Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication

How Do Social Media Influencers Support College Students' Mental Well-Being? A Theory-Driven Content Analysis of YouTube Videos on Mental Health

Grounded in social learning theory, this study investigates the impact of social media influencers (SMIs) on the mental well-being of college students through YouTube videos. By analyzing 115 videos from 88 influencers with over 5,000 subscribers, this study identifies distinct communication strategies tied to influencer attributes. Notably, findings reveal that strategies such as cultivating affective social presence, showing identification with friends and mental health organizations, and incorporating narrative evidence, are positively linked to increased user commenting behavior. The study also examines variations in strategy use across gender and influencer tiers, with micro-influencers excelling in employing most of these effective strategies. Emphasizing the pivotal role of SMIs, as observational learning role models, this research sheds light on their influence in fostering supportive online communities that encourage open dialogue and reflective learning on mental health. The implications can extend to the field of digital health communications.

Critical Issues in Psychological Services Within Italian Schools: Definition, Contexts, Interventions, and Legislation for Vulnerable Populations

BACKGROUND

This paper presents a comprehensive literature review that investigates the pivotal role of school psychologists within the Italian educational context, highlighting their importance in promoting mental health and students' well-being, emphasizing the importance of a comprehensive school psychology evidence-based service to facilitate the personal and professional development of both students and staff.

METHODS

To conduct this review, we utilized databases such as Scopus, ResearchGate, PsycINFO, and PubMed to access recent scientific literature related to school psychologists in Italy, focusing primarily on studies published between 2018 and 2025. We employed keywords including "school psychologist in Italy", "mental health", "COVID-19", "COVID-19 and school psychologists", and "school psychologist legislation in Italy" to guide our search.

RESULTS

By synthesizing the existing literature, this study aims to explore the integration and effectiveness of psychological services in Italian schools, particularly in light of the challenges posed by the COVID-19 pandemic. This review provides an overview of the current state of school psychology evidence-based services in Italy, with particular attention to the emotional and psychological challenges exacerbated by the pandemic. This event that has profoundly impacted community life highlighted the importance of mental health, prompting Italy to enhance the presence of psychologists within schools. Furthermore, this review critically analyzes the existing laws and psychological frameworks, drawing on data from an extensive examination of legislative documents and the previous literature regarding the implementation of school psychology services. The findings reveal that 69.2% of Italian schools adopted a school psychology service following legislative initiatives, aimed at addressing the trauma and discomfort caused by the pandemic.

CONCLUSIONS

Despite this progress, the presence of this figure is still rare and while significant steps have been taken, a shift towards a more preventative and holistic model is currently essential.

The Disputable Costs of Sleeping

It is currently affirmed that sleep detracts from time for foraging, reproductive, and anti-predatory activities. In contrast, we show that the sleep-related reductions in food intake and reproductive activities may, in fact, be benefits. Furthermore, the present report shows that the optimal prey are the immature, weak, sick, and senescent animals and rarely the sleeping fit adults. Indeed, the reduced sleeping time observed in prey animals occurs, not because of an evolutionary antipredation pressure but because of the time-expensive foraging-related activities and the digestion of the high-cellulose content in the herbivores' diet, an activity that leaves reduced amounts of daily time for sleeping. We conclude that the need for sleep ranks lower than those of foraging, reproduction, and antipredation activities.

Impact of Electrical Stimulation on Mental Stress, Depression, and Anxiety: A Systematic Review

Individuals experiencing high levels of stress face significant impacts on their overall well-being and quality of life. Electrical stimulation techniques have emerged as promising interventions to address mental stress, depression, and anxiety. This systematic review investigates the impact of different electrical stimulation approaches on these types of disorders. The review synthesizes data from 30 studies, revealing promising findings and identifying several research gaps and challenges. The results indicate that electrical stimulation has the potential to alleviate symptoms of anxiety, depression, and tension, although the degree of efficacy varies among different patient populations and modalities. Nevertheless, the findings also underscore the necessity of standardized protocols and additional research to ascertain the most effective treatment parameters. There is also a need for integrated methodologies that combine hybrid EEG-fNIRS techniques with stress induction paradigms, the exploration of alternative stimulation modalities beyond tDCS, and the investigation of the combined effects of stimulation on stress. Despite these challenges, the growing body of evidence underscores the potential of electrical stimulation as a valuable tool to manage mental stress, depression, and anxiety, paving the way for future advancements in this field.

Immunometabolic Blood Biomarkers of Developmental Trajectories of Depressive Symptoms: Findings from the ALSPAC Birth Cohort

Depression is associated with immunological and metabolic alterations, but immunometabolic characteristics of developmental trajectories of depressive symptoms remain unclear. Studies of longitudinal trends of depressive symptoms in young people could provide insight into aetiological mechanisms and heterogeneity behind depression, and origins of possible common cardiometabolic comorbidities for depression. Using depressive symptoms scores measured on 10 occasions between ages 10 and 25 years in the Avon Longitudinal Study of Parents and Children (n=7302), we identified four distinct trajectories: low-stable (70% of the sample), adolescent-limited (13%), adulthood-onset (10%) and adolescent-persistent (7%). We examined associations of these trajectories with: i) anthropometric, cardiometabolic and psychiatric phenotypes using multivariable regression (n=1709-3410); ii) 67 blood immunological proteins and 57 metabolomic features using empirical Bayes moderated linear models (n=2059 and n=2240 respectively); and iii) 28 blood cell counts and biochemical measures using multivariable regression (n=2256). Relative to the low-stable group, risk of depression and anxiety in adulthood was higher for all other groups, especially in the adolescent-persistent (RR depression =13.11, 95% CI 9.59-17.90; RR GAD =11.77, 95% CI 8.58-16.14) and adulthood-onset (RR depression =6.25, 95% CI 4.50-8.68; RR GAD =4.66, 95% CI 3.29-6.60) groups. The three depression-related trajectories vary in their immunometabolic profile, with evidence of little or no alterations in the adolescent-limited group. The adulthood-onset group shows widespread classical immunometabolic changes (e.g., increased immune cell counts and insulin resistance), while the adolescent-persistent group is characterised by higher BMI both in childhood and adulthood with few other immunometabolic changes. These findings point to distinct mechanisms and prevention opportunities for adverse cardiometabolic profile in different groups of young people with depression.

Glutamate receptor expression in the PL-BLA circuit is associated with susceptibility to showing the PTSD-like phenotype

While many individuals experience traumatic events during their lifetimes, only some go on to develop post-traumatic stress disorder (PTSD). This susceptibility and resilience to developing PTSD can be modelled in rodents using the stress-enhanced fear learning (SEFL) procedure, in which rats are exposed to a session of massed, unpredictable footshocks and subsequently assessed on tasks of adaptive fear learning. It has previously been observed that subpopulations of rats are susceptible and resilient to showing the PTSD-like phenotype following SEFL, and that these rats show differences in glutamate receptor expression in the basolateral amygdala. However, it is currently unknown whether structural differences are observed in other brain regions implicated in stress responding and memory. Using the refined SEFL procedure, this study aimed to determine whether expression of GluN2B, GluA1 and GluA2 receptor subunits in the prelimbic and infralimbic cortices, and dorsal hippocampus could be correlated to the SEFL-phenotype or shock experience in male rats. Here we show that following SEFL, differences can be observed in receptor subunit expression in the infralimbic cortex and dorsal hippocampus as a function of shock experience, whilst differences in the prelimbic cortex are associated with susceptibility. Importantly, these structural changes can be observed in male rats that are group-housed and exposed to 13-shocks rather than 15-shocks, indicating that the refined SEFL procedure offers a robust animal analogue of the non-associative fear sensitisation that occurs in PTSD. Future studies using this procedure could pave the way to the eventual development of pharmacological treatments to alleviate or prevent stress-induced psychopathology in susceptible individuals.

Male and Female Mice Are Similarly Susceptible to Chronic Nondiscriminatory Social Defeat Stress Despite Differences in Attack Frequency from Aggressor

Rationale

Mood disorders are often precipitated by chronic stress and can result in an inability to adapt to the environment and increased vulnerability to challenging experiences. While diagnoses of mood disorders are diagnosed twice as frequently in women than in men, most preclinical chronic social defeat stress mouse models exclude females due to decreased aggression toward female intruders.

Objectives

We previously reported that the chronic non-discriminatory social defeat stress (CNSDS) paradigm is effective in both sexes, allowing for comparisons between male and female mice. We aimed to improve the screening protocol to identify CD-1 aggressors for use in CNSDS and the method for determining susceptibility to CNSDS. Finally, we aimed to determine whether susceptibility to CNSDS correlated with impaired performance in a satiety-based outcome devaluation task.

Methods

We analyzed CNSDS screening and social defeat sessions to determine appropriate parameters for selecting CD-1 aggressors and investigated aggressions toward male and female intruder mice. We also investigated CNSDS effects on a reward valuation task.

Results

We observed that despite receiving fewer attacks, female mice are equally susceptible to CNSDS as males and that CNSDS abolished satiety-based outcome devaluation in susceptible male and female mice, but not in resilient male and female mice.

Conclusions

These data suggest that CNSDS-defined susceptible and resilient phenotypes extend to reward behaviors.

Systematic Review and Meta-Analysis: Predictors of Relapsing, Recurrent, and Chronic Depression in Young People

OBJECTIVE

Youth depression disrupts the social and vocational transition into adulthood. Most depression burden is caused by recurring or chronic episodes. Identifying young people at risk for relapsing, recurring, or chronic depression is critical. We systematically reviewed and meta-analyzed the literature on prognostic factors for relapsing, recurrent, and chronic depression in young people.

METHOD

We searched the literature up (MEDLINE, PsycINFO, CINAHL, Embase, CENTRAL, WHO ICTRP, ClinicalTrials.gov, bioRxiv, MedRxiv) to March 6, 2024, and included cohort studies and randomized trials that assessed any prognostic factor for relapse, recurrence, or chronicity of depression in young people (aged 10-25 years at baseline) with a minimum of a 3-month follow-up. We assessed individual study risk of bias of using the QUIPS tool and the certainty of evidence via the GRADE approach. We conducted random-effects meta-analyses with Hartung-Knapp-Sidik-Jonkman adjustment when 3 or more estimates on the same prognostic factor were available. Qualitative synthesis was conducted to identify promising prognostic factors that could not be meta-analyzed.

RESULTS

A total of 76 reports of 46 studies (unique cohorts or trials) were included that tested 388 unique prognostic factors in 7,488 young people experiencing depression. The majority of the reports were at high risk of bias (87%). We conducted 22 meta-analyses on unadjusted, and 7 on adjusted, prognostic factors of a poor course trajectory (ie, combined relapse, recurrence, and chronicity). Female sex (adjusted; odds ratio [95% CI] = 1.49 [1.15, 1.93], p = .003), higher severity of depressive symptoms (unadjusted; standardized mean difference [95% CI] = 0.53 [0.33, 0.73], p < .001), lower global functioning (unadjusted; standardized mean difference [95% CI] = -0.35 [-0.60, -0.10], p = .005), more suicidal thoughts and behaviors (unadjusted; standardized mean difference [95% CI] = 0.52 [0.03, 1.01], p = .045), and longer sleep-onset latency (unadjusted; mean difference [95% CI] = 6.96 [1.48, 12.44] minutes, p = .013) at baseline predicted a poor course trajectory of depression. The certainty of the evidence was overall very low to moderate. Promising prognostic factors that could not be meta-analyzed included relational/interpersonal factors (friend relationships and family relationships/structure).

CONCLUSION

Our findings demonstrate the prognostic value of demographic and clinical factors for poor course trajectories of depression in young people. More research is needed to confirm the potential value of relational/interpersonal factors in predicting poor depression course. Limitations of the literature include the high risk of bias of included studies, which indicates that future studies should include large sample sizes and wider diversity of prognostic markers (eg, genetic and neurobiological) in multivariable models. The critical next step is to combine the identified prognostic factors and to evaluate their clinical value in identifying individuals at risk for a poor course trajectory of depression during youth, a life stage in which most of the disability and burden attributable to depression can be averted.

STUDY PREREGISTRATION INFORMATION

Prognostic factors for relapsing, recurrent or chronic depression in youth: a systematic review with meta-analysis; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023458646.

Survey and Analysis of Mental Health among Otolaryngology Nurses Following the Conclusion of COVID-19 Prevention and Control Measures

Aims/Background The coronavirus disease 2019 (COVID-19) pandemic placed unique pressures on healthcare workers, especially nurses. This study examines the factors influencing mental health, stress perception, and burnout among otolaryngology nurses after the cessation of COVID-19 prevention and control. Methods A cross-sectional study was conducted among 220 otolaryngology nurses in Sichuan province from 20 January to 28 January, 2023. Data were collected using a general information questionnaire, the Nurse Workplace Mental Health Questionnaire, the Chinese Perceived Stress Scale (CPSS-14), and the Maslach Burnout Inventory-General Survey (MBI-GS). Statistical analyses included the Kruskal-Wallis test, Spearman correlation analysis, and multiple linear regression to identify significant factors and relationships within the dataset. Results Of the 220 questionnaires distributed, 218 were valid, yielding a recovery rate of 99.09%. The cohort included 3 males (mean age: 34.67 ± 12.39) and 215 females (mean age: 35.63 ± 9.27). The average mental health score was 128.10 ± 21.29, indicating a moderate level of psychological well-being. The CPSS-14 average score was 37.42 ± 7.27, reflecting moderate stress, while MBI-GS scores highlighted varying levels of burnout, especially in emotional exhaustion (median = 10.00). The Kruskal-Wallis test identified significant factors affecting mental health, stress, and burnout, including family support, COVID-19 testing status, staffing adequacy, frequency of caring for critically ill patients, teamwork satisfaction, job satisfaction, and resignation plans (p < 0.05). Spearman correlation analysis revealed significant negative associations between mental health and stress (r = -0.525) and total burnout scores (r = -0.646; p < 0.01). Multiple linear regression identified emotional exhaustion (β = -0.922), low personal accomplishment (β = -0.623), and inadequate staffing (β = -2.769) as significant negative predictors of mental health, while teamwork satisfaction (β = 5.516) and job satisfaction (β = 5.032) were positively associated with improved mental health (p < 0.01). Conclusion Otolaryngology nurses experience notable mental health challenges in the post-pandemic era, driven by stress and burnout. Addressing staffing shortages, fostering teamwork, and enhancing job satisfaction are critical strategies to improve their psychological well-being.

Mental health service contact in children with and without physical-mental multimorbidity

PURPOSE

To estimate six-month prevalence of child mental health service contacts and quantify associations between child health status and mental health service contacts, including number of types of contacts.

METHODS

Data come from 6,242 children aged 4-17 years in the Ontario Child Health Study. A list of chronic conditions developed by Statistics Canada measured physical illness. The Emotional Behavioural Scales assessed mental illness. Child health status was categorized as healthy, physical illness only, mental illness only, and multimorbid (≥ 1 physical and ≥ 1 mental illness). Mental health service contact was aggregated to general medicine, urgent medicine, specialized mental health, school-based, alternative, and any contact (≥ 1 of the aforementioned contacts). Regression models quantified associations between health status and type of mental health contact, including number of types of contacts.

RESULTS

Weighted prevalence estimates showed 261,739 (21.4%) children had mental health-related service contact, with school-based services being the most common contact amongst all children, regardless of health status. Children with multimorbidity had higher odds for every mental health contact than healthy controls (OR range: 4.00-6.70). A dose-response was observed, such that the number of contacts increased from physical illness only (OR = 1.49, CI: 1.10-1.99) to mental illness only (OR = 3.39, CI: 2.59-4.44) to multimorbidity (OR = 4.13, CI: 2.78-6.15).

CONCLUSION

Over one-fifth of children had mental health-related service contact and contacts were highest among children with multimorbidity. Types of mental health contacts for children with multimorbidity are diverse, with further research needed to elucidate the barriers and facilitators of mental health use.

Social stress task with parental support or self-instruction decreases negative cognitions in children with social anxiety disorder

Social anxiety disorder (SAD) is highly prevalent in childhood, yet research on cognitive processes in children with SAD is limited. This study examined anticipatory rumination (AR), self-focused attention (SFA), and post-event processing (PEP) in children with SAD and healthy controls (HC), and the impact of possible influencing factors (two conditions: parental support, self-instruction). Based on adult cognitive models, we hypothesized that children with SAD would report more negative and similar positive AR, more internal SFA, similar external focus, more negative and similar positive PEP compared to HCs. We predicted that both conditions would reduce negative AR, internal SFA, and negative PEP, with stronger effects in HCs. Participants (ages 9-14; SAD: n = 43, HC: n = 48) completed two speech tasks (T1, T2) in front of a peer audience. Children with SAD reported more negative AR, internal SFA, and negative PEP than HCs in both sessions. All children reported more negative AR, internal SFA, and negative PEP in T1 than T2. Surprisingly, these effects were equally strong in both groups. Condition effects were comparable across groups, with reduced negative cognitive processes in T2. These findings highlight cognitive biases in childhood SAD and the need for further research on their modifiability.

The Healthy Minds, Thriving Kids Project: Educator perspectives on relevance and potential impact of a mental health skill building program

BACKGROUND

Healthy Minds Thriving Kids (HMTK) is a free to user mental health skill building program developed by the Child Mind Institute with the aim to normalize conversations about emotional health and provide educators with wellness tools. The aim of this study was to explore the applicability of the HMTK program for universal school-based delivery from the perspective of educators, specifically to understand acceptability of program materials, perception of the quality of the program, and impressions of the program's usefulness and relevance across K-12 settings.

METHODS

The HMTK program was available to view by educator registrants between 01/26/2022 and 09/07/2022 in the State of California. Educator participants viewed an introductory video for the program and a minimum of two skills videos before participating in an online survey.

RESULTS

Of 68,861 registrants to the website, 64,376 provided survey data. Post-pandemic levels of stress and anxiety were increased, and 89.5% of respondents said young people required a greater degree of support than in the past. Almost all educators (90%) endorsed a need for additional mental health skill building tools for students, and following review of HMTK, > 80% of respondents said they would use the program in their classrooms. Most (86.6%) found the program engaging, and 85.1% found the program relevant to and representative of their student cohorts. More than three quarters (79.6%) said their students would find the program engaging and beneficial. Post-exposure to HMTK, 18.8% more educators believed that the State of California was committed to supporting students' emotional learning.

CONCLUSION

This survey demonstrates that from the perspective of educators the HMTK program is a valuable and complementary resource to school curricula to improve the mental health skills of young people. It provides an easy-to-implement framework that school districts and administrators can integrate within their curriculum planning.

Prevalence and socio-demographic correlates of mental health indices among schoolchildren in Albania

AIM

Our objective was to assess the prevalence and socio-demographic distribution of a wide range of mental health indices among Albanian children.

METHODS

A cross-sectional study was conducted in Albania in 2022, including a nationwide representative sample of 5454 schoolchildren aged 11, 13 and 15 years (~52% girls; response rate 96%). Data on 10 mental health indices were gathered, along with socio-demographic factors of schoolchildren. General linear model and binary logistic regression were employed for assessing the associations of mental health indices with socio-demographic factors.

RESULTS

Overall, the prevalence of poorer mental health indices was 5.2% for not good health, 61% for feeling low, 59% for irritability, 56% for nervousness, 33% for sleep difficulties, 31% for loneliness, 16% for low mood, 36% for low self-efficacy, 15% for anxiety and 35% for negative COVID-19 impact on mental health. Girls, older schoolchildren and those whose fathers were unemployed exhibited a significantly higher prevalence of poorer mental health for most of the indices. Children from rural areas and those from less affluent families had a higher prevalence of poorer self-rated health.

CONCLUSIONS

Our study sheds light on the concerning prevalence of various mental health indices among Albanian children. The main findings underscore the need for targeted interventions to address these challenges, particularly among vulnerable groups such as girls, older children and those from economically disadvantaged backgrounds. Urgent action is necessary to support the mental well-being of all children, especially those who are at the highest risk.

Gene-level connections between anxiety disorders, ADHD, and head and neck cancer: insights from a computational biology approach

Background

Anxiety disorders (AD), ADHD, and head and neck cancer (HNC) are complex conditions with potential genetic interconnections that remain to be fully elucidated. The purpose of this study is to investigate gene-level connections among ADHD, AD, and HNC.

Method

A comprehensive literature mining approach identified potential gene-disease relationships from PubMed and bioinformatics databases, analyzing 19,924 genes. An AI-driven computational process constructed a gene-disease relationship table using the Adjusted Binomial Method Algorithm (ABMA) to evaluate association reliability. Overlapping genes were analyzed through protein-protein interaction (PPI) networks, functional annotations, and literature-based pathway analyses to elucidate shared and unique genetic mechanisms linking these diseases.

Results

The analysis identified 141 significant genes associated with AD, 153 with ADHD, and 1,065 with HNC (q-value < 0.05). These genes demonstrated significant overlap (odds ratio ≥ 1.8; p ≤ 2.58E-2) and high interconnectivity (PPI network density ≥ 0.39, clustering coefficient ≥ 0.76, and diameter ≤ 3). Centrality analysis revealed core genes such as IL-6, MYC, NLRP3, and CXCR4 as critical mediators. Functional enrichment analysis identified key pathways, including serotonergic synapse, inflammatory response, and Toll-like receptor signaling, highlighting the involvement of neuronal and immune mechanisms. Functional pathway analysis demonstrated reciprocal genetic influences among AD, ADHD, and HNC, emphasizing shared and distinct gene-level connections that may underlie their co-occurrence and mutual risk factors.

Conclusion

This study reveals a complex and interconnected genetic network among AD, ADHD, and HNC, highlighting shared pathways, unique mechanisms, and critical genes, providing valuable insights into the genetic underpinnings of these conditions and potential avenues for therapeutic exploration.

The impact of maternal parenting stress on early childhood development: the mediating role of maternal depression and the moderating effect of family resilience

OBJECTIVE

Early childhood is a critical stage of rapid cognitive, social, emotional, and physical development. The development during this period is crucial for the long-term health and well-being of children. This study investigates the influence of maternal parenting stress on early childhood development, with a specific focus on the mediating role of maternal depression and the moderating effect of family resilience.

METHODS

A nine-month longitudinal study was conducted involving 558 children and their mothers.

RESULTS

The study found that maternal parenting stress significantly negatively impacts early childhood development. Maternal depression acts as a mediator between maternal parenting stress and early childhood development. Furthermore, family resilience was found to significantly moderate both the initial and latter parts of this mediating relationship.

CONCLUSION

The study highlights the protective role of family resilience in this mediating process, contributing to the expansion of the Family Adjustment and Adaptation Response Model and enriching family educational practices.

Exploring generalized anxiety disorder symptoms: key insights from a population-based study in Iran

AIM

Generalized Anxiety Disorder (GAD) is a common mental health condition with considerable impacts on both individuals and society, associated with high healthcare costs and reduced quality of life. Linked to a range of genetic, psychological, and social factors, GAD also frequently coexists with other mental health conditions. This study investigates the socio-demographic, environmental, and psychosocial risk factors for GAD symptoms in an urban Iranian population, addressing a key research gap and guiding targeted interventions.

METHOD

A cross-sectional study was conducted to determine the prevalence and associated factors of GAD symptoms among adults in Tehran. Using multi-stage sampling, participants completed questionnaires on socio-demographic characteristics, recent stressors, and DSM-5 criteria for GAD. Descriptive statistics identified prevalence patterns, and logistic regression models evaluated associations and adjusted for confounders (p < 0.05). Analyses were conducted in STATA v.14, with adjusted odds ratios and 95% confidence intervals reported.

RESULTS

Of 970 participants, 26% met criteria for GAD (CI 95%: 22%-32%). Individuals with GAD were more likely to be single, dissatisfied with life, of low socioeconomic status, and to report non-healthy status and recent stressors. In multivariable regression, significant risk factors for GAD included female gender (AOR = 1.4, p < 0.01), experiencing at least one recent stressful event (AOR = 1.9, p = 0.01), and poor health status (AOR = 2.8, p < 0.05).

CONCLUSION

This study highlights the prevalence of GAD symptoms in Tehran and underscores the critical roles of policymakers and healthcare providers in addressing it. Effective management requires a multifaceted approach, including individual treatment, social integration, and community support. Future research should focus on culturally sensitive interventions and awareness campaigns to reduce stigma. Overall, the study enriches the literature on GAD in Iran and encourages collaborative efforts to enhance mental health outcomes and community well-being.

Clinical manifestations of children and adolescents with anxiety disorders with and without specific learning disorders

BACKGROUND

Anxiety disorders (ADs) are common among children and adolescents and frequently co-occur with specific learning disorder (SLD). Approximately 20% of children with SLD meet criteria for ADs, while those with anxiety are six times more likely to have a premorbid SLD. The strong relationship between premorbid SLD and ADs underscores the importance of examining developmental trajectories and manifestations of neuropsychiatric conditions like ADs, particularly when SLD is present. In this context, this study investigates the clinical profiles of children and adolescents with a first diagnosis of an AD and a history of SLD compared to those with a first diagnosis of an AD without a history of SLD. The analysis focuses on various clinical characteristics, including developmental history, demographic aspects, age of anxiety onset, global functioning, types of ADs, self-report anxiety and depressive symptoms, and adaptive behavior. Additionally, the study aims to explore the relationship between anxiety symptoms and depressive symptoms, adaptive behavior, and age.

METHODS

We conducted a cross-sectional, retrospective study with 78 participants from the Child and Adolescent Neuropsychiatry Unit, divided into two groups: those with ADs alone (Group AD, n = 42) and those with both ADs and premorbid SLD (Group AD + SLD, n = 36). We collected data on developmental history, demographic information, age of anxiety onset, global functioning, anxiety and depressive symptoms, and adaptive behavior.

RESULTS

Our findings revealed that Group AD experienced more stressful life events and had higher cognitive levels, whereas Group AD + SLD showed a greater impairment in global functioning. Notably, Group AD exhibited lower social adaptive behavior and higher self-reported anxiety and depressive symptoms than Group AD + SLD, possibly indicating a greater awareness of their emotional distress.

CONCLUSIONS

These findings highlight the impact of premorbid neurodevelopmental disorders into clinical manifestations of psychopathological symptoms. In particular, results underline the importance of developing tailored clinical interventions for children with co-occurring ADs and learning difficulties, focusing more on their emotional awareness to better address the unique challenges posed by the comorbidity.

Infraslow Closed-Loop Brain Training for Anxiety and Depression (ISAD): A pilot randomised, sham-controlled trial in adult females with internalizing disorders

INTRODUCTION

The core resting-state networks (RSNs) have been shown to be dysfunctional in individuals with internalizing disorders (IDs; e.g., anxiety, depression). Source-localised, closed-loop brain training of infraslow (≤ 0.1 Hz) EEG signals may have the potential to reduce symptoms associated with IDs and restore normal core RSN function.

METHODS

We conducted a pilot randomized, double-blind, sham-controlled, parallel-group (3-arm) trial of infraslow neurofeedback (ISF-NFB) in adult females (n = 60) with IDs. Primary endpoints, which included the Hospital Anxiety and Depression Scale (HADS) and resting-state EEG activity and connectivity, were measured at baseline and post 6 sessions.

RESULTS

This study found credible evidence of strong nonspecific effects as evidenced by clinically important HADS score improvements (i.e., reductions) across groups. An absence of HADS score change differences between the sham and active groups indicated a lack of specific effects. Although there were credible slow (0.2-1.5 Hz) and delta (2-3.5 Hz) band activity reductions in the 1-region ISF-NFB group relative to sham within the targeted region of interest (i.e., posterior cingulate), differences in activity and connectivity modulation in the targeted frequency band of interest (i.e., ISFs = 0.01-0.1 Hz) were lacking between sham and active groups. Credible positive associations between changes in HADS depression scores and anterior cingulate cortex slow and delta activity also were found.

CONCLUSIONS

Short-term sham and genuine ISF-NFB resulted in rapid, clinically important improvements that were nonspecific in nature and possibly driven by placebo-related mechanisms. Future ISF-NFB trials should consider implementing design modifications that may better induce differential modulation of ISFs between sham and treatment groups, thereby enhancing the potential for specific clinical effects in ID populations.

TRIAL REGISTRATION

The trial was prospectively registered with the Australia New Zealand Clinical Trials Registry (ANZCTR; Trial ID: ACTRN12619001428156).

Predicting treatment response to cognitive behavior therapy in social anxiety disorder on the basis of demographics, psychiatric history, and scales: A machine learning approach

Only about half of patients with social anxiety disorder (SAD) respond substantially to cognitive behavioral therapy (CBT). However, there has been little evidence available to clinicians or patients about whether any individual patient is more or less likely to have a positive response to CBT. Here, we used machine learning on data from 157 patients to examine whether individual patient responses to CBT can be predicted based on demographic information, psychiatric history, and self-reported or clinician-reported scales, subscales and questionnaires acquired prior to treatment. Machine learning models were able to explain about 26% of the variance in final treatment improvements. To assess generalizability, we evaluated multiple machine learning models using cross-validation and determined which input features were essential for prediction. While prediction accuracy was similar across models, the importance of specific features varied across models. In general, the combination of total scale score, subscale scores and responses to individual questions on a severity measure, the Liebowitz Social Anxiety Scale (LSAS), was the most informative in achieving the highest predictions that alone accounted for about 26% of the variance in treatment outcome. Demographic information, psychiatric history, personality measures, other self-reported or clinician-reported questionnaires, and clinical scales related to anxiety, depression, and quality of life provided no additional predictive power. These findings indicate that combining scaled and individual responses to LSAS questions are informative for predicting individual response to CBT in patients with SAD.

Reliable multimodal brain signatures predict mental health outcomes in children

BACKGROUND

Inter-individual brain differences likely precede the emergence of mood and anxiety disorders, however, the specific brain alterations remain unclear. While many studies focus on a single imaging modality in isolation, recent advances in multimodal image analysis allow for a more comprehensive understanding of the complex neurobiology that underlies mental health.

METHODS

In a large population-based cohort of children from the Adolescent Brain Cognitive Development (ABCD) study (N > 10K), we applied data-driven linked independent component analysis to identify linked variations in cortical structure and white matter microstructure that together predict longitudinal behavioural and mental health symptoms. Brain differences were examined in a sub-sample of twins depending on the presence of at-risk behaviours.

RESULTS

Two multimodal brain signatures at age 9-10y predicted longitudinal mental health symptoms from 9-12y, with small effect sizes. Cortical variations in association, limbic and default mode regions linked with peripheral white matter microstructure together predicted higher depression and anxiety symptoms across two independent split-halves. The brain signature differed amongst depression and anxiety symptom trajectories and related to emotion-regulation network functional connectivity. Linked variations of subcortical structures and projection tract microstructure variably predicted behavioural inhibition, sensation seeking, and psychosis symptom severity over time in male participants. These brain patterns were significantly different between pairs of twins discordant for self-injurious behaviour.

CONCLUSIONS

Our results demonstrate reliable, multimodal brain patterns in childhood, before mood and anxiety disorders tend to emerge, that lay the foundation for long-term mental health outcomes and offer targets for early identification of children at-risk.

Psychosocial and cognitive determinants of 10-year depressive symptom trajectories in patients with cardiovascular disease: The SMART-Medea Study

BACKGROUND

Middle-aged and older adults presenting clinically relevant depressive symptoms are often undiagnosed. Understanding the determinants of late-life depressive symptoms could improve prognosis. Further, individuals with manifest cardiovascular disease (CVD) are at an increased risk of depression. This study investigated if psychosocial and cognitive factors are associated with depressive symptom trajectories in individuals with CVD.

METHODS

Longitudinal data from the SMART-Medea study of 752 participants (median age 62 years, women 18 %) with a history of CVD was used. Psychosocial determinants (i.e., history of depression, anxiety, neuroticism, locus of control, adverse childhood events, recent adverse events, social support, and somatization) and cognition (i.e., memory functioning, working memory, executive functioning, and processing speed) were assessed via multinomial logistic regressions with depressive symptoms trajectories as outcome (i.e., "never depressed" (reference), "energy/sleep difficulties", "mild depressive symptoms" and "fluctuating severe depression"). Depressive symptom trajectories were based off of longitudinal PHQ-9 scores and created using latent class analysis. Analyses were adjusted for age, sex/gender, and education.

RESULTS

All psychosocial factors were associated with depressive symptom trajectories, except for social support, with increasing associations from the "energy/sleep difficulties" to the "fluctuating severe depression". For cognitive factors, only memory functioning was associated with decreased odds of "fluctuating severe depression" (OR = 0.63, 95 % CI = 0.47-0.85).

LIMITATIONS

The study population consisted of mostly white male participants with CVD; thus, the generalizability to other populations is low.

CONCLUSIONS

Our findings emphasize that a wide range of psychosocial factors are associated with mild as well as severe trajectories of depressive symptoms in patients with manifest CVD. Focusing on psychosocial factors could improve one's prognosis of depressive symptomology.

Prevalence of depressive symptoms in people aged 50 years and older: A retrospective cross-sectional study

BACKGROUND

Depression is a serious health problem worldwide and is often associated with disability and reduced quality of life. In aging societies, early recognition of depression in older adults is highly relevant. Therefore, this study investigated the prevalence of depressive symptoms in individuals aged 50 and older with the aim to identify those at risk for major depression.

METHODS

We performed a retrospective cross-sectional study with data from 1000BRAINS to assess depressive symptoms in a sample of 1017 healthy adults aged 50 and older. The prevalence and dimension of depressive symptoms were measured by the Beck Depression Inventory II, and differences between demographic, clinical, and lifestyle-associated variables and the prevalence of depressive symptoms were analyzed.

RESULTS

Depressive symptoms were present in 21.3 % of the participants and were minimal in 14.2 %, mild in 4.5 %, moderate in 1.8 %, and severe in 0.8 %. The prevalence of depressive symptoms was highest in the age group 50 to 59 years, and the prevalence of severe depressive symptoms decreased with increasing age. A positive family history of depression, cognitive impairment, medication intake, and polyneuropathy were associated with significantly higher levels of depressive symptoms.

LIMITATIONS

The retrospective cross-sectional design and evaluation of depressive symptoms by a self-rating instrument may limit the generalizability of the results.

CONCLUSION

This study supports earlier findings of a higher prevalence of depressive symptoms among older adults. The group aged 50 to 59 appears to be particularly affected. Additionally, poor physical health, greater cognitive impairment, and sex-specific factors appear to contribute to depressive symptomatology.

Mindfulness-Based Integrative Programme: The effectiveness, acceptability, and predictors of responses to a novel low-dose mindfulness-based intervention

Mindfulness-Based Interventions (MBIs) have shown promising results in improving mental health in the general population. However, traditional MBIs require substantial time and effort due to the high dose of mindfulness practice, which makes them inaccessible to many individuals. This study aimed to (1) test the effectiveness of a novel low-dose MBI-Mindfulness-Based Integrative Programme (MBIP)-delivered synchronously online, on mental health symptom severity, emotion regulation, and trait mindfulness in the general population; (2) test the acceptability of this intervention; and (3) identify baseline characteristics that may predict changes in emotion regulation. A non-randomised controlled trial design was used to compare pre- to post-intervention change scores in trait mindfulness (FFMQ), mental health symptom severity (SCL-90-R GSI), and emotion dysregulation (DERS) between a self-selected and self-paid experimental group (n = 116) and a passive control group (n = 115). The experimental group showed significant increases in trait mindfulness and reductions in mental health symptom severity and emotion dysregulation, with effect sizes ranging from small to large, which is comparable to traditional in-person MBIs. Baseline trait mindfulness and mental health symptom severity significantly predicted intervention outcomes, with greater improvements in emotion regulation among participants with lower baseline scores. Participants demonstrated high levels of engagement and reported high satisfaction with the intervention. These findings support the acceptability and effectiveness of a novel low-dose, synchronous online MBI for the general population.

Brain Fog and Cognitive Dysfunction in Posttraumatic Stress Disorder: An Evidence-Based Review

The term "brain fog" has long been used both colloquially and in research literature in reference to various neurocognitive phenomenon that detract from cognitive efficiency. We define "brain fog" as the subjective experience of cognitive difficulties, in keeping with the most common colloquial and research use of the term. While a recent increase in use of this term has largely been in the context of the post-coronavirus-19 condition known as long COVID, "brain fog" has also been discussed in relation to several other conditions including mental health conditions such as post-traumatic stress disorder (PTSD). PTSD is associated with both subjective cognitive complaints and relative deficits on cognitive testing, but the phenomenology and mechanisms contributing to "brain fog" in this population are poorly understood. PTSD psychopathology across cognitive, affective and physiological symptom domains have been tied to "brain fog". Furthermore, dissociative symptoms common in PTSD also contribute to the experience of "brain fog". Comorbid physical and mental health conditions may also increase the risk of experiencing "brain fog" among individuals with PTSD. Considerations for the assessment of "brain fog" in PTSD as part of psychodiagnostic assessment are discussed. While standard psychological intervention for PTSD is associated with a reduction in subjective cognitive deficits, other cognitive interventions may be valuable when "brain fog" persists following PTSD remission or when "brain fog" interferes with treatment. Limitations of current research on "brain fog" in PTSD include a lack of consistent definition and operationalization of "brain fog" in the literature, as well as limited tools for measurement. Future research should address these limitations, as well as further evaluate the use of cognitive remediation as an intervention for "brain fog".

Progress and Prospects of Research on the Impact of Mental Health of Youth Sailors-A Bibliometric-Based Analysis

Background: The mental health of youth sailors has garnered increasing attention from both coaches and researchers, as evidenced by the growing appearance of related keywords in scientific literature. Despite this rising interest, no studies have yet specifically focused on the mental health of this population. Methods: This study conducted a bibliometric analysis of 315 articles retrieved from the Web of Science database. These articles were analyzed to identify trends, influential authors, institutions, and regions in the field of youth sailor mental health. Results: The analysis yielded several key findings: (1) Depression, anxiety, and mental health disorders are the primary areas of focus in the literature on youth sailors' mental health; (2) Rosemary Purcell is identified as the most influential author in this domain; (3) the University of Melbourne, Orygen, and Deakin University are the top three contributing institutions; (4) Australia, the USA, Canada, China, and England are the five most prominent regions involved in this research. Conclusions: This study provides a comprehensive overview of current research on the mental health of young sailors. By emphasising the most influential contributors and research trends, it aims to raise awareness amongst coaches and researchers, eventually supporting efforts to improve the mental health of young sailors.

Safety and Efficacy of Continuous Theta Burst "Intensive" Posterior Parietal Cortex Stimulation in Generalized Anxiety Disorder: A Randomized Double-Blind Sham-Controlled Trial

OBJECTIVES

Citing nonresponse to conventional treatments, neuromodulation based treatments are needed in generalized anxiety disorder (GAD). Data regarding continuous TBS (cTBS) in GAD has been anecdotal. Citing right posterior parietal cortex (PPC) hyperconnectivity in GAD, we aimed to study the effect of intensive cTBS targeting PPC in a randomized rater-blinded placebo-control design.

MATERIAL AND METHODS

Forty-four patients age range 18-59 years (baseline Hamilton Anxiety Rating Scale [HAM-A] score >18 or Clinical Global Impression Severity [CGI-S] score of ≥4) were randomly allocated to active cTBS (n = 22) and sham cTBS (n = 22) groups using block randomization method. They received 10 cTBS sessions, 2 sessions per day (total of 1200 pulses) for 5 days in a week at 80% motor threshold. HAM-A, World Health Organization's abbreviated quality of life assessment (WHOQOL-BREF), and CGI-S were assessed at baseline, after the last session, and at 2 weeks after cTBS with gender as covariate. Intention-to-treat analysis was conducted and missing values were replaced using the last observation carried forward method.

RESULTS

On repeated measures analysis of variance, a significant between-group time effect for HAM-A (F = 29.6; P = 0.001; ηp2 = 0.420), CGI-S (F = 24.7; P = 0.001; ηp2 = 0.376), and WHOQOL-BREF (F = 29.6; P = 0.001; ηp2 = 0.420). Logs of odds of response of >50% improvement in HAM-A between active and sham groups is 3.27 (95% CI [0.345, 6.20]). No major side effects were reported and none discontinued the trial because of side effects.

CONCLUSIONS

Our trial concludes that cTBS of posterior parietal cortex is safe, well-tolerated, and effective in GAD.

Impact of enhanced recovery after surgery on psychological outcomes in total hip arthroplasty

BACKGROUND

The occurrence of pain catastrophizing, depression, and anxiety is prevalent among patients undergoing primary total hip arthroplasty (THA). The Enhanced Recovery After Surgery protocol (ERAS-P) has demonstrated its efficacy in alleviating peri-operative stress responses in such patients. This study endeavors to explore the influence of ERAS-P on patient satisfaction, as well as the levels of pain catastrophizing, surgery-related anxiety, and depression following primary THA.

HYPOTHESIS

ERAS-P exerts a beneficial influence on patient satisfaction, mitigating pain catastrophizing, and reducing surgery-related anxiety and depression following primary THA.

PATIENTS AND METHODS

Data were retrospectively reviewed for patients who underwent primary THA between 2017 and 2020. Patients in the control group who received usual care were matched in a 1:1 ratio for baseline characteristics to patients in the ERAS-P group who followed ERAS-P. All patients were evaluated and analyzed for pain catastrophizing, depression and anxiety using the Pain Catastrophizing Scale (PCS) and Hospital Anxiety and Depression Scale (HADS) at postoperative 1 weeks, 6 weeks, 3 months, 6 months and 1 year.

RESULTS

182 patients in the ERAS-P group and 182 in the control group were analyzed using propensity score matching (PSM). Compared to the control group, ERAS-P patients showed significantly higher satisfaction levels (p = 0.002). They also experienced a notable reduction in pain catastrophizing at 1 week, 6 weeks, and 3 months postoperatively (p < 0.05 for all). Anxiety levels decreased markedly at 1 week and 6 weeks (p < 0.001 for both). Depression scores in the ERAS-P group declined significantly at these same time points up to 6 months (p < 0.05 for all). Remarkably, ERAS-P patients exhibited a greater decrease in peri-operative pain catastrophizing and anxiety, accompanied by a faster recovery. However, its effectiveness waned over time, with both groups reporting comparable outcomes within a few months.

DISCUSSION

Patients undergoing THA after adhering to the ERAS-P exhibit a more favorable outcome in improving peri-operative patient-reported depression, anxiety, and pain catastrophizing screenings compared to those following the traditional care scheme. Although these advantages gradually diminished over time, the outcomes for both groups converged to be similar within a few months. Nonetheless, ERAS-P retains its notable advantages for THA patients who grapple with psychological symptoms.

LEVEL OF EVIDENCE

III.

Person-centered analyses reveal that developmental adversity at moderate levels and neural threat/safety discrimination are associated with lower anxiety in early adulthood

Parsing heterogeneity in the nature of adversity exposure and neurobiological functioning may facilitate better understanding of how adversity shapes individual variation in risk for and resilience against anxiety. One putative mechanism linking adversity exposure with anxiety is disrupted threat and safety learning. Here, we applied a person-centered approach (latent profile analysis) to characterize patterns of adversity exposure at specific developmental stages and threat/safety discrimination in corticolimbic circuitry in 120 young adults. We then compared how the resultant profiles differed in anxiety symptoms. Three latent profiles emerged: (1) a group with lower lifetime adversity, higher neural activation to threat, and lower neural activation to safety; (2) a group with moderate adversity during middle childhood and adolescence, lower neural activation to threat, and higher neural activation to safety; and (3) a group with higher lifetime adversity exposure and minimal neural activation to both threat and safety. Individuals in the second profile had lower anxiety than the other profiles. These findings demonstrate how variability in within-person combinations of adversity exposure and neural threat/safety discrimination can differentially relate to anxiety, and suggest that for some individuals, moderate adversity exposure during middle childhood and adolescence could be associated with processes that foster resilience to future anxiety.

Fractionating impulsivity and reward-related phenotypes in adolescent mice

Adolescence is a developmental period characterized by changes in the brain and behavior, including heightened reward seeking, increased impulsivity, and elevated risk-taking behavior. It is also a sensitive period for the development of a number of behavioral and psychiatric disorders associated with pathological phenotypes of reward processing and impulsivity. Landmark human studies are charting the development of impulsivity and other reward-related phenotypes to identify the facets and timecourse of the adolescent phenotype. Collecting similar data from mice is important to enable molecular, cellular, and circuit-level interrogation of adolescent maturation of reward, motivation, and impulsive behavior. These complex phenotypes have traditionally been difficult to assay in adolescent mice. Here, using a combination of approaches including homecage testing, we tested a number of facets of reward seeking, impulsivity, motivation, and incentive salience attribution during adolescent development. We found that adolescent mice show increased reward seeking, impulsive action, and motivation. Interestingly, we found no effect of adolescence on impulsive choice, sign-tracking, reward-learning, or conditioned reinforcement. Overall, our studies set the stage for approaches to study multi-faceted phenotypes related to impulsivity and other reward-related behaviors in adolescent mice to examine the developmental trajectories of brain and behavior.

Understanding the complex network of anxiety, depression, sleep problems, and smartphone addiction among college art students using network analysis

Background

This study employs a network analysis approach to explore the interconnections between anxiety, depression, and sleep problems and smartphone addiction among college students using network analysis, offering a new perspective on these prevalent mental health issues.

Methods

A cross-sectional study was conducted among art students at a public university in the province of Fujian, China. Data were collected using the Generalized Anxiety Disorder Scale-7, Patient Health Questionnaire-9, Pittsburgh Sleep Quality Index, and Mobile Phone Addiction Index. The R package was used in the analysis for statistical analysis, and information was collected using multi-stage sampling as well as stratified sampling. Network analysis was utilized to identify bivariate associations between symptoms, core components, co-occurring patterns, and key nodes within the network. Network stability and accuracy were assessed using the bootstrap method, and network comparisons were conducted across subgroups based on gender, residential condition, and sibling status.

Results

The study included 2,057 participants. The network analysis revealed uncontrollable worry as the most central symptom, with low energy and excessive worry also identified as key symptoms within the network. Bridge symptoms such as daytime dysfunction, self-harm or suicidal ideation, abnormal behavior and speech, and sensory fear were found to be critical in linking anxiety, depression, and sleep problems. The network of comorbid symptoms and smartphone addiction highlighted inefficiency and loss of control as central factors influencing mental health. No significant differences in network characteristics were found across the subgroups, suggesting the universality of the identified network structure.

Conclusion

This study delineates the intricate network of anxiety, depression, sleep problems, and smartphone addiction among college students, identifying key symptomatic intersections and their implications for mental health.

Parenting style patterns and their longitudinal impact on mental health in abused and nonabused adolescents

Background

While the impact of parenting styles on adolescents' mental health is well documented, no study has used latent person-oriented methods to analyze the effects of parenting style trajectories, experienced by physically abused and nonabused adolescents from early to middle adolescence, on mental health outcomes.

Method

In this longitudinal study, we used latent transition analysis (LTA) to detect parenting patterns and their trajectories among 1,709 adolescents from 44 high schools in Switzerland across three data waves (2021-2023) by applying a multigroup comparison between physically nonabused and abused adolescents. Using multinomial regression, we tested the effects of the detected parenting patterns on adolescents' mental health.

Results

Along with the two known patterns, termed "supportive" and "negative" parenting, two new parenting patterns which we termed "absent" (low levels on all tested parenting styles) and "ambiguous" (middle to high levels on all tested parenting styles) emerged as playing a key role in the perceptions of adolescents with and without parental abuse experience longitudinally. These four patterns developed in diverse ways: Supportive parenting decreased for abused adolescents over time but remained stable for the nonabused adolescents. The absent parenting level was stable over time among abused adolescents when compared to the outcomes experienced by adolescents subjected to the negative parenting pattern. Furthermore, we found a remarkable decline in the number of nonabused adolescents in the absence pattern from Wave 1 to Wave 3. Further, we also found that abused adolescents reported more negative parenting than nonabused adolescents. Additionally, we found that supportive parenting was beneficial for adolescents' mental health whereas negative, ambiguous, and absent parenting all had detrimental effects.

Conclusions

These findings highlight the beneficial association of supportive parenting and the detrimental effects of negative, ambiguous, and absent parenting. This also suggests that we must consider a more complex approach that involves examining a blend of different parenting styles when analyzing adolescent mental health.

Application of the Random Forest Algorithm for Accurate Bipolar Disorder Classification

Bipolar disorder (BD) is a complex psychiatric condition characterized by alternating episodes of mania and depression, posing significant challenges for accurate and timely diagnosis. This study explores the use of the Random Forest (RF) algorithm as a machine learning approach to classify patients with BD and healthy controls based on electroencephalogram (EEG) data. A total of 330 participants, including euthymic BD patients and healthy controls, were analyzed. EEG recordings were processed to extract key features, including power in frequency bands and complexity metrics such as the Hurst Exponent, which measures the persistence or randomness of a time series, and the Higuchi's Fractal Dimension, which is used to quantify the irregularity of brain signals. The RF model demonstrated robust performance, achieving an average accuracy of 93.41%, with recall and specificity exceeding 93%. These results highlight the algorithm's capacity to handle complex, noisy datasets while identifying key features relevant for classification. Importantly, the model provided interpretable insights into the physiological markers associated with BD, reinforcing the clinical value of EEG as a diagnostic tool. The findings suggest that RF is a reliable and accessible method for supporting the diagnosis of BD, complementing traditional clinical practices. Its ability to reduce diagnostic delays, improve classification accuracy, and optimize resource allocation make it a promising tool for integrating artificial intelligence into psychiatric care. This study represents a significant step toward precision psychiatry, leveraging technology to improve the understanding and management of complex mental health disorders.

Towards a neurodevelopmental model of bipolar disorder: a critical review of trait- and state-related functional neuroimaging in adolescents and young adults

Neurodevelopmental mechanisms are increasingly implicated in bipolar disorder (BD), highlighting the importance of their study in young persons. Neuroimaging studies have demonstrated a central role for frontotemporal corticolimbic brain systems that subserve processing and regulation of emotions, and processing of reward in adults with BD. As adolescence and young adulthood (AYA) is a time when fully syndromal BD often emerges, and when these brain systems undergo dynamic maturational changes, the AYA epoch is implicated as a critical period in the neurodevelopment of BD. Functional magnetic resonance imaging (fMRI) studies can be especially informative in identifying the functional neuroanatomy in adolescents and young adults with BD (BDAYA) and at high risk for BD (HR-BDAYA) that is related to acute mood states and trait vulnerability to the disorder. The identification of early emerging brain differences, trait- and state-based, can contribute to the elucidation of the developmental neuropathophysiology of BD, and to the generation of treatment and prevention targets. In this critical review, fMRI studies of BDAYA and HR-BDAYA are discussed, and a preliminary neurodevelopmental model is presented based on a convergence of literature that suggests early emerging dysfunction in subcortical (e.g., amygdalar, striatal, thalamic) and caudal and ventral cortical regions, especially ventral prefrontal cortex (vPFC) and insula, and connections among them, persisting as trait-related features. More rostral and dorsal cortical alterations, and bilaterality progress later, with lateralization, and direction of functional imaging findings differing by mood state. Altered functioning of these brain regions, and regions they are strongly connected to, are implicated in the range of symptoms seen in BD, such as the insula in interoception, precentral gyrus in motor changes, and prefrontal cortex in cognition. Current limitations, and outlook on the future use of neuroimaging evidence to inform interventions and prevent the onset of mood episodes in BDAYA, are outlined.

Digital Mental Health Interventions for University Students With Mental Health Difficulties: A Systematic Review and Meta-Analysis

BACKGROUND

While third-level educational institutions have long provided counselling, a sharp rise in demand has led to limited access to mental health supports for many students, including those with ongoing difficulties. Digital mental health interventions represent one response to this unmet need, given the potential low cost and scalability associated with no-to-low human resources involved.

OBJECTIVE

The aim of this study was to conduct a systematic review and meta-analysis of the literature examining effectiveness of digital mental health interventions for university students with ongoing mental health difficulties.

METHODS

The following databases were searched: PubMed, EBSCOhost (CINHAHL/PsycINFO/PsycArticles) and Web of Science. Two-armed randomised-control trials were included in the meta-analysis. A random-effects meta-analysis was conducted and standardised mean differences were calculated. Effect sizes were then compared in terms of therapeutic approach, and whether interventions were fully automated or guided interventions. This study was registered with PROSPERO, CRD42024504265.

RESULTS

Thirty four eligible studies were included in this narrative synthesis, of which 21 randomised-controlled trials were included in the meta-analysis. Random-effects meta-analysis indicated an overall medium effect size in favour of digital interventions for both depression (Cohen's d = 0.55), and anxiety (Cohen's d = 0. 46). Of note, for anxiety outcomes, fully automated interventions appeared more effective (d = 0.55) than guided interventions (d = 0.35).

CONCLUSIONS

Digital mental health interventions are associated with beneficial effects for college students when measured in terms of anxiety and depression symptom severity. For anxiety, fully automated interventions may be more effective than guided interventions to reduce symptom severity.

A latent classes analysis to detect cognitive and emotional profiles in cancer patients

Thought style has been described as a mediator between cancer diagnosis and the emotional response to cancer. Describe the latent profiles related to thought style (rumination, cognitive engagement, and cognitive avoidance) and emotional response in a sample of cancer patients. 159 cancer patients were assessed prior to starting treatment. Measurement instruments used were HADS, Cancer response thought style inventory, distress thermometer, and PTGI. Analysis of latent classes to explore profiles of who share the same thought style. The solution had 4 subgroups: first group was avoidance, the means for anxiety, depression and post-traumatic growth were the lowest of the four groups. The second group was rumination, presenting highest scores for anxiety, depression and post-traumatic growth. The third group was indeterminate, this group presented low anxiety and depression. The fourth group, with cognitive engagement presented low anxiety and depression and post-traumatic growth was high.

Outcomes that Matter to Youth and Families in Behavioral Health Services

Patient-centered outcomes research helps youth and families using behavioral health services make informed decisions about treatments to help them achieve the outcomes most important to them. However, there are few efforts to identify the outcomes valued by youth and families systematically. This project aimed to support the development of behavioral health services that deliver outcomes valued by families by identifying the outcomes that youth and young adults with behavioral health needs and caregivers say matter most to them. We engaged 34 youth and young adults (YYA) with behavioral health needs, alongside 42 caregivers from six U.S. regions, in two rounds of one-hour virtual focus groups. The initial round involved participants identifying what they hoped to gain from using behavioral health services for personal, familial, and parental or child well-being and the attributes of positive service experiences. We coded responses using qualitative analytical software, culminating in synthesized reports. Subsequently, the second round entailed participants' review and refinement of initial findings. Across sessions, each group reported the top three outcomes deemed most important for children, YYA, parents, families, and their service experiences. YYA identified being understood by others, improving their interpersonal relationships, and feeling heard as the highest priority behavioral health service outcomes. Caregivers of children and youth with behavioral health needs identified having accessible services that meet their needs, having providers that collaborate effectively with parents and other service systems, and experiencing consistent and continuous behavioral health care for their child as the most important behavioral health service outcomes. Both YYA with behavioral health needs and caregivers of children and youth prioritized gaining the necessary knowledge, resources, and tools to support their or their child's behavioral health. Additionally, both participant groups emphasized the importance of effective communication with providers, within their families, and with peers. Minimizing judgment and stigma from society, providers, and other professionals also emerged as a critical outcome for these groups. It is essential for research and policy development to focus on and cater to the outcomes that are important and valued by YYA and their families to maximize family engagement in care.

Exploring the associations between the presence, characteristics, and biopsychosocial covariates of pain and lifetime depression in adolescents: A cross-sectional ABCD study analysis

INTRODUCTION

Depression and pain co-occur, even during adolescence. However, there is limited knowledge on the association between pain and lifetime depression, and which biopsychosocial measures are associated with this co-occurrence.

METHODS

Cross-sectional analysis of the Adolescent Brain and Cognitive Development (ABCD) two-year follow-up. We explored associations between the presence and characteristics of past month pain (intensity, duration, activity limitations, and number of pain sites) and lifetime depression using logistic regression. We explored associations of brain structure, physical, behavioural, emotional, social, and cognitive measures with lifetime depression and past month pain compared to having had one or neither condition using multinomial logistic regression.

RESULTS

A total of 5211 adolescents (mean age = 12.0 years) who had: (1) no lifetime mental ill-health and no pain (n = 3327); (2) pain only (n = 1407); (3) lifetime depressive disorder but no pain (n = 272); and (4) lifetime depressive disorder and pain (n = 205) were included. Pain presence was associated with lifetime depression (OR[95%CI]: 1.76 [1.45, 2.13], p < 0.001). Pain-related activity limitations (1.13 [1.06, 1.21], p < 0.001) and the number of pain sites (1.06 [1.02, 1.09], p < 0.001) were associated with lifetime depression. Various behavioural, emotional, social, and cognitive, but not brain structure or physical measures, were associated with lifetime depression and past month pain.

LIMITATIONS

Longitudinal analyses should validate prognostic markers for predicting co-occurring depression and pain.

CONCLUSIONS

Results support an association between the presence and characteristics of pain and lifetime depression during adolescence and could indicate the need for more integrated recognition and clinical care of youth experiencing both depression and pain.

Sleep Quality as a Critical Pathway Between Adverse Childhood Experiences and Multimorbidity and the Impact of Lifestyle

OBJECTIVES

This study aims to establish the effects of ACEs on multimorbidity through sleep quality and investigate whether lifestyle factors (e.g., eating habits and exercise) may influence this relationship among middle-aged and older adults.

METHODS

Participants were drawn from a cross-sectional sample of community dwelling older adults (N = 276, 55+) and three waves of data from the Midlife in the United States study (MIDUS, N = 843). We examined the direct and indirect effects of ACEs, sleep quality, and health conditions, as well as the conditional effects of physical activity and eating habits.

RESULTS

Across both samples, sleep quality mediated the relationship between ACEs and chronic health conditions. Moderating effects of unhealthy eating and physical activity differed between samples.

DISCUSSION

Sleep quality is an important pathway connecting ACEs and adult multimorbidity, and health behaviors may provide targets for intervention particularly in older adults.

The psychometric properties of the Mini Social Phobia Inventory in a treatment seeking sample of children and their caregivers

The Mini Social Phobia Inventory (Mini-SPIN) is a short 3-item measure of social anxiety disorder (SAD). Using existing data, the current study examined the psychometric properties of the Mini-SPIN using a large, treatment seeking sample of children aged 6-16 years with data available for youth (n = 695, 170) and their caregivers (n = 703, 177) at pre-treatment and follow-up, respectively. The ability of the Mini-SPIN to discriminate between those with and without SAD was examined at pre-treatment and 6-month follow-up, across caregiver and child report. The criterion group validity, internal consistency and construct validity of the measure was also examined. Results revealed that at pre-treatment the Mini-SPIN demonstrated good discriminant validity in detecting cases of SAD from non-SAD (with cut-off of 4 on child report, and 6 on caregiver report). At 6-month follow-up, the discriminant ability of the Mini-SPIN was found to be less than acceptable for child reported scores, but acceptable for caregiver reported scores. The Mini-SPIN further demonstrated good criterion group validity, internal consistency and construct validity across caregiver and child report. Overall, the findings from the current study lend further support for the use of the Mini-SPIN as a screening tool for SAD.

Bifidobacterium longum CECT 30763 improves depressive- and anxiety-like behavior in a social defeat mouse model through the immune and dopaminergic systems

Adolescence is a crucial period marked by profound changes in the brain. Exposure to psychological stressors such as bullying, abuse or maltreatment during this developmental period may increase the risk of developing depression, anxiety and comorbid cardiometabolic conditions. Chronic psychological stress is associated with behavioral changes and disruption of the hypothalamic-pituitary-adrenal axis, leading to corticosterone overproduction in rodents and changes in both the immune system and the gut microbiome. Here, we demonstrate the ability of Bifidobacterium longum CECT 30763 (B. longum) to ameliorate adolescent depressive and anxiety-like behaviors in a chronic social defeat (CSD) mouse model. The mechanisms underlying this beneficial effect are related to the ability of B. longum to attenuate the inflammation and immune cell changes induced by CSD after the initial stress exposure through the induction of T regulatory cells with enduring effects that may prevent and mitigate the adverse consequences of repeated stress exposure on mental and cardiometabolic health. B. longum administration also normalized dopamine release, metabolism and signaling at the end of the intervention, which may secondarily contribute to the reversal of behavioral changes. The anti-inflammatory effects of B. longum could also explain its cardioprotective effects, which were reflected in an amelioration of the oxidative stress-induced damage in the heart and improved lipid metabolism in the liver. Overall, our findings suggest that B. longum regulates the links between the immune and dopaminergic systems from the gut to the brain, potentially underpinning its beneficial psychobiotic and physiological effects in CSD.

A Scoping Review of Interventions Designed to Increase Behavioural Health Service Engagement

BACKGROUND

A documented underutilization of behavioural health interventions with known efficacy for treating psychological disorders exists. Thus, engagement enhancement approaches (EEAs) exist to help increase individuals' use of behavioural health interventions. EEAs target a range of barriers to treatment; therefore, a wide variety of approaches exist.

METHOD

To better understand what EEA approaches exist and in which contexts they are most widely implemented, this study conducted a scoping review of existing EEAs to increase treatment engagement in effective interventions for behavioural health disorders. Specifically, the purpose of this review was to characterize EEAs by type, modality, target population, and to examine the intersection of these categories. Additionally, this review examined research rigour and cultural considerations among existing EEAs.

RESULTS

We found that most of the identified studies targeted individual-level barriers through psychoeducation and awareness campaigns. These primarily focused on adults with substance use disorders or major depressive disorder and occurred in person at a provider location. This review identified several limitations and gaps in the literature regarding EEAs, such a shortage of scientifically rigorous studies that assess these approaches, the lack of cultural adaptations made to EEAs to specifically support minoritized individuals, the narrow focus of targeting individual-level barriers, and the limited scope of target groups.

CONCLUSIONS

This review offers clinicians and behavioural health researchers information regarding the selection of approaches to increase engagement in accessing behavioural health interventions, as well as suggestions for future research to address disparities and develop solutions to the systemic barriers of the EEAs.

Substance use and mental health symptoms in adults with prenatal alcohol exposure

BACKGROUND

Substance use and mental health problems have been documented in individuals with prenatal alcohol exposure (PAE) in young adulthood, but little is known about how these patterns progress over time into midlife. The current study examined rates of substance use in a sample of adults with PAE in mid-life compared to a demographically similar contrast group.

METHODS

Participants (n = 233) were drawn from two longitudinal cohorts of individuals recruited prenatally and followed into adulthood. Measures of cognition, substance use, and self-reported mental health functioning were obtained.

RESULTS

Differences among groups (PAE no dysmorphology, PAE with dysmorphology, No PAE contrast group) were examined on demographic variables of interest and substance use outcomes. Both PAE groups experienced higher levels of Adverse Childhood Experiences (ACEs) compared to the contrast group. We also observed higher rates of current tobacco use in those with PAE; those with PAE and no dysmorphology had almost twice the rate of current tobacco use as the nonexposed contrast group. We observed similar rates of high risk drinking on the Alcohol Use Identification Test (AUDIT) in all groups. Individuals with PAE also showed high rates of cannabis use compared to national averages. Generalized linear regressions examining predictive effects of PAE on substance use outcomes did not show significant results, though female sex at birth was predictive of current cannabis use. Current alcohol use predicted depression and PTSD symptoms, and significant interactions were observed between PAE group and ACEs on depression, PTSD, anxiety, and psychotic symptoms.

CONCLUSION

This is one of the only studies to examine rates of alcohol and other substance use among adults in mid-life with PAE. Results suggest that relationships between PAE, substance use, and mental health symptoms are complex, and it will be important for future studies to examine factors associated with high-risk substance use among this vulnerable population.

Social connection interventions and depression in young adults: a systematic review and meta-analysis

PURPOSE

Early adulthood is a period which may increase vulnerability to loneliness and mental health difficulties among young adults. Social networks play an important role in buffering against adverse mental health, but there is a lack of evidence around whether social connection interventions could play a role in preventing mental health difficulties for young adults.

METHODS

A systematic review and meta-analysis was conducted (PROSPERO ID: CRD42023395595). PubMed, PsycInfo, and Scopus were searched (01 January 2000-01 January 2023). Studies were eligible if they (i) were quantitative, (ii) included young adults (18-24 years) from the general population, (iii) tested a social intervention which aimed to increase the quantity or quality of social connections or reduce loneliness, (iv) had a comparison group, and (v) measured depression and loneliness/social connection as outcomes. Following study screening and selection, the data extraction and risk of bias assessments were independently conducted in duplicate. The Cochrane RoB-2 tool and ROBINS-I tool were used to assess risk of bias. Results were narratively synthesised and random effects meta-analysis with standardised mean differences was conducted.

RESULTS

Six studies were included; four in-person interventions with higher education students, one online intervention with higher education students, and one intervention for youth involved in street life. The studies were mostly rated as having some or moderate concerns with risk of bias. The interventions were associated with an overall mean reduction in depression for young adults (SMD = -0.19; 95% CI, -0.33 to -0.05; p = 0.008; 4 studies, excluding studies with serious risk of bias). All interventions had beneficial effects on a range of diverse social connection outcomes, but there was no overall statistically significant mean reduction in loneliness for young adults in pooled analyses (SMD = -0.10; 95% CI, -0.24 to 0.05; p = 0.188; 3 studies).

CONCLUSION

Social connection interventions show some promise in improving depression and social connection outcomes in young adults but more high-quality research, across diverse settings, is needed in this area.

Anxiety Symptoms Predict Subsequent Depressive Symptoms in Neurodivergent Youth: A 10-Year Longitudinal Study

Neurodivergent youth often experience anxiety and depressive symptoms that may hamper adaptive functioning and well-being. There is little knowledge of how anxiety and depression are related in neurodivergent youth. Therefore, we aimed to examine whether the relationship between anxiety and depressive symptoms is uni- or bidirectional in neurodiverse youth. We assessed self-reported anxiety and depressive symptoms over time in 173 youth (Mbaseline age = 11.7 years, SD = 2.1, 64% males, 36% females). The sample comprised 38 autistic youth, 85 youth diagnosed with attention-deficit/hyperactivity disorder (ADHD), and 50 comparison youth assessed at baseline (T1), 2-year follow-up (T2, 97% retention), and 10-year follow-up (T3, 73% retention). We used cross-lagged models to analyze the data. In neurodivergent youth, more anxiety symptoms at T1 and T2 predicted more depressive symptoms at T2 and T3. Preceding anxiety symptoms were linked with later depressive symptoms, even after accounting for autoregressive effects of depressive symptoms. The results are consistent with a prodromal model in which anxiety symptoms can independently foreshadow the emergence of depressive symptoms over the course of development among neurodivergent youth. Potentially, addressing anxiety symptoms among youth with autism or ADHD could play a role in preventing the onset of youth depression.

Temporal Tendencies: Exploring the Impact of Chronotype Timing on Youth Depression Risk

Developmental changes in youth sleep preferences (chronotype) and pubertal development are consequential for youth risk for depression. Previous research has identified individual differences in chronotype in risk for psychopathology. However, little is known regarding how the timing of chronotype may confer risk in youth. This study addressed this gap by examining associations between chronotypal timing and symptoms of depression in youth. Community youth (N = 155; M age =12.7) completed self-report measures of chronotype, pubertal status and depression every six months for a period of one year (three assessment points). Regression analyses showed that chronotypal timing predicted change in depressive symptoms across six months (b = -0.66, p = 0.019), but not across any other timeframe. Findings suggested that youth experiencing more of a morning preference compared to same-aged peers were at increased risk for later depression across six months. Chronotypal timing continued to predict changes in symptoms of depression controlling for gender (b = -0.63, p = 0.023) and pubertal timing (b = -0.72, p = 0.012). These findings suggest that chronotypal timing is prospectively related to changes in youth symptoms of depression. Results indicate that attention to the timing of normative changes in chronotype is warranted, in addition to mean-level differences.

Structure-function coupling in network connectivity and associations with negative affectivity in a group of transdiagnostic adolescents

The study of brain connectivity, both functional and structural, can inform us on the development of psychopathology. The use of multimodal MRI methods allows us to study associations between structural and functional connectivity, and how this relates to psychopathology. This may be especially useful during childhood and adolescence, a period where most forms of psychopathology manifest for the first time. The current paper explores structure-function coupling, measured through diffusion and resting-state functional MRI, and quantified as the correlation between structural and functional connectivity matrices. We investigate associations between psychopathology and coupling in a transdiagnostic group of adolescents, including many treatment-seeking youth with relatively high levels of symptoms (n = 72, Mage = 13.3). We used a bifactor model to extract our main outcome measure, Negative Affectivity, from anxiety and irritability ratings. This provided the principal measure of psychopathology. Supplementary analyses investigated 'domain-specific' factors of anxiety and irritability. Findings indicate a positive association between negative affectivity and structure-function coupling between the default mode and the fronto-parietal control networks. Higher structure-function coupling may indicate heightened structural constraints on function, which limit functional network reorganization during adolescence required for healthy psychological outcomes.

Utilizing the CFIR framework for mapping the facilitators and barriers of implementing teachers led school mental health programs - a scoping review

BACKGROUND

Ample evidence has been generated regarding the effectiveness of school-based mental health interventions as part of the continuum of care for children and capacity building of teachers to deal with the emotional and behavioral challenges of students. The increasing trend of utilization of teachers as the natural support system of children and the huge financial impact of public health interventions highlights the need to review all available evidence regarding multilevel factors that facilitate or pose a challenge to the provision of School Mental Health Programs (SMHP) using teachers as providers. The current review aims to map extracted evidence under the Consolidated Framework for Implementation Research (CFIR) domains to support future implementation research on school-based mental health services.

METHODS

The scoping review included experimental, qualitative studies, and systematic reviews involving teacher-led mental health programs conducted in the school setting to improve the socio-emotional well-being of children and adolescents irrespective of time and geographical limitations. All (published and unpublished) evidence in English from Pubmed, Cochrane database of systematic reviews and clinical trials, Scopus, and Science Direct was searched using keywords and Boolean combinations and extracted using study designs, place of study, year of publication, sample size, and target population. A qualitative analysis of implementation facilitators and barriers cited by the studies was carried out and mapped on CFIR.

RESULTS

This review identified barriers and facilitators of implementation across school-based mental health Programs in 29 studies. The major emerging themes were those related to the inner setting of the organization, the process of implementation, and the characteristics of individuals involved in implementation. These included the availability of structural characteristics, positive school culture, organizational readiness, committed leadership, and beliefs of the providers.

CONCLUSION

Findings highlight the need for early assessment of contextual factors acting as barriers and facilitators and careful execution following realistic planning and stakeholders' engagement to ensure the success of SMHP.

Reward Neurocircuitry Predicts Longitudinal Changes in Alcohol Use Following Trauma Exposure

BACKGROUND

Trauma is a risk factor for developing maladaptive alcohol use. Preclinical research has shown that stress alters the processing of midbrain and striatal reward and incentive signals. However, little research has been conducted on alterations in reward-related neurocircuitry posttrauma in humans. Neuroimaging markers may be particularly useful because they can provide insight into the mechanisms that may make an individual vulnerable to developing trauma-related psychopathologies. In this study, we aimed to identify reward-related neural correlates associated with changes in alcohol use after trauma exposure.

METHODS

Participants were recruited from U.S. emergency departments for the AURORA study (n = 286; 178 female). Trauma-related change in alcohol use at 8 weeks posttrauma relative to pretrauma was quantified as a change in 30-day total drinking per the PhenX Toolkit Alcohol 30-Day Quantity and Frequency measure. Reward-related neurocircuitry activation and functional connectivity were assessed 2 weeks posttrauma using functional magnetic resonance imaging during a monetary reward task using region of interest and whole-brain voxelwise analyses.

RESULTS

Greater increase in alcohol use from pretrauma to 8 weeks posttrauma was predicted by 1) greater ventral tegmental area, 2) greater cerebellum activation during gain > loss trials measured 2 weeks posttrauma, and 3) greater seed-based functional connectivity between the ventral tegmental area and lateral occipital cortex and precuneus.

CONCLUSIONS

Altered ventral tegmental area activation and functional connectivity early posttrauma may be associated with reward seeking and processing, thereby contributing to greater alcohol use posttrauma. These data provide novel evidence of neural correlates that underlie increased alcohol use early posttrauma that may be targeted via early interventions to prevent the development of maladaptive alcohol use.

Predicting clinical improvement in youth using a national-scale multicomponent digital mental health intervention

INTRODUCTION

Youth mental health services are characterised by high demand and modest clinical outcomes. While digital mental health interventions (DMHIs) have been shown to be clinically effective, the relationship between DMHI use and outcome is unclear. The current study sought to identify the factors affecting the relationship between DMHI use and depression and anxiety symptom improvement in sub-groups of young people.

METHOD

An observational cohort design included young people aged 12-25 years engaging with a DMHI (MOST) from October 2020 to October 2023. The primary outcome was improvement at 12 weeks on the Patient Health Questionnaire-4 (PHQ4). DMHIs were combinations of self-paced digital cognitive-behavioural therapy content, social network interactions, and professional support. A machine learning clustering algorithm was used to identify distinct user clusters based on baseline characteristics and multiple logistic regression models examined the relationship between DMHI usage and improvement.

RESULTS

Two distinct user clusters emerged, differing by symptom severity, age, service setting, and concurrent external treatment. 46.7% of "Severe" users and 39.8% of "Mild-Moderate" users significantly improved. Greater use of therapy content and professional support interactions were associated with improvement for the Mild-Moderate group only (OR = 1.16, 95% CI: 1.04-1.30, p = 0.008).

CONCLUSION

While a greater proportion of users in the Severe group significantly improved, increased MOST use was associated with symptom improvement only for the Mild-Moderate group. These findings highlight the complexity of the relationship between DMHI use and outcome. Other unmeasured mediating or moderating factors such concurrent 'offline' treatment may help explain the results. Further research is required to better understand the relationship between DMHI use and clinical outcomes.