Psychometric properties of the Beck Depression Inventory-II: a comprehensive review

Comprehensive investigation of factor structure and gender equivalence of the Beck Depression Inventory-II among nonclinical adolescents

The Beck Depression Inventory-II (BDI-II) is a widely used tool for rating the severity of depressive symptoms. Studies on the factor structure of the BDI-II in adolescents have yielded controversial findings. Most studies have reported an oblique two-factor model that describes the 'cognitive' and 'somatic-affective' dimensions. However, there is variation in the item composition of each factor across studies. Alternative factor structures have been proposed, including one-factor, three-factor, hierarchical, and bifactor models. Additionally, there is limited data on measurement invariance across genders. This study aimed to examine hypothetical factor structures and gender equivalence of the BDI-II in a sample of Brazilian nonclinical adolescents (N = 1,184, aged 13-18 years, 59.1% females). Cross-validation of the BDI-II was performed through exploratory (EFA) and confirmatory factor analysis (CFA). Measurement invariance was evaluated using multigroup-CFA (MG-CFA). EFA suggested an oblique two-factor model depicting "affective-cognitive" and "somatic" dimensions. CFA tested competing models for the structure of BDI-II, including the simple one- and two-factor models, a bifactor model, and the EFA model along with its corresponding bifactor model. All models demonstrated adequate and similar fitness, well-defined factors, and good reliability. Bifactor analyses indicated a robust general factor with low reliable variance in total scores attributed to multidimensionality caused by the group factors in bifactor models. MG-CFA supported invariance across gender, suggesting that the same BDI-II construct could be applied to both female and male adolescents. This study provides evidence that the BDI-II could be used as a unidimensional measure of depressive symptoms in adolescents by researchers and clinicians.

Translational evaluation of metabolic risk factors impacting DBS efficacy for PD-related sleep and depressive disorders: preclinical, prospective and cohort studies

BACKGROUND

Parkinson's disease (PD) is linked with metabolic risk factors including body mass index (BMI), fasting blood glucose (FBG), cholesterol levels, and triglycerides (TG). The extent to which these factors affect motor symptoms, depression, and sleep problems in PD, as well as their role in determining the success of deep brain stimulation (DBS) therapy, is yet to be fully understood.

METHODS

This study delved into the effects of metabolic risk factors like BMI, FBG, cholesterol, and TG on the outcomes of DBS in treating PD-related depression and sleep disturbances across both mouse models and human subjects.

RESULTS

DBS showcased noticeable betterment in depression and sleep perturbations in both PD-afflicted mice and patients. High-sugar-high-fat diet aggravates MPTP-induced depression and sleep disorders in mice. PD-afflicted individuals presenting with depressive and sleep disorders demonstrated elevated metrics of BMI, FBG, blood cholesterol, and TG. Remarkably, these metrics bore considerable adverse influences on the efficiency of DBS in ameliorating depression and sleep issues yet spared motor symptoms. The favorable impacts of DBS persisted for ~6 years, after which a significant decline was noted. Importantly, our translational evidence from both murine controls and patient cohorts indicated that antihyperglycemic and antihyperlipidemic therapies bolstered the efficacy of DBS in mitigating PD-related depression and sleep disturbances, without impinging upon motor functions in patients.

CONCLUSION

In summary, this research emphasizes that DBS is a powerful treatment option for depression and sleep issues in PD, with its success influenced by metabolic risk factors. It further suggests that incorporating treatments for high blood sugar and cholesterol can enhance the efficacy of DBS in treating depression and sleep disturbances in PD, without impacting motor symptoms, highlighting the importance of metabolic risk management in PD patients receiving DBS.

Discriminability of the Beck Depression Inventory and its Abbreviations in an Adolescent Psychiatric Sample

Background

The Beck Depression Inventory (BDI) is a widely acknowledged self-report screening tool for evaluating the presence and intensity of depressive symptoms. The BDI-IA, although an older version, is highly correlated with the updated BDI-II, remains clinically valuable, and is widely used due to its free availability.

Aim

This study aimed to examine the psychometric properties of the BDI-IA and compare its diagnostic accuracy with the abbreviated BDI-SF, BDI-PC, and BDI-6 versions against gold-standard research diagnoses in a representative Finnish adolescent clinical population.

Methods

The participants were referred outpatient adolescents aged 13-20 years (N = 752, 73% female). We investigated structural validity with item factor analysis and evaluated the criterion validity of mean scores and factor scores with various diagnostic measures. Sample-optimal cut-offs (criterion unweighted Cohen's kappa) were estimated with a bootstrap procedure.

Results

The sample-optimal cut-off for the full BDI was 19, slightly higher than that suggested by the previous literature. The abbreviations of the BDI-IA were demonstrated to be as good as the full scale in detecting depressive symptoms in all three diagnostic categorizations.

Conclusion

The use of brief and user-friendly questionnaires such as the BDI-PC or BDI-6 is recommended to ensure optimal depression screening and minimize the administrative burden, especially in primary care settings where clinical decision-making and referrals often need to occur within a limited time frame.

Efficacy of Transcranial Direct Current Stimulation (tDCS) on Neuropsychiatric Symptoms in Multiple Sclerosis (MS)-A Review and Insight into Possible Mechanisms of Action

Introduction: Neuropsychiatric symptoms such as depression and anxiety are a significant burden on patients with multiple sclerosis (MS). Their pathophysiology is complex and yet to be fully understood. There is an urgent need for non-invasive treatments that directly target the brain and help patients with MS. One such possible treatment is transcranial direct current stimulation (tDCS), a popular and effective non-invasive brain stimulation technique. Methods: This mechanistic review explores the efficacy of tDCS in treating depression and anxiety in MS while focusing on the underlying mechanisms of action. Understanding these mechanisms is crucial, as neuropsychiatric symptoms in MS arise from complex neuroinflammatory and neurodegenerative processes. This review offers insights that may direct more focused and efficient therapeutic approaches by investigating the ways in which tDCS affects inflammation, brain plasticity, and neural connections. Searches were conducted using the PubMed/Medline, ResearchGate, Cochrane, and Google Scholar databases. Results: The literature search yielded 11 studies to be included in this review, with a total of 175 patients participating in the included studies. In most studies, tDCS did not significantly reduce depression or anxiety scores as the studied patients did not have elevated scores indicating depression and anxiety. In the few studies where the patients had scores indicating mild/moderate dysfunction, tDCS was more effective. The risk of bias in the included studies was assessed as moderate. Despite the null or near-null results, tDCS may still prove to be an effective treatment option for depression and anxiety in MS, because tDCS produces a neurobiological effect on the brain and nervous system. To facilitate further work, several possible mechanisms of action of tDCS have been reported, such as the modulation of the frontal-midline theta, reductions in neuroinflammation, the modulation of the HPA axis, and cerebral blood flow regulation. Conclusions: Although tDCS did not overall demonstrate positive effects in reducing depression and anxiety in the studied MS patients, the role of tDCS in this area should not be underestimated. Evidence from other studies indicates the effectiveness of tDCS in reducing depression and anxiety, but the studies included in this review did not include patients with sufficient depression or anxiety. Future studies are needed to confirm the effectiveness of tDCS in neuropsychiatric dysfunctions in MS.

Assessing hand motor function in chronic immune-mediated neuropathies: a proof-of-concept study using a data glove

BACKGROUND

Chronic immune-mediated neuropathies are clinically heterogeneous and require regular, objective, and multidimensional monitoring to individualize treatment. However, established outcome measures are insufficient regarding measurement quality criteria (e.g., reliability, objectivity) or functional relevance. Wearables such as data gloves might be helpful, allowing repeated quantification of complex everyday life-relevant motor function of the hand.

METHODS

25 patients with chronic inflammatory demyelinating polyneuropathy or multifocal motor neuropathy were followed-up at five time points during maintenance therapy with intravenous immunoglobulin. 14 of them showed clinically relevant hand motor impairment. We examined the patients' hand function using a data glove which quantifies the active range of motion (ROM) of the hand based on three different movement patterns. In addition, clinical outcome parameters (grip strength measurement, MRC Sum Score, INCAT disability score), nerve conduction studies (NCS), and high-resolution ultrasound (HRUS) were performed, and patient-reported outcome measures (PROMs) like the Rasch-built Overall Disability Scale (R-ODS) were assessed. We calculated correlation coefficients, performed Receiver Operating Characteristic analysis, as well as correlation analyses for the glove data and clinical outcome parameters. Longitudinal analyses were based on a Linear Mixed Model, and we assessed construct validity of the data glove by analyzing correlations between the glove measurements and well-established clinical parameters.

RESULTS

We found good to excellent test-retest reliability for the ROM in all glove movement patterns (Intraclass correlation coefficients = 0.83-0.94), underlining the ability to capture clinical stability. Moreover, the glove demonstrated adequate, sensitivity and specificity in detecting hand motor impairment (area under the curve (AUC): 0.714-0.780), and it performed better than NCS and HRUS (AUC: 0.552/0.701). The AUC values for the metrically scaled parameters include: Vigorimeter (AUC: 0.929) and R-ODS (AUC: 0.698). Additionally, the data glove proved to be a valid tool, as we demonstrated moderate to strong, significant correlations between the glove and established clinical parameters (especially Vigorimeter), as well as PROMs (especially R-ODS).

CONCLUSIONS

This data glove allowed for a non-invasive assessment of the hand motor function and yielded investigator-independent results that reliably reflected individual functional deficits with relevance to everyday life. Future studies should explore the ability to predict clinically meaningful responses to immunomodulatory treatment and to support and monitor rehabilitation progress, with potential applications in other neurological diseases as well. Trial registration at the German Clinical Trials Register, Deutsches Register Klinischer Studien (DRKS: 00027345), retrospectively registered on 23rd March 2022: https://drks.de/search/de/trial/DRKS00027345.

Targeting sleep quality in acutely traumatized individuals to reduce the risk for PTSD: study protocol for a multicentre randomized clinical trial

Background: There is a great need for feasible interventions in the initial period after a trauma that minimize the risk of developing a clinically relevant PTSD. The majority of people suffer from severe sleep disorders after a traumatic event. Because sleep is essential for processing emotional memories, we aim to improve sleep quality in acutely traumatized patients to benefit adaptive trauma processing and thereby prevent PTSD development.Objective: In a multicentre randomized controlled trial (RCT), we will investigate whether digital cognitive behavioural therapy for insomnia (dCBT-I) has the potential to not only increase sleep quality in acutely traumatized individuals but also reduce trauma-related symptoms (specific PTSD symptoms as well as related symptoms such as depression, anxiety and functional outcomes) and the risk for PTSD development in acutely traumatized individuals. Moreover, we will test if sleep disturbances pre-therapy predict the development of later PTSD symptoms.Method: We aim to recruit 104 patients who will be randomly assigned to an app-based sleep intervention utilizing CBT-I or a sleep diary as an add-on to treatment-as-usual (TAU) in outpatient acute trauma centres. Sleep quality, PTSD symptoms and everyday functioning will be measured before, after the intervention and at a 6-month follow-up.Conclusion: To our knowledge, this multicentre RCT is the first study to use dCBT-I as an early intervention for trauma. It may improve the understanding of the role of sleep in the development of PTSD and has the potential to contribute to the development of an easy-to-use early intervention for acutely traumatized individuals.

Efficacy of Fractional CO2 Laser Therapy in Improving Symptoms and Quality of Life in Women with Refractory Vulvar Lichen Sclerosus: A Prospective Observational Study

Lichen sclerosus (LS) is a chronic inflammatory condition predominantly affecting the anogenital region of postmenopausal women. It is associated with considerable aesthetic and functional impairments and an increased risk of squamous cell carcinoma. While high-potency topical corticosteroids remain the cornerstone of treatment, therapeutic options for patients with refractory LS are scarce. Fractional CO2 laser therapy has emerged as a potential second-line intervention aiming to mitigate symptoms and improve quality of life. This prospective observational study investigated the short-term efficacy and safety of fractional CO2 laser therapy in 75 women with refractory LS who underwent four treatment sessions between January 2022 and February 2024. Sixty-nine patients completed the protocol, demonstrating significant reductions in key symptoms, including pruritus (VAS score from 7.53 ± 3.02 to 4.08 ± 3.07), pain (5.83 ± 3.84 to 2.42 ± 2.85), and dyspareunia (8.26 ± 2.82 to 6.34 ± 3.30). Quality of life, sexual function, and psychological well-being also improved, as evidenced by reductions in Dermatology Life Quality Index (DLQI) scores (10.72 ± 7.25 to 5.94 ± 5.16), enhancements in sexual function (FSFI scores from 10.48 ± 8.46 to 15.52 ± 9.59), and decreased depression severity (BDI scores from 16.66 ± 12.64 to 5.94 ± 5.16). Importantly, no adverse effects were reported during the study period. Although these findings highlight the potential of fractional CO2 laser therapy as a safe and effective adjunct for refractory LS, it is essential to acknowledge the study's limitations, particularly the relatively short follow-up period. Longer-term studies are warranted to confirm sustained benefits and to evaluate the broader applicability of this approach.

Psychological Symptom Cluster Severity Profiles Are Associated With Higher Levels of Stress and Worse Quality of Life in Postmenopausal Women With Breast Cancer

BACKGROUND

Although common, the severity of the psychological symptom cluster (PSC) (ie, co-occurrence of anxiety, depression, fatigue, sleep disturbance) varies among women with breast cancer. In addition, the impact of various types of stress and other risk factors on its severity are understudied, and the influence of the PSC on quality of life (QOL) outcomes remains poorly characterized.

OBJECTIVE

To identify subgroups of postmenopausal women with breast cancer with distinct PSC severity profiles following surgery and evaluate whether these subgroups differed in terms of demographic and clinical characteristics, symptoms, social and posttraumatic stress, and QOL.

METHODS

Following surgery, 159 postmenopausal women with early-stage, hormone receptor-positive breast cancer completed assessments of anxiety, depression, fatigue, sleep disturbance, cognitive function, physical symptoms, stress, and QOL. Latent profile analysis was used to identify subgroups of women based on the severity of the prespecified PSC. Parametric and nonparametric tests were used to evaluate for subgroup differences.

RESULTS

Three distinct PSC severity subgroups were identified (ie, Lower [71.7%], Moderate [23.9%], Higher [4.4%]). Compared with the Lower subgroup, the Moderate subgroup was less likely to have received prior radiation, and the Moderate and Higher subgroups had worse perceived cognitive function, higher symptom burden, higher posttraumatic stress, and lower QOL. Clinically relevant sleep disturbance was common across PSC subgroups.

CONCLUSIONS

PSC severity is associated with higher posttraumatic stress and poorer QOL following breast surgery. Sleep disturbance is a common problem and may be undertreated.

IMPLICATIONS FOR PRACTICE

Assessments of posttraumatic stress and sleep disturbance are needed for timely intervention.

Spatial discrimination in patients with MSA, PSP, DIP, and VP with pain

Pain is common in Parkinson's disease and frequently observed in other diseases involving parkinsonism. Abnormal scaling function in PD has been reportedly associated with pain, but the role of this function in pain in other parkinsonism-related diseases remains unknown. We screened 127 patients with multiple system atrophy (MSA, n = 24), progressive supranuclear palsy (PSP, n = 15), drug-induced parkinsonism (DIP, n = 56), or vascular parkinsonism (VP, n = 32). After screening, 79 patients with parkinsonism (23 MSA, 10 PSP, 28 DIP, and 18 VP patients) were included in the study. We divided the patients of each group into two groups (with or without pain).The percentages of patients in those groups with pain were 73.9%, 50.0%, 67.9%, and 66.7%, respectively. There was no difference in mean SDT between patients with and without pain in any disease (all p ≥ 0.052). The number of patients showing unmeasurable SDT did not differ between those with and without pain in any disease (all p ≥ 0.316). Our study found no evidence of a role of scaling function in pain development in parkinsonian disorders such as atypical parkinsonism, DIP, and VP.

Associations between sleep duration, depression status, and cognitive function among Chinese elderly: A community-based study

BACKGROUND

The associations of sleep duration and depressive status on cognitive function among the elderly remain controversial. This study aimed to investigate the associative effects and mediating mechanisms between sleep duration and depressive status on cognitive function in elderly adults.

METHODS

Participants were recruited from cross-sectional and cohort surveys of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We identified thresholds for sleep duration and depression and used logistic regression to explore their independent and joint effects on cognitive impairment. Further, we analyze the mediating effects of depressive status on the association between sleep duration and cognitive function.

RESULTS

Of 13840 elderly (median age: 84 years, female: 54.6 %), 2835 (20.5 %) had cognitive impairment. Compared with those who slept 6-8 h, the ORs (95%CIs) for those who slept < 6 h and > 8 h were 0.98 (0.85, 1.12) and 1.48 (1.32, 1.66). Compared with non-depressed, the OR (95%CI) for the depressed participants was 1.74 (1.53, 1.98). Compared with those with sleep 6-8 h and none-depression, those with sleep > 8 h and depression had the highest odds of cognitive impairment (OR = 2.40, 95%CI: 1.88-3.07). Additionally, Compared with those who slept 6-8 h, the associations between depression-mediated short and long sleep and cognitive impairment were 51.1 % and 6.5 %, respectively.

LIMITATIONS

Cross-sectional studies require caution in the interpretation of causal associations.

CONCLUSIONS

Long sleep and depression were independently and jointly associated with higher odds of cognitive impairment among the Chinese elderly, and short sleep increased the risk of cognitive impairment by promoting the prevalence of depression.

The effect of mindfulness-based cognitive therapy on PTSD and depression symptoms in trauma-exposed black adults: Pilot randomized controlled trial results

Low-income, urban-dwelling Black adults are disproportionately affected by traumatic experiences, post-traumatic stress disorder (PTSD), and depression and encounter inequities in treatment access. In addition to the benefits Mindfulness-Based Cognitive Therapy (MBCT) for depression, there is preliminary evidence of successful symptom reduction in PTSD via MBCT across two prior pilot studies in veterans. Studies examining the effects of MBCT among trauma-exposed Black adults remains limited, and examination of effects across specific PTSD clusters is almost nonexistent. We examined the preliminary efficacy of adapted MBCT versus waitlist control (WLC) on PTSD and depression symptoms in a pilot randomized controlled trial (RCT). Black adults (N = 80; 86.10 % women) with repeated trauma exposure, who screened positive for PTSD and depression, were recruited from an urban public hospital and randomized to 8-week adapted MBCT or WLC. Symptoms were measured pretreatment and posttreatment with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and the Beck Depression Inventory-II (BDI-II). Mixed model analyses were conducted with an intent-to-treat approach, examining change in PTSD and depression scores between MBCT and WLC over time. There was no significant difference in total PTSD and depression symptom change between MBCT and WLC. CAPS-5 avoidance symptoms showed a nominally significant decrease in the MBCT group (F[1, 68.10] = 5.98, p = .017; t[71.60] = 3.61, p < .001). Findings suggest MBCT might be helpful for addressing avoidance symptoms among Black adults with comorbid PTSD and depression. Although lacking power to draw final conclusions about treatment efficacy, this study provides preliminary data suggesting the importance of future fully powered trials.

Associations between PTSD and temporal discounting: The role of future thinking

BACKGROUND AND OBJECTIVES

Despite documented alterations in future thinking in posttraumatic stress disorder (PTSD), our understanding of how individuals with PTSD make future-oriented decisions is limited. We tested the hypothesis that increased discounting in association with PTSD reflects failure to spontaneously envision future rewarding situations.

METHODS

Thirty-seven trauma exposed war-zone veterans completed a standard temporal discounting task as well as a temporal discounting task accompanied by episodic future thinking cues.

RESULTS

Severity of PTSD symptoms was associated with preference for sooner, smaller rewards in the standard task. Consistent with our hypothesis, when participants engaged in future thinking, greater PTSD symptom severity was no longer associated with steeper discounting. Moreover, difficulty anticipating future events, as measured contemporaneously in a separate task (Verfaellie et al., 2024), mediated the relationship between PTSD symptom severity and degree of discounting in the standard task. Among PTSD symptom clusters, the severity of avoidance and negative alterations in cognition and mood was related to steeper discounting. Measures of depression and alcohol use were not associated with discounting.

LIMITATIONS

The sample included mostly male, predominantly White veterans who experienced primarily combat-related trauma.

CONCLUSIONS

PTSD-associated alterations in temporal discounting reflect failure to spontaneously imagine future positive events. Two common correlates of PTSD, depression and alcohol use, could not account for the observed associations between PTSD and future-oriented decisions.

Cortical intermittent theta burst stimulation on gait pathomechanics and urinary tract dysfunction in incomplete spinal cord injury patients: Protocol for a randomized controlled trial

Gait impairment and neurogenic bladder are co-existing common findings in incomplete spinal cord injury (iSCI). Repetitive transcranial magnetic stimulation (rTMS), evident to be a promising strategy adjunct to physical rehabilitation to regain normal ambulation in SCI. However, there is a need to evaluate the role of Intermittent theta burst stimulation (iTBS), a type of patterned rTMS in restoring gait and neurogenic bladder in SCI patients. The aim of the present study is to quantify the effect of iTBS on spatiotemporal, kinetic, and kinematic parameters of gait and neurogenic bladder dyssynergia in iSCI. After maturing all exclusion and inclusion criteria, thirty iSCI patients will be randomly divided into three groups: Group-A (sham), Group-B (active rTMS) and Group-C (active iTBS). Each group will receive stimulation adjunct to physical rehabilitation for 2 weeks. All patients will undergo gait analysis, as well assessment of bladder, electrophysiological, neurological, functional, and psychosocial parameters. All parameters will be assessed at baseline and 6th week (1st follow-up). Parameters except urodynamics and gait analysis will also be assessed after the end of the 2 weeks of the intervention (post-intervention) and at 12th week (2nd follow-up). Appropriate statistical analysis will be done using various parametric and non-parametric tests based on results.

Prevalence and risk factors of anxiety and depression in diabetic retinopathy patients: A cross-sectional study using multiple scales

OBJECTIVE

To investigate the prevalence of anxiety and depression, and explore their related factors in all types of diabetic retinopathy (DR) patients more precisely and accurately by multiple scales.

METHODS

Beck anxiety inventory (BAI), self-rating anxiety scale (SAS), beck depression inventory (BDI), and self-rating depression scale (SDS) scores were assessed in 247 DR patients and 250 non-retinopathic diabetes mellitus (NRDM) patients.

RESULTS

In DR patients, there were 32 patients with proliferative DR and 115 patients with impaired visual acuity. The prevalences (95% confidence interval) of anxiety were 38.5% (32.4%-44.6%) and 32.0% (26.2%-37.8%) by BAI and SAS, while those for depression were 31.6% (25.8%-37.4%) and 25.1% (19.7%-30.5%) by BDI and SDS in DR patients. BAI score (P = 0.003), BAI-defined anxiety rate (P = 0.010), SAS score (P = 0.001), SAS-defined anxiety rate (P = 0.006), BDI score (P = 0.005), BDI-defined depression rate (P = 0.028), and SDS score (P = 0.001) were increased in DR patients versus NRDM patients. In DR patients, proliferative DR independently related to BAI-defined anxiety (P < 0.001) and SAS-defined anxiety (P < 0.001). Female (P = 0.016) and proliferative DR (P < 0.001) independently associated with BDI-defined depression; female (P = 0.007), DM duration (P = 0.025), triglyceride (TG) (P = 0.026), and proliferative DR (P = 0.014) independently associated with SDS-defined depression. The combination of these independent factors showed acceptable abilities in predicting BAI-defined anxiety, SAS-defined anxiety, BDI-defined depression, or SDS-defined depression in DR patients, with area under curves of 0.626, 0.656, 0.696, and 0.741, respectively (all P < 0.001).

CONCLUSION

Anxiety and depression are prevalent; meanwhile, proliferative DR, female, DM duration, and TG independently relate to anxiety or depression in DR patients.

[Investigation of the Reliability and Validity of the Chinese Version of the Beck Depression Inventory-Ⅱ in Middle School Students of Yi Ethnicity in Liangshan Prefecture, China]

Objective

To assess the reliability and validity of the Chinese version of the Beck Depression Inventory, Second Edition (BDI-Ⅱ-C) among Yi middle school students in Liangshan Prefecture.

Methods

A stratified cluster sampling method was used to select 466 Yi middle and high school students in Liangshan Prefecture to respond to the BDI-Ⅱ-C. The general demographic characteristics of the samples were described, and independent sample t-test, chi-square test, and reliability analysis were conducted to analyze the data. The sample was randomly divided into 2 halves for exploratory factor analysis and confirmatory factor analysis.

Results

The Cronbach's alpha coefficient for BDI-Ⅱ-C was 0.925 for the sample of Yi middle school students in Liangshan Prefecture. The correlation coefficients between individual items ranged from 0.192 to 0.612, and those between individual items and total scores ranged from 0.492 to 0.761. Exploratory factor analysis found that the scale could be divided into three dimensions, including emotional symptoms, somatic symptoms, and negative symptoms. Confirmatory factor analysis results revealed that the various indicators of the three-factor model were χ 2/df=1.604, comparative fit index (CFI)=0.940, Tucker-Lewis index (TLI)=0.932, incremental fit index (IFI)=0.941, and root mean square error of approximation (RMSEA)=0.051.

Conclusion

BDI-Ⅱ-C exhibits good reliability and validity among Yi middle school students in Liangshan Prefecture, but the convergent validity of the structural validity is poor.

Analysis of Suicidal Behavior in Adult Inpatients with Anorexia Nervosa: Prevalence of Suicide Attempts and Non-Suicidal Self-Injury and Associated Factors-Data Before and After the COVID-19 Pandemic

Background/Objectives: Anorexia nervosa (AN) has a high mortality rate frequently related to suicidality; however, there are few studies on suicide attempts (SAs) and non-suicidal self-injuries (NSSIs) in adult inpatients with AN. This study aims to describe SA and NSSI prevalence and related clinical and sociodemographic factors in adult inpatients with AN. Methods: We retrospectively analyzed data on 298 inpatients hospitalized between 2014 and 2023. Suicidality and clinical and sociodemographic data were collected by experienced psychiatrists; then, the patients completed a battery of self-report questionnaires investigating eating-related and general psychopathology. Results: A total of 9.7% of the inpatients reported an SA in their lifetime, and 13.4% reported NSSI. The percentages were lower among patients with restricter-type AN (5.6% SA and 6.6% NSSI) and higher among patients with binge-purging AN (18% SA and 27% NSSI). SAs were associated with unemployment, binge-purging AN, personality disorders, and lifetime sexual abuse; NSSIs were correlated with family psychiatric disorders, binge-purging AN, personality disorders, body dissatisfaction, restriction, and eating-related concerns. No differences emerged in the frequency of reported suicidality between patients tested before and after the COVID-19 pandemic. Conclusions: Suicidality is a relevant issue in AN. Many factors in the history of the patients and their eating-related pathologies should be considered as potentially associated with SA and NSSI and carefully assessed.

Machine Learning Model for Predicting Walking Ability in Lower Limb Amputees

Background/Objectives: The number of individuals with lower limb loss (LLL) is rising. Therefore, identifying the walking potential in individuals with LLL and prescribing adequate prosthetic systems are crucial. Various factors can influence participants' walking ability, to different extents. The aim of the present study was to apply machine learning methods to develop a predictive mode. This model can assist rehabilitation and limb loss care teams in making informed decisions regarding prosthesis prescription and predicting walking ability in individuals with LLL. Methods: The present study was designed as a prospective cross-sectional study encompassing 104 consecutively recruited participants with LLL (average age 62.1 ± 10.9 years, 80 (76.9%) men) at the Medical Rehabilitation Clinic. Demographic, physical, psychological, and social status data of patients were collected at the beginning of the rehabilitation program. At the end of the treatment, K-level estimation of functional ability, a Timed Up and Go Test (TUG), and a Two-Minute Walking Test (TMWT) were performed. Support vector machines (SVM) were used to develop the prediction model. Results: Three decision trees were created, one for each output, as follows: K-level, TUG, and TMWT. For all three outputs, there were eight significant predictors (balance, body mass index, age, Beck depression inventory, amputation level, muscle strength of the residual extremity hip extensors, intact extremity (IE) plantar flexors, and IE hip extensors). For the K-level, the ninth predictor was The Multidimensional Scale of Perceived Social Support (MSPSS). Conclusions: Using the SVM model, we can predict the K-level, TUG, and TMWT with high accuracy. These clinical assessments could be incorporated into routine clinical practice to guide clinicians and inform patients of their potential level of ambulation.

ACT with CF: A randomized trial of acceptance and commitment therapy vs supportive psychotherapy for adults with cystic fibrosis

PURPOSE

Psychological distress, including anxiety and depression, is common among adults with CF, associating with poor quality of life, lung function, and healthcare utilization. This 3-year, multi-site, telehealth-delivered randomized trial sought to determine whether Acceptance and Commitment Therapy (ACT with CF) is superior to supportive psychotherapy (SP), in improving psychological functioning for adults with CF.

METHODS

One hundred twenty-four adults with CF and elevated anxiety and/or depressive symptoms were recruited coincident with the first COVID lockdown, from Thomas Jefferson University Hospitals, University of Virginia, Augusta University, Duke University Medical Center, and social media. Participants were randomized to 6 weeks of either ACT with CF or SP, delivered via Zoom. They completed measures of psychological functioning: depression (BDI-II), anxiety (BAI), cognitive fusion (CFQ-13), acceptance and committed action (AAQ-II); and barriers to adherence at baseline, post-treatment, and at 3-months follow-up. Biobehavioral outcomes, including CF severity and treatment burden, were gathered using EMR data.

RESULTS

Participants were young adults (mean age 25 years [SD = 12]), female (75 %), on CFTR modulators (67 %), psychotropic medication(s) (60 %), with previous psychotherapy engagement (72 %). Treatment effects were evaluated using analysis of covariance, controlling for baseline levels of respective outcomes, age, biological sex, and FEV1. ACT demonstrated greater improvements in psychological functioning at 6-weeks (mean score = 57.3 [51.6, 63.0]) relative to SP (mean score = 67.8 [62.2, 73.5], Cohen's d = 0.59, P = .017), with largest improvements in cognitive fusion (CFQ-13) and acceptance and committed action (AAQ-II). Treatment improvements in psychological functioning persisted at 3-months (ACT: 59.7 (53.5, 65.9) vs. SP: 69.0 [62.6, 75.4], Cohen's d = 0.40, P = .041), with ACT demonstrating continued improvements in the CFQ-13 and AAQ-II. Negative affect scores were not consistently improved on our mean-rank composite outcome variable (Cohen's d = 0.22, P = .170), despite post hoc reductions in BDI-II scores (ACT: -7.4 [-9.4, -5.4] vs. SP: -4.5 [-6.4, -2.6], P = .040). Improvements in psychological flexibility (CFQ-13 and AAQ-II) were also robustly associated with reductions in negative affect (B = -0.45, P < .001). Individuals in ACT with greater baseline barriers to medication adherence reported greater reductions in barriers after treatment (P = .026). Individuals with lower baseline FEV1/FVC ratios (e.g. ≤ 65 %) demonstrating greater improvements in ACT compared with SP (ACT: 7.3 [1.7, 12.8] vs. SP: 1.3 [-3.2, 5.8], P = .036 for interaction).

CONCLUSIONS

ACT with CF was superior to SP in improving psychological functioning among adults with CF and elevated psychological distress, with additional benefits in secondary biobehavioral outcomes in a subset of individuals with greater medical burden. Improvements in psychological flexibility strongly associated with reductions in negative affect.

CLINICALTRIALS

gov ID #NCT04114227 Supported by the Boomer Esiason Foundation.

Implementation Study of "Building Resilience," Including Positive Psychology Interventions and Positive Emotion Regulation Training in Patients With Severe Mental Illness in an Adult Outpatient Psychiatric Mental Health Setting: An Exploratory Clinical Trial

Deficits in positive emotion regulation skills may be an important factor in the development and maintenance of anxiety and mood disorders. A treatment, which includes strategies to build and strengthen positive emotion regulation skills has been provided to patients primarily diagnosed with an anxiety and or mood disorder in an adult mental health outpatient service setting. To study the effects on positive and negative emotion, emotion regulation skills, emotional disorder symptoms, quality of life, and wellbeing during a new developed treatment. An exploratory clinical trial was used to conduct a preliminary assessment of a novel intervention. The intervention was provided in a group format over a 6-week period and independent practice over an 8-week period. Outcome variables were assessed pre- and post-treatment and at a 2-month follow up. Life quality, subjective wellbeing ratings, depressive and anxiety symptoms improved at follow up. The data suggests that the intervention may have the potential to produce desired change in positive emotion regulation. Preliminary findings suggest the intervention can have beneficial effects. These findings are promising and support the possibility that disturbances in positive emotion regulation may be a generative target for treatment research.

Sport practice and depression during adolescence: Special emphasis on performance level and sport discipline

OBJECTIVES

Depression is one of the most prevalent diseases worldwide, with almost half of the adolescent population affected according to latest research. Given this serious burden of disease, research points toward interventions that could effectively fight this disease in this population subset. One of these pivotal interventions is physical activity, although the effects of different sport types and sport performance level on depression have not yet been studied in adolescent populations. Accordingly, the objective of the current study was to assess the relationship between depressive symptoms, sport type and performance level in a large adolescent population.

DESIGN

Cross-sectional study assessing a large cohort of adolescents through self-reported data.

METHODS

10,248 participants aged 11-19 years old answered questionnaires regarding depressive symptoms and sporting habits and were classified according to their sport performance level: from physically inactive to internationally competitive.

RESULTS

Girls reported higher incidence of depressive symptoms than boys, difference that further increased during late adolescence. Performance level was related to depressive symptoms: inactive participants reported the highest depressive scores while internationally competitive athletes reported the lowest. However, there were no differences between competitive athletes of different performance levels. Further, sport type had a small influence on depressive symptoms.

CONCLUSIONS

All these findings result in a potential guideline for future research and community health recommendations: as long as sufficient physical activity levels are met and the adolescent engages in sporting activities, the protection against depressive symptoms remains largely unrelated to the sport type and the level at which he or she performs.

Effects of a digital self-efficacy training in stressed university students: A randomized controlled trial

OBJECTIVE

Self-efficacy is associated with positive mental health outcomes. We developed and tested a digital self-efficacy training for daily recall of autobiographical self-efficacy memories (e.g., memories of successfully overcoming a personal challenge).

METHOD

In this randomized controlled trial, we investigated the effects of the week-long digital self-efficacy training on key mental health outcomes, including anxiety, stress, and hopelessness, and on self-efficacy in 93 university students (mean age 23.3 years, SD: 3.49) with elevated self-reported stress levels. Participants completed either the self-efficacy training combined with ecological momentary assessment (EMA) (training group) or EMA only (control group).

RESULTS

We found significantly reduced hopelessness and trait anxiety in the training group compared to the control group at post-assessment (one day post intervention). Effects on ratings of self-efficacy at post-assessment were also significant when controlling for baseline self-efficacy.

CONCLUSIONS

This stand-alone digital self-efficacy training was significantly associated with a number of positive effects on outcomes compared to a control condition, including reduced hopelessness, trait anxiety, and increased self-efficacy. Future work is needed to replicate and investigate the long-term effects of the training and explore its implementation in clinical populations.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05617248.

Explainable Multi-Layer Dynamic Ensemble Framework Optimized for Depression Detection and Severity Assessment

BACKGROUND

Depression is a pervasive mental health condition, particularly affecting older adults, where early detection and intervention are essential to mitigate its impact. This study presents an explainable multi-layer dynamic ensemble framework designed to detect depression and assess its severity, aiming to improve diagnostic precision and provide insights into contributing health factors.

METHODS

Using data from the National Social Life, Health, and Aging Project (NSHAP), this framework combines classical machine learning models, static ensemble methods, and dynamic ensemble selection (DES) approaches across two stages: detection and severity prediction. The depression detection stage classifies individuals as normal or depressed, while the severity prediction stage further classifies depressed cases as mild or moderate-severe. Finally, a confirmation depression scale prediction model estimates depression severity scores to support the two stages. Explainable AI (XAI) techniques are applied to improve model interpretability, making the framework more suitable for clinical applications.

RESULTS

The framework's FIRE-KNOP DES algorithm demonstrated high efficacy, achieving 88.33% accuracy in depression detection and 83.68% in severity prediction. XAI analysis identified mental and non-mental health indicators as significant factors in the framework's performance, emphasizing the value of these features for accurate depression assessment.

CONCLUSIONS

This study emphasizes the potential of dynamic ensemble learning in mental health assessments, particularly in detecting and evaluating depression severity. The findings provide a strong foundation for future use of dynamic ensemble frameworks in mental health assessments, demonstrating their potential for practical clinical applications.

Emotion regulation use in daily-life and its association with success of emotion-regulation, self-efficacy, stress, and state rumination

Introduction

Investigations on emotion regulation strategies (ERS) primarily focus on the influence of instructed emotion regulation (ER) on outcomes. However, recent work has shown that selection of ERS is dependent on, e.g., situational demands and personal resources.

Methods

In this current investigation, we used an online diary to investigate ERS used by free choice and their association with ER-success, stress and rumination. We identified four factors of ERS: cognitive perspective change, cognitive-behavioral problem-solving, suppression-distraction and body-social ERS. Associations of ERS with stress, state-rumination and ER-success were investigated using multilevel-mixed-models, allowing to separate within- and between-subject effects.

Results

Our results show that, on a within-subject level, all adaptive ERS were positively associated with ER-success, while maladaptive ERS as well as higher stress and state rumination were negatively associated with ER-success. On the other hand, only within-subject cognitive ERS were associated with higher self-efficacy. Maladaptive ERS-use was consequently positively associated with stress and state rumination. Surprisingly, only cognitive perspective change ERS were negatively associated with state rumination. Cognitive-behavioral problem-solving was positively associated with stress and success of emotion regulation.

Discussion

We interpret these results in the light of situational constraints of ERS-use and the importance of the assessment of these in future studies.

The effect of recreational therapy application on fatigue in hemodialysis patients: a randomized clinical trial

BACKGROUND

Chronic Kidney Disease (CKD) is a progressive disorder that often leads to End-Stage Renal Disease (ESRD), necessitating hemodialysis (HD) treatment. Fatigue is a prevalent and debilitating symptom among HD patients, significantly affecting their quality of life. Recreational Therapy (RT) is a therapeutic recreational service designed to maintain and restore a person's level of performance and independence in daily activities. This study aimed to evaluate the effect of a smartphone-based recreational therapy intervention on fatigue in hemodialysis patients.

METHODS

This randomized controlled trial was conducted on HD patients at a hospital in Mashhad, Iran. The intervention group received a custom-designed recreational therapy mobile application, including music, comedy, exercise, and educational content. The control group received standard care. Fatigue was assessed using the Multidimensional Fatigue Inventory (MFI-20) before and after the 30-day intervention.

RESULTS

A total of 72 patients (36 per group) participated in the study. The intervention group demonstrated a significant reduction in overall fatigue scores and improvements across various fatigue dimensions, including general fatigue, physical fatigue, mental fatigue, reduced activity, and reduced motivation, compared to the control group (p < 0.001).

CONCLUSION

The smartphone-based recreational therapy intervention effectively reduced fatigue in hemodialysis patients. This approach could be a valuable complementary strategy for managing fatigue in this population. Further research is needed to explore the long-term sustainability of these benefits and the intervention's impact on other patient-reported outcomes.

TRIAL REGISTRATION

This study was registered in the Iranian Registry of Clinical Trials (no. IRCT20220803055608N1) on 29/08/2022.

Cluster analysis identifies long COVID subtypes in Belgian patients

Severe acute respiratory syndrome coronavirus infection presents complications known as long COVID, a multisystemic organ disease which allows multidimensional analysis. This study aims to uncover clusters of long COVID cases and establish their correlation with the clinical classification developed at the Clinical Research Unit of Brugmann University Hospital, Brussels. Such an endeavour is instrumental in customizing patient management strategies tailored to the unique needs of each distinct group. A two-stage multidimensional exploratory analysis was performed on a retrospective cohort of 205 long COVID patients, involving a factorial analysis of mixed data, and then hierarchical clustering post component analysis. The study's sample comprised 76% women, with an average age of 44.5 years. Three clinical forms were identified: long, persistent, and post-viral syndrome. Multidimensional analysis using demographic, clinical, and biological variables identified three clusters of patients. Biological data did not provide sufficient differentiation between clusters. This emphasizes the importance of identifying or classifying long COVID patients according to their predominant clinical syndrome. Long COVID phenotypes, as well as clinical forms, appear to be associated with distinct pathophysiological mechanisms or genetic predispositions. This underscores the need for further research.

Sexual dysfunction and associated factors in Behçet's disease: a case-control study

Sexual health is an important part of a healthy life. The aim of this study is to define Behçet's sexual dysfunction and the factors affecting it. Sixty-nine patients with Behçet's disease (BD) and 74 healthy controls were included in the study. International Index of Erectile Function (IIEF), the Female Sexual Function Index (FSFI), the Beck Depression Inventory (BDI), and the Short Form Health Survey (SF-36) were filled out by patients and healthy control group (HCG). Follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin and estradiol or testosterone levels according to gender were measured in Behçet's patients. The rate of sexual dysfunction and its relationship with gonadal hormones, Beck depression and SF 36 subgroups were evaluated in Behçet's patients. Sixty-nine patients with BD (mean age 39.55 ± 11.7) and 74 HCG (mean age 36.9 ± 6.84) were included in the study. Sexual dysfunction was observed in 74% (49) of BD and 59.5% (44) of HCG (p = 0.047). Prolactin level is within normal limits in all patients. Although there are abnormal levels of gonadal hormones, no relationship was found with sexual dysfunction. Depression especially is more prevalent compared to the healthy population (p = 0.016). The presence of depression negatively affects sexual life. Depression, SF 36 physical role limitations, energy vitality, vitality and mental health were associated with sexual dysfunction in patients with Behçet's disease. Sexual dysfunction was associated with the presence of depression and SF-36 subscales in Behçet's patients.

Diurnal and Daily Symptom Variation in Patients with End Stage Kidney Disease: An Ecological Momentary Assessment Study

Key Points

Patients treated with maintenance hemodialysis report a higher symptom burden on the days they receive hemodialysis treatment, compared with non-hemodialysis days. The severity of physical, cognitive, and mood symptoms can vary diurnally, and the pattern of this variation may differ between hemodialysis and non-hemodialysis days. Ecological momentary assessment can provide insights into the complex, dynamic symptom experiences of patients on hemodialysis.

Background

Patients with ESKD on hemodialysis experience a high symptom burden, which is compounded by unpredictable fluctuations in symptom severity. Few studies have used ecological momentary assessment to determine how symptoms vary over time. This study aimed to characterize the diurnal and day-to-day variability in symptoms among patients receiving hemodialysis.

Methods

Patients enrolled in the Technology-Assisted Collaborative Care trial rated the intensity of physical, cognitive, and mood symptoms using an automated telephone-administered version of the Daytime Insomnia Symptom Scale at four time points (morning, early afternoon, late afternoon, evening) for seven consecutive days at baseline. Confirmatory factor analysis was used to verify the original four-factor solution for the Daytime Insomnia Symptom Scale: sleepiness/fatigue (SF), alert cognition (AC), positive mood (PM), and negative mood (NM). Symptom domain scores were calculated for each time point, and mixed modeling with random patient effects was used to examine differences in daily symptoms at daily time points between hemodialysis and non-hemodialysis days after controlling for age, sex, race, and comorbidity burden.

Results

One hundred sixty patients were enrolled (mean±SD age 58±14 years, 45% women, 52% White). Diurnal symptom variation existed; trends were nonlinear and differed by hemodialysis versus non-hemodialysis days. Day-to-day symptom variation also existed; patients endorsed better physical, cognitive, and mood states (i.e ., higher AC and PM) as well as lower symptom burden (i.e ., lower SF and NM) on non-hemodialysis days compared with hemodialysis days at all time points. The greatest day-to-day mean differences (MDs) were observed in the early afternoon for all symptom domains: AC (MD=0.17 P < 0.001), PM (MD=0.28, P < 0.001), SF (MD=−0.66, P < 0.001), and NM (MD=−0.26, P < 0.001).

Conclusions

Patients with ESKD demonstrate diurnal variation in symptoms and greater symptom burden on hemodialysis days compared with non-hemodialysis days, with the most extreme differences in symptom severity occurring in the early afternoon.

Clinical Trial registration number:

ClinicalTrials.gov NCT03440853 .

A randomized clinical trial to evaluate feasibility, tolerability, and preliminary target engagement for a novel executive working memory training in adolescents with ADHD

OBJECTIVE

Working memory training for Attention-Deficit/Hyperactivity Disorder (ADHD) has focused on increasing working memory capacity, with inconclusive evidence for its effectiveness. Alternative training targets are executive working memory (EWM) processes that promote flexibility or bolster stability of working memory contents to guide behavior via selective attention. This randomized, placebo-controlled study was designed to assess feasibility, tolerability, and behavioral target engagement of a novel EWM training for ADHD.

METHOD

62 ADHD-diagnosed adolescents (12-18 years) were randomized to EWM training or placebo arms for 20 remotely coached sessions conducted over 4-5 weeks. Primary outcome measures were behavioral changes on EWM tasks. Secondary outcomes were intervention tolerability, trial retention, and responsiveness to adaptive training difficulty manipulations.

RESULTS

Linear regression analyses found intervention participants showed medium effect size improvements, many of which were statistically significant, on Shifting and Filtering EWM task accuracy and Shifting and Updating reaction time measures. Intervention participants maintained strong self-rated motivation, mood, and engagement and progressed through the adaptive difficulty measures, which was further reflected in high trial retention.

CONCLUSIONS

The results suggest that these EWM processes show promise as training targets for ADHD. The subsequent NIMH R33-funded extension clinical trial will seek to replicate and extend these findings.

The impact of cannabis use proximal to sleep and cannabinoid metabolites on sleep architecture

STUDY OBJECTIVES

Cannabis is a common sleep aid; however, the effects of its use prior to sleep are poorly understood. This study aims to determine the impact of nonmedical whole plant cannabis use 3 hours prior to sleep and measured cannabis metabolites on polysomnogram measures.

METHODS

This is a cross-sectional study of 177 healthy adults who provided detailed cannabis use history, underwent a 1-night home sleep test and had measurement of 11 plasma and urinary cannabinoids, quantified using mass spectroscopy, the morning after the home sleep test. Multivariable models were used to assess the relationship between cannabis use proximal to sleep, which was defined as use 3 hours before sleep, and individual home sleep test measurements. Correlation between metabolite concentrations and polysomnogram measures were assessed.

RESULTS

In adjusted models, cannabis use proximal to sleep was associated with increased wake after sleep onset (median 60.5 vs 45.8 minutes), rate ratio 1.59 (1.22, 2.05), and increased proportion of stage 1 sleep (median 15.2% vs 12.3%), effect estimate 0.16 (0.06, 0.25). Compared to nonusers, frequent cannabis users (> 20 days per month) also had increased wake after sleep onset and stage 1 sleep, in addition to increased rapid eye movement latency and decreased percent sleep efficiency. Δ9-tetrahydrocannabinol metabolites correlated with these home sleep test measures.

CONCLUSIONS

Cannabis use proximal to sleep was associated with minimal changes in sleep architecture. Its use was not associated with measures of improved sleep including increased sleep time or efficiency and may be associated with poor quality sleep through increased wake onset and stage 1 sleep.

CITATION

Althoff MD, Kinney GL, Aloia MS, Sempio C, Klawitter J, Bowler RP. The impact of cannabis use proximal to sleep and cannabinoid metabolites on sleep architecture. J Clin Sleep Med. 2024;20(10):1615-1625.

Comparison of Resting-State Functional Connectivity Between Generalized Anxiety Disorder and Social Anxiety Disorder: Differences in the Nucleus Accumbens and Thalamus Network

Background: Generalized anxiety disorder (GAD) and social anxiety disorder (SAD) are distinguished by whether anxiety is limited to social situations. However, reports on the differences in brain functional networks between GAD and SAD are few. Our objective is to understand the pathogenesis of GAD and SAD by examining the differences in resting brain function between patients with GAD and SAD and healthy controls (HCs). Methods: This study included 21 patients with SAD, 17 patients with GAD, and 30 HCs. Participants underwent psychological assessments and resting-state functional magnetic resonance imaging. Whole-brain analyses were performed to compare resting-state functional connectivity (rsFC) among the groups. In addition, logistic regression analysis was conducted on the rsFC to identify significant differences between GAD and SAD. Results: Patients with SAD and GAD had significantly higher rsFC between the bilateral postcentral gyri and bilateral amygdalae/thalami than HCs. Compared with patients with SAD, those with GAD had significantly higher rsFC between the right nucleus accumbens and bilateral thalami and between the left nucleus accumbens and right thalamus. rsFC between the left nucleus accumbens and right thalamus positively correlated with state anxiety in patients with SAD and GAD, respectively. In addition, logistic regression analysis revealed that the right nucleus accumbens and the right thalamus connectivity could distinguish SAD from GAD. Conclusions: GAD and SAD were distinguished by the right nucleus accumbens and the right thalamus connectivity. Our findings offer insights into the disease-specific neural basis of SAD and GAD. Clinical Trial Registration Number: UMIN000024087. Impact Statement This study is the first to identify a resting state functional connectivity that distinguishes social anxiety disorder (SAD) from generalized anxiety disorder (GAD) and to clarify a common connectivity in both disorders. We found that the connectivity between the right nucleus accumbens and the right thalamus differentiated SAD from GAD. Furthermore, these rsFC differences suggest an underlying basis for fear overgeneralization. Our findings shed light on the pathophysiology of these conditions and could be used as a basis for further studies to improve outcomes for such patients.

Psychometric properties of Polish version of the 36-item WHODAS 2.0 in individuals with fibromyalgia

Fibromyalgia (FM) is chronic, widespread musculoskeletal pain and accompanying fatigue, sleep disturbances, cognitive, psychological, and somatic symptoms. The aim of the study is to assess the psychometric properties of the Polish version of the 36-item WHODAS 2.0 in FM patients. This is a cross-sectional study involving 456 FM polish patients. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) 36-item version, the Fibromyalgia Impact Questionnaire (FIQ) and Beck's Depression Inventory (BDI) were used as an assessment tool in the study. The internal consistency of the 36-item WHODAS 2.0 was assessed using Cronbach's alpha. Values ranging from 0.824 to 0.951 were obtained. The interclass correlation coefficients (ICC) were very high. Internal structure of the 36-item WHODAS 2.0 was checked with Confirmatory Factor Analysis (CFA). RMSEA = 0.069, CFI = 0.963, TLI = 0.96, SRMR = 0.081 proved exactness of original six-dimensional structure of WHODAS 2.0. External validity was assessed by correlating the 36-item WHODAS 2.0 scores with the scores of two previously validated tools: FIQ and BDI. Positive correlations were obtained between the 36-item WHODAS 2.0 and these tools. Based on the conducted research, it has been shown that the 36-item WHODAS 2.0 is a reliable and valid tool for assessing disability in individuals with FM in Poland.

Predictability of sleep in insomnia: sleep patterns of patients from a sleep psychology clinic

The present study aims at identifying sleep patterns in insomnia in a clinical sample using three strategies to define poor nights. Sleep diaries and self-reported questionnaires were collected from 77 clinical patients with insomnia. The conditional probabilities of observing a poor night after 1, 2, or 3 consecutive poor nights were computed according to three strategies with same criteria for sleep onset latency, wake after sleep onset, and sleep efficiency, but varying criterion for total sleep time. Latent profile analyses were conducted to derive sleep patterns. Uni- and multivariate analyses were conducted to characterise the sleep patterns identified. A total of 1586 nights were analysed. The strategy used significantly influenced the average percentage of reported poor nights. Two to three sleep patterns were derived per strategy. Within each strategy, sleep patterns differed from each other on sleep variables and night-to-night variability. Results suggest the existence of sleep patterns in insomnia among individuals consulting in psychological clinics. Adding a total sleep time of 6-h cut-off as a criterion to define poor nights increases the accuracy of the strategy to define poor night and allows to identify sleep patterns of poor nights in insomnia.

(Fire)fighting the pandemic: PTSD and depression symptom profiles and longitudinal correlates

Background: Firefighters face regular exposure to potentially traumatic events, which is associated with the development of post-traumatic stress disorder (PTSD) and depression. Despite the high comorbidity, there remains limited understanding of the co-occurrence of PTSD and depression in terms of symptom patterns. Due to the unique stressors added by the COVID-19 pandemic, it is relevant to also understand this comorbidity in light of the impact of the COVID-19 pandemic.Objective: This study aimed to identify PTSD and depression symptom profiles in firefighters, and correlates thereof, using latent profile analysis (LPA).Method: 139 Dutch Firefighters (93% male) completed self-report surveys prior to the COVID-19 pandemic (T1) and after the outbreak COVID-19 pandemic (T2) on PTSD, depression, COVID-19 related stressors and other relevant correlates.Results: LPA demonstrated the best fit for a three-profile solution for PTSD and depression at T2 encompassing a low symptom profile (35%), a moderate symptom profile (46%), and an elevated symptom profile (19%). Profiles displayed mostly below clinical range scores for both PTSD and depression at T2. PTSD severity at T1, depression severity at T1, loneliness at T2, COVID-19-related stressors at T2 were significantly and positively related to PTSD and depression symptom profiles at T2.Conclusion: Our results shed light on the resilience of firefighters. Even in light of COVID-19 pandemic, firefighters seemed to maintain generally low levels of psychopathology. Despite firefighters' overall resilience, our findings highlight loneliness and the negative impact of the COVID-19 pandemic as potential risk factors for increased severity of PTSD and depression symptoms.

A comparison of reappraisal and self-compassion as an emotion regulation strategy in the context of maltreatment

OBJECTIVE

Maltreatment is a significant contributor of emotion dysregulation. Self-compassion could be an effective novel emotion regulation strategy for maltreatment. We compare self-compassion and other strategies with and without the context of maltreatment.

METHODS

We recruited a cross-sectional sample of 188 adult participants using Mechanical Turk (21-69 years), with and without childhood maltreatment exposure, to complete an emotion regulation task comparing reappraisal, self-compassion, and a non-instruction condition for positive and negative emotions. We examined the impact of valence and strategy on self-reported emotional intensity in response to each image, and analyzed the interaction of maltreatment exposure and severity with valence and regulation strategy.

FINDINGS

Without factoring in maltreatment, we observed significant differences between reappraisal and self-compassion (F(1,14,117.1) = 5.716, p < 0.001) in response to emotional images. When using self-compassion, negative images evoked less intense negative emotions, and more extreme positive emotions compared to reappraisal. We also detected a significant interaction of valence, strategy, and maltreatment severity (F(2,16,818.2) = 4.24, p = 0.014). We observed differences in emotional responses for those with high levels and low levels of maltreatment severity between strategies. Self-compassion use resulted in the most consistent emotional ratings across all severity levels for negative image trials, while reappraisal and non-instructed trials minimized emotional responses as severity increased. In response to positive images, reappraisal was most effective at minimizing emotions at low levels of maltreatment severity and performed similarly to self-compassion at higher levels of severity.

CONCLUSION

The current study provides early evidence that self-compassion performs effectively as an emotion regulation strategy. It performed similarly, or superior, to reappraisal in the context of maltreatment and was consistently effective across both maltreatment and abuse severity in a cross-sectional sample. We observed more extreme positive affect in those who experienced maltreatment. However, these strategies performed similarly when we did not include maltreatment, indicating similar general effectiveness. These findings have potential implications for further research regarding emotion regulation strategies and for clinical interventions as a function of maltreatment.

Food Avoidance and Aversive Goal Value Computation in Anorexia Nervosa

Anorexia nervosa (AN) is associated with food restriction and significantly low body weight, but the neurobiology of food avoidance in AN is unknown. Animal research suggests that food avoidance can be triggered by conditioned fear that engages the anterior cingulate and nucleus accumbens. We hypothesized that the neural activation during food avoidance in AN could be modeled based on aversive goal value processing. Nineteen females with AN and thirty healthy controls matched for age underwent functional magnetic resonance brain imaging while conducting a food avoidance task. During active control free-bid and computer-generated forced-bid trials, participants bid money to avoid eating food items. Brain activation was parametrically modulated with the trial-by-trial placed bids. During free-bid trials, the AN group engaged the caudate nucleus, nucleus accumbens, ventral anterior cingulate, and inferior and medial orbitofrontal cortex more than the control group. High- versus low-bid trials in the AN group were associated with higher caudate nucleus response. Emotion dysregulation and intolerance of uncertainty scores were inversely associated with nucleus accumbens free-bid trial brain response in AN. This study supports the idea that food avoidance behavior in AN involves aversive goal value computation in the nucleus accumbens, caudate nucleus, anterior cingulate, and orbitofrontal cortex.

The interplay of brain neurotransmission and mental fatigue: A research protocol

INTRODUCTION

Mental fatigue (MF) significantly affects both cognitive and physical performance. However, the precise mechanisms, particularly concerning neurotransmission, require further investigation. An implication of the role of dopamine (DA) and noradrenaline (NA) is stated, but empirical evidence for this theory still needs to be provided. To address this gap, we aim to investigate the role of brain neurotransmission in elucidating if, and how prolonged cognitive activity induces MF and its subsequent impact on cognitive performance.

METHODS

This study (registration number: G095422N) will adopt a randomized cross-over design with sixteen healthy participants aged 18-35 years. The sessions include a familiarization, two experimental (DA: 20mg Methylphenidate; NA: 8mg Reboxetine) conditions, and one placebo (lactose tablet: 10mg) condition. A 60-minute individualized Stroop task will be used to investigate whether, and how the onset of MF changes under the influence of reuptake inhibitors. Attention and response inhibition will be assessed before and after the MF-inducing task using a Go/NoGo task. The integration of physiological (electroencephalography, heart rate), behavioral (attention, response inhibition), and subjective indicators (scales and questionnaires) will be used to detect the underlying mechanisms holistically. Data analysis will involve linear mixed models with significance at p<0.05.

DISCUSSION

The integration of diverse techniques and analyses offers a comprehensive perspective on the onset and impact of MF, introducing a novel approach. Future research plans involve extending this protocol to explore the connection between brain neurotransmission and physical fatigue. This protocol will further advance our understanding of the complex interplay between the brain and fatigue.

Depression weights in patients with gastric cancer: Bibliometric analysis as a weapon to chart the future of research

Bibliometric analyses are increasing in the field of gastric cancer. This letter discusses a recently published analysis that focused on the bidirectional relationship between depression and gastric cancer and evaluated the types of papers published in this field and the changes in the direction of research. There is an increasing need for new, clinically relevant studies of this association.

Probiotics and magnesium orotate for the treatment of major depressive disorder: a randomised double blind controlled trial

Following on from our pilot studies, this study aimed to test the efficacy of a combination of probiotics (Lactobacillus acidophilus, Bifidobacterium bifidum, Streptococcus thermophilus), magnesium orotate and coenzyme 10 for the treatment of major depressive disorder (MDD) through a double-blind placebo controlled clinical trial. The participants were 120 adults diagnosed with MDD randomised to daily oral administration, over 8 weeks, of either the intervention or placebo, with a 16-week follow-up period. Intent-to-treat analysis found a significantly lower frequency of the presence of a major depressive episode in the intervention group compared with placebo at the end of the 8-week treatment phase, with no difference between the two conditions at 8-week follow-up. Both the categorical and continuous measure of depressive symptoms showed a significant difference between the two conditions at 4 weeks, but not 8 and 16 weeks. The secondary end-point was demonstrated with an overall reduction in self-rated symptoms of anxiety and stress in the active treatment group compared with placebo. These findings suggest that the combination of probiotics, magnesium orotate and coenzyme 10 may be an effective treatment of MDD over an 8-week period.

Adjunctive use of mindfulness-based mobile application in depression: randomized controlled study

Mindfulness-based interventions (MBI) are effective in relapse prevention in Major Depressive Disorder (MDD). Internet-based interventions have been demonstrated to be effective in the treatment of MDD. Consequently, the integration of MBI through mobile applications emerges as a promising supplementary intervention for MDD, contributing to the augmentation of mental health services, particularly within ambulatory care contexts. The current randomized controlled study is designed to evaluate the efficacy of adjunctive MBI delivered via a mobile app in mitigating symptom severity and stress levels. This assessment involves a comparison with standard treatment practices in an ambulatory setting among individuals diagnosed with MDD. A total of 83 patients diagnosed with MDD (depressive episode, recurrent depression or depressive phase of bipolar disorder) were randomly allocated to the intervention (41 patients) or control condition (42 patients). The intervention consisted of the daily use of the mindfulness mobile application "Headspace" for thirty days. The control condition was treatment as usual (TAU) only. The symptom severity has been assessed by the Beck Depression Inventory (BDI-II) as well as the Hamilton Depression Rating Scale (HDRS-17). Blood pressure and resting heart rate have been assessed as secondary outcome. Upon hospital discharge, the mean scores on the Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HDRS) signaled partial remission of MDD in both treatment arms. In both groups, a subsequent decrease in both self-reported and expert-rated scores was evident after a 30-day period. However, the decrease in depression severity as measured by HDRS was significantly higher in the MBI group compared to the control group after 30 days. For secondary outcomes, systolic blood pressure was lower in the intervention group compared to control group. The total drop-out rate was 29%. Short term mindfulness intervention via mobile application (30 days) can be beneficial as adjunctive therapy to treatment as usual in patients with MDD.

Association between apathy and caregiver burden in patients with amyotrophic lateral sclerosis: a cross-sectional study

OBJECTIVES

To investigate the relationship among patients' apathy, cognitive impairment, depression, anxiety, and caregiver burden in amyotrophic lateral sclerosis (ALS).

DESIGN

A cross-sectional study design was used.

SETTING

The study was conducted at a tertiary hospital in Wuhan, Hubei, China.

PARTICIPANTS

A total of 109 patients with ALS and their caregivers were included.

OUTCOME MEASURES

Patients with ALS were screened using the Edinburgh Cognitive and Behavioural Screen, Beck Depression Inventory-II, Generalised Anxiety Disorder-7 and Apathy Scale to assess their cognition, depression, anxiety and apathy, respectively. The primary caregivers completed the Zarit Burden Interview. The association between apathy, cognitive impairment, depression, anxiety and caregiver burden was analysed using logistic regression. Mediation models were employed to investigate the mediating effect of patients' apathy on the relationship between depression/anxiety and caregiver burden.

RESULTS

Patients in the high caregiver burden group exhibited significantly higher levels of depression, anxiety and apathy compared with those in the low caregiver burden group (p<0.05). There was a positive association observed between caregiver burden and disease course (rs=0.198, p<0.05), depression (rs=0.189, p<0.05), anxiety (rs=0.257, p<0.05) and apathy (rs=0.388, p<0.05). There was a negative association between caregiver burden and the Revised ALS Functional Rating Scale (rs=-0.275, p<0.05). Apathy was an independent risk factor for higher caregiver burden (OR 1.121, 95% CI 1.041 to 1.206, p<0.05). Apathy fully mediated the relationship between depression and caregiver burden (β=0.35, 95% CI 0.16 to 0.54, p<0.05) while partially mediating the relationship between anxiety and caregiver burden (β=0.34, 95% CI 0.16 to 0.52, p<0.05).

CONCLUSIONS

Apathy, depression and anxiety exerted a detrimental impact on caregiver burden in individuals with ALS. Apathy played a mediating role in the relationship between depression and caregiver burden and between anxiety and caregiver burden. These findings underscore the importance of identifying apathy and developing interventions for its management within the context of ALS.

Unilateral vs. bilateral DLPFC rTMS: comparative effects on depression, visual-spatial memory, inhibitory control and cognitive flexibility in major depressive disorder

Background

Exciting left DLPFC activity with high frequency and inhibiting right DLPFC with low frequency repetitive transcranial magnetic stimulation (rTMS) has shown antidepressant effects in major depressive disorder (MDD) and executive functions. However, few studies have directly compared unilateral and bilateral protocols.

Methods

Forty-seven individuals with treatment-resistant MDD underwent 10 sessions of rTMS over left DLPFC (20 Hz), bilateral DLPFC (left 20 Hz, right 1 Hz), or sham stimulation. Outcomes were depression (Beck Depression Inventory-II), visual-spatial memory (Corsi Block Test), response inhibition (Go/No-Go task), and cognitive flexibility (Wisconsin Card Sorting Test) assessed before and after treatment.

Results

Both unilateral and bilateral rTMS significantly reduced depression levels versus sham controls based on BDI-II scores. While bilateral stimulation did not improve Corsi Test performance, unilateral protocol enhanced visual-spatial memory. On the Go/No-Go task, accuracy was higher in both active stimulation groups compared to sham, with no response time differences. Neither unilateral nor bilateral rTMS had significant effects on cognitive flexibility per the WCST.

Conclusions

Despite comparable antidepressant effects, unilateral stimulation had some cognitive advantages over bilateral rTMS, potentially due to greater left dorsolateral prefrontal cortex excitation. Further research on parameter optimization is warranted.

Sweat-based stress screening with gas chromatography-ion mobility spectrometry and electronic nose

BACKGROUND

Diagnosis of stress generally involves uses of questionnaires which can provide biased results. The more reliable approach relies on observation of individual symptoms by psychiatrists which is time consuming and could not be applicable for massive scale screening tests. This research established alternative approaches with gas chromatography-ion mobility spectrometry (GC-IMS) and electronic nose (e-nose) to perform fast stress screening based on fingerprinting of highly volatile compounds in headspaces of sweat. The investigated samples were obtained from 154 female nurse volunteers who also provided the data of questionnaire-based mental health scores with the high stress cases confirmed by psychiatrists.

RESULTS

The interviews by psychiatrists revealed 14 volunteers with high stress. Their axillary sweat samples and that from 32 nurses with low/moderate stress (controls) were collected onto cotton rods and analysed with GC-IMS. The possible marker peaks were selected based on the accuracy data. They were tentatively identified as ammonia, diethyl ether, methanol, octane, pentane, acetone and dimethylamine which could involve different endogenous mechanisms or the relationships with the local microbiomes. The data were further analysed using partial least squares discriminant analysis with the receiver operating characteristic curves showing the optimum accuracy, sensitivity and selectivity of 87%, 86% and 88%, respectively. Providing that the samples were obtained from the nurses without deodorant uses, the high stress cases could be screened using e-nose sensors with the accuracy of 89%. The sensor responses could be correlated with the marker peak area data in GC-IMS with the coefficients ranging from -0.70 to 0.80.

SIGNIFICANCE

This represents the first investigation of highly volatile compound markers in sweat for high stress screening. The established methods were simple, reliable, rapid and non-invasive, which could be further adapted into the portable platform of e-nose sensors with the practical application to perform the screening tests for nurses in Phra Nakorn Si Ayutthaya hospital, Thailand.

Externally orienting cues improve cognitive control in OCD

BACKGROUND AND OBJECTIVES

An executive overload model of obsessive-compulsive disorder (OCD) posits that broad difficulties with executive functioning in OCD result from an overload on the executive system by obsessive thoughts. It implies that, if individuals with OCD "snap out" of their obsessive thoughts, their performance on neurocognitive tasks will improve.

METHODS

We test this prediction using the revised Attention Network Test, ANT-R, and distinct subsamples of data from unmedicated OCD and healthy controls (HC). ANT-R includes Simon and Flanker tasks; in both, incongruent trials take longer to resolve ('conflict costs'). On some trials, a warning cue helps participants to respond faster ('alerting benefits'). In OCD (N = 34) and HC (N = 46), matched on age, IQ, and sex, we tested (1) the effect of OCD on alerting benefits, and (2) the effect of OCD on warning cue related reductions in conflict costs. In a distinct subsample of OCD (N = 32) and HC (N = 51), we assessed whether alerting benefits and cue-related reductions in conflict costs are associated differently with different OCD symptoms.

RESULTS

A warning cue can help individuals with OCD more than HC to improve performance on Simon and Flanker tasks. This effect is positively associated with severity of contamination symptoms.

LIMITATIONS

This study did not directly assess how distracted participants are by obsessive thoughts. It relied on the ANT-R subtraction measures. Symptom severity was assessed using self-report measures.

CONCLUSIONS

Difficulties in resolving conflict during decision-making in OCD can be modulated by a warning cue presented immediately before an attentional task.

Predictors of Symptom Reduction and Remission Among People with Anxiety: Secondary Analyses from a Randomized Controlled Trial

Despite the substantial disease burden of anxiety disorders, only limited or conflicting data on prognostic factors is available. Most studies include patients in the secondary healthcare sector thus, the generalizability of findings is limited. The present study examines predictors of symptom reduction and remission in patients with anxiety disorders in a primary care setting. 214 patients with anxiety disorders, recruited as part of the Collabri Flex trial, were included in secondary analyses. Data on potential predictors of anxiety symptoms at 6-month follow-up was collected at baseline, including patient characteristics related to demography, illness, comorbidity, functional level, life quality, and self-efficacy. The outcomes were symptom reduction and remission. Univariate and multivariate linear and logistic regression analyses were conducted to assess the associations between predictor variables and the outcome, and machine-learning methods were also applied. In multiple linear regression analysis, anxiety severity at baseline (β = -6.05, 95% CI = -7.54,-4.56, p < 0.001) and general psychological problems and symptoms of psychopathology (SCL-90-R score) (β = 2.19, 95% CI = 0.24,4.14, p = 0.028) were significantly associated with symptom change at 6 months. Moreover, self-efficacy was associated with the outcome, however no longer significant in the multiple regression model. In multiple logistic regression analysis, anxiety severity at baseline (OR = 0.54, 95% CI = -1.13,-0.12, p = 0.018) was significantly associated with remission at 6 months. There was no predictive performance of the machine-learning models. Our study contributes with information that could be valuable knowledge for managing anxiety disorders in primary care.

Subthalamic DBS does not restore deficits in corticospinal suppression during movement preparation in Parkinson's disease

OBJECTIVE

Parkinson's disease (PD) patients exhibit changes in mechanisms underlying movement preparation, particularly the suppression of corticospinal excitability - termed "preparatory suppression" - which is thought to facilitate movement execution in healthy individuals. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) being an attractive treatment for advanced PD, we aimed to study the potential contribution of this nucleus to PD-related changes in such corticospinal dynamics.

METHODS

On two consecutive days, we applied single-pulse transcranial magnetic stimulation to the primary motor cortex of 20 advanced PD patients treated with bilateral STN-DBS (ON vs. OFF), as well as 20 healthy control subjects. Motor-evoked potentials (MEPs) were elicited at rest or during movement preparation in an instructed-delay choice reaction time task including left- or right-hand responses. Preparatory suppression was assessed by expressing MEPs during movement preparation relative to rest.

RESULTS

PD patients exhibited a deficit in preparatory suppression when it was probed on the responding hand side, particularly when this corresponded to their most-affected hand, regardless of their STN-DBS status.

CONCLUSIONS

Advanced PD patients displayed a reduction in preparatory suppression which was not restored by STN-DBS.

SIGNIFICANCE

The current findings confirm that PD patients lack preparatory suppression, as previously reported. Yet, the fact that this deficit was not responsive to STN-DBS calls for future studies on the neural source of this regulatory mechanism during movement preparation.

Assessing shared psychological constructs as risk factors in comorbid PTSD-AUD combat-exposed male veterans

PTSD and AUD are frequently comorbid post-trauma outcomes. Much remains unknown about shared risk factors as PTSD and AUD work tends to be conducted in isolation. We examined how self-report measures of distress tolerance (DT), experiential avoidance (EA), and drinking motives (DM) differed across diagnostic groups in white, male combat-exposed veterans (n = 77). A MANOVA indicated a significant difference in constructs by group, F (5, 210) = 4.7, p = <.001. Follow-up ANOVAs indicated DM subscales (Coping: F (3,82) = 21.3; Social: F (3,82) = 13.1; Enhancement: F (3,82) = 10.4; ps = <.001) and EA (F (3,73) = 7.8, p < .001) differed by groups but not DT. Post hoc comparisons indicated that mean scores of the comorbid and AUD-only groups were significantly higher than controls for all DM subscales (all ps < .01). EA scores were significantly higher for the comorbid as compared to control (p < .001) and PTS-only (p = .007) groups. Findings support shared psychological factors in a comorbid PTSD-AUD population.

Identifying mechanistic links between sleep disturbance and binge eating: the role of depressed mood

Global sleep disturbance is robustly linked with a subjective sense of loss-of-control over eating (LOC). Depressed mood has been proposed as a mechanism to explain the bi-directional relationship between sleep disturbance and LOC eating. The current study evaluated whether sleep disturbance indirectly affects LOC eating via depressed mood. Adults seeking treatment for a DSM-5 binge-spectrum eating disorder (e.g. bulimia nervosa, binge-eating disorder) were recruited (n = 79) and asked to complete self-report questionnaires assessing sleep disturbance and depression, and a semi-structured interview assessing LOC eating. Tests of indirect effects evaluated the effect of depressed mood on the association between global sleep disturbance and LOC frequency covarying for BMI and parent study. A significant indirect effect of depressed mood on the association between global sleep disturbance and frequency of LOC eating was identified (Est = 1.519, S.E. = 0.859, p = .033). The indirect effect of depressed mood on the association between sleep disturbance and LOC eating may indicate that depressed mood serves as a mechanistic link between sleep disturbance and LOC eating. The findings offer preliminary support for adjunctive treatments targeting both sleep disturbance and depressed mood for LOC eating. Future research should explore these pathways in a larger clinical sample.

Linking Affect Dynamics and Well-Being: A Novel Methodological Approach for Mental Health

Emotions are dynamic processes; their variability relates to psychological well-being and psychopathology. Affective alterations have been linked to mental diseases like depression, although little is known about how similar patterns occur in healthy individuals. This study investigates the psychophysiological correlations of emotional processing in healthy subjects, specifically exploring the relationship between depressive traits, cognitive distortions, and facial electromyographic (f-EMG) responses during affective transitions. A cohort of 44 healthy participants underwent f-EMG recording while viewing emotional images from the International Affective Picture System (IAPS). Self-report measures included the Beck Depression Inventory (BDI) and the Cognitive Distortion Scale (CDS). Higher BDI scores were associated with increased EMG activity in the corrugator muscle during transitions between positive and negative emotional states. Cognitive distortions such as Catastrophizing, All-or-Nothing Thinking, and Minimization showed significant positive correlations with EMG activity, indicating that individuals with higher levels of these distortions experienced greater facial muscle activation during emotional transitions. This study's results indicate that there is a bidirectional correlation between depressed features and cognitive distortions and alterations in facial emotional processing, even in healthy subjects. Facial EMG in the context of dynamic affective transitions has the potential to be used as a non-invasive method for detecting abnormal emotional reactions at an early stage. This might help in identifying individuals who are at risk of developing depression and guide therapies to prevent its advancement.

Alterations in Vagal Tone Are Associated with Changes in the Gut Microbiota of Adults with Anxiety and Depression Symptoms: Analysis of Fecal Metabolite Profiles

Accumulating evidence suggests that interactions between the brain and gut microbiota significantly impact brain function and mental health. In the present study, we aimed to investigate whether young, healthy adults without psychiatric diagnoses exhibit differences in metabolic stool and microbiota profiles based on depression/anxiety scores and heart rate variability (HRV) parameters. Untargeted nuclear magnetic resonance-based metabolomics was used to identify fecal metabolic profiles. Results were subjected to multivariate analysis through principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA), and the metabolites were identified through VIP score. Metabolites separating asymptomatic and symptomatic groups were acetate, valine, and glutamate, followed by sugar regions, glutamine, acetone, valerate, and acetoacetate. The main metabolites identified in high vagal tone (HVT) and low vagal tone (LVT) groups were acetate, valerate, and glutamate, followed by propionate and butyrate. In addition to the metabolites identified by the PLS-DA test, significant differences in aspartate, sarcosine, malate, and methionine were observed between the groups. Levels of acetoacetate were higher in both symptomatic and LVT groups. Valerate levels were significantly increased in the symptomatic group, while isovalerate, propionate, glutamate, and acetone levels were significantly increased in the LVT group. Furthermore, distinct abundance between groups was only confirmed for the Firmicutes phylum. Differences between participants with high and low vagal tone suggest that certain metabolites are involved in communication between the vagus nerve and the brain.

Effect of intra-operative Magnesium sulphate on the occurrence of post-operative delirium and insomnia in patients undergoing lumbar fixation: a randomized controlled trial

BACKGROUND

Over the last two decades, a large body of literature has focused on studying the prevalence and outcome of the postoperative delirium and sleep disturbance. The aim of this work was to evaluate the effect of intraoperative administration of Magnesium sulphate on the occurrence of post-operative delirium and insomnia in patients undergoing lumbar fixation.

METHODS

This prospective randomized controlled trial was carried out on 80 patients indicated for lumbar fixation; 40 of them received conventional general anesthesia with extra administration of intraoperative magnesium sulphate (Mg sulphate group), and the other 40 received conventional general anesthesia only (control group). Both groups were submitted to pre-operative assessment of depression using Beck Depression inventory (BDI) scale, pre-operative assessment of fatigue using a fatigue questionnaire, pre- and post-operative assessment of insomnia using Insomnia severity index (ISI), post-operative assessment of delirium using Memorial delirium assessment scale (MDAS), post-operative assessment of pain using Visual Analogue Scale (VAS), and pre- and post-operative Quantitative electroencephalography (QEEG).

RESULTS

Mg sulphate administration, age, pre-operative BDI, pre-operative ISI, and post-operative VAS were independent predictors of post-operative ISI (P-value < 0.001, 0.047, 0.021, < 0.001, and < 0.001 respectively). Age and post-operative VAS were independent predictors of post-operative MDAS (P-value = 0.008, 0.013 respectively). Mg sulphate administration and pre-operative ISI were independent predictors of post-operative VAS (P-value = 0.010, 0.006 respectively).

CONCLUSION

There was a significant relationship between intraoperative Mg sulphate administration and both post-operative insomnia and pain in unadjusted and adjusted analysis.