Risks of all-cause and suicide mortality in mental disorders: a meta-review

The effects of selected phytochemicals on schizophrenia symptoms: A review

There are suggested treatment options for schizophrenia (SZ), including antipsychotic medications. Unfortunately, these drugs mostly ameliorate only the positive symptoms of SZ, and patients have less tendency for compliance due to the drug's side effects. Hence, there is a need for additional or adjunct therapeutic options. This review considers selected phytochemicals with anti-schizophrenic activity as an alternative therapy. We searched the scientific literature and reviewed the evidence from pre-clinical (animal) and clinical studies using some phytochemicals in SZ. The reviewed phytochemicals provided varying potential beneficial effects on SZ. Of particular interest, berberine may provide additional ameliorative advantages against the disorder. Although still nascent in scientific research, these studies suggest a potential adjunct therapeutic option against the pathophysiological pathways implicated in SZ. We recommend robust, carefully performed randomized controlled trials evaluating the role of these phytochemicals in SZ.

Longitudinal association between stigma and suicidal ideation among patients with major depressive disorder

BACKGROUND

To explore the longitudinal associations between stigma and suicidal ideation among patients with major depressive disorder (MDD).

METHODS

Data were from patients with MDD in the Depression Cohort in China. At baseline and weeks 4, 8, 12, 24, 48, and 72, the presence (yes and no) and severity (scores) of suicidal ideation were evaluated using the Beck Scale for Suicide Ideation, and stigma was assessed using the Depression Stigma Scale. Generalized linear mixed models were used to explore the association between stigma and suicidal ideation.

RESULTS

Among 1123 patients with a mean age of 27.9 (SD, 7.3) years, 71.1 % were female. Restricted cubic splines showed positive linear dose-response associations of personal stigma and perceived stigma with the likelihood and severity of suicidal ideation. The adjusted ORs (95 % CIs) for each 10 score increment in personal stigma and perceived stigma were 1.49 (1.18, 1.89) and 1.46 (1.20, 1.77) for the likelihood of suicidal ideation, respectively. The adjusted β coefficients (95 % CIs) for each 10 score increment in personal stigma and perceived stigma were 0.222 (0.121, 0.322) and 0.202 (0.123, 0.281) for suicidal ideation scores, respectively.

LIMITATIONS

Information on sigma, suicidal ideation, and potential covariates was self-reported, so reporting bias was inevitable.

CONCLUSIONS

In this longitudinal study in patients with MDD, more severe personal stigma and perceived stigma were associated with a higher likelihood of suicidal ideation and more severe suicidal ideation. These findings suggest that reducing personal stigma and perceived stigma may help prevent suicidal behavior among patients with MDD.

Trends and determinants of prescription of lithium and antidepressants for bipolar disorder in a large health care system between 2017 and 2022

BACKGROUND

Previous studies raised concerns about declining use of lithium and increased use of antidepressants in treatment of bipolar disorder (BP). We describe recent trends in prescription of psychotropic medications for BP and examine demographic, socioeconomic and clinical factors associated with their prescription.

METHODS

We analyzed data from the electronic health records on 12,824 patients with BP in a large academic health system between 2017 and 2022. We calculated annual prescription rates for BP medications, and then used logistic regression to examine factors associated with their prescription.

RESULTS

We found a modest increase in lithium prescription and a slight decrease for antidepressants. Lithium was prescribed to 27 % of patients, while antidepressants were prescribed to 52 % of patients, nearly half without a concomitant mood stabilizer. Patients who were Black (odds ratio [OR] = 0.70 95 % confidence interval [CI] = 0.65-0.76), had public insurance (OR = 0.87, 95 % CI = 0.81-0.94), lived in areas of higher social deprivation (OR = 0.84, 95 % CI = 0.76-0.93), or were seen in primary care (OR = 0.21, 95 % CI = 0.17-0.24) were less likely to be prescribed lithium. Patients who lived in areas of greater deprivation (OR = 1.42, 95 % CI = 1.20-1.68), were older (60+; OR = 2.64, 95 % CI = 1.96-3.58), and were seen in primary care (OR = 7.46, 95 % CI = 6.43-8.66) were more likely to be prescribed antidepressants without a concomitant mood stabilizer.

CONCLUSIONS

Lithium remains underutilized even though it is a first-line treatment for BP, especially among certain sub-groups. Antidepressants are widely used to treat BP, often without mood stabilizers despite caution by most clinical guidelines. These findings underscore the need for continued efforts to promote use of best evidence-treatments for BP and reduce disparities in their use.

Dose-response association between the intake of various subtypes of polyunsaturated fatty acids and depression

BACKGROUND

Depression is a major global mental health issue. Previous studies have suggested an association between the intake of polyunsaturated fatty acids (PUFAs) and depression, but the conclusions remain controversial. Additionally, there is limited research on the relationship between the intake of specific fatty acid subtypes, such as linoleic acid (LA), arachidonic acid (AA), alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and Docosapentaenoic acid (DPA), and depression.

OBJECTIVE

The relationship between different types of PUFAs and depression risks remains unclear. This study aimed to investigate how the intake of various subtypes of n-3 and n-6 PUFAs correlates with depression.

METHODS

Participants from the National Health and Nutrition Examination Survey (NHANES) database, spanning from 2005 to 2018, were categorized into two groups: those with depression and those without, based on Patient Health Questionnaire-9 scores. The average daily intake of each PUFAs subtype was assessed through two 24-h dietary recall interviews, propensity score matching was employed to address baseline disparities, and multivariate logistic regression analysis to identify independent markers.

RESULTS

The study included 18,798 participants, of whom 1287 were classified as having depression. Post-propensity score matching, multivariate logistic regression analysis revealed an inverse correlation between the intake of AA, ALA, EPA, and DHA and the risk of depression. Restricted cubic spline analysis demonstrated a linear inverse relationship between AA, ALA and EPA intake and depression. Conversely, DHA intake exhibited a nonlinear relationship with depression. No significant association was found between LA or DPA intake and depression risk.

CONCLUSION

Different types of PUFAs appear to influence depression risks differently in adults, with increased intake, AA, ALA, EPA and DHA providing a protective effect against depression.

Psychoneuroimmunoendocrinological and neuroanatomical basis of suicidal behavior: potential therapeutic strategies with a focus on transcranial magnetic stimulation (TMS)

Suicidal behavior is a complex phenomenon influenced by psychological, environmental, and biological factors. It affects a significant portion of the global population, with more than 720,000 deaths annually and millions of individuals experiencing suicidal ideation. Among those who attempt suicide, only a fraction progresses to a fatal outcome, emphasizing the importance of understanding individual vulnerabilities. This review explores the neuroanatomical basis of suicidal behavior, focusing on key brain regions and potential pathways for neuromodulation therapies, particularly Transcranial Magnetic Stimulation (TMS). The dorsolateral prefrontal cortex (DLPFC) plays a central role in cognitive control and emotional regulation, with extensive connections to the anterior cingulate cortex, amygdala, orbitofrontal cortex, hippocampus, and thalamus. Dysfunctions in these circuits contribute to heightened impulsivity, impaired decision-making, and emotional dysregulation in individuals with suicidal behavior. Structural and functional abnormalities in the DLPFC, coupled with altered neurotransmitter systems and inflammatory markers, have been consistently linked to suicidality. TMS, targeting the left DLPFC, has shown promise in reducing suicidal ideation by modulating frontostriatal connectivity, enhancing neuroplasticity, and improving cortical excitability. High-frequency TMS and accelerated theta-burst stimulation protocols demonstrate rapid therapeutic effects, though further research is needed to establish standardized treatment guidelines. Understanding the anatomical circuits implicated in suicidal behavior provides valuable insights for early risk assessment and the development of targeted neuromodulation interventions aimed at reducing the burden of suicide across diverse psychiatric populations.

Risk of suicide in people living with dementia and comorbid mental health conditions: A systematic review and meta-analysis

BACKGROUND

People with dementia (PwD) are more vulnerable to experiencing suicidal ideation than the general population. Within this group, certain risk factors such as being younger and male increase risk of death by suicide. However, currently little is known on whether comorbid mental health conditions in this population also elevate the risk of suicide outcomes. We aimed to determine if comorbid mental health conditions increased the risk of suicidal ideation, suicide attempts and death by suicide in PwD.

METHODS

Five databases were searched from inception to July 2023. Peer-reviewed publications reporting data for suicide outcomes in PwD with a comorbid mental health condition were included. Random effects meta-analyses models were used to calculate the pooled effect sizes.

RESULTS

22 relevant studies were identified for inclusion 14 of which reported sufficient data to be included in the meta-analyses. In PwD, those with a general psychiatric comorbidity were at increased risk of death by suicide (OR = 2.61, [95%CI: 1.47; 4.63]). Those with comorbid depression or anxiety were at increased risk of all suicide outcomes (depression: ideation OR = 5.11, [95%CI:1.73;15.07], attempt OR = 7.75, [95%CI:2.68;22.41], death OR = 3.44 [95%CI:1.65;7.18]; anxiety: ideation OR = 3.69, [95%CI:1.41;9.66]; attempt OR = 2.27, [95%CI:1.08;4.78]; death OR = 2.36, [95%CI:2.02;2.75]). PwD and comorbid personality disorder and substance use were at increased risk of suicide attempt (OR = 4.60, [95%CI:1.36;15.55] and death by suicide (OR = 2.19, [95%CI:1.80;2.66] respectively.

CONCLUSION

Comorbid mental health conditions put PwD at increased risk of suicide outcomes. There is an urgent need for the assessment and monitoring of mental health in PwD in routine care to mitigate suicide risk.

Endo Belly: A Mixed Methods Exploration of Body Image, Disordered Eating, and Psychopathology in Endometriosis

OBJECTIVE

There is increasing interest in the impact of endometriosis on body image, however, there is minimal understanding of the presence and nature of disordered eating. As body image dissatisfaction is elevated in this population and a risk factor for eating disorders, it is likely that disordered eating is also elevated which has important clinical implications for prevention and intervention. The current study aimed to explore the relationships between endometriosis, body image flexibility, eating disorder psychopathology, negative affect, and self-criticism using a mixed-methods design.

METHOD

People (n = 179) with endometriosis, over the age of 18 years, and living in Australia were recruited using social media. Quantitative measures included the Body Image Acceptance and Action Questionnaire, Eating Disorder Examination Questionnaire 7-item Short Form, Depression Anxiety and Stress Scales, and the Inadequate Self subscale of the Forms of Self-Criticising/Attacking and Self-Reassuring Scale. Participants were also asked two open-ended questions that enabled reflexive thematic analysis of the impact endometriosis has on body image and eating, using Braun and Clarke's six phase process.

RESULTS

Participants were mostly female, heterosexual, White, and had a mean age of 30. The sample demonstrated high levels of eating disorder psychopathology, negative affect, and self-criticism, and low body image flexibility. Thematic analysis yielded three main themes, that were highly consistent with quantitative findings: Body disappointment, Food as an enemy, and Stolen identity and joy.

CONCLUSIONS

This study highlights the need for prevention and intervention efforts focused on reducing eating disorder psychopathology and body image concerns experienced by individuals with endometriosis.

Assessing Obstetrics and Gynecology (OBGYN) Clinicians' Knowledge, Practice, and Attitudes toward Anorexia Nervosa, Atypical Anorexia Nervosa, and Amenorrhea

STUDY OBJECTIVE

Anorexia nervosa (AN) and atypical anorexia nervosa (AAN) are eating disorders (EDs) characterized by extreme restriction of energy intake. However, in contrast to individuals with AN, those with AAN are not underweight. Although individuals with either AN or AAN can experience associated functional hypothalamic amenorrhea (FHA) that may prompt them to seek gynecologic care, little is known about obstetricians' and gynecologists' (OBGYNs') knowledge and approach to these patients; this study sought to fill this gap.

METHODS

A total of 119 OBGYNs read vignettes describing an underweight patient with AN and a normal-weight patient with AAN presenting with FHA. The OBGYNs then responded to items assessing their approaches, knowledge, and attitudes toward patients with amenorrhea and EDs more broadly.

RESULTS

The participants ranked FHA as significantly more likely in the underweight vignette than in the normal-weight vignette. The participants reported that they more frequently ask about weight, eating, exercise, and body image in underweight patients with amenorrhea relative to patients who are normal weight or overweight. Overall, the participants demonstrated low knowledge of AN and AAN and reported less familiarity with AAN.

CONCLUSION

OBGYNs may be less likely to identify FHA and assess for an ED in non-underweight patients with secondary amenorrhea. Therefore, patients with AAN having complications of malnutrition may be less likely to be properly evaluated and treated. Future research should investigate educational interventions that aim to improve OBGYN assessment and management of patients of varying weights who have EDs .

Peripheral mitochondrial DNA as a neuroinflammatory biomarker for major depressive disorder

In the pathogenesis of major depressive disorder, chronic stress-related neuroinflammation hinders favorable prognosis and antidepressant response. Mitochondrial DNA may be an inflammatory trigger, after its release from stress-induced dysfunctional central nervous system mitochondria into peripheral circulation. This evidence supports the potential use of peripheral mitochondrial DNA as a neuroinflammatory biomarker for the diagnosis and treatment of major depressive disorder. Herein, we critically review the neuroinflammation theory in major depressive disorder, providing compelling evidence that mitochondrial DNA release acts as a critical biological substrate, and that it constitutes the neuroinflammatory disease pathway. After its release, mitochondrial DNA can be carried in the exosomes and transported to extracellular spaces in the central nervous system and peripheral circulation. Detectable exosomes render encaged mitochondrial DNA relatively stable. This mitochondrial DNA in peripheral circulation can thus be directly detected in clinical practice. These characteristics illustrate the potential for mitochondrial DNA to serve as an innovative clinical biomarker and molecular treatment target for major depressive disorder. This review also highlights the future potential value of clinical applications combining mitochondrial DNA with a panel of other biomarkers, to improve diagnostic precision in major depressive disorder.

Life expectancy associated with specific mental disorders and the contribution of causes of death: a population-based study in the region of Catalonia

There is strong evidence that people with mental disorders have a premature mortality, with physical diseases, as well as suicide, accounting for it in large part. However, there is a lack of studies focused on common mental disorders in Southern Europe. This study aims to calculate the reduction in life expectancy for different mental disorders according to all-cause mortality and for specific causes of death using national registers from Catalonia (Spain). This population register-based study includes clinical information on all adults over 18 years of age using the Catalan public healthcare system from January 2005 to December 2016 (355,540 females and 182,529 males with mental disorders). Mental disorders were classified into eleven categories, and causes of death were grouped as natural and unnatural and then further divided into nine groups. For each disorder, the life-years lost were estimated for all-cause mortality and for each specific cause of death in males and females. All mental disorders showed a shorter remaining life expectancy after diagnosis than the reference population of the same age. The disorders associated with the largest reduction in life expectancy were alcohol and drug dependence and abuse, and schizophrenia. Natural causes and, to a lesser extent, suicide, were the predominant contributors to excess mortality for all types of mental disorders. Our findings suggest that mental disorders are associated with premature mortality in Catalonia. Furthermore, natural causes are the primary contributors to premature mortality, indicating the need for better management of medical conditions in this population.

Suicidal ideation and avoidant/restrictive food intake disorder: Findings from the ARFID-GEN study

This study examined the prevalence of suicidal ideation (SI) among adults with avoidant/restrictive food intake disorder (ARFID) across different demographic groups and explored associations between SI and specific ARFID dimensions. The sample included 3299 adults who screened positive for ARFID using two validated scales. SI over the past two weeks was assessed using item 9 from the Patient Health Questionnaire-9. The overall prevalence of SI was 22.9 %, with a higher prevalence among transgender and gender-diverse (TGD) individuals (34.7 %) compared to cisgender men (17.8 %) and cisgender women (16.8 %). Participants with SI (mean = 27.6 years, SD = 10.1) were younger than those without SI (mean = 32.3 years, SD = 13.4). The ARFID dimensions picky eating/sensory-based avoidance and low appetite/lack of interest in eating or food were positively associated with SI; however, these associations became non-significant after adjusting for age, gender, and depression. Interestingly, fear/concern about aversive consequences was significantly negatively associated with SI after adjusting for covariates. Our results suggest that the fear presentation of ARFID may be a distinct subtype with a lower risk of suicidality compared to other presentations, highlighting the importance of comprehensively evaluating ARFID dimensions and underlying depressive symptoms to better address the risk of suicidality.

Psychological intervention in individuals with subthreshold depression: individual participant data meta-analysis of treatment effects and moderators

BACKGROUND

It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.

AIMS

To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.

METHOD

Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment-covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.

RESULTS

IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = -0.48 to -0.27). Effects could not be ascertained up to 24 months (s.m.d. = -0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27-2.79), reliable improvement (relative risk = 1.38-3.17), deterioration (relative risk = 0.67-0.54) and close-to-symptom-free status (relative risk = 1.41-2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = -0.33 for PHQ-9 = 5).

CONCLUSIONS

Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.

Different genetic liabilities to neuropsychiatric conditions in suicides with no prior suicidality

Importance

Though suicide attempt is the most robust predictor of suicide death, few who attempt go on to die by suicide (<10%), and ∼50% of all suicide deaths occur in the absence of evidence of prior attempts. Risks in this latter group are particularly poorly understood.

Objective

Data from the Utah Suicide Mortality Risk Study (USMRS) were used to study underlying polygenic liabilities among suicide deaths without evidence of prior nonfatal suicidal thoughts or behaviors (SD-N) compared to suicide deaths with prior nonfatal suicidality (SD-S).

Design

We used an analysis of covariance design, comparing SD-N to SD-S and to population controls with similar genetic ancestry from the United Kingdom.

Setting

We selected 12 source studies to generate descriptive quantitative polygenic scores (PGS) reflecting neuropsychiatric conditions. Analysis of covariance was used to evaluate suicide mortality subsets and controls adjusted for sex, age, and genetic ancestry effects.

Participants

Suicide deaths were population-ascertained through a 25-year collaboration with the Utah State Office of the Medical Examiner. Evidence of suicidality was determined from diagnoses and clinical notes, yielding 1,364 SD-N and 1,467 SD-S deaths, compared to 20,368 controls.

Main Outcomes

The tested PGS spanned 12 psychiatric, neurodevelopmental, and neurodegenerative conditions.

Results

SD-N were significantly more male (82.33% vs. 67.76%) and older at death (47.26 years vs. 41.36 years) than SD-S. Controls were significantly less male than both suicide subsets (43.71%). Genetic ancestry was similar across suicide subsets and controls (% European: 96.77%, 96.81%, and 97.38%). Comparing SD-N to SD-S revealed significantly lower PGS in SD-N for: MDD (p=0.0015), neuroticism (p=0.0016), anxiety (p=0.0048), Alzheimer's (p=0.011), depressed affect (p=0.015), schizophrenia (p=0.020), PTSD (p=0.023), and bipolar disorder (p=0.028). This attenuation in SD-N was particularly pronounced for depressed affect, neuroticism, and Alzheimer's, where PGS were not different from controls. Sex-specific analyses suggested attenuation of PGS in SD-N was driven by males for MDD, anxiety, and PTSD, and by females for bipolar disorder, neuroticism, and Alzheimer's.

Conclusions and Relevance

SD-N have significantly different genetic liabilities from SD-S, particularly regarding neuropsychiatric conditions. Results have far-reaching implications both for future research and for preventions for those at highest risk of mortality.

KEY POINTS

Question

What are underlying genetic liabilities related to neuropsychiatric conditions in the roughly half of suicide deaths with no evidence of prior nonfatal suicidal thoughts or behaviors (SD-N), a group that has not previously been accessible for study?

Findings

These suicide deaths with no prior nonfatal suicidality showed significantly attenuated underlying polygenic liabilities associated with mental health traditionally thought to be core features of suicide mortality risk, and justifies additional studies of underlying risks associated with non-psychiatric conditions and behaviors.

Meaning

These differences in underlying liabilities between suicide deaths with and without prior suicidality suggest departure from the traditional mental health risks that have been the focus of suicide risk discovery, and impel new directions for future research and prevention efforts.

Virtual Versus In-Person Intensive Outpatient Treatment for Eating Disorders During the COVID-19 Pandemic in United States-Based Treatment Facilities: Naturalistic Study

BACKGROUND

While virtual therapy has proven effective in treating eating disorders (EDs), little work has examined virtual therapy at higher levels of care, which are treatment options providing more support than weekly outpatient therapy including intensive outpatient (IOP) treatment.

OBJECTIVE

This study aimed to add to the limited research on in-person versus virtual treatment at a higher level of care by comparing treatment outcomes between an in-person IOP and a virtual IOP (VIOP) for patients with EDs. We hypothesized that there would be no differences in improvements between VIOP and in-person IOP groups.

METHODS

This study has a nonrandomized multiple cohort design. Patients with EDs receiving treatment who completed both admission and discharge questionnaires in VIOP treatment (n=231) and in-person IOP treatment (n=39) between 2021 and mid-2022 within a large ED health care system in the United States were included. The Eating Disorder Examination-Questionnaire (EDE-Q) was used to measure ED symptoms. The Patient Health Questionnaire-9 (PHQ-9) was used to measure depression, and item 9 of the PHQ-9 was used to measure suicidal ideation. Welch t tests on admission, discharge, and raw change scores were conducted. Logistic regressions were conducted predicting treatment program (reference group VIOP vs in-person IOP) from the residualized change in each outcome and were adjusted for all significantly different factors between groups.

RESULTS

VIOP patients were significantly older (mean 28.03, SD 11.09) than in-person IOP patients (mean 19.51, SD 6.98) and displayed significantly different numbers of ED diagnoses and more comorbid psychiatric diagnoses (VIOP: mean 1.23, SD 1.12; in-person IOP: mean 0.33, SD 0.84) but no differences in race (VIOP: 175/231, 75.6% White; in-person IOP: 30/39, 76.9% White), gender (VIOP: 196/231, 84.8% female; in-person IOP: 35/39, 89.7% female), or length of stay (VIOP: mean 58.84, SD 26.69; in-person IOP: mean 57.33, SD 19.67). When compared to in-person IOP patients, controlling for age, diagnosis, number of comorbid diagnoses, and admission scores, VIOP patients did not exhibit significantly different improvements in ED symptom scores (EDE-Q Global: b=0.01, SE 0.18, t=0.04, odds ratio [OR] 1.01, 95% CI 0.71-1.43; P=.97). However, VIOP patients exhibited significantly greater improvements in depression scores (PHQ-9: b=-0.14, SE 0.05, t230=-2.85, OR 0.87, 95% CI 0.79-0.96; P=.004) and the PHQ-9 suicidal ideation item (PHQ-9 item 9: b=-0.72, SE 0.34, t230=-2.13, OR 0.49, 95% CI 0.25-0.93; P=.03).

CONCLUSIONS

ED outcomes were similar for VIOP and in-person IOP patients. Contrary to our hypotheses, depression and suicidal ideation outcomes improved more for VIOP patients than for in-person IOP patients. Furthermore, treatment access for non-White and older adults does not appear descriptively worse for VIOP treatment compared to in-person IOP treatment, though these trends should be further explored. VIOP treatment may improve treatment access in an equitable fashion without reducing treatment quality.

Using effective connectivity-based predictive modeling to predict MDD scale scores from multisite rs-fMRI data

BACKGROUND

Major depressive disorder (MDD) is a severe mental illness, and the Hamilton Depression Rating Scale (HAMD) is commonly used to quantify its severity. Our aim is to develop a predictive model for MDD symptoms using machine learning techniques based on effective connectivity (EC) from resting-state functional magnetic resonance imaging (rs-fMRI).

NEW METHOD

We obtained large-scale rs-fMRI data and HAMD scores from the multi-site REST-meta-MDD dataset. Average time series were extracted using different atlases. Brain EC features were computed using Granger causality analysis based on symbolic path coefficients, and a machine learning model based on EC was constructed to predict HAMD scores. Finally, the most predictive features were identified and visualized.

RESULTS

Experimental results indicate that different brain atlases significantly impact predictive performance, with the Dosenbach atlas performing best. EC-based models outperformed functional connectivity, achieving the best predictive accuracy (r = 0.81, p < 0.001, Root Mean Squared Error=3.55). Among various machine learning methods, support vector regression demonstrated superior performance.

COMPARISON WITH EXISTING METHODS

Current phenotype score prediction primarily relies on FC, which cannot indicate the direction of information flow within brain networks. Our method is based on EC, which contains more comprehensive brain network information and has been validated on large-scale multi-site data.

CONCLUSIONS

Brain network connectivity features effectively predict HAMD scores in MDD patients. The identified EC feature network may serve as a biomarker for predicting symptom severity. Our work may provide clinically significant insights for the early diagnosis of MDD, thereby facilitating the development of personalized diagnostic tools and therapeutic interventions.

Potential Harm in the Psychological Treatment of Sexual and Gender Minority Youth

Sexual and gender minority (SGM) individuals show disproportionately high rates of mental distress relative to their cisgender, heterosexual peers resulting from minority stress, or unique identity-related stressors. The majority of research on minority stress and mental health in SGM individuals has focused on adults, a notable gap given that SGM youth face unique developmental factors that intersect with identity development and availability of support resources. SGM youth therefore represent a critical population for the mental health workforce to serve competently. Mental health providers risk significant harm to their SGM youth clients if they do not understand the mechanisms underlying mental health disparities in this population. This article will review treatment practices that carry the potential for harm with SGM youth, including harms that are more overt and attempt to change SGM identities (i.e., so-called "conversion therapies"), and others that are more covert, such as neglecting to consider SGM identity in conceptualization and treatment (e.g., eating disorders), pathologizing SGM identity and behaviors (e.g., personality disorders, social anxiety), and reinforcing stigma related to SGM identities (e.g., obsessive-compulsive disorder). Accordingly, this article reviews each of these potential harms in detail and provides alternative recommendations for affirming and justice-based treatment for SGM youth.

Electrocortical Profiles in Relation to Childhood Adversity and Depression Severity: A Preliminary Report

Objective: Assessment of electroencephalographic (EEG) activity in depression has provided insights into neural profiles of the illness. However, there is limited understanding on how symptom severity and risk factors, such as childhood adversity, influence EEG features. Methods: Eyes-closed EEG was acquired in N = 28 depressed individuals being treated in a tertiary psychiatric setting. Absolute alpha, beta, theta, and delta power and inter-/intra-hemispheric coherence were examined. Relations between the Montgomery-Åsberg Depression Scale (MADRS) and Adverse Childhood Experience (ACE) Questionnaire and EEG features were assessed. Results: Individuals in the high (MADRS≥30) versus lower (MADRS ≤ 29) symptom severity group exhibited greater overall beta power, and lower Fp1-Fp2 delta and theta coherence. Those with high (≥3) versus lower (≤2) ACE scores exhibited greater T7-T8 beta coherence. Lowest F3-F4 beta coherence was observed in those with high ACE/high depression severity. A negative correlation existed between F8-P8 alpha coherence and symptom severity. Conclusions: Those with higher depression severity exhibit increased beta power, possibly reflecting a hyper-vigilant state. Depression severity and ACE history may produce subtle alterations in frontal delta/theta and temporal/frontal beta coherence regions. Significance: This is the first study to examine the neural impact of depression severity and ACE-assessed childhood trauma in depressed individuals receiving treatment in a tertiary setting, accounting for the clinical reality of the prevalence of their co-occurrence.

Outcomes of an organisational change program aimed at increasing smoking cessation support within Australian community managed mental health organisations: A cluster randomised controlled trial

AIM

To test the effectiveness of an organisational change intervention aimed at increasing the offer of nicotine replacement therapy (NRT) in community managed mental health organisations.

DESIGN

A pragmatic cluster randomised controlled trial with cluster as the unit of randomisation and six- and nine-month follow-up from baseline.

SETTING

Twelve clusters comprising 26 sites providing community based, psychosocial support to people with severe mental illness in New South Wales, Australia, were randomised to control (n = 13 sites, n = 118 consumers) or intervention (n = 13 sites, n = 139 consumers) arms between 2018 and 2019.

PARTICIPANTS

Eligible consumers (aged 16 years and older; self-reported daily or occasional cigarette use) completed surveys at baseline (n = 257) and at six- (n = 162, 63%) and nine-month follow-up (n = 144, 56%).

INTERVENTION

The intervention included a financial grant, face-to-face and on-line training and proactive monthly support to guide implementation. The active control condition included on-line training and generic, scheduled support via email.

MEASUREMENTS

The primary outcome was whether consumers reported receiving an offer of NRT at nine-month follow-up. Secondary outcomes at the consumer, staff and organisational level were also measured.

FINDINGS

Consumers in the intervention group had statistically significantly higher odds of being offered NRT at nine-month follow-up compared with control (intention to treat missing = no offer: 38% versus 7%, odds ratio 5.72, 95% confidence interval = 2.2, 14.9). There were no statistically significant differences in seven-day point prevalence or continuous abstinence at six- or nine-month follow-ups.

CONCLUSIONS

An organisational change-based program led to an increase in the offer of nicotine replacement therapy (NRT) nine months after program initiation in community managed mental health organisations, compared with active control. There was evidence of greater NRT use in the intervention condition at nine months but no evidence of differences on abstinence measures at six or nine months.

Absence of nonfatal suicidal behavior preceding suicide death reveals differences in clinical risks

Nonfatal suicidal behavior is the most robust predictor of suicide death. However, only ∼10 % of those who survive an attempt go on to die by suicide. Moreover, ∼50 % of suicide deaths occur in the absence of prior known attempts, suggesting risks other than nonfatal suicide attempt need to be identified to help prevent suicide mortality. We studied data from 4,000 population-ascertained suicide deaths and 26,191 population controls to improve understanding of suicide deaths without prior nonfatal attempts. This study included 2,253 suicide deaths and 3,375 controls with evidence of nonfatal suicidal ideation or behaviors (SUI_SI/SB and CTL_SI/SB) from diagnostic codes and natural language processing of electronic health records notes. Characteristics of these groups were compared to 1,669 suicides with no prior nonfatal SI/SB (SUI_None) and 22,816 controls with no lifetime suicidality (CTL_None). The SUI_None and CTL_None groups had fewer overall diagnoses and were older than SUI_SI/SB and CTL_SI/SB. Mental health diagnoses were far less common in both the SUI_None and CTL_None groups; mental health problems were far less associated with suicide death than with presence of SI/SB. Physical health diagnoses were conversely more often associated with risk of suicide death than with presence of SI/SB. Pending replication, results indicate highly significant clinical differences among suicide deaths with versus without prior nonfatal SI/SB, and suggest that, for a substantial number of individuals at risk for suicide mortality, history of SI/SB does not serve as an effective clinical marker of risk.

Altered Gut Microbiota and Plasma Metabolome Profiles Characterize Depression Individuals with Ischemic Stroke: A Comparative Analysis

Purpose

Depression has been recognized as a significant risk factor for ischemic stroke (IS). This study aimed to describe gut microbiota differences between depression people with and without IS, thereby establishing the link between gut microbiota and an elevated risk of IS development in people with depression.

People and Methods

This study included 30 hospitalized patients with comorbid depression and IS, and 30 age-/sex-matched patients with depression alone. We used two approaches: (1) genetic analysis techniques (16S rRNA gene sequencing) to map gut microbial ecosystems, and (2) broad-spectrum chemical (nontargeted metabolomics) analysis to detect blood metabolites.

Results

Alpha (α)-diversity and beta (β)-diversity of people with depression, with or without IS, did not show significant differences between the two groups. The IS group showed increased levels of gut bacteria carrying pro-inflammatory molecules, specifically Gram-negative Enterobacteriaceae containing lipopolysaccharide (LPS) components, the Linear discriminant analysis (LDA) value =4.177, P=0.014. Alongside, the IS group reduced populations of beneficial microbes that produce butyric acid important for gut health, such as Acidaminococcaceae (LDA value =4.045, P=0.014), Roseburia (LDA value =3.894, P=0.007), and Fusicatenibacter (LDA value =3.345, P=0.012), compared to the non-IS group. 38 plasma metabolites with significant differences between people with IS and non-IS groups. The abundance of Alloprevotella and Bacteroides massiliensis was correlated with 9 and 4 metabolites, respectively.

Conclusion

This study highlighted that people with depression and IS exhibited distinct alterations in both their gut microbiome and metabolite profiles, in contrast to people with depression without IS. These findings may guide future interventions targeting gut microbiota to identify IS in depression people.

Association between telomere length and psychiatric disorders: a bidirectional Mendelian randomization study

Observational studies have suggested that shorter telomere length (TL) may be a risk factor for psychiatric disorders. However, whether this association underlie causal effects remains unknown. This study aims to investigate the potential association between TL and psychiatric disorders by conducting a bidirectional Mendelian randomization (MR) study. Summary statistics for TL were obtained from the UK Biobank (n = 472,174), while summary statistics for ten psychiatric disorders were acquired from the Psychiatric Genomics Consortium (PGC). The inverse-variance weighted (IVW) method was used as primary analysis, with the MR-Egger, weighted median, MR-PRESSO, simple mode, and weighted mode approaches were utilized as sensitivity analyses. Our findings indicated a potential association between genetic predisposition to attention deficit hyperactivity disorder (ADHD) and shortened TL (Beta = - 0.039, SE = 0.011, P = 4.00E-04). Additionally, posttraumatic stress disorder (PTSD) may be was potentially associated with TL (Beta = - 0.014, SE = 0.006, P = 0.019). Our findings suggest a potential correlation between ADHD and TL, yet no significant association exists between TL and other psychiatric disorders. Nevertheless, considering the small effect size and the fact that it might have limited practical clinical significance, TL may not function as a biomarker for psychiatric disorders.

Perspectives on a transitional housing program for people who use substances who experience homelessness and live with a mental health issue: a pilot study in an urban northern city in Canada

BACKGROUND

A new transitional housing program was established in Sudbury, Ontario, Canada, in response to the escalating prevalence of substance use and homelessness, and the specific challenges faced in Northern Ontario. There is a scarcity of research investigating the implementation of housing programs with clinical, social, and functional support for people with substance use in Northern settings in the era of Fentanyl and its analogs and a contaminated dangerous drug supply. To bridge this knowledge gap, we evaluated a unique harm reduction-focused transitional housing program. Our study objectives encompassed exploring patients' viewpoints on considerations when implementing a transitional housing program for people with substance use and mental disorders.

METHODS

This is a qualitative interview study of 12 clients from a transitional housing program that offers comprehensive health and social assistance through addiction medicine, psychiatric consultation, primary care, and harm reduction services to clients in a transitional housing program in an Urban setting in Northern Canada. This study was a pilot project, to gather their perspectives on the care provided by the team. Maslow's Hierarchy of Needs was used to contextualize the data.

RESULTS

Participants emphasized the importance of the program's housing first approach, its positive impact on accessing health and social services, and the increase in sense of belonging, self-esteem, and confidence because of being in the program. Participants also indicated that the program had a positive overall impact, leading to reduced substance use, improved mental and emotional well-being, and enhanced socio-economic conditions. However, several considerations were highlighted as important for ensuring the effectiveness of the program, such as better aligning client and program expectations, facilitating access to community supports with food, support with medication regimen, providing empathetic engagement, and individualizing approaches to care.

CONCLUSION

A new transitional housing program in a Northern Urban setting in the era of an increasingly contaminated drug supply led to perceived positive outcomes for clients. Important considerations include focusing (or enhancing supports) on physiological needs and empathetic, individualized approaches to care.

Neurobiology and Cognition in Girls at High-Risk of Eating Disorders: Exploring Imaging-Derived Trait Markers

BACKGROUND

Eating disorders (EDs) are serious psychiatric disorders characterized by impairments in neurocognition and altered brain structure. To date the majority of studies have investigated these in acutely ill or recovered individuals. Studying children at familial high risk (FHR) for psychiatric disorders allows investigating vulnerability traits or trait markers that may be present before disorder onset. Our study is the first one to examine executive function and brain structure in girls at FHR for ED (Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder) compared to controls (girls not at familial high risk - HC).

METHODS

Forty-six (46) FHR girls (median age: 10.5 years, range: 9) and 50 HC girls (median age: 12 years, range: 8) completed a battery of neuropsychological tests assessing cognitive flexibility, inhibitory control, and working memory. Structural magnetic resonance imaging assessed grey matter volume (GMV) and cortical thickness (CT).

RESULTS

Girls at FHR for ED performed a higher number of errors in a cognitive flexibility task compared to HC (β = 0.15, p < 0.05). They also had increased GMV in posterior regions such as the right supramarginal gyrus, middle occipital gyrus, and lingual/fusiform gyrus compared to HC (p < 0.05 cluster-level FWE-corrected), as well as increased CT in the left transverse pole (p < 0.001) and right posterior cingulate cortex (p < 0.05).

CONCLUSIONS

Girls at FHR show characteristic neurocognitive performance similar to that seen in individuals with ED, as well as differences in brain structure compared to HC. Our findings, together with previous evidence, highlight impairment in cognitive flexibility as a possible trait marker of ED. Further longitudinal studies are needed to confirm differences in GMV and CT identified in this study.

Clinician Perceptions of the Stereotype Content Describing People With Eating Disorders: A Weight-Inclusive Perspective

OBJECTIVE

Eating disorder stigma is influenced by body size in ways that may cultivate a particularly disadvantageous therapeutic milieu. The present study applied the stereotype content model to investigate the perceptions of mental health providers toward people with eating disorders and a range of eating behaviors, and how these perceptions vary by body size.

METHOD

Using a within-participants design, mental health providers (N = 361) were presented with brief descriptions of 12 groups and asked questions about their perceived warmth and competence: People with anorexia nervosa, bulimia nervosa, orthorexia nervosa, and binge eating disorder; fat people with atypical anorexia nervosa, bulimia nervosa, orthorexia nervosa, and binge eating disorder; dieters; fat dieters; intuitive eaters; and fat intuitive eaters.

RESULTS

All fat groups were perceived as less competent than their general counterparts. Fat people with atypical anorexia nervosa were perceived as warmer than people with anorexia nervosa, whereas fat intuitive eaters were perceived as less warm than intuitive eaters. Cluster analysis yielded three clusters: (1) a higher-competence, higher-warmth cluster, representing intuitive eaters; (2) a higher-competence, lower-warmth cluster, representing people with anorexia nervosa, bulimia nervosa, orthorexia nervosa, and dieters; and (3) a lower-competence, mid-warmth cluster, representing people with binge eating disorder and all fat groups.

DISCUSSION

The stereotype content model offers a useful framework to understand mental health providers' warmth and competence perceptions of people with a range of eating disorders and behaviors. Competence and warmth perceptions are shaped by body size and the restrictiveness of eating disorders and behaviors.

Factors Associated with Weight Change in Adults with Severe Mental Illness: Results from a Large Cross-Sectional Survey

Background/objectives: Individuals with severe mental illness (SMI) have a reduced life expectancy of 15-25 years. This is due to a number of modifiable and non-modifiable risk factors. Levels of overweight and obesity in this group are 1.8 times higher than in the general population and diet quality is poor. Excess weight is linked to a range of serious long-term physical and mental health conditions. This paper presents the findings of a large cross-sectional survey of adults living with SMI. The survey aimed to understand the current weight, weight gain and diet quality of this group and secondly, to explore the association between weight change, diet quality, antipsychotic medication and weight management. Methods: Five hundred and twenty-nine participants (58% male, mean age 49.3) living with SMI completed the survey. Results: Results showed 42% of the sample were living with obesity and almost half reported having gained 6 kg or more at least once in their adult life. Overall, 6% of the sample reported eating no fruit or vegetables and the same proportion had the highest consumption of carbonated drinks. There was no difference by weight category. Those taking antipsychotic medication and currently managing their weight were more likely to experience weight gain or fluctuation. Conclusions: These results suggest that excess weight and poor diet quality are a major problem in adults with SMI and that current weight management provision is ineffective in addressing the specific needs of people living with SMI.

Developing Digital Mental Health Tools With Culturally Diverse Parents and Young People: Qualitative User-Centered Design Study

BACKGROUND

Approximately 39% of young people (aged 16-24 y) experience mental ill health, but only 23% seek professional help. Early intervention is essential for reducing the impacts of mental illness, but young people, particularly those from culturally diverse communities, report experiencing shame and stigma, which can deter them from engaging with face-to-face services. Digital mental health (DMH) tools promise to increase access, but there is a lack of literature exploring the suitability of DMH tools for culturally diverse populations.

OBJECTIVE

The project was conducted in partnership with a large-scale national DMH organization that promotes evidence-based early intervention, treatment, and support of mental health in young people and their families. The organization wanted to develop a self-directed web-based platform for parents and young people that integrates psychological assessments and intervention pathways via a web-based "check-in" tool. Our project explored the views of culturally diverse parents and young people on the opportunities and barriers to engagement with a web-based DMH screening tool.

METHODS

We conducted a 2-phase qualitative study aiming to identify potential issues faced by culturally diverse communities when engaging with DMH tools designed for the Australian public. We worked with 18 culturally diverse participants (parents: n=8, 44%; young people: n=10, 56%) in a series of design-led workshops drawing on methods from speculative design and user experience to understand the opportunities and barriers that organizations might face when implementing population-level DMH tools with culturally diverse communities. NVivo was used to conduct thematic analyses of the audio-recorded and transcribed workshop data.

RESULTS

Five themes were constructed from the workshops: (1) trust in the use and application of a DMH tool, (2) data management and sharing, (3) sociocultural influences on mental health, (4) generational differences in mental health and digital literacy, and (5) stigma and culturally based discrimination in mental health support.

CONCLUSIONS

The emergent themes have important considerations for researchers wishing to develop more inclusive DMH tools. The study found that healthy parent-child relationships will increase engagement in mental health support for young persons from culturally diverse backgrounds. Barriers to engagement with DMH tools included culturally based discrimination, the influence of culture on mental health support, and the potential impact of a diagnostic label on help seeking. The study's findings suggest a need for culturally safe psychoeducation for culturally diverse end users that fosters self-determination with tailored resources. They also highlight important key challenges when working with culturally diverse populations.

Evaluating the acceptability and effectiveness of a french safety planning type interventions protocol, a post suicide attempt intervention

Death by suicide affects approximately 800,000 people per year worldwide, and a history of suicide attempt is the primary risk factor for future suicide. Safety Planning-Type Interventions (SPTI) is a brief intervention, validated by the Stanley team, as a strategy for preventing suicidal reoccurrence. The aim of this study is to evaluate the feasibility of this management by healthcare professionals and the acceptability by patients in suicidal crisis in a French post-emergency department setting. This was an observational cross-sectional study. A selected sample of 80 participants, who received the SPTI, completed a semi-structured interview comprising open-ended questions about the acceptability of the intervention. Feasibility was assessed by the possibility of implementing the intervention according to healthcare professionals. 94% of participants agreed to receive the SPTI. Participants seemed to find the safety plan acceptable in the majority of cases (with a satisfaction rate of 85.1%), and they believed that this intervention could be useful in the future in 81.1% of cases. Regarding the professionals, they appeared to find the intervention feasible, with a satisfaction rate of 80.5%. Finally, the presence of depressive symptoms seemed to be the only clinical parameter that could negatively influence the patient's acceptability of the intervention, and the presence of alcohol dependency symptoms affected its feasibility. The SPTI is a validated brief intervention in suicidal crisis for the prevention of recurrence. This study demonstrates feasibility and acceptability in the French population.

The causal relationship between six mental disorders and breast cancer risk: A two-sample Mendelian randomization study

Psychological disorders such as schizophrenia, bipolar disorder (BD), major depressive disorder (MDD), attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and anxiety disorder (AD) are widespread. Mendelian randomization (MR) was used in this study in order to investigate possible causal relationships between psychiatric disorders and breast cancer (BC). We employed publicly accessible summary statistics from extensive genome-wide association studies to identify, perform quality control, and cluster genetic variant loci linked to schizophrenia, ADHD, MDD, ASD, BD, AD, and BC as instrumental variables. The MR analysis utilized inverse variance weighting, MR-Egger regression, and weighted median estimation to assess the causal links between psychiatric disorders and BC. Additionally, heterogeneity and sensitivity tests were conducted to ensure the robustness of inverse variance weighting results. According to the results of the two-sample MR analysis, schizophrenia, BD, MDD, ADHD, ASD are not causally linked to BC. According to the results of the two-sample MR analysis, schizophrenia, BD, MDD, ADHD, ASD are not causally linked to BC. But there is a causal relationship between AD and BC. The MR analysis showed no evidence of a causal relationship between schizophrenia, BD, MDD, ADHD, ASD, and BC risk. However, research found a genetic causal relationship between AD and BC, and it is positively correlated.

The curvilinear relationship between hepatic steatosis index and depression: Findings from the NHANES

BACKGROUND

Previous studies have established a link between depression and fatty liver disease, yet the relationship with the Hepatic Steatosis Index (HSI) has not been thoroughly investigated. This study aims to explore the potential association between HSI and depression.

METHODS

We investigated the association between HSI and depression (PHQ-9 depression score ≥ 10) using a weighted multiple logistic regression model and stratified analysis. Non-linear associations were explored using fitted smooth curves. A recursive method was employed to identify inflection points and construct a two-part linear regression model. Subgroup analysis was conducted to examine the differences in this association within various subgroups.

RESULTS

Our study included 43,888 participants. The mean HSI was 37.06, with a range of 0 to 135.92. Multivariate logistic regression analysis, showed that the OR for the association between HSI and depression was 1.02 (95 % CI: 1.01, 1.02). This means that there is 2 % increase likelihood of depression for each unit increase in HSI. A nonlinear relationship was observed, with an inflection point identified at an HSI value of 29.72, indicating a negative correlation below the threshold and a positive correlation above it. Stratified analysis indicated that, aside from participants with BMI ≥ 30 who displayed a linear positive association, HSI showed a curvilinear association with depression in other groups are similar to that observed in the overall sample. In subgroup analyses, statistically significant interactions were observed between HSI and depression within groups defined by education level and smoking status.

CONCLUSION

We found a curvilinear relationship between HSI and Depression.

Association between greenness and suicide attempts in patients with depression: A nationwide longitudinal cohort study

BACKGROUND

Although multiple emerging studies have suggested the relationship between greenness and mental health, evidence regarding associations among green space, suicide attempts, and depression is still limited. In this study, we aimed to estimate the association of greenness with suicide attempts in patients with depression.

METHODS

This study used the National Health Insurance Service database in South Korea to construct a cohort of patients diagnosed with depression during 2012-2013 (n = 677,498) with an 8-year follow-up period. Residential greenness was measured as the district-level annual average of the Enhanced Vegetation Index. The primary outcome was the suicide attempt, and categorized suicide attempts (non-violent and violent methods) were also examined. A Cox regression with time-varying variables was performed to assess the association between greenness and suicide attempts, and stratified analyses were conducted by sex, age, insurance premium, and disability status.

RESULTS

A higher level of greenness was associated with lower suicide attempts among patients with depression (HR: 0.789; 95% CI: 0.677, 0.918). The protective association was higher for suicide attempts by violent methods (HR: 0.733; 0.545, 0.987) than non-violent methods (HR: 0.812; 0.680, 0.970), based on point estimates. Among patients with depression, males, individuals aged 35-64 years, and Medical Aid beneficiaries showed a more prominent association with greenness.

CONCLUSIONS

This nationwide cohort study provides epidemiological evidence for the benefits of residential greenness in reducing suicide among patients with depression and suggests the appropriateness of public health policies for increasing green spaces.

Association between depressive symptoms and premature death: An exploratory mediation analysis via mitochondrial function

BACKGROUND

Depression is a common mental health issue that can lead to various physical and psychological diseases. However, the relationship between depressive symptoms and premature death remains unclear.

METHODS

In this study, we used data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014 to assess the relationship between depressive symptoms and premature mortality and the potential influence of mitochondrial function on this relationship. The Patient Health Questionnaire-9 (PHQ-9) was used to assess the severity of depressive symptoms. Mortality data were obtained from the National Death Index (NDI). Mitochondrial function was assessed by measuring methylmalonic acid (MMA) levels. Multivariate logistic regression was used to assess the association between depressive symptoms and premature mortality, controlling for demographic, lifestyle, and disease-related factors. Restricted cubic splines were plotted, and propensity score matching (PSM) was used to create balanced groups. Finally, mediation analysis was performed to investigate the mediating role of MMA in the association between depressive symptoms and premature mortality.

RESULTS

This study included a total of 6599 participants. The results showed a substantial positive association (odds ratio [OR] = 1.452; 95 % confidence interval [CI], 1.038-2.031; p < 0.05) between depressive symptoms and premature mortality. The significance of this relationship was maintained after PSM analysis (OR = 2.370; 95 % CI, 1.749-3.212; p < 0.01). Mediation analysis showed that MMA partially mediated this relationship, with a mediation proportion of 4.1 %.

CONCLUSION

This study indicates that depressive symptoms significantly increases the risk of premature death and mitochondrial dysfunction partially mediates this positive relationship. Additional prospective and experimental studies are warranted to verify these findings.

Survival following psychiatric diagnoses in early adulthood

AIMS

To establish the increased all-cause mortality risk after an inpatient episode of care with a diagnosis of a severe psychiatric disorder in young people.

METHODS

The data included all psychiatric inpatient episodes for psychiatric diagnoses in Western Australia between 2005 and 2022 linked with the state death registry. Participants were only included if they turned 18 years of age between 2005 and 2016, so survival from first adult admission until the study end date could be compared with age-gender matched life tables.

RESULTS

A total of 18,893 individuals had an admission with a primary or secondary diagnosis for a selected psychiatric diagnosis in the study period, across which time 485 died. Admission for substance use disorders presented the greatest risk of mortality, increasing the risk of death in early adulthood by more than three times (observed/expected = 3.07; 95% confidence interval = [2.76, 3.42]; p < 0.001), followed closely by bipolar disorders (observed/expected = 2.95; 95% confidence interval = [2.09, 4.03]; p < 0.001), while having any two or more comorbid disorders was associated with an increased death rate (observed/expected = 3.30; 95% confidence interval = [2.72, 3.97]; p < 0.001). The Kaplan-Meier curves also suggested that the proportionate increased risk of mortality remained relatively constant across the study period for all diagnoses.

CONCLUSION

Inpatient admission for psychiatric disorders increased the risk of all-cause mortality in early adulthood by between two and three times and the increased death rate did not substantively reduce over time. Effective long-term support services are needed to reduce the premature mortality observed among these young adults.

Trends and disparities in schizophrenia related mortality in the United States: An analysis of CDC WONDER database, 1999-2020

BACKGROUND

Schizophrenia is a mental health condition that typically begins between ages 18 and 25, significantly impairs daily functioning, ranks among the leading causes of disability worldwide, and is associated with a shortened lifespan. Mortality in schizophrenia is often linked to cardiovascular disease, driven by poor lifestyle choices, limited access to physical healthcare, frequent comorbidities, and non-compliance with antipsychotic medications. This article analyzes mortality trends among U.S. adults aged 35-85 + years with schizophrenia from 1999 to 2020 using CDC Wonder data, contributing valuable insights to the existing literature on this topic.

METHOD

Data from death certificates between 1999 and 2020 were obtained from the CDC WONDER database using ICD-10 code F20 to identify deaths where schizophrenia was listed as a primary or contributing cause, covering all 50 states and the District of Columbia. Demographic data, including race/ethnicity, age, and gender, and information on the place, year, and setting of death-residences, hospices, nursing homes/long-term care facilities, and medical institutions-were collected. We analyzed schizophrenia-related mortality trends in the U.S. from 1999 to 2020. We used the Joinpoint Regression Program (Version 5.1.0, National Cancer Institute) to calculate the annual percent change (APC) and Average Annual Percentage Change (AAPC) in AAMR, along with their 95 % CIs, to identify significant trends over time. Statistical significance was set at P < 0.05.

RESULTS

We identified 80,836 schizophrenia-related deaths, with the highest proportion occurring in nursing homes and long-term care facilities. The overall age-adjusted mortality rate (AAMR) rose from 23.9 in 1999-27.2 in 2020. Notably, the AAMR decreased between 1999 and 2015, with a significant increase from 2015 to 2020.

CONCLUSIONS

This study reveals an increase in the age-adjusted mortality rate (AAMR) for schizophrenia-related deaths among adults from 1999 to 2020, which highlights critical insights for healthcare professionals and policymakers. Further research is needed to identify modifiable factors to reduce morbidity and mortality, potentially easing the burden on healthcare resources and improving the quality of life for those with schizophrenia. Understanding these trends is essential for addressing gaps in the healthcare system and directing resources to areas of greatest need.

Characterizing suicidal thoughts and behaviours in individuals presenting to a psychiatric emergency department: a protocol for a multimethod approach for suicide prevention research

INTRODUCTION

Identifying individuals at risk of suicide remains an ongoing challenge. Previous research investigating risk factors for suicidal thoughts and behaviours (STB) has been informative for assessing suicide risk. However, the complex biological, psychological and sociocultural factors underlying STB have not been comprehensively captured to date, which has limited our understanding of how these factors interact to influence STB. Moreover, acute care settings, such as emergency departments (EDs), are often first points of contact for individuals with STB, highlighting a need for more research in these settings.

METHODS AND ANALYSIS

We aim to (1) characterize a cohort seeking care for STB and their clinical trajectories; (2) situate the cohort by comparing its characteristics and outcomes to other groups seeking emergency care; (3) explore their experiences of seeking care; and (4) examine blood-based biomarkers modulating risk for STB. Using a multimethod, prospective cohort design, we will follow up to 500 people aged 16 or older presenting to the ED with STB at a psychiatric hospital over 1 year. Analyses will involve descriptive statistics and latent profile analysis to characterize the cohort, hypothesis tests and regression models to situate the cohort, qualitative analysis based on a realist research framework to understand experiences, and within-participant comparisons of proteins, mRNA and epigenetic DNA modifications to examine biomarkers of contrasting states of STB.

ETHICS AND DISSEMINATION

This study was approved by the hospital's Research Ethics Board with safeguards in place to ensure the well-being of participants and research team. An integrated knowledge translation approach will be used for dissemination, wherein patient and family advisors are engaged throughout each study phase. Findings will enhance our understanding of the multifactorial nature of suicide risk, inform strategies for prevention and provide important insights into characteristics, experiences and outcomes of individuals with STB, who are under-represented in mental health research.

United States-based practice guidelines for children and adolescents with eating disorders : Synthesis of clinical practice guidelines

INTRODUCTION

Several practice guidelines exist from professional organizations in the United States to support the assessment and management of eating disorders in children and adolescents. This manuscript synthesizes the key areas of overlap from these guidelines and provides directions for future research and alignment to improve care.

RECOMMENDATIONS

Consistent screening for eating disorders in primary care is recommended to ensure early identification and referral to treatment. Outpatient treatment supported by families, including family based treatment, is the first line of care recommended by guidelines. Multidisciplinary treatment teams benefit patients in covering the variety of aspects of health that eating disorders impact, including mental health, nutritional health, and physical health. Patients may require hospitalization under certain medical criteria such as bradycardia or specific lab abnormalities.

CONCLUSIONS

Guidelines show consensus on the importance of early identification and treatment access, involvement of family in treatment, and the use of a multidisciplinary treatment team. However, future work is needed to guide care of Avoidant/Restrictive Food Intake Disorder (ARFID), as well as the impact of weight inclusive care and the development of validated screening tools for children and adolescents for all eating disorders.

Diabetes and suicide: a nationwide longitudinal cohort study among the Japanese working-age population

BACKGROUND

Although the mental health burden of diabetes has received substantial attention, there is limited evidence on whether the risk of suicide-a severe consequence of mental health problems-increases among individuals with diabetes. Therefore, this study investigated the association between diabetes and suicide in Japan.

METHODS

This nationwide longitudinal cohort study included adults aged 18-74 years, who were enrolled in the Japan Health Insurance Association's health insurance programme between 2015 and 2022. Individuals newly diagnosed with diabetes were matched in a 1:1 ratio with those without diabetes, based on age and sex. We employed multivariable Cox proportional hazard models to estimate the hazard ratios for suicide in relation to the diagnosis of diabetes, adjusting for potential confounders, such as sociodemographic characteristics, history of psychiatric disorders, physical measurements, health behaviours and laboratory data.

RESULTS

Among 4 210 272 individuals in the matched-pair cohort, we observed 337 deaths by suicide among those with diabetes and 250 deaths by suicide among those without diabetes. After conditioning on potential confounders, diabetes diagnosis was linked to an increased risk of suicide (HR (95% CI) = 1.25 (1.06 to 1.47)). The association tended to be larger among those aged younger than 40 years and among women (among those aged 18-39 years, HR=1.69 (95% CI 1.05 to 2.73); among women, HR=1.56 (95% CI 0.92 to 2.64)).

CONCLUSION

Diabetes diagnosis may increase suicide risk among the working-age population, even after conditioning on potential confounders. Our findings underscore the importance of psychosocial support following a diagnosis.

Effects of exercise training on cognition in adults with depression: A systematic review and three-level meta-analysis

BACKGROUND

Cognitive impairment is a central feature of depression. Exercise training has enormous potential as a nonpharmacological intervention to improve cognition in depressed individuals.

OBJECTIVE

This review aimed to evaluate and update the effect of exercise training on overall cognition and its subdomains, as well as whether moderators influence the effect of exercise training on cognition in depressed adults.

DESIGN

Systematic review and three-level meta-analysis of randomized controlled trials.

METHODS

We systematically searched Embase, Ovid MEDLINE, Web of Science, PubMed, and Scopus from their inception to February 14, 2024, and updated the search results on December 5, 2024. Randomized controlled trials investigating how exercise training affected cognition in depressed adults were included. The meta-analysis was performed using a random-effects model in R. We used the Physiotherapy Evidence Database scale to evaluate the study's quality.

RESULTS

Twenty-two studies were included. Exercise training showed statistically significant improvements in overall cognition [g = 0.21; 95 % confidence interval (CI) = 0.12, 0.30] and cognitive subdomains of processing speed (g = 0.20; 95 % CI = 0.04, 0.36), attention (g = 0.21; 95 % CI = 0.06, 0.35), memory (g = 0.24; 95 % CI = 0.11, 0.38), and executive function (g = 0.21; 95 % CI = 0.09, 0.33) compared with comparison groups in depressed adults. The greater cognitive benefits were observed when participants exercised twice a week (g = 0.30; 95 % CI = 0.03, 0.56), at a low intensity (g = 0.26; 95 % CI = 0.08, 0.43), spent more than 60 min per session (g = 0.24; 95 % CI = 0.05, 0.44), 150 min or more per week (g = 0.27; 95 % CI = 0.09, 0.45), had a program duration more than 10 weeks (g = 0.25; 95 % CI = 0.12, 0.39), and engaged in mind-body exercise (g = 0.26; 95 % CI = 0.08, 0.43). The clinical setting, sample size, and comparison group for memory moderated the effects of exercise training on cognition.

CONCLUSIONS

Exercise training is an effective nonpharmacological intervention that enhances overall cognition and subdomains of processing speed, attention, memory, and executive function compared with comparison groups in depressed adults. This study only included English-language articles, which may have caused a language bias, and Egger's test revealed a possibility of publication bias.

REGISTRATION NUMBER

CRD42023457900 (PROSPERO).

TWEETABLE ABSTRACT

Exercise training is an effective nonpharmacological intervention for adults with depression to improve overall cognition and cognitive subdomains of processing speed, attention, memory, and executive function compared with comparison groups.

Identification of key genes and pathways in schizophrenia: a bioinformatics analysis based on GWAS and GEO

Introduction

Schizophrenia is a mental illness that is associated with many disorders, such as incoherence of mental activities, and impairment of perception, thinking, emotions, and behavior. Although the exact cause of schizophrenia is unknown, many studies have highlighted the role of genetic background and environmental factors in this disease. Therefore, the identification of key genes involved in schizophrenia provides a promising opportunity to develop novel diagnosis and/or treatment methods. This study aims to investigate schizophrenia-related hub genes by bioinformatics analysis based on genome-wide association (GWAS) and gene expression omnibus (GEO) datasets.

Material and methods

In this study, the GWAS catalog and GEO dataset were used to identify key candidate genes and pathways that are important in the diagnosis and treatment of schizophrenia, and then the results were analyzed using Enrichr and Cytoscape tools.

Result

According to our result NRXN, CACNA1C, and GRIN2A genes had the highest scores in the GWAS analyses and BRCA1, ATM, and STAT1 genes had the highest scores in the GEO dataset. Also, glucuronidation, ascorbate, and aldarate metabolism pathways in the GWAS, PI3K/AKT and Rap1 signaling in the GEO had the highest associations with schizophrenia.

Conclusion

This study highlights the need for further validation of the genes and molecular pathways in schizophrenia. Also, the identified genes could be promising candidates for future diagnostic and/or treatment strategies for schizophrenia.

Diagnostic pathways and mortality across psychotic disorders: Evidence from Catalonia integrated health records

INTRODUCTION

Although psychotic disorders are associated with significant morbidity and mortality, the diagnostic trajectories and mortality risks across the spectrum of these disorders remain poorly understood. This study aimed to characterize diagnostic pathways and compare mortality outcomes across psychotic disorders in Catalonia.

METHODS

We conducted a retrospective cohort study using electronic health records of 357,007 adults accessing mental health services in Catalonia from 2015 through 2019. Diagnostic categories included schizophrenia, bipolar disorder, schizoaffective disorder, delusional disorder, other non-organic psychoses, unipolar psychotic depression, and other mental health diagnoses. Cox proportional hazards models assessed mortality risk, adjusting for sociodemographic factors and comorbidities.

RESULTS

About one-third of the sample received their first psychotic disorder diagnosis in specialized care. All psychotic disorders showed elevated mortality risk vs other mental health conditions. Schizophrenia had the highest risk (HR, 2.63; 95%CI, 2.46-2.81, p<0.001 followed by schizoaffective (HR, 1.99; 95%CI, 1.77-2.24, p<0.001) and delusional disorders (HR, 1.92; 95%CI, 1.66-2.21, p<0.001). Low socioeconomic status (HR, 3.69; 95%CI, 3.48-3.92, p<0.001) and comorbidities (HR, 1.82 per comorbidity; 95%CI, 1.81-1.83, p<0.001) were significant predictors of mortality across diagnoses. Gradient boosting machine modeling identified comorbidities (56.07%) and diagnostic category (24.51%) as top predictors of mortality risk.

CONCLUSIONS

This study demonstrates significantly elevated mortality risk across the spectrum of psychotic disorders in a Southern European context, with socioeconomic factors and medical comorbidities emerging as critical determinants. These findings underscore the need for integrated care approaches addressing both mental and physical health needs in psychotic disorders.

Inequalities in somatic comorbidities among immigrants and Norwegians with and without common mental disorders: a national register study

PURPOSE

Comorbidity between mental disorders and somatic diseases exacerbates health outcomes and contributes to premature mortality. However, differences in this comorbidity among immigrant groups compared to the majority population are unclear. This study aims to examine disparities in the risk relationship between common mental disorders (CMDs) and somatic diseases among the majority population (Norwegians) and various immigrant groups.

METHODS

This national register study uses information from 3 142 925 residents aged 18+on diagnosed CMDs and selected somatic diseases for years 2008-2016. Poisson regression models were used to study the association between CMD and somatic diseases (i.e., cardiovascular diseases (CVDs), endocrine and metabolic diseases, cancer, and infectious diseases). Differences in risk between Norwegians and immigrant groups were investigated by introducing interaction terms between CMD and immigrant background.

RESULTS

Individuals with CMDs had a higher risk for all somatic diseases compared to those without, regardless of immigrant status. Immigrant groups varied in comorbidity, with those without CMDs showing similar or lower risk compared to Norwegians. However, immigrants with CMDs from non-Western countries (i.e., Eastern Europe, sub-Saharan Africa, South Asia) had a significantly higher probability of developing CVD, hypertension, and diabetes mellitus than Norwegians with CMDs. Additionally, SSA immigrants with CMDs also had a higher risk for viral hepatitis.

CONCLUSION

Findings suggest that immigrant groups experience varying degrees of comorbidity, which underscores the need for tailored healthcare interventions to address these disparities effectively.

Determinants of violent behaviors in individuals with severe mental illnesses: a cross-sectional study from 23 community health centers in Nanjing, China

BACKGROUND

Individuals with severe mental illnesses (SMIs) are at an increased risk of exhibiting violent behaviors, which may result in significant negative consequences, including damaged relationships, property destruction, and harm to themselves or others. The purpose is to investigate the current status of violent behaviors among individuals with SMIs and identify factors within the demographic information, psychological status, and treatment status of individuals with SMIs that may influence the occurrence of violent behaviors.

METHODS

We conducted a cross-sectional survey of 1108 individuals with SMIs. The Logistic regression and Chi-squared Automatic Interaction Detection (CHAID) tree model were employed to analyze the influencing factors of violent behaviors in individuals with SMIs and compare their predictive performance.

RESULTS

49.6% of the participants engaged in violent behaviors in the past 12 months. The study identified that factors influencing violent behavior in individuals with SMIs include medication adherence, self-reported health status, employment, household income, experience of discrimination, disease concealment, access to medical assistance, and comorbidities. Medication adherence was identified as the most critical factor affecting violent behavior in individuals with SMIs. Logistic regression model and CHAID tree model had comparable predictive accuracy with AUC values of 0.734 and 0.730, respectively. No statistically significant difference was observed in the predictive performance of the two models (Z = -0.745, P = 0.456).

CONCLUSIONS

Individuals with SMIs are at a higher risk of violent behavior, which is influenced by multiple factors, particularly medication adherence. This adherence may be a key determinant in the occurrence of violent behavior among individuals with SMIs. Healthcare professionals should implement targeted interventions addressing these influencing factors to prevent the manifestation of violent behavior in individuals with SMIs.

Methods for the assessment of biological age - A systematic review

Biological age has long been proposed to complement chronological age because it has the potential to provide a more accurate assessment of someone's ageing process and functional status. At present, there are several methods to determine an individual's biological age through the measurement of biomarkers of ageing. This review compares methods for assessing biological age in adults, analyses biomarkers of ageing, and determines the goals for which biological age can be calculated, in order to help determine a gold standard for measuring biological age. Articles were eligible if studies included a test battery and statistical method to calculate biological age. Literature research included the databases Medline, Embase, Cochrane Library, Web of Science and ClinicalTrials.gov. In total, 56 studies were included and the risk of bias in each of them was assessed. The most commonly used methods to assess biological age are Klemera and Doubal's method, principal component analysis, multiple linear regression, PhenoAge and Hochschild's method. Klemera and Doubal's method has proved the most reliable. Apart from using different statistical methods, the difference between the biological ageing scores lies in the choice of biomarkers of ageing, especially the inclusion of chronological age as a biomarker of ageing. Most of the included studies aimed to establish a new biological ageing score or compare biological age to different measurements of functionality of the human body. In conclusion, there is still no consensus on a gold standard and more research on this topic is necessary. Study protocol PROSPERO ID: CRD42021287548.

Association Between Use of Services To Address Adverse Social Determinants of Health and Documented Suicide Attempt Among Patients in the Veterans Health Administration

Suicide prevention is a top priority for the US Department of Veterans Affairs (VA), and suicide is often associated with adverse social factors (e.g., financial, legal, and housing problems). The VA provides social services integrated with healthcare services, which may increase the opportunities to detect and document suicide attempt in EHR records. Using VA administrative data, we examined three cohorts of all patients from 2014 to 2018 who had housing instability (n = 659,987), justice involvement (n = 200,487), and unemployment (n = 346,556). Administrative records were used to determine ordinal indicators of receipt of VA social services (no services, low, or high). The outcome was suicide attempt noted in the healthcare record (i.e., documented suicide attempt) in the 1-6 months following the incident adverse social factor. We conducted logistic regressions utilizing a discrete-time survival framework with person-month as the unit of analysis, which facilitated accounting for covariates while isolating the independent association of social service utilization. After adjusting for covariates, high receipt of housing services (vs. no services) was significantly associated with documented suicide attempt during the 6-month observation period (aOR = 1.14, 95%CI = 1.06-1.22). A similar association was observed for high vs. no use of justice programs (aOR 1.24; 95% CI:1.12-1.37). There was no significant association between employment services utilization and documented suicide attempt during the 6-month observation period. Our finding that utilization of social services as positively associated with documented suicide attempt likely reflects increased suicide attempt surveillance and documentation with social service involvement. Future research should explore operationalizing patient-level distress in administrative data.

Adverse Neonatal Outcomes Among Children Born to Mothers Eating Disorders: A Register-Based Cohort Study

OBJECTIVE

We examined the risk of adverse neonatal outcomes among children born to mothers with anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS).

DESIGN

Cohort study.

SETTING

Population-based using Danish national registers.

POPULATION

We included 1 517 839 singletons born between 1991 and 2015 in Denmark.

METHODS

For each ED subtype, we compared children born to mothers with a recent (≤ 2 years before conception and during pregnancy) or past (> 2 years before conception) diagnosis, with children born to mothers who had not been diagnosed with the ED of interest before the index delivery.

MAIN OUTCOME MEASURES

Using multinomial logistic regression, we estimated relative risk ratios (RRRs) and 95% confidence intervals (CIs) for gestational age, birthweight, weight-for-gestational age, low Apgar score, Caesarean section, congenital malformations and postpartum haemorrhage.

RESULTS

Both recent and past AN were associated with increased risk of low birthweight (recent: RRR = 2.36 [95% CI = 1.76-3.18]; past: 1.22 [1.04-1.43]), small-for-gestational age (recent: 1.52 [1.01-2.26]; past: 1.37 [1.16-1.62]), and preterm birth (recent: 1.83 [1.37-2.45]; past: 1.17 [1.00-1.36]), with more pronounced risks in recent AN. Recent (but not past) BN was associated with increased risk of low Apgar score (1.44 [1.03-2.00]). Recent (but not past) EDNOS was associated with increased risk of SGA (1.53 [1.04-2.27]).

CONCLUSIONS

Children born to mothers with EDs have an increased risk of some adverse neonatal outcomes, with more pronounced risks in recent than past EDs. These results underscore the need for improved prevention of maternal EDs and enhanced monitoring throughout pregnancy to mitigate adverse outcomes.

Sex-Specific Association Between Polymorphisms in Estrogen Receptor Alpha Gene (ESR1) and Depression: A Genome-Wide Association Study of All of Us and UK Biobank Data

Major depressive disorder (MDD) is prevalent worldwide, substantially and negatively impacting both the quality and length of life of 280 million people globally. The genetic risk factors of MDD have been studied in various previous research, but the findings lack consistency. Sex/gender and racial/ethnic disparities have been reported; however, many previous genetic studies, represented by large-scale genome-wide association studies (GWASs) are known to lack diversity in the study cohorts. All of Us is a biorepository aiming to focus on the historically underrepresented groups. We perform GWASs for the MDD phenotype, using over 200,000 participants' genotypes and carry out sex- and racial/ethnic-specific subgroup studies. We identified a risk locus (chr6:151945242) in Estrogen Receptor Alpha Gene (ESR1) (p = 1.70 × 10 - 9 $1.70\times {10}^{-9}$ ), and further confirmed the genetic association is sex-specific. The single-nucleotide polymorphism (SNP) chr6:151945242 was significant only in the male group, but not in the female group. These findings were replicated in the UK Biobank and echo with existing studies on the ESR1 gene and depressive disorders. Our results indicate that the All of Us program is a reliable resource for GWAS, as well as shedding light on further investigation of sex- and racial/ethnic-specific genome association, especially in underrepresented groups of the US population.

Comprehensive insights into emerging advances in the Neurobiology of anorexia

BACKGROUND

Anorexia is a complex eating disorder influenced by genetic, environmental, psychological, and socio-cultural factors. Research into its molecular mechanisms and neural circuits has deepened our understanding of its pathogenesis. Recent advances in neuroscience, molecular biology, and genetics have revealed key molecular and neural circuit mechanisms underlying anorexia.

AIM OF REVIEW

Clarify the peripheral and central molecular mechanisms regulating various types of anorexia, identify key cytokines and neural circuits, and propose new strategies for its treatment. Key scientific concepts of review: Anorexia animal models, including activity-induced, genetic mutation, and inflammation-induced types, are explored for their relevance to studying the disorder. Anorexic behavior is regulated by cytokines, hormones (like GDF15, GLP-1, and leptin), and neural circuits such as AgRP, serotonergic, dopaminergic, and glutamatergic pathways. Disruptions in these pathways, including GABAergic signaling in AgRP neurons and 5-HT2C and D2 receptors, contribute to anorexia. Potential therapies target neurotransmitter receptors, ghrelin receptors, and the GDF15-GFRAL pathway, offering insights for treating anorexia, immune responses, and obesity.

Cognitive behavioral therapy for insomnia across the spectrum of alcohol use disorder: A systematic review and meta-analysis

Insomnia is prevalent among patients with alcohol use disorder (AUD), potentially undermining treatment and increasing the risk of relapse. Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for insomnia, but its efficacy is not well-characterized in patients across the spectrum of AUD. The aim of this meta-analysis was to quantify the effectiveness of CBT-I in improving insomnia severity and alcohol-related outcomes in adults with heavy alcohol use and/or varying levels of AUD severity and comorbid insomnia. MEDLINE, Cochrane Library, PsycINFO and ClinicalTrials.gov were systematically searched (up to February 2024) to retrieve randomized controlled trials (RCTs). Multilevel meta-analyses were conducted to estimate mean differences over time in insomnia severity, measured using the Insomnia Severity Index (ISI), as well as in alcohol craving and alcohol-related psychosocial problems between CBT-I and control groups. For the number of heavy-drinking/abstinent days, incidence rate ratios were estimated. Risk of bias was assessed using the Risk of Bias 2 (RoB 2) tool. Eight RCTs encompassing 426 adults (68.78 % men) were included. Compared with control conditions, CBT-I resulted in a large reduction of insomnia severity post-treatment [estimated ISI reduction = -5.51, 95% CI (-7.13 to -3.90)], which was maintained at 1-to-3-month [7 studies; estimate = -4.39, 95% CI (-6.08 to -2.70)], and 6-month follow-up [4 studies; estimate = -4.55, 95% CI (-6.77 to -2.33)]. Alcohol-related outcomes were reported less consistently, and no significant differences were found. The included trials were judged to have a low or moderate overall risk of bias for the assessment of all outcomes. CBT-I effectively reduces insomnia severity across the spectrum of AUD, supporting wide implementation in AUD prevention and treatment settings. PROSPERO REGISTRATION NUMBER: CRD42023464612.

Prevalence and Correlates of Suicide Attempts in Chinese Outpatients With First-Episode and Drug-Naïve Psychotic Major Depressive Disorder at Different Ages of Onset

BACKGROUND

Prior research has shown varying suicide attempt rates based on the age of onset in major depressive disorder (MDD) patients. However, there is a paucity of research on psychotic major depressive disorder (PMD) patients. This study aimed to assess the prevalence and correlates of suicide attempts in PMD patients stratified by age of onset.

METHODS

Totally, 1718 first-episode drug-naïve MDD outpatients were recruited, divided into early-age onset (EAO) and middle-age onset (MAO) based on the first episode before age 45/after age 45. Clinical severity was assessed using the Hamilton Depression Rating Scale (HAMD), the Hamilton Anxiety Rating Scale (HAMA) and the Positive and Negative Syndrome Scale (PANSS) positive subscale. In addition, thyroid hormone and glucolipid metabolism indicators were measured.

RESULTS

In EAO PMD patients, HAMA scale score and thyroid-stimulating hormone (TSH) levels were associated with suicide attempts. The area under the receiver operating characteristic curve (AUROC) was 0.892. In MAO PMD patients, TSH and diastolic blood pressure were associated with suicide attempts. The AUROC was 0.862.

CONCLUSION

This study demonstrates that the prevalence and correlates of suicide attempts vary among PMD patients with different ages of onset. Age of onset should be considered in the prevention and treatment of suicide attempts in patients with PMD.