). It also regulated the expression of the SERT protein, Th17 differentiation, IL-17 secretion, and compromised the integrity of BBB, yielding similar outcomes in CUMS mice. However, these results could be reversed by SR1001. Moreover, IL-17 effectively elevated the SERT protein level and activated the JAK1-STAT6 signaling pathway in vivo and in vitro.

CONCLUSION

The inhibition of Th17 differentiation and the reduction of peripheral IL-17 release could decrease sensitivity to fluoxetine resistance and relieve the depression-like behavior. This process might be associated with the JAK1-STAT6 pathway.

Interventions to Foster Mental Health and Reintegration in Individuals Who Are Unemployed: Systematic Review

BACKGROUND

Unemployment is a risk factor for the development and perpetuation of psychological distress. Finding support for affected individuals can be particularly challenging, which causes a vicious cycle of psychological distress and unemployment.

OBJECTIVE

The aim of this systematic review is to assess and summarize existing evidence regarding interventions that address both mental health and re-employment, emphasizing accessibility through community or social care structures.

METHODS

A systematic literature search using PubMed and EBSCOhost and an additional search using reference list screening were conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In order to identify interventions for the mental health and re-employment of individuals experiencing psychological distress and unemployment, an inclusion process according to the PICO (population, intervention, comparison, and outcome) scheme and the study design was applied. Title and abstract screening and full-text screening for eligibility were performed independently by 2 reviewers. Quality assessments using the Cochrane Risk of Bias Tools for randomized and nonrandomized trials were conducted by 2 independent reviewers.

RESULTS

The initial systematic search yielded 4442 results, and 15 articles were additionally identified via reference list screening. Eventually, 74 articles were subjected to a thorough evaluation process by 2 independent reviewers. The interrater reliability was determined to be good, with a Cohen κ score of 0.770. After a multistep extraction process, 17 studies remained for inclusion, with each focusing on the improvement of mental health, re-employment, or both outcomes. A heterogeneous pattern of results emerged, with most interventions showing improvement in either mental health or re-employment. Most studies were assessed as having a moderate (n=7) or high (n=9) risk of bias.

CONCLUSIONS

The results of the systematic research indicate that low-threshold services in close cooperation with institutions and exchange with other supportive stakeholders should be fostered. Derivable overarching themes and intervention content for integrative support measures can serve as guidelines for future interventions.

TRIAL REGISTRATION

PROSPERO CRD42022378490; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022378490.

Disease prevalence and working ability among socio-medically assessed unemployed people in Germany between 2016 and 2021: A secondary data analysis of the Federal Employment Agency

OBJECTIVES

To assess socio-medical status of unemployed persons registered in Germany between 2016 and 2021 regarding medical diagnoses and work ability.

STUDY DESIGN

We conducted a secondary data analysis.

METHODS

We used t-test to compare means of groups and odds ratio to calculate the probability for work ability.

RESULTS

4.3 million clients were assessed (43.3 ± 13.2 years; 52.4 % male). Nearly all clients (96.5 %) received at least one diagnosis. Regarding first and secondary diagnosis, 52.1 % suffered from mental disorders, followed by diseases of the musculoskeletal system and connective tissue (31.4 %), and the circulatory system (10.7 %). Of those with at least one diagnosis 41.7 % were unable to return to work. Clients with mental disorders (first diagnosis) were more likely to be unable to work (68.2 %, n = 958,144) than those with diseases of the musculoskeletal system and connective tissue (16.9 %, n = 237,459) and diseases of the circulatory system (9.4 %, n = 131,513).

CONCLUSIONS

Our study provides disease prevalence and work ability based on secondary data of all socio-medical assessments of the German Federal Employment Agency between 2016 and 2021. Further studies should be enhanced by both individual and external factors to provide a broader perspective. Labor market policy instruments should address both, the improvement of re-employment rates and the targeted prevention of diseases among unemployed. It is mandatory to define target populations who suffer from an increased risk for (mental) health problems and to design future labor market instruments.

Fluoxetine mitigates hypothermia and inflammatory responses in lipopolysaccharide-induced systemic inflammation: Insights into serotonergic and hypothalamic thermoregulatory mechanisms

An abnormally elevated mortality rate is evident in cases of sepsis. To study specific mechanisms of sepsis experimentally, lipopolysaccharide (LPS) systemically administered has been used as a model, in which an exaggerated immune response, neurochemistry settings, and fever following hypothermia take place. Notably, systemic inflammation (SI) can modulate the central serotonergic pathways and being influenced by it. This influence extends to the hypothalamus, which holds a hierarchical significance in the control of body temperature (Tb). This study investigates the potential impact of orally administered fluoxetine (FLX), a selective serotonin reuptake inhibitor (SSRI) given orally for 7 days before on LPS-induced SI (1.5 mg/kg, i.v.) in rats. The assessment involved monitoring Tb, heat loss index (HLI), along non-shivering thermogenesis assessed by oxygen consumption. Cytokine levels in the spleen and blood, along with nitric oxide (NO), and prostaglandins (PGs) E2 and D2, levels were also measured. The findings reveal increased plasma NO, cytokines in plasma and spleen, and hypothalamus PGE2 levels during SI. Interestingly, FLX mitigated LPS-induced hypothermia, accompanied by a reduction in plasma and splenic NO, interleukins (IL) 6, and 10. Additionally, the results align with the hypothesis that hypothermia, blunted by FLX, develops in fact in a regulated form, as an adaptive strategy.

Npbwr1 signaling mediates fast antidepressant action

Chronic stress is a major risk factor for depression, a leading cause of disability and suicide. Because current antidepressants work slowly, have common side effects, and are only effective in a minority of patients, there is an unmet need to identify the underlying molecular mechanisms. Here, we identify the receptor for neuropeptides B and W, Npbwr1, as a key regulator of depressive-like symptoms. Npbwr1 is increased in the nucleus accumbens of chronically stressed mice and postmortem in patients diagnosed with depression. Using viral-mediated gene transfer, we demonstrate a causal link between Npbwr1, dendritic spine morphology, the biomarker Bdnf, and depressive-like behaviors. Importantly, microinjection of the synthetic antagonist of Npbwr1, CYM50769, rapidly ameliorates depressive-like behavioral symptoms and alters Bdnf levels. CYM50769 is selective, well tolerated, and shows effects up to 7 days after administration of a single dose. In summary, these findings advance our understanding of mood and chronic stress and warrant further investigation of CYM50769 as a potential fast-acting antidepressant.

The repercussions of watching scenes of the escalating conflict in Gaza strip on the mental health of adolescents in a neighboring country

BACKGROUND

Over the past decade, prompt technological innovation has accelerated the news dissemination of armed conflict and wars through various media channels, yielding mass fear, anxiety, and depression. Adolescents are more susceptible to experiencing mental distress as a result of watching such uncensored scenes.

AIM

This study aimed to assess the psychological impact of exposure to conflict scenes in the Gaza Strip on the mental health of school adolescents.

METHODS

A cross-sectional study involved 519 adolescents aged 11-18 years, recruited through clustered sampling technique from private and public middle and high schools in Gharbia governorate, Egypt. An anonymous self-administered questionnaire was deployed and included the Arabic version of the depression, anxiety, and stress scale (DASS21).

RESULTS

Around 30% of the studied adolescents were diagnosed as stressed, 61.5% were depressed, and 57% were anxious. These adverse mental outcomes were more prevalent among females and adolescents in high schools. Additionally, participants who were regularly exposed to conflict scenes for an average of 5-7 days per week, with a viewing duration exceeding 3 h per day, were more likely to experience these mental issues.

CONCLUSIONS

The study unveiled a high prevalence rate of stress, depression, and anxiety among adolescents. This observation was positively associated with the frequency and intensity of media exposure to the conflict scenes in the area. Supportive initiatives and controlling exposure to media for adolescents in conflict zones have unequivocal value in ameliorating mental disorders.

PM2.5 exposure modifies the association of physical activity with depressive symptoms and glaucoma in middle aged and elderly Chinese

It remains unclear that trade-off between the benefits of regular physical activity (PA) and the potentially harmful effects of exposure to PM2.5 (particulate matter with aerodynamic diameter < 2.5 μm) in highly polluted regions. Therefore, we aimed to investigate the modification of PM2.5 on the associations of PA volume and intensity with depressive symptoms and glaucoma in individuals with or without depressive symptoms. Data of this study was obtained from the China Health and Retirement Longitudinal Survey (CHARLS) implemented during 2011 to 2020. PA volume and intensity were measured by a standardized questionnaire; a machine learning prediction model was applied to ascertain the PM2.5 concentrations. Cox proportional hazards regression models were employed to explore associations. A total of 20,930 participants were finally included, with 11,214 analyzed for PA and depressive symptom risk and 16,965 analyzed for PA and glaucoma risk. PA volume or intensity was independent protective factor for incident depressive symptoms, while PM2.5 was independent risk factor for depressive symptoms and glaucoma in participants with or without depressive symptoms. Among participants with low PM2.5 exposure (< 35 micrograms per cubic meter [µg/m3]), PA volume or intensity showed an inverse association with the risk of incident depressive symptoms, but insignificant associations between PA volume or intensity and glaucoma risk were observed in either participants with or without depressive symptoms. Among participants with high PM2.5 exposure (≥ 35 µg/m3), higher PA volume or intensity increased the risks of depressive symptoms and glaucoma. Higher PA level was associated with a reduced risk of depressive symptoms only among participants with low PM2.5 exposure, and higher PA did not decrease the risk of glaucoma regardless of PM2.5 level. Our findings recommend regular PA to prevent depressive symptoms in less polluted regions and reinforce the importance of air quality improvement.

SunGold Kiwifruit and Psychological Health (GoKiPH): A Randomised Controlled Crossover Trial

Background/Objectives: The consumption of SunGold kiwifruit, a fruit rich in vitamin C, has been associated with improved mood in healthy individuals with low vitamin C levels. However, no studies have examined this relationship in individuals with elevated mood disturbance. This study examined the potential for SunGold kiwifruit to improve psychological wellbeing in mood-disturbed adults. Methods: This study was a two-period, non-blinded crossover trial. Adults (n = 26) aged 18-60 years with mild to moderate mood disturbance were randomised with a two-week washout between periods. During each 4-week period, participants consumed either two SunGold kiwifruit daily or their usual diet. The primary outcome was mean change in total mood disturbance scores from the kiwifruit period compared to the diet-as-usual period. Secondary outcomes were blood plasma vitamin C concentration, wellbeing, vitality and gastrointestinal symptoms. Participants and researchers were unblinded to condition and intervention. Results: Scores for total mood disturbance (65.2%, p < 0.001), wellbeing (10.5%, p < 0.01) and vitality (17.3%, p = 0.001) significantly improved in the kiwifruit condition compared to the usual diet. Vitamin C (27.5%, p = 0.002) concentrations also improved and gastrointestinal symptom reduction was evident during kiwifruit consumption (16.2%, p = 0.003). There were no serious adverse events. SunGold kiwifruit consumption resulted in significant reductions in total mood disturbance scores and improvements in wellbeing, vitality and vitamin C concentrations. Gastrointestinal symptom severity also significantly reduced. Conclusions: Results provide preliminary evidence of the potential benefits of kiwifruit for reducing mood disturbance in adult populations. Further studies in diverse groups, including clinical populations, are warranted.

Nasal In-Situ Gels of Brij®-Enriched Novasomes as Optimistic Nanovesicular Carriers for Enhancing Anti-Depressant Action of Agomelatine

The purpose of study was to exploit distinctive features of nasal administration route to boost agomelatine permeation and upgrade its anti-depressant action after being embedded in Brij®-enriched novasomes (NVs) as non-phospholipid vesicular systems. Different amounts and types of excipients were used to evaluate NVs using definitive screening design (DSD). Optimal NV was incorporated in thermosensitive in-situ gels containing poloxamer 407 (P-407) and hydroxypropyl methyl cellulose (HPMC). After evaluation of novasomal in-situ gels (NVGs), optimal NVG was subjected to ex-vivo, in-vivo, and biochemical investigations. Results showed significant increase in entrapment capability (EC%), particle size (P.S), and zeta potential (Z.P) of NVs after increasing free fatty acid, surfactant, and cholesterol amounts. The capability of Brij® to improve fluidization of lipid bilayers, decrease P.S, and increase Z.P was observed. Lipohilicity, EC%, and Z.P of Brij® 56-enriched NVs were higher than those containing Brij® 35. Gradual increase in HPMC concentration and gel/NV ratio led to marked decrease in gelation time and spreadability and increase in gel strength and viscosity values of NVGs. Optimal NVG9 displayed higher permeation profile (538.34 μg/cm2) and drug flux (39.38 μg/cm2.h-1) through fresh sheep nasal mucosa in comparison to control gel (150.76 μg/cm2 and 14.44 μg/cm2.h-1, respectively). Rats treated with nasal optimal NVG9 manifested increased sucrose preference (SP) percent (80.73%) and levels of dopamine (50.42 ng/g) and serotonin (44.92 ng/g) with decreased low latency time values (5.86 min). This study confirmed the in-vivo safety and amplification of precognitive and anti-depressant action of agomelatine after intranasal administration.

Tracking the Prevalence of Depression Among Older Adults in Singapore: Results From the Second Wave of the Well-Being of Singapore Elderly Study

Background: Late-life depression has serious public health implications due to its impact on healthcare systems and the economy. As the prevalence of depression tends to change over time across populations, continuous disease surveillance is warranted to inform evidence-based preventive interventions. The well-being of the Singapore elderly (WiSE) is the second study in the series that looked at the prevalence and correlates of depression in a multiethnic population in Singapore. Methods: This single-phase and comprehensive cross-sectional study employed stage 1 diagnosis of geriatric mental state-automated geriatric examination for computer-assisted taxonomy (GMS-AGECAT) to capture depression and subsyndromal depression. Results: The prevalence of depression and subsyndromal depression was 4.4% and 11.9%, respectively, compared to 3.7% and 13.4% in 2013 (p=0.425). Indians, those who were divorced and had below primary education had higher odds of depression (2.2, 3.6, and 4.2 times, respectively). Depression was associated with severe disability, loneliness, suicidal ideations, poor life satisfaction, health status, and social connections. Conclusion: Despite a decade of preventive efforts for the population, there has not been any decrease in the prevalence of depression. There needs to be continued efforts to strengthen prevention, detection, and access to care of those with depression. A multiprong community-based preventive strategy focusing on social as well as health factors is needed to promote social connections, reduce loneliness, and promote the overall wellbeing of the elderly.

Prevalence and sociodemographic configurations of anxiety and depression among caregivers of individuals with mental illness: A meta-analysis and qualitative comparative analysis

BACKGROUND

Caring for individuals with mental illness involves significant challenges from both the unique symptoms and societal stigma associated with these conditions, often leading to caregiver neglect despite the heightened risk of anxiety and depression among caregivers. This study was designed to quantify the prevalence of anxiety and depression among caregivers and to offer a detailed configurational analysis of their sociodemographic attributes.

METHODS

Random-effects meta-analyses were conducted using generalized linear mixed models to calculate the prevalence rates for each study. We explored potential sources of heterogeneity through meta-regression and subgroup analyses. Qualitative Comparative Analysis (QCA) was utilized to identify sociodemographic configurations that contribute to anxiety and depression. The study was pre-registered in PROSPERO (CRD42023478003).

RESULTS

A total of 52 studies involving 10,232 participants were included. The prevalence of depression was 43.91 % (95 % CI: 34.62 %-53.65 %), anxiety was 66.56 % (95 % CI: 48.45 %-80.82 %), and comorbidity was 37.24 % (95 % CI, 19.75 %-58.85 %). QCA identified four sociodemographic configurations contributing to depression and two contributing to anxiety. Key contributors to depression included younger, unmarried, highly educated female caregivers, as well as older, married caregivers caring for patients with schizophrenia. Anxiety was more prevalent among older, married caregivers of patients with schizophrenia and younger, highly educated female caregivers.

LIMITATIONS

Differences in the measurement tools used across studies may have impacted the results of this study.

CONCLUSIONS

The high prevalence of depression and anxiety among caregivers of individuals with mental illness underscores the need for targeted mental health services and policies.

Trajectories of depressive symptoms of mothers and fathers over 11 years

Aims . Parental postpartum depressive symptoms have been extensively studied, but the combined longitudinal depression trajectories of parents and their long-term development beyond the postpartum period remain largely underexplored. We identified dyadic longitudinal depressive symptom trajectories in new parents, followed over an 11-year period, and compared parental characteristics, as well as child temperament and mental health factors, across different parental trajectory classes.

Joint effects of traffic-related air pollution and hypertensive disorders of pregnancy on maternal postpartum depressive and anxiety symptoms

BACKGROUND

Ambient air pollution has been linked to postpartum depression. However, few studies have investigated the effects of traffic-related NOx on postpartum depression and whether any pregnancy-related factors might increase susceptibility.

OBJECTIVES

To evaluate the association between traffic-related NOx and postpartum depressive and anxiety symptoms, and effect modification by pregnancy-related hypertension.

METHODS

This study included 453 predominantly low-income Hispanic/Latina women in the MADRES cohort. Daily traffic-related NOx concentrations by road class were estimated using the California LINE-source dispersion model (CALINE4) at participants' residential locations and averaged across pregnancy. Postpartum depressive and anxiety symptoms were evaluated by a validated questionnaire (Postpartum Distress Measure, PDM) at 1, 3, 6 and 12 months postpartum. Multivariate linear regressions were performed to estimate the associations at each timepoint. Interaction terms were added to the linear models to assess effect modification by hypertensive disorders of pregnancy (HDPs). Repeated measurement analyses were conducted by using mixed effect models.

RESULTS

We found prenatal traffic-related NOx was associated with increased PDM scores. Specifically, mothers exposed to an IQR (0.22 ppb) increase in NOx from major roads had 3.78% (95% CI: 0.53-7.14%) and 5.27% (95% CI: 0.33-10.45%) significantly higher 3-month and 12-month PDM scores, respectively. Similarly, in repeated measurement analyses, higher NOx from major roads was associated with 3.06% (95% CI: 0.43-5.76%) significantly higher PDM scores across the first year postpartum. Effect modification by HDPs was observed: higher freeway/highway and total NOx among mothers with HDPs were associated with significantly higher PDM scores at 12 months postpartum compared to those without HDPs.

IMPACT

This study shows that prenatal traffic-related air pollution was associated with postpartum depressive and anxiety symptoms. The study also found novel evidence of greater susceptibility among women with HDPs, which advances the understanding of the relationships between air pollution, maternal cardiometabolic health during pregnancy and postpartum mental health. Our study has potential implications for clinical intervention to mitigate the effects of traffic-related pollution on postpartum mental health disorders. The findings can also offer valuable insights into urban planning strategies concerning the implementation of emission control measures and the creation of green spaces.

Hypothalamic-pituitary-adrenal axis functioning in offspring of parents with a major affective disorder: a meta-analytic review

Because the offspring of parents with an affective disorder (OAD) are at high risk for developing mental disorders, and persons with an affective disorder (AD) show dysfunctional hypothalamic-pituitary-adrenal (HPA) axis activity, changes in HPA functioning in OAD might be an etiological risk factor that precedes the development of ADs. The primary aim of the meta-analysis was to quantitatively summarize the existing data on different indices of diurnal cortisol in the OAD. The secondary aim was to explore potential moderators of this relation. Following PRISMA guidelines, we included 26 studies (3052 offspring) on diurnal cortisol in our meta-analysis after an initial screening of 3408 articles. Intercept-only and meta-regression models were computed using the robust variance estimation method. Analyses examining mean cortisol levels at discrete timepoints, total cortisol output, and the cortisol rise in response to awakening (CAR) were conducted separately. The results demonstrated that the OAD had higher mean levels of cortisol at different timepoints throughout the day compared to controls (Hedge's g = 0.21). There was evidence of publication bias in studies examining CAR, such that effect sizes were positively biased. The present findings are consistent with a meta-analysis showing elevated cortisol in youth having an AD. Notable limitations across studies include the method of cortisol measurement and assessment of ADs. Altogether, these results highlight the fact that increased cortisol levels may act as a potential neuroendocrine antecedent and/or risk factor for the development of ADs among high risk youth.

Prevalence and moderators of depression symptoms among black individuals in Western Countries: a systematic review and meta-analysis among 1.3 million people in 421 studies

Background

Black people living in Western countries face a range of structural challenges and disparities (e.g. difficult socio-economic conditions, historical and intergenerational trauma, police brutality, racism) that adversely affect their mental health. This study assesses depression prevalence among Black individuals in minority contexts, examining sociodemographic factors, study type, evaluation period, publication year, and measures; and differences in depression rates between Black individuals and other racial groups (Asian, Indigenous, Latinx, White).

Methods

To identify studies, a comprehensive search strategy was developed and executed on September 30, 2022 across six databases (Allied and Complementary Medicine Database, APA PsycInfo, CINAHL. Cochrane CENTRAL, Embase, MEDLINE). The meta-analysis protocol was registered with PROSPERO (CRD42020155634). A random-effects meta-analysis estimated depression prevalence among Black individuals. Meta-regression tested differences by racial background, gender, sample type, evaluation method, age group, and publication year, reporting Odd ratios (ORs) with Confidence intervals (CIs).

Findings

From 21,215 citations, 421 studies were included with a sample of 1,305,366 Black individuals (411 studies were conducted in North America, 9 in Europe, and one in both Europe and North America). Pooled prevalence was 20.2% (95% CI: 18.7%-21.7%) among Black individuals, 13.4% (95% CI: 10.2-16.9) among Asians, 21.0% (95% CI: 18.7-23.5) among Latinx, and 17.8% (95% CI: 16.3-19.2) among Whites. It was significantly lower among White (OR = 0.98, p = 0.04, 95% CI: 0.95, 1.00) and Asian people (OR = 0.94, p = 0.004, 95% CI: 0.90, 0.98) compared to Black individuals. Pooled prevalence was 26.6% for the past week (95% CI: 24.6%-28.6%), 22.1% (95% CI: 19.2-23.1) for the past two weeks, 21.6% (95% CI: 11.6-33.5) for the past month, 9.1% (95% CI: 7.7%-10.7%) for the past year, and 16.6 (95% CI: 12.9-20.8) for lifetime. Depression prevalence was higher among Black women (24.3%; 95% CI: 21.3-27.4) and in North America (20.3%; 95% CI: 18.8-21.9). Depression prevalence was higher in 2000-2009 (23.5%; 95% CI: 20.9-26.2), decreased in 2010-2019 (17.7%; 95% CI: 15.6-19.9) and increased since 2020 (20.6%; 95% CI: 17.5-23.8).

Interpretation

As depression constitutes a burden among Black individuals in the West, it is urgent to mobilize public health agencies, research funding agencies and clinicians to develop and implement antiracist and culturally adapted prevention and intervention programs.

Funding

Public Health Agency of Canada, (grant number 1920-HQ-000053), the Social Sciences and Humanities Research Council (SSHRC) and Canadian Institutes of Health Research (CIHR) (grant number 469050).

Diagnosis of Major Depressive Disorder Based on Individualized Brain Functional and Structural Connectivity

BACKGROUND

Traditional neuroimaging studies have primarily emphasized analysis at the group level, often neglecting the specificity at the individual level. Recently, there has been a growing interest in individual differences in brain connectivity. Investigating individual-specific connectivity is important for understanding the mechanisms of major depressive disorder (MDD) and the variations among individuals.

PURPOSE

To integrate individualized functional connectivity and structural connectivity with machine learning techniques to distinguish people with MDD and healthy controls (HCs).

STUDY TYPE

Prospective.

SUBJECTS

A total of 182 patients with MDD and 157 HCs and a verification cohort including 54 patients and 46 HCs.

FIELD STRENGTH/SEQUENCE

3.0 T/T1-weighted imaging, resting-state functional MRI with echo-planar sequence, and diffusion tensor imaging with single-shot spin echo.

ASSESSMENT

Functional and structural brain networks from rs-fMRI and DTI data were constructed, respectively. Based on these networks, individualized functional connectivity (IFC) and individualized structural connectivity (ISC) were extracted using common orthogonal basis extraction (COBE). Subsequently, multimodal canonical correlation analysis combined with joint independent component analysis (mCCA + jICA) was conducted to fusion analysis to identify the joint and unique independent components (ICs) across multiple modes. These ICs were utilized to generate features, and a support vector machine (SVM) model was implemented for the classification of MDD.

STATISTICAL TESTS

The differences in individualized connectivity between patients and controls were compared using two-sample t test, with a significance threshold set at P < 0.05. The established model was tested and evaluated using the receiver operating characteristic (ROC) curve.

RESULTS

The classification performance of the constructed individualized connectivity feature model after multisequence fusion increased from 72.2% to 90.3%. Furthermore, the prediction model showed significant predictive power for assessing the severity of depression in patients with MDD (r = 0.544).

DATA CONCLUSION

The integration of IFC and ISC through multisequence fusion enhances our capacity to identify MDD, highlighting the advantages of the individualized approach and underscoring its significance in MDD research.

LEVEL OF EVIDENCE

1 TECHNICAL EFFICACY: Stage 2.

Beyond rheumatoid arthritis: A meta-analysis of the prevalence of anxiety and depressive disorders in rheumatoid arthritis

BACKGROUND

The prevalence of anxiety and depressive disorders in patients with rheumatoid arthritis (RA) is heterogenous with reports from 2.4 % to 85.2 % and 15 %-73.2 %, respectively. The present study provides meta-analytic current, and lifetime estimates of anxiety and depressive disorders amongst those living with RA.

METHOD

An online search of PubMed, PsycINFO, CINAHL, and WoS was conducted. Of the 3801 articles identified, 13 and 22 studies were coded for anxiety or depressive disorder prevalence in RA, respectively. Studies were included if they prospectively examined individuals (age >16) with RA, used semi-structured diagnostic interviews, and reported lifetime or current anxiety or depressive disorder comorbidity.

RESULTS

Data were analyzed using a Bayesian multilevel modelling approach, revealing current and lifetime prevalence of anxiety disorders to be 13.5 % CI95 % (9.2-17.3) and 22.2 %, CI95 % (15.9-29.1), respectively. Models also demonstrated the current and lifetime prevalence of depressive disorders to be 17.9 % CI95 % (10.1-27.1) and 32.4 %, CI95 % (18.3-47.6), respectively. Moderator analyses revealed numerically greater rates of GAD and MDD than other anxiety or depressive disorders.

LIMITATIONS

There were too few estimates to extensively model several moderators or to conduct exhaustive comparisons of demographic populations requiring greater representation such as males, non-White participants, and people with young adult RA onset.

CONCLUSIONS

The prevalence and risk for comorbid anxiety and depressive disorders in RA is extremely high. Routine screening and ongoing monitoring of individuals with RA for comorbid anxiety and depressive disorders is important to support improved prognosis.

Decoding tryptophan: Pioneering new frontiers in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a complex autoimmune disease that affects multiple organ systems, with its pathogenesis intricately tied to genetic, environmental, and immune regulatory factors. In recent years, the aberration of tryptophan metabolism has emerged as a key player in the disease, particularly through the activation of the kynurenine pathway and its influence on immune regulation. This review delves into the critical pathways of tryptophan metabolism and its profound impact on the multi-system manifestations of SLE, including its connections to the nervous system, kidneys, skin, and other organs. Additionally, it examines how tryptophan metabolism modulates the function of various immune cell types. The review also explores potential therapeutic avenues targeting tryptophan metabolism, such as dietary interventions, probiotic modulation, IDO expression inhibition, and immunoadsorption techniques. While current research has underscored the pivotal role of tryptophan metabolism in the onset and progression of SLE, its full therapeutic potential remains to be fully elucidated. This review aims to provide a solid scientific foundation for therapeutic strategies based on modulating tryptophan metabolism in SLE, offering a comprehensive overview of both clinical and basic research in this rapidly evolving field.

Neuropsychiatric manifestations in systemic lupus erythematosus and Sjogren's disease

INTRODUCTION

Autoimmune diseases often present in a systemic manner, affecting various organs and tissues. Involvement of the central and peripheral nervous system is not uncommon in these conditions and is associated with high morbidity and mortality. Therefore, early recognition of the neuropsychiatric manifestations associated with rheumatologic diseases is essential for the introduction of appropriate therapies with the objective of providing a better quality of life for individuals.

OBJECTIVE

To provide a literature review of the neuropsychiatric manifestations related to Systemic Lupus Erythematosus (SLE) and primary Sjögren's Disease (pSD), through the description of signs, symptoms, and immunological variables associated with these conditions.

METHODS

A literature review was conducted by searching for national and international articles available in the SciELO and PubMed databases related to the description of neurological and psychiatric manifestations in patients with the rheumatologic diseases of interest in this study.

RESULTS

The main NP manifestations presented in SLE and pSD are discussed, focusing on clinical presentation and etiology. Treatment option are, however, mainly based on expert opinion, since a few randomized controlled trials have been done.

CONCLUSIONS

There is a high prevalence of neuropsychiatric manifestations associated with SLE and pSD. The variety of physiopathology pathways may explain the variety of symptoms, however pathological findings are rare. Multicenter studies on attribution protocols and treatment are necessary to address the current gaps.

Clinical characteristics, comorbidities, and correlation with advanced lipedema stages: A retrospective study from a Swiss referral centre

INTRODUCTION

Lipedema is a chronic condition involving abnormal fat deposition in the lower limbs, often underdiagnosed, and poorly understood. We examined the epidemiological and clinical characteristics of a large patient cohort in Switzerland and their associations with disease severity.

METHODS

We included women aged 18 and over with lipedema at Lausanne University Hospital (CHUV), Switzerland. Demographic and clinical data, including disease type, stage, symptoms, and comorbidities, were collected. Descriptive statistics were used to summarise the data, and logistic regression was employed for analysis.

RESULTS

A total of 381 females (mean age 41.9 years) were included, mostly classified as type III (48.3%) and IV (30.2%) lipedema. In our population, 26.6% of patients were classified as stage 1, 44.5% as stage 2, and 28.9% as stages 3-4. Family history was reported in 49.9%, with symptoms often starting during adolescence (62.2%). Pain affected 87.9%, and quality of life (QoL) was significantly reduced, with 71.5% reporting low physical and 67.4% low mental well-being. Comorbidities were present in 92.1%, increasing with advanced disease stage, with chronic venous disease (86.2%) and obesity (51.7%) being the most common. Univariate analysis showed advanced lipedema was associated with age (OR: 1.07, 95% CI: 1.05-1.09), BMI (OR: 1.24, 95% CI: 1.19-1.29), and comorbidities (OR: 1.59, 95% CI: 1.39-1.81). Multivariate analysis confirmed age (OR: 1.06, 95% CI: 1.04-1.08) and BMI (OR: 1.22, 95% CI: 1.17-1.28) as correlates with disease stage.

CONCLUSIONS

Our study highlights frequent comorbidities in patients with lipedema, including chronic venous disease, obesity, and mental health conditions such as anxiety and depression. The distribution of comorbidities supports the need for tailored management. The correlation between disease stages, age, and BMI suggests potential progression, warranting confirmation through prospective studies.

Integrating Mental Health Services into Primary Care Settings: A Multiple Case Study of Congolese Experiences Testing the Feasibility of the WHO's Mental Health Gap Action Programme

Some experiences of integrating mental health into primary care settings, testing the feasibility of the World Health Organization's mental health Gap Action Programme, have been launched in the Democratic Republic of the Congo to address treatment gaps. However, they have not yet been documented to look at scaling up. This study described the health outcomes and lessons learned from two of these experiences. A multiple case study was conducted on two integration programmes in the urban Tshamilemba district in the Haut-Katanga province, ongoing since 2021, and in the rural Mangembo district in the Kongo Central province, ongoing since 2022. Data were collected between July and August 2024 from focus group discussions, interviews, document reviews, including routine health information systems. We carried out descriptive statistical analyses to measure indicators of accessibility and the use of services, and content analysis to explore the lessons learned. A total of 1708 individuals with mental disorders were treated in primary care settings between 2021/22 and 2024 under both programmes. From 2021 to 2024, the curative consultations rate for mental disorders, which was unknown at the start of both programmes, reached 14.4 new cases/1000 inhabitants/year in the Tshamilemba district and 14.2 new cases/1000 inhabitants/year in the Mangembo district. Several lessons were learned, related to each phase of mental health Gap Action Programme. The findings confirm the feasibility and effectiveness of the mental health Gap Action Programme in the Congolese context and highlight the need for concerted action to address the identified challenges.

Mechanisms creating homogamy in depressiveness in couples: A longitudinal study from Czechia

Couples often resemble each other in characteristics like depression, but the reasons for this homogamy (i.e., similarity) remain unclear. We investigated two potential mechanisms: preference for a self-similar partner and convergence (i.e., increasing similarity) over time. In a nationally representative sample of 2,793 Czech individuals who we surveyed three times in one year, we examined self-reports of participants', their ideal partners', and their actual partners' "pessimism and depressiveness". Participants preferred partners less depressive than themselves, yet their actual partners were more depressive than desired. Those who ended their relationships showed a greater ideal-versus-actual partner discrepancy than those who stayed together. In stable relationships, individuals adjusted their ideal preferences to align more closely with their actual partners over time. We identified four relationship classes with latent class growth modeling based on self and partner evaluations: both non-depressive, both depressive, self depressive and partner non-depressive, and self non-depressive and partner depressive. Romantic relationships were most stable when both partners were non-depressive and most likely to dissolve when both were depressive. While we failed to detect convergence overall, we found it within heterogamous (i.e., dissimilar) classes. Overall, our findings suggest that homogamy and heterogamy in depressiveness are complexly associated with relationship maintenance.

Neuropsychiatric Manifestations of Long COVID-19: A Narrative Review of Clinical Aspects and Therapeutic Approaches

The COVID-19 (C-19) pandemic has highlighted the significance of understanding the long-term effects of this disease on the quality of life of those infected. Long COVID-19 (L-C19) presents as persistent symptoms that continue beyond the main illness period, usually lasting weeks to years. One of the lesser-known but significant aspects of L-C19 is its impact on neuropsychiatric manifestations, which can have a profound effect on an individual's quality of life. Research shows that L-C19 creates neuropsychiatric issues such as mental fog, emotional problems, and brain disease symptoms, along with sleep changes, extreme fatigue, severe head pain, tremors with seizures, and pain in nerves. People with cognitive problems plus fatigue and mood disorders experience great difficulty handling everyday activities, personal hygiene, and social interactions. Neuropsychiatric symptoms make people withdraw from social activity and hurt relationships, thus causing feelings of loneliness. The unpredictable state of L-C19 generates heavy psychological pressure through emotional suffering, including depression and anxiety. Neuropsychiatric changes such as cognitive impairment, fatigue, and mood swings make it hard for people to work or study effectively, which decreases their output at school or work and lowers their job contentment. The purpose of this narrative review is to summarize the clinical data present in the literature regarding the neuropsychiatric manifestations of L-C19, to identify current methods of diagnosis and treatment that lead to correct management of the condition, and to highlight the impact of these manifestations on patients' quality of life.

The role of senescence-related genes in major depressive disorder: insights from machine learning and single cell analysis

BACKGROUND

Evidence indicates that patients with Major Depressive Disorder (MDD) exhibit a senescence phenotype or an increased susceptibility to premature senescence. However, the relationship between senescence-related genes (SRGs) and MDD remains underexplored.

METHODS

We analyzed 144 MDD samples and 72 healthy controls from the GEO database to compare SRGs expression. Using Random Forest (RF) and Support Vector Machine-Recursive Feature Elimination (SVM-RFE), we identified five hub SRGs to construct a logistic regression model. Consensus cluster analysis, based on SRGs expression patterns, identified subclusters of MDD patients. Weighted Gene Co-expression Network Analysis (WGCNA) identified gene modules strongly linked to each cluster. Single-cell RNA sequencing was used to analyze MDD SRGs functions.

RESULTS

The five hub SRGs: ALOX15B, TNFSF13, MARCH 15, UBTD1, and MAPK14 showed differential expression between MDD patients and controls. Diagnostics models based on these hub genes demonstrated high accuracy. The hub SRGs correlated positively with neutrophils and negatively with T lymphocytes. SRGs expression pattern revealed two distinct MDD subclusters. WGCNA identified significant gene modules within these subclusters. Additionally, individual endothelial cells with high senescence scores were found to interact with astrocytes via the Notch signaling pathway, suggesting a specific role in MDD pathogenesis.

CONCLUSION

This comprehensive study elucidates the significant role of SRGs in MDD, highlighting the importance of the Notch signaling pathway in mediating senescence effects.

Prevalence of major depressive disorder in Iranian men from 2011 to 2022; a systematic review and meta-analysis

BACKGROUND

Major depressive disorder (MDD) is one of the health problems that imposes a large disease burden on the community. Its prevalence is based on gender. Therefore, this study aims to investigate the prevalence of MDD in Iranian men between 2011 and 2022.

METHODS

The Medline, Embase, Scopus, Web of Sciences, PsycINfo, and Iranian databases were searched for studies published from January 2011 to December 2022. Two independent reviewers screened the observational studies conducted on men aged 15 years and older with MDD. The interested outcomes were the prevalence type of MDD.

RESULTS

Data of 5 studies were included in the present meta-analysis. Among 10,667 participants in the study, 1479 (13.9%) individuals had a history of MDD. In the subgroup analysis, the average lifetime prevalence was 7.6% (95% confidence interval [CI]; 4.7 - 12.0%) and the point prevalence was 19.1% (95% confidence interval [CI]; 6.7 - 43.5%) based on random effect model. The 12-month prevalence was 10.8% (95% confidence interval [CI]; 9.8 - 11.9%) based on the single study.

CONCLUSION

Preventive and therapeutic programs are strongly recommended due to the high prevalence of major depression in Iranian men and the lack of sufficient studies in this field.

Demographic and clinical predictors of response and remission in the treatment of major depressive disorder with ketamine and esketamine: A systematic review

Accumulating evidence supports the efficacy of (es)ketamine in the treatment of major depressive disorder (MDD), particularly treatment-resistant depression (TRD). Yet around 50% of the individuals with TRD do not respond to (es)ketamine. Elucidating predictors of response and remission could improve treatment outcomes at the individual level by defining subpopulations that are most likely to benefit from (es)ketamine. This systematic review outlines the predictive value of demographic and clinical characteristics for treatment outcomes of (es)ketamine in MDD. A systematic literature search was performed to retrieve studies investigating the association between baseline characteristics and the likelihood of achieving response and remission following (es)ketamine treatment in MDD. Forty-four studies investigating the association between response and remission and demographic variables, characteristics of the depressive episode, treatment resistance, psychiatric comorbidities, symptomatology, suicidal risk/attempts, family/personal history, medication use, somatic variables, personality traits, and neurocognitive performance were included. The predictive value of demographic and clinical variables for treatment outcomes of (es)ketamine was limited with either no significant relationship or inconsistent results. Findings provide preliminary support for a positive association of response with anhedonia, sleep disturbances, childhood physical abuse, obesity, openness, better episodic memory, and visual learning, poorer neurocognitive performance, slower processing speed, and lower attention, as well as a negative association with melancholic depression, benzodiazepine use, and metabolic syndrome. However, these characteristics have been investigated in a limited number of studies and warrant replication. These findings suggest that (es)ketamine represents a promising treatment prospect for individuals who present clinical characteristics that are often considered difficult to treat.

Does childhood curiosity influence depression in adulthood?

BACKGROUND

Depression has become a major public health problem in the globe. However, previous studies have rarely explored the influence of character strengths on depression in adulthood from the perspective of adult self-assessment of childhood. Based on the data obtained from a national survey, the present study aimed to explore the influence of curiosity on depression and gender differences in the internal mechanism from the perspective of adult self-assessment of childhood.

METHODS

This study used data from the 2020 China Family Panel Study to assess participants' childhood curiosity, future confidence, subjective social status, and depression in adulthood. The study sample included 17,162 adults. In this study, the moderated mediation model was analyzed using PROCESS 4.1 software program.

RESULTS

Childhood curiosity had a strong association with depression in adulthood. For men, future confidence partially mediated the relationship between childhood curiosity and depression in adulthood. For women, future confidence completely mediated the relationship between the two main variables. Furthermore, subjective social status moderated the relationship between future confidence and depression in adulthood.

CONCLUSIONS

Childhood curiosity seemed to have protective effects against depression in adulthood. In this process, future confidence served as an important mediator, and this mediating effect showed a significant gender difference. Furthermore, compared to high subjective social status, low subjective social status had a greater influence on the relationship between future confidence and depression in adulthood.

Self-Management Interventions for Black Women at Risk for Cardiovascular Disease: A Systematic Literature Review

Cardiovascular disease (CVD) is the leading cause of death among Black women. When compared with their non-Hispanic White counterparts, Black women are about 50% more likely to have uncontrolled high blood pressure (BP). The disproportionate burden of CVD in Black women highlights the need for CVD prevention programs in this population. The present systematic literature review examined the updated literature on the efficacy of primary prevention self-management interventions for Black women with CVD risk factors. Searches were run on PubMed, Cochrane, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases based on the following inclusion criteria: papers published from September 22, 2018; English language; U.S. studies only; original research reports; prospective clinical trials; cardiovascular health promotion/self-management interventions that target at least two health practices for primary prevention; comorbid conditions without a cardiovascular event; at least one patient-level outcome; and Black women at least 18 years of age. Twelve papers met the inclusion criteria. Health practices targeted included physical activity, nutrition, weight loss, health knowledge, and BP control. Nine of the 12 papers reported statistically significant improvements on at least one CVD risk factor including weight loss, physical activity, BP control, waist circumference, and depression. Culturally tailored self-management interventions appear to be feasible with weak to moderately high evidence of efficacy for reducing CVD risk factors in Black women. Further research should focus on the influence that social determinants of health, including mental health, may have on self-management and CVD risk in this population.

Timing of adverse childhood experiences and depressive, anxiety, comorbid symptoms among Chinese female nurses: A life course perspective

BACKGROUND

Nurses demonstrate a greater vulnerability to developing depressive and anxiety symptoms compared to the general population. Adverse Childhood Experiences (ACEs) are known risk factors for mental health issues, but impact of timing of these experiences remains unclear.

OBJECTIVE

To investigate associations between timing of ACEs and depressive, anxiety, comorbid symptoms.

PARTICIPANTS AND SETTING

Using convenience sampling, a cross-sectional study was conducted. The sample was 1966 female nurses from seven hospitals in Zhejiang Province, China.

METHODS

Nurses completed a questionnaire assessing sociodemographic characteristics, ACEs, depressive and anxiety symptoms. Timing of ACEs was categorized as childhood, adolescence, and both periods. Comorbid symptoms referred to simultaneous presence of both depressive and anxiety symptoms. Multivariable logistic regression was used to examine associations between ACEs timing and mental health outcomes, presented as Odds Ratios (ORs) with 95 % Confidence Intervals (CIs).

RESULTS

A total of 429 (21.82 %) participants experienced ACEs in both periods. ACEs occurring only in childhood, only in adolescence, and in both periods were all associated with increased depressive, anxiety, and comorbid symptoms. An increasing trend in number of ACEs from childhood to adolescence was linked to higher symptoms in adulthood. Familial ACEs in both periods were strongly linked to higher depressive (OR = 1.85, 95 % CI [1.14, 3.01]), anxiety (OR = 2.55, 95 % CI [1.41, 4.60]), and comorbid symptoms (OR = 2.92, 95 % CI [1.50, 5.70]).

CONCLUSIONS

The timing of ACEs influenced the development of mental health issues. It is imperative to provide targeted psychological support based on timing of ACEs to improve mental health in this population.

Altered resting-state amplitudes of low-frequency fluctuations in offspring of parents with a diagnosis of bipolar disorder or major depressive disorder

Offspring of parents with bipolar disorder (BD) or major depressive disorder (MDD) are at high biological risk (HR) of these disorders given their significant heritability. Thus, studying neural correlates in youths at HR-MDD and HR-BD appears essential to understand the development of mood disorders before their onset. Resting-state amplitudes of low-frequency fluctuations (ALFF) and fractioned ALFF (fALFF) shows moderate to high test-retest reliability which makes it a great tool to identify biomarkers. However, this avenue is still largely unexplored. Using the Healthy Brain Network biobank, we identified 150 children and adolescents HR-MDD, 50 HR-BD and 150 not at risk of any psychiatric disorder (i.e., the control group). We then examined differences in relative ALFF/fALFF signals during resting-state. At a corrected threshold, participants HR-MDD displayed lower resting-state ALFF signals in the dorsal caudate nucleus compared to the control group. The HR-BD group showed increased fALFF values in the primary motor cortex compared to the control group. Therefore, robust differences were noted in regions that could be linked to important symptoms of mood disorders, namely psychomotor retardation, and agitation. At an uncorrected threshold, differences were noted in the central opercular cortex and the cerebellar. The database is a community-referred cohort and heterogeneous in terms of children's psychiatric diagnosis and symptomatology, which may have altered the results. ALFF and fALFF results for the comparison between both HR groups and the control group overlapped, suggesting good convergence. More studies measuring ALFF/fALFF in HR are needed to replicate these results.

Increased Interleukin-6 Levels in Responders with Treatment-Resistant Depression After Bright Light Therapy

Treatment-resistant depression (TRD) remains a challenge despite the growing number of interventions. Peripheral interleukin-6 (IL-6) levels have repeatedly been associated with both the presence and response to different treatments in TRD. There is currently no information available on the effects of bright light therapy (BLT) on serum IL-6 levels. This study assessed the effects of BLT on serum IL-6 levels in TRD patients. Serum IL-6 was determined at two points in TRD patients-at baseline and after 4 weeks of BLT-and at a single point in the healthy controls. Depression severity was measured by the Hamilton Rating Scale for Depression (HAMD)-17 and the Montgomery-Åsberg Depression Rating Scale (MADRS). The study included 104 females, 54 diagnosed with TRD (median age 52.5) and 50 healthy controls (median age 44.5). At baseline, patients had higher IL-6 levels than the controls. BLT treatment reduced HAMD-17 and MADRS scores. Serum IL-6 levels were not significantly affected by the 4 weeks of BLT. However, when patients were divided according to treatment response, IL-6 levels were increased in responders to BLT. The neuroinflammatory mechanism may be involved in the etiopathogenesis and the treatment of TRD, while changes in serum IL-6 levels may be potential indicators of response to treatment.

Development of Multimorbidity Indexes Based on Common Mental Health Conditions

Objectives

Numerous multimorbidity indexes exist, focused primarily or solely on somatic conditions. We developed mental multimorbidity indexes as epidemiological tools.

Methods

Participants in the French NutriNet-Santé cohort (73.5% women; mean age = 59.5 ± 13.7 years; index development N = 20,000; index comparison N = 7,259) completed self-report questionnaires (2020-2022) regarding depressive symptoms, anxiety, eating disorders, insomnia, alcohol use disorders, cognitive difficulties, and the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). Using established cutoffs, participants were split into 2 groups for each condition. Tweedie regression analyses were performed with the 6 mental health conditions as exposures and the WHODAS 2.0 score as the outcome. Performance (C-index) and calibration of the indexes were compared with a simple count.

Results

A general and a sex-specific mental multimorbidity indexes were developed; both were significantly associated with the disability score. The new indexes had slightly better predictive performance than simple counts of mental disorders.

Conclusion

We developed mental multimorbidity indexes as epidemiological research tools. Future prospective studies could investigate their predictive potential regarding outcomes such as medication use, healthcare utilization, and quality of life.

Global Burden of Complex Regional Pain Syndrome in At-Risk Populations: Estimates of Prevalence From 35 Countries Between 1993 and 2023

BACKGROUND

Complex regional pain syndrome (CRPS) is a debilitating and painful condition accompanied by sensory, autonomic, trophic, and/or motor abnormalities. Although CRPS is rare in the general population, the prevalence among individuals at higher risk, particularly posttraumatic and postsurgical patients, remains unknown. This study aims to provide a benchmark that quantifies CRPS prevalence in high-risk groups, and offers insights on potential predictors of developing CRPS.

METHODS

We conducted a systematic review and meta-analysis to identify studies reporting prevalence of CRPS after an inciting event (eg, fracture, surgery), specifically 12-month and 24-month prevalence (primary outcomes), as well as 3-month and 6-month prevalence (secondary outcomes). Estimates from individual studies were transformed using double-arcsine transformation, and the resulting estimates with 95% confidence interval (CI) were pooled in a meta-analysis using a random-effects model.

RESULTS

We included 214 articles with data from 2491,378 participants worldwide (35 countries), of which 16,873 had CRPS. The pooled 12-month and 24-month global prevalence was 3.04% (95% CI, 2.64-3.48) and 6.46% (95% CI, 5.46-7.53), respectively. Subgroup analysis and meta-regression were performed to understand the impact of population-dependent (mechanism of injury, type of CRPS), contextual-dependent (socioeconomic status), and methodological-dependent (study design, publication year) factors. The 12-month prevalence was higher in countries with a high human development index (HDI) compared to those with a medium or very high HDI, was higher in participants with a traumatic inciting injury only versus those with surgical injury only or traumatic/surgical injury, and was higher in prospective versus retrospective studies. Meta-regression analysis showed that publication year was a significant moderator, with more recent articles reporting lower 12-month prevalence.

CONCLUSIONS

This study provides a benchmark of the global prevalence of CRPS, which anesthesiologists and pain specialists can use to prioritize early diagnosis and identify those at the highest risk for CRPS.

Relationship between sleep disorders and depressive symptoms among young women in Japan: a web-based cross-sectional study

OBJECTIVES

Japanese people are known to get the least amount of sleep in the world, and in particular, the increase in sleep deprived young women is a serious problem. Sleep deprivation is considered to be associated with depression, but the factors involved in this problem are unclear. This study aimed to examine the association between sociodemographic factors, lifestyle choices, sleep-related characteristics and depressive symptoms in young Japanese women.

DESIGN

Web-based cross-sectional study.

PARTICIPANTS

We distributed an online survey aiming to recruit young Japanese women ages 18 to 29 from 8 November 2022 to 2 February 2023.

PRIMARY AND SECONDARY OUTCOME MEASURES

Sociodemographic, lifestyle, health, and sleep characteristics were compared among participants according to the presence or absence of depressive symptoms, as assessed by the Patient Health Questionnaire 2 (Cut-off value: 3 points).

RESULTS

Overall, 540 participants aged between 19 and 29 years were enrolled in the study. The overall prevalence of depressive symptoms was 15.6%. The group with depressive symptoms had a higher rate of current smoking status at 38.5% (unadjusted OR 3.716, 95% CI 1.624 to 8.502). Multiple logistic analyses revealed that depressive symptoms were associated with increased sleep onset latency (β=0.282; p=0.048; OR, 1.325; 95% CI, 1.003 to 1.752) and daytime dysfunction (β=0.550; p<0.001; OR, 1.733; 95% CI, 1.281 to 2.343) after adjusting for the effects of smoking habits.

CONCLUSIONS

Depressive symptoms were found to be associated with sleep disorders in young Japanese women, and paying attention to sleep onset latency and daytime dysfunction which are one of the strongest related factors to depressive symptoms could be a clue to improving sleep disorders and depressive symptoms.

Periodic limb movements in sleep in patients using antidepressants

Depression and periodic limb movement disease are both common disorders which frequently co-exist. Furthermore, antidepressants are known to cause and worsen periodic limb movements in sleep, which can worsen the quality of sleep and subsequently daytime symptoms. However, the effect of antidepressants on periodic limb movements is not uniform and depends on their mechanism of action. In this review we summarise the knowledge on the mechanism of periodic limb movements in sleep, and how changes in the concentration of neurotransmitters can contribute to them. We comprehensively evaluate the literature on antidepressants induced periodic limb movement in sleep. Based on this, we suggest clinical implications and further focus on research.

The efficacy of vortioxetine in the acute treatment of major depressive disorder: A systematic review and meta-analysis

BACKGROUND

Among the available pharmacological treatments for acute major depressive disorder (MDD), vortioxetine, a serotonin transporter inhibitor (SERT), has been widely used for its multimodal action on serotonin neurotransmission, which produces essential changes also on glutamate, gamma amino butyric acid (GABA), norepinephrine, acetylcholine, and dopamine.

AIM

This systematic review and meta-analysis aimed to evaluate the acute efficacy of vortioxetine across multiple dosing and to evaluate whether there is a dose-response effect and as well there is a dose-response issue with respect to side effects in acute depression.

METHODS

According to PRISMA guidelines, we systematically searched three major electronic databases (PubMed/MEDLINE, PsycINFO, and Cochrane Central Register of Controlled Trials) for Randomized Controlled Trial (RCT) studies published between January 2013 and April 2024. Twenty-four studies were included in the review and two meta-analyses were conducted to determine whether the mean Montgomery-Asberg Depression Rating Scale (MADRS) scale values in the placebo groups differ significantly from the mean MADRS scale values in the group receiving vortioxetine 10 mg or vortioxetine 20 mg.

RESULTS

Vortioxetine significantly improved acute depression severity, anxiety symptoms, and cognitive function, with high response and remission rates in acute MDD. It was also well tolerated with a relatively low occurrence of severe or serious treatment-emergent adverse events (TEAEs). Observing the results of the meta-analysis, the effect was significant for both vortioxetine 10 and 20 mg, with a greater effect size for vortioxetine 20 mg.

CONCLUSION

Vortioxetine should be considered efficacious as a first- and second-line therapy.

Neurological Manifestations of Systemic Lupus Erythematosus: A Comprehensive Review

Neurological involvement in systemic lupus erythematosus (SLE) poses significant challenges, impacting patient morbidity, mortality, and quality of life. This narrative review provides an update on the pathogenesis, clinical presentation, diagnosis, and management of neurological SLE. The multifaceted pathophysiology involves immune-mediated and vascular mechanisms such as autoantibodies, neuroinflammation, complement dysregulation, and genetic factors. Neuropsychiatric SLE (NPSLE) manifests in a variety of ways, including cognitive dysfunction, mood disorders, psychosis, cerebrovascular disease, demyelinating syndromes, and neuropathies. Diagnosing neurological SLE is complicated by nonspecific and fluctuating symptoms, requiring comprehensive neurological examination, neuroimaging, autoantibody profiling, and cerebrospinal fluid analysis. Current management strategies include corticosteroids, immunosuppressive agents, and emerging biologics targeting specific immune pathways. Managing neuropsychiatric symptoms, seizures, and neuropathic pain remains a complex aspect of treatment. This review highlights the importance of early recognition and tailored management approaches to improve patient outcomes in neurological SLE.

Inhibition of emotional faces in clinical and subclinical depression

Impaired inhibition of emotional material is an important cognitive component of depression. The current aim was to determine if participants with major depression (MDD) and/or subclinical depression (dysphoria) exhibit impaired inhibition of sad faces on a face-word variant of the Stroop task. Study 1: patients with MDD (n = 28) and healthy controls (n = 32) were presented with positive and negative words superimposed across happy, sad, and neutral faces. Study 2: dysphoric (n = 23) and non-dysphoric (n = 35) participants were presented with positive and negative words superimposed across happy and sad faces (shown upright and inverted). Participants were told to ignore the faces and categorise the words. Patients with MDD experienced greater interference from sad faces than did the controls. Healthy controls experienced greater interference from happy than sad faces, whereas interference levels from happy and sad faces did not differ in patients with MDD. Dysphoric participants experienced greater interference from sad faces than did non-dysphoric participants, and from sad faces than happy. The amount of interference from happy and sad faces did not differ in the non-dysphoric participants. Clinical and subclinical depression are linked to impaired inhibition of sad faces, which might represent a risk factor for depression and a potential target for intervention.

Gambling-specific metacognitions, depression, and responsible gambling in Macao, China

The Self-regulatory Executive Function model elucidates how metacognitions link to the development and maintenance of gambling disorder, however whether, and how, metacognitions explain responsible gambling remains unknown. This study is the first to address this knowledge gap by: (a) examining whether both generic and gambling-specific metacognitions explain variances in responsible gambling; and (b) testing the mediating role of depression between generic/gambling-specific metacognitions and responsible gambling. A two-stage cluster random sampling method was used to obtain a probability sample of 837 Chinese adult gamblers (48.5 % men, mean age = 41.11, SD = 14.31) in Macao, China. Hierarchical regression analysis indicated that gambling-specific metacognitions contributed to an additional 23 % variance explained in responsible gambling after considering generic metacognitions and demographics. Path analysis further showed that the direct paths from generic, positive and negative gambling-specific metacognitions to responsible gambling were all significant while the positive type showing a stronger effect. Moreover, depression partially mediated the effects of both generic and gambling-specific metacognitions on responsible gambling. Findings suggest that responsible gambling campaigns should consider improving the awareness of metacognitions and emotion regulation in depression among Chinese adult gamblers.

Gypenosides alleviate oxidative stress in the hippocampus, promote mitophagy, and mitigate depressive-like behaviors induced by CUMS via SIRT1

ETHNOPHARMACOLOGICAL RELEVANCE

The use and efficacy of Gynostemma [Gynostemma pentaphyllum (Thunb.) Makino], a versatile traditional Chinese herb, was first documented in the renowned pharmacopoeia, "Compendium of Materia Medica". Gypenosides (Gps), saponin components are the primary constituents responsible for its biological activities and clinical effects, which include antioxidant, immunoregulatory, antitumor, and neuroprotective properties. Pharmacological studies have shown that Gps has the potential to combat depression. However, the exact molecular mechanisms underlying its antidepressant effects remain unclear.

AIM OF THE STUDY

This study aims to elucidate the mechanisms underlying the antidepressant effects of Gps through antioxidative stress, utilizing an integrated approach that includes network pharmacology, molecular simulations, and experimental validation.

MATERIALS AND METHODS

Sprague-Dawley rats were subjected to chronic unpredictable mild stress (CUMS) and were orally administered doses of Gps (50 and 100 mg/kg) and fluoxetine (10 mg/kg). The regulatory effects of Gps on depression-like behaviors in CUMS rats and their impact on oxidative stress levels in the hippocampus region were evaluated. Network pharmacology was used to investigate the mechanisms by which Gps affects oxidative stress in depression, and was accompanied by molecular docking and dynamics simulations. CUMS rats were treated orally with Gps (100 mg/kg) and injected with EX527 for rescue experiments to validate the role of SIRT1 in antioxidative stress and evaluate the impact of Gps on mitophagy.

RESULTS

Gps ameliorated depression-like behaviors induced by CUMS in rats. The improvements observed included an increased sucrose preference, reduced immobility time in the tail suspension and forced swim tests, and an increased movement distance in the open-field test. Additionally, Gps effectively reduced reactive oxygen species, malondialdehyde, and 8-hydroxy-2'-deoxyguanosine levels in the hippocampus, while increasing the contents of ATP, catalase, superoxide dismutase, and glutathione, indicating an increased capacity for antioxidative stress in the hippocampus. Furthermore, Gps increased the number of neuronal cells in the hippocampal CA1 region and the level of mitochondrial autophagy, with SIRT1 as a potential key target. Inhibition of SIRT1 expression by exposure to EX527 reversed the beneficial effects of Gps, further validating the critical role of SIRT1 in the regulation of oxidative stress and improving depression-like behavior.

CONCLUSION

Gps improved the antioxidative stress capacity of the hippocampus and promoted mitophagy in CUMS rats through SIRT1, thus protecting hippocampal neurons and improving depression-like behavior.

A volumetric study of the choroid plexus in neuropsychiatric systemic lupus erythematosus

Much evidence suggests that the choroid plexus (CP) plays an important role in the pathophysiology of systemic lupus erythematosus (SLE), but its imaging profile in neuropsychiatric SLE (NPSLE) remains unexplored. To evaluate CP volume in NPSLE patients using MRI. This retrospective study evaluated patients with SLE who underwent MRI of the brain, including three-dimensional T1-weighted imaging. CP volumes were automatically segmented. CP volume was evaluated using multivariable linear regression adjusted for age, sex, and total intracranial volume among three groups: NPSLE group, non-NPSLE group, and healthy control group (HC). Correlation analysis was performed between CP volume and clinical variables in the patient group. A total of 138 patients with SLE were included in the analysis. It was found that the right CP volume was greater in NPSLE compared with non-NPSLE and HC. When stratified according to their diagnosed status, newly diagnosed NPSLE had significantly greater CP volumes bilaterally compared with HC. Right CP volume was positively associated with Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores in the patient group. All statistical significance levels were p < 0.05. CP enlargement could reflect a neuroinflammatory response that occurs at NPSLE disease onset. CP volume may serve as a promising marker for SLE, especially for newly diagnosed NPSLE.

Advances in Targeted Therapy for Systemic Lupus Erythematosus: Current Treatments and Novel Approaches

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse clinical manifestations that can lead to severe organ damage. The complex pathophysiology of SLE makes treatment selection difficult. This review examines the current evidence for biological therapies in SLE, including the anti-B cell activating factor antibody belimumab; the type I interferon receptor antagonist anifrolumab; the novel calcineurin inhibitor voclosporin; and rituximab, which targets CD20 on B cells. We also describe emerging therapies, including novel agents in development and CD19-directed chimeric antigen receptor (CAR) T cell therapy, which has shown promise in early clinical experience. Recent advances in biomarker research, including interferon signatures and transcriptomic profiles, may facilitate patient stratification and treatment selection. This review offers insights into current and future treatment strategies for patients with SLE by analyzing clinical trial results and recent immunological findings.

Organ-based characterization of B cells in patients with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a chronic, inflammatory, and progressive autoimmune disease. The unclear pathogenesis, high heterogeneity, and prolonged course of the disease present significant challenges for effective clinical management of lupus patients. Dysregulation of the immune system and disruption of immune tolerance, particularly through the abnormal activation of B lymphocytes and the production of excessive autoantibodies, lead to widespread inflammation and tissue damage, resulting in multi-organ impairment. Currently, there is no systematic review that examines the specificity of B cell characteristics and pathogenic mechanisms across various organs. This paper reviews current research on B cells in lupus patients and summarizes the distinct characteristics of B cells in different organs. By integrating clinical manifestations of organ damage in patients with a focus on the organ-specific features of B cells, we provide a new perspective on enhancing the efficacy of lupus-targeted B cell therapy strategies.

The Interplay of Personality Traits and Psychological Well-Being: Insights from a Study of Italian Undergraduates

OBJECTIVES

The mental health and well-being of university students are crucial areas of research due to their significant impact on academic success, personal development, and overall life satisfaction. Since previous research consistently shows that the stress related to academic challenges can significantly affect mental health, the study aims to examine the relationship between personality traits, locus of control, and psychological well-being outcomes.

METHODS

In the present study, 67 Italian undergraduate students (19.45 ± 1.62 years) were evaluated to assess the connections between personality traits, locus of control, and key psychological outcomes including depression, anxiety, sleep disturbances, and subjective memory complaints.

RESULTS

The analyses of the collected variables revealed a strong interrelationship between stress, anxiety, depression, and insomnia, contributing to a general construct termed psychological well-being disturbances (PWBD). When considering the Big Five personality traits, a significant positive association with internal control and mindfulness levels was observed both for extraversion and conscientiousness, while neuroticism was associated with increased external control and subjective memory complaints.

CONCLUSIONS

These findings highlight the importance of understanding personality traits in shaping psychological well-being and coping mechanisms among students. Educational institutions should consider incorporating personality-based approaches into their support systems, as fostering traits linked to better psychological well-being, such as extraversion, conscientiousness, and agreeableness, may help mitigate the negative impact of stress and anxiety commonly experienced in academic settings.

Psychometric properties of the Swedish version of the Patient Health Questionnaire-9: an investigation using Rasch analysis and confirmatory factor analysis

Depression is one of the most common psychiatric conditions. Given its high prevalence and disease burden, accurate diagnostic procedures and valid instruments are warranted to identify those in need of treatment. The Patient Health Questionnaire-9 (PHQ-9) is one of the most widely used self-report measures of depression, and its validity and reliability has been evaluated in several languages. However, the Swedish translation has yet not been subject to psychometric evaluation, and no previous psychometric evaluation of the instrument have used both Rasch analysis and classic test theory. The aim of this study was to investigate validity and reliability of the PHQ-9 in a Swedish sample of individuals with self-reported current or past mental health problems using Rasch analysis and confirmatory factor analysis. A sample of 4958 participants was recruited from an online survey covering different aspects of covid-19 and mental health targeted towards individuals with mental health problems. Results showed that a one-factor solution fit the data after removing one item and that some items had a different response pattern for older respondents. Furthermore, after removing item 2 and merging the two middle response categories for item 9, the Swedish translation of PHQ-9 showed adequate psychometric properties. The findings suggests that the Swedish translation of PHQ-9 may need to be adapted in order to make adequate interpretations of an individual score and to differentiate between populations. Further tests of its validity and reliability in other Swedish samples are needed to fully understand the properties of the Swedish version of PHQ-9.

Application of machine learning in depression risk prediction for connective tissue diseases

This study retrospectively collected clinical data from 480 patients with connective tissue diseases (CTDs) at Nanjing First Hospital between August 2019 and December 2023 to develop and validate a multi-classification machine learning (ML) model for assessing depression risk. Addressing the limitations of traditional assessment tools, six ML models were constructed using univariate analysis and the LASSO algorithm, with the categorical boosting (Catboost) model emerging as the best performer, demonstrating strong predictive ability across different depression severity levels (none_F1 = 0.879, mild_F1 = 0.627, moderate and severe_F1 = 0.588). Additionally, the study provided an interpretation of the best-performing model using SHAP and developed a user-friendly R Shiny application ( https://macnomogram.shinyapps.io/Catboost/ ) to facilitate clinical use. The findings suggest that the Catboost model represents a significant advancement in assessing depression risk among CTD patients, highlighting the potential of ML in enhancing mental health management for this patient population.

Monitoring the Response of Treatment in Major Depressive Disorder with EEG: Could it be an Indicator of Returning to Health in Responders

Background: Quantitative electroencephalography (qEEG) data can facilitate the monitoring of treatment progress and the evaluation of therapeutic responses in patients with Major Depressive Disorder (MDD). This study aims to compare the qEEG data of MDD patients and healthy controls, both before and after treatment, to assess the effect of treatment response on neural activity. Methods: A total of 72 patients, aged 18-60, who had not used any psychopharmacological medication for at least two weeks, were included in the study. Based on a minimum 50% reduction in scores on the Hamilton Depression Rating Scale (HDRS-17) and Hamilton Anxiety Rating Scale (HARS), the patients were divided into two groups: responders (n = 51) and non-responders (n = 21). qEEG data were recorded before and after treatment. Results: Responders exhibited a significant shift in cortical activity-particularly in theta, alpha, and high-beta power-toward patterns resembling those observed in the healthy control group (improvement range: 15% to 67%). In contrast, non-responders showed minimal changes in cortical activity (improvement range: 38% to 46%). These findings suggest that while qEEG spectral data reflect marked neural changes in responders, no significant alterations occur in non-responders. Conclusion: The use of qEEG spectral analysis to monitor MDD patients provides valuable insights into treatment efficacy. The distinct patterns of cortical activity observed across most brain regions before treatment, compared to healthy individuals, highlight the potential of qEEG to predict treatment outcomes.