Age of onset and cumulative risk of mental disorders: a cross-national analysis of population surveys from 29 countries

Mind at rest, mind at risk: A prospective population-based study of sleep and subsequent mental disorders

Background

Depression and anxiety disorders are highly prevalent among young adults, with evidence suggesting sleep problems as key risk factors.

Objective

This study aimed to examine the association between insomnia and sleep characteristics with major depressive episode (MDE) and anxiety disorders, and the association after accounting for baseline mental health symptoms.

Methods

We conducted a prospective cohort study using data from the Students' Health and Wellbeing Study (SHoT), surveying Norwegian higher education students aged 18 to 35 (N = 53,362). A diagnostic assessment of 10,460 participants was conducted in 2023. Self-reported insomnia, sleep duration, sleep onset latency, and wake after sleep onset were recorded in 2022. MDE and five types of anxiety disorders were assessed after one year using a self-administered CIDI 5.0. Analyses adjusted for age, sex, baseline mental health symptoms, and somatic conditions.

Results

Insomnia in young adults was associated with a significantly increased risk of MDE (adjusted RR = 3.50, 95 % CI = 3.18-3.84) and generalized anxiety disorder (GAD) (adjusted RR = 2.82, 95 % CI = 2.55-3.12) one year later. Sleep duration showed a reversed J-shaped association with mental disorders, with both short and, to a lesser extent, long sleep durations linked to elevated risks, even after adjusting for baseline mental health symptoms and somatic conditions. Although the associations were attenuated after adjustment, they remained statistically significant.

Conclusion

Sleep disturbances, including insomnia and abnormal sleep durations, predict mental health issues in young adults, even after accounting for baseline mental health and somatic health. Addressing sleep problems early may help prevent subsequent mental health conditions in this population.

Covariates in studies examining longitudinal relationships between substance use and mental health problems among youth: A meta-epidemiologic review

INTRODUCTION

This meta-epidemiological review examines covariate selection and reporting practices in observational studies analyzing longitudinal relationships between youth substance use and mental health problems (internalizing and externalizing).

METHODS

Sixty-nine studies published in high-impact journals from 2018 to 2023 were included. Studies were included if they explored prospective relationships between substance use and mental health among youth (12-25 years) and used repeated measures designs. Data extraction focused on study characteristics, covariates and their selection methods, and reporting practices.

RESULTS

There were 574 covariates included across studies; 33 were included as moderators and 18 were included as mediators. At the study level, the most common covariate domains included demographics (90 % of included studies had at least one demographic, mostly sex), substance-related variables (67 %; mostly alcohol or smoking), internalizing symptoms (39 %; mostly depression), family-related variables (29 %; mostly parental substance use or mental illness), and externalizing symptoms (19 %; mostly conduct). 93 % of studies had unique sets of lower-order covariates. Across all studies (n = 69), only 35 % provided details for how, and why, all covariates were selected with only 12 % reporting selecting covariates a priori, and none being pre-registered. Only 60 % mentioned confounding and only 13 % mentioned risk of confounding in their conclusions.

CONCLUSIONS

The findings highlight the need for improved covariate selection and reporting practices. Establishing a core set of covariates and adhering to standardized reporting guidelines would enhance the comparability and reliability of research findings in this field. Researchers can use this review to identify and justify the inclusion and exclusion of commonly reported covariates when analyzing relationships between youth substance use and mental health problems.

Take a Look at Me Now: The Use of Virtual Reality in the Treatment of Social Anxiety Disorder

In anxiety and related disorders, Virtual Reality Exposure Therapy (VRET) was one of the first steps toward integrating technology into psychological treatments. In this article, we discuss crucial therapeutical skills and provide a case conceptualisation for the treatment of social anxiety disorder with VRET. The case conceptualisation is based on evidence-based cognitive-behavioural treatment approaches. Social anxiety can be very challenging to treat with exposure in vivo, and virtual reality exposure offers the added benefit of being able to create social situations and real-time interactions within the therapeutic context. The case conceptualisation presented is worked out for a 23-year-old female with social anxiety disorder who is increasingly hindered by her anxiety in her professional and personal life. The treatment rationale of VRET, homework assignments, and progress of therapy are presented. Additionally, this paper discusses what steps to take if the first exposure experiences are not successful and how to progress in such cases. Therapeutic pitfalls are illustrated within this case and potential solutions on how to avoid these pitfalls are addressed.

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.

Genomics of Anxiety Disorders

Anxiety disorders are the most prevalent psychiatric conditions in the general population. Despite the early observation of family aggregation of anxiety disorders with a heritability of 30% to 50%, their exact genetic structure is not yet determined. Evidence suggests a composition of common and rare genetic factors contributing to the etiology of anxiety disorders. Recent hypothesis-free genome-wide association studies in mega cohorts mostly with a broad anxiety phenotype rendered an increasing number of novel genetic loci. Epigenetic research is still in its infancy with first evidence showing dynamic changes in response to environmental influences and during the therapy course.

Policy implications of the 2020-22 Australian study of mental health and wellbeing

The objective of this paper is to summarise the policy implications of key findings from the 2020-22 Australian National Study of Mental Health and Wellbeing (NSMHWB). We provide an analysis of policy implications of four papers in this issue of the journal from the 2020-22 NSMHWB (N = 15,893) and the 2007 NSMHWB (N = 8841). The 2020-2022 NSMHWB reported a lifetime prevalence rate of common mental disorders of 40.2% (95% confidence interval [CI] = 39.2-41.3) and 12-month prevalence rate of 20.2% (95% CI 19.5-21.0). Overall, adult Australians were significantly more likely to experience a 12-month mental disorder in 2020-22 compared with 2007, with the change most striking in among those aged 16-24 years (odds ratio [OR] 1.2, 95% CI 1.1-1.3). Individuals aged 16-24 years in 2020-22 were significantly more likely to experience a 12-month anxiety disorder (OR 2.9, 95% CI = 2.3-3.7, depressive disorder (OR 2.8 95% CI = 2.1-3.9) or comorbidity (relative risk [RR] = 1.4, 95% CI = 1.2-1.7) compared with those aged 16-24 years in 2007. In 2020-22, the proportion of Australians who had experienced suicidal ideation, suicide plans and suicide attempts in the past 12 months was 3.3%, 1.1% and 0.3%. Under half (46.5% 95% CI 44.1-48.8) of adults with a 12-month mental disorder sought treatment. Mental disorders remain an endemic feature of Australia's overall health landscape and appear to be increasing, especially in younger cohorts. While service use rates have improved over time, there is still some way to go. Epidemiological surveys such as the 2020-22 NSMHWB are important for understanding changing prevalence and the population not accessing services. Innovative prevention and treatment strategies will be needed to address the increasing rates of disorders in younger Australian adults. Equally innovative and bold policy responses will be essential.

Network analysis of Internet addiction and depression among Chinese adolescents

BACKGROUND

Internet addiction (IA) and depression are common mental health concerns, with burgeoning empirical evidence highlighting their significant comorbid relationship among adolescents. We aimed to establish network structures for IA and depression among Chinese adolescents, and to identify the core and bridge symptoms.

METHODS

A total of 8176 participants were recruited from Henan Province, Central China. The 10-item Center for Epidemiological Studies Depression Scale (CESD) and 20-item Self-report Internet Addiction Test (IAT) was used to measure depression and IA, respectively. IA, depression and the co-occurrence network structures were constructed using network analysis. Strength, the centrality index, was used to identify the core symptoms. Bridge symptoms were assessed using the bridge strength.

RESULTS

Node CESD7 ("Could not get things going") was the most influential node in the depression network model, followed by CESD1 ("Felt sadness") and CESD2 ("Everything was an effort"). Node IAT16 ("Reluctant to be offline") was the most influential node in the IA network model, followed by IAT20 ("Web made you feel better"), IAT15 ("Fantasized about being on the web") and IAT2 ("Neglected household chores"). CESD7 ("Could not get things going") in the depression-IA network was the most key bridge symptom linking depression and IA, followed by CESD8 ("Trouble focus"). Significant gender difference in edge weights was observed (p = 0.002).

LIMITATIONS

This cross-sectional study collected data through self-report measures.

CONCLUSIONS

The core symptoms and key bridge symptoms in the networks are crucial for the precise intervention of adolescent depression and IA.

Longitudinal Development of Neurocognitive Functioning and Gray Matter Volume in Youths With Recurrent Psychosis Spectrum Symptoms

BACKGROUND AND HYPOTHESIS

Neurodevelopmental risk-factor models of psychosis highlight the importance of early developmental deviations in the emergence of psychosis. However, few longitudinal studies map neurodevelopment and neurocognitive trajectories across age in preclinical psychosis. We investigated longitudinal trajectories in neurocognition and brain volume in a community cohort of adolescents with recurrent psychosis spectrum (PS) symptoms, tracking their development into young adulthood compared to their typically developing (TD) peers.

STUDY DESIGN

Utilizing the Philadelphia Neurodevelopmental Cohort, we analyzed data of 231 youths aged 8-30 with at least one follow-up assessment, including 88 with PS.

STUDY RESULTS

Individuals with PS showed similar developmental trajectories but demonstrated significant impairments in executive functioning (t = -2.81, q = 0.010), memory (t = -2.34, q = 0.019), complex cognition (t = -3.72, q = 0.001), social cognition (t = -2.73, q = 0.010), motor (t = -2.50, q = 0.015), and general cognition (t = -3.20, q = 0.004). Lower cortical (t = -2.46, P = .014) and subcortical (t = -2.41, P = .016) gray matter volume in the recurrent PS group compared to the TD group were documented with age-related group differences becoming less pronounced by young adulthood. Further analyses revealed age-by-group interactions (qs < 0.05) observed in a few temporal and frontal regions, with differences between groups at earlier ages.

CONCLUSIONS

These findings suggest that recurrent PS symptoms are linked to early neurocognitive and brain structure deficits, highlighting the need for interventions to reduce psychosis risk and support healthy neurodevelopment.

Ningbo Schizophrenia Cohort (NSC)-a longitudinal ambispective cohort based on electronic health records: cohort profile

PURPOSE

Electronic health records (EHR) passively generate large datasets on real-world patient populations in easily retrievable form, allowing the cost-efficient and timely execution of epidemiological cohorts on a broad array of topics. However, EHR-based cohorts specialising in mental disorders have not yet been reported. Ningbo has made significant achievements in healthcare data management in China. This study, relying on the Ningbo Mental Health Information System and the Ningbo Regional Health Information Platform, has established the Ningbo Schizophrenia Cohort (NSC), providing an exemplary study for cohort studies on schizophrenia.

PARTICIPANTS

This population-based ambispective cohort study included patients with schizophrenia aged 18-65 years at the time of diagnosis who were eligible for healthcare services in Ningbo, China. Participants were identified using the Ningbo Mental Health Information System between 1 January 2010, and 31 December 2023. Once an individual enters the NSC, they are followed up continuously until death or relocation. A total of 26 899 patients with schizophrenia are included in the NSC.

FINDINGS TO DATE

Among 26 899 patients, 55.4% were female and 53.1% had less than 7 years of education. Until 31 December 2023, 4505 deaths occurred, and 97.83% of patients had at least one electronic medical record. The median age at diagnosis for non-survivors (median (IQR): 40 (29-51) years) was higher than that of survivors (median (IQR): 34 (26-45) years).

FUTURE PLANS

The NSC will continue to collect longitudinal data to capture the full life cycle of schizophrenia, including pre-onset, diagnosis, follow-up, recovery or death. This will result in a continuous, complete and multidimensional EHR for patients with schizophrenia. Planned future research aims to generate new real-world evidence on the aetiology of schizophrenia, investigate comorbidities to facilitate co-management and develop predictive models for schizophrenia and related cardiovascular diseases.

TRIAL REGISTRATION NUMBER

NCT06370793.

Perceived need for treatment for mental disorders: A review and critical evaluation

Mental disorders are highly prevalent worldwide. Unfortunately, most people with these disorders do not receive any treatment. This is due in part to a large set of barriers that impede treatment delivery. An initial barrier is the perception that one does not need treatment. Perceived need for treatment (PNFT) refers to whether an individual sees a need to obtain an intervention for their mental health problem. Among individuals with a mental disorder, lack of perceived need is the most common reason people give for not initiating treatment. This article describes PNFT, its characteristics, correlates, and predictors. A critical evaluation of the concept challenges key notions such as whether meeting criteria for a disorder means that someone needs treatment, whether PNFT actually is the initial obstacle limiting treatment seeking, how people may seek an intervention but do not elect mental health treatment, and that PNFT is neither a necessary nor a sufficient condition for entering treatment. Several research priorities are discussed including the importance of perceived need among parents and other caregivers, evaluating whether increasing the rates of PNFT would actually increase service use, the need to study the treatment needs of many neglected groups, and considering whether PNFT influences other facets of the treatment process (e.g., adherence to treatment, dropping out early) where perceiving there no longer is a mental health problem may occur.

The epidemiological burden of major depressive disorder in women of childbearing age and its relationship with the sociodemographic index: A systematic analysis based on the global burden of disease study from 1990 to 2021

BACKGROUND

The global burden and trends of Major depressive disorder (MDD) among women of childbearing age (WCBA) remain unclear.

METHODS

This study utilized data from the Global Burden of Disease database to extract information on the prevalence, incidence, and disability-adjusted life years (DALYs) related to major depression among WCBA from 1990 to 2021. The study estimated the annual percentage change to assess trends in disease burden and calculated point estimates using 95 % uncertainty intervals.

RESULTS

Between 1990 and 2021, there was a significant increase in the incidence, prevalence, and number of DALYs associated with MDD among WCBA, with increases of 73 %, 73 %, and 72 %, respectively. In low Sociodemographic Index (SDI) regions, WCBA exhibited the highest prevalence, incidence, and DALYs of MDD, whereas high SDI regions had the highest prevalence. East Asia was the only region that reported a decline in the prevalence, incidence, and DALYs associated with MDD. The Central America region experienced the most substantial increases in incidence and DALYs, while East Asia showed the most notable declines in prevalence and DALYs. At the country level, Singapore had the largest global declines in prevalence, incidence, and DALYs, whereas Mexico exhibited the most significant rise. Age group analysis revealed that the most pronounced increase in cases of major depression was observed among women aged 45-49 years.

CONCLUSION

Over the past 32 years, the burden of MDD among WCBA has significantly increased worldwide, particularly in low SDI and high SDI regions, as well as among the 45-49 age group.

African leadership in brain diplomacy: The Yaoundé declaration advances the global brain economy playbook for better brain health

Africa, the world's second-largest continent is home to 1.5 billion people, accounting for nearly 20% of the global population, (60% under age 25). By 2050, Africa's population will be 2.5 billion, and by 2035, more young Africans will be entering the workforce each year than in the rest of the world combined. Africa also hosts a rich social, cultural, and geopolitical diversity across its 5 geopolitical zones covering 54 countries. It is the most genetically, culturally, and linguistically diverse region on the planet. However, Africa's contribution to the global economy could be more significant if it urgently embraces the brain economy and leads in the development of new methodologies and approaches which can be exported around the world. In this paper, we explain our strategy to advance the Yaoundé Declaration for the Brain Economy, Brain Health, and Brain Capital. The Declaration has been endorsed by Cameroon's President, His Excellency Paul Biya, and demonstrates African leadership in global brain and society innovations, laying out a roadmap for how Africa can outcompete other economies by deftly deploying brain science-inspired policies and investments. We outline a new economic approach for African jobs, economic growth, sustainability, resilience, health, and well-being. The brain economy offers a broader framework than the current sustainable development goals (SDG) agenda. The Yaoundé Declaration is trans-disciplinary and cross-cutting across sectors: 32 sitting members of government from different sectors having co-authored this paper. It aligns with many aspects of the United Nations Pact for the Future and can accelerate the SDG.

Association between eveningness and depressive symptoms in daytime workers: A cross-sectional analysis of the Aichi Workers' Cohort Study

Objectives

Eveningness (evening preference in chronotype) has been reported to be associated with a number of psychiatric problems. We examined a cross-sectional association between eveningness and depressive symptoms in daytime workers.

Methods

The subjects were 4410 civil servants (71.7% male, aged 18-69 years [mean, 43.5 years]) with no history of depressive disorder who did not perform shift work, and for whom there were no missing data. The association between eveningness, determined using the reduced Morningness-Eveningness Questionnaire, and depressive symptoms, determined using the shorter form of the Central Epidemiological Studies Depression scale, was assessed with logistic regression analysis adjusted for potential confounding factors (gender, income, living alone, breakfast intake, coffee consumption, drinking habits, exercise, smoking, working hours, sleep duration, and difficulty falling asleep).

Results

Of the subjects, 529 (12.0%) had eveningness, and 1408 (31.9%) reported depressive symptoms. Depressive symptoms were reported more frequently by those with eveningness than by those with other chronotypes (57.3% vs 28.5%). The association between eveningness and depression (gender- and age-adjusted odds ratio, 3.27; 95% confidence interval, 2.71-3.95) was significant after adjustment for the other confounding factors (odds ratio, 2.40; 95% confidence interval, 1.96-2.95).

Conclusions

Our results suggest that eveningness is associated with depressive symptoms among day workers and that this association is independent of potential confounding factors. Further longitudinal studies are needed to examine the causal relationship.

Harmonizing the inner orchestra: the impact of urbanization and evolution of stress, inflammation, diet, and lifestyles in depression

PURPOSE OF REVIEW

This review explores the intersection of urbanization, stress, inflammation, diet, lifestyle changes, and digital evolution as key factors influencing depression, emphasizing the necessity for integrative and evolutionary perspectives in mental health and intervention.

RECENT FINDINGS

Epidemiological studies reveal a dramatic increase in common mental disorders, particularly depression, alongside parallel increases in suicide, unemployment, and divorce rates. Evolutionary perspectives suggest that mechanisms once advantageous for survival, such as stress responses and inflammatory processes, may contribute to mental health challenges in modern urban environments. Moreover, the mental health crisis among generation Z underscores the impact of digital evolution, where the shift from play-based to phone-based childhood contributes significantly to rising depression rates. Recent research highlights the significant role of omega-3 fatty acids, circadian rhythm regulation, mindfulness, and anti-inflammatory lifestyle interventions in mitigating depressive symptoms.

SUMMARY

The interplay between our evolutionary heritage and rapid societal changes has created a "symphony" of factors contributing to depression. Understanding these evolutionary mismatches in stress responses, inflammatory processes, dietary shifts, circadian disruptions, and digitalization provides new insights into the etiology of depression. This holistic approach, conceptualized as "harmonizing the inner orchestra," offers promising avenues for prevention and treatment strategies that address the multifaceted nature of depression in our modern world.

Classroom-Level and Individual-Level Prosociality and Help-Seeking Behaviors Among Adolescents

Importance

Although individual prosociality, defined as voluntary behavior intended to benefit another, is known to promote help-seeking behaviors among adolescents, it remains unclear whether a prosocial community, such as the classroom, also facilitates these behaviors.

Objective

To investigate the associations of classroom-level and individual-level prosociality with help-seeking behaviors, considering age and gender, and to examine moderation effects of being bullied.

Design, Setting, and Participants

In this cross-sectional study, annual surveys were conducted via questionnaire among students in Japanese junior and senior high schools from 2020 to 2023. The first wave was administered from October 1 to November 7, 2020, followed by the second wave from June 4 to July 13, 2021, the third wave from June 17 to July 19, 2022, and the fourth wave from June 19 to July 28, 2023.

Exposure

Classroom-level prosociality was defined as the mean prosociality of all students within a classroom, while individual-level prosociality was measured as the deviation from this classroom mean. Prosociality was assessed using the prosocial subscale of the self-reported Strengths and Difficulties Questionnaire.

Main Outcomes and Measures

Generalized mixed-effects models estimated the associations of classroom-level and individual-level prosociality with help-seeking behaviors (including poor help-seeking and seeking help from friends, family members, homeroom teachers, and physicians) while considering subgroups based on grades and gender, as well as the moderation effect of being bullied. Help-seeking behaviors were evaluated by a question about seeking help for one's mental health problems ("Are you currently consulting anyone to discuss your psychological stress or mental health problems?"), with multiple options. The robustness of the main findings were tested by models stratified by survey year.

Results

The analysis included 21 845 participants (mean [SD] school grade, 10.4 [1.2]; 16.6% junior high school students and 83.4% senior high school students; 53.3% boys). Classroom-level prosociality was associated with a higher rate of help-seeking from friends among senior high school students (odds ratio [OR], 1.26, 95% CI, 1.17-1.35), which confirmed the robustness. No moderation effect of being bullied was found in this association. Higher individual-level prosociality was associated with increased help-seeking from various sources across nearly all models and subgroups, regardless of being bullied (friends: OR, 1.15 [95% CI, 1.13-1.17]; P < .001; family members: OR, 1.09 [95% CI, 1.07-1.11]; P < .001; homeroom teachers: OR, 1.15 [95% CI, 1.10-1.19]; P < .001; school nurses: OR, 1.19 [95% CI, 1.12-1.28]; P < .001; and physicians: OR, 1.14 [95% CI, 1.07-1.20]; P < .001).

Conclusions and Relevance

This cross-sectional study of 21 845 students found that both classroom-level and individual-level prosociality were associated with higher rates of help-seeking from peers among senior high school students, while accounting for individual characteristics. Enhancing classroom prosociality could foster help-seeking behaviors through reciprocal peer support, benefiting even those who experienced bullying.

Effects of Omega-3 PUFAs on lipid profiles and antioxidant response in depressed adolescents: A metabolomic and lipidomic study

Adolescent depression is a significant global health challenge, with many patients responding inadequately to antidepressant treatments. Omega-3 polyunsaturated fatty acids (ω3 PUFAs) have been proposed as a potential adjunctive treatment, but their precise mechanisms remain poorly understood. This study aimed to explore the mechanisms through which ω3 PUFAs exert their antidepressant effects and to identify potential biomarkers for their therapeutic response. A comprehensive assessment of plasma metabolomic and erythrocyte membrane lipidomic was performed on 51 depressed adolescents who were randomly assigned to received either ω3 PUFAs plus paroxetine (n = 27) or paroxetine alone (n = 24) for 12 weeks. Following ω3 PUFA supplementation, phospholipid metabolism emerged as the most significantly altered pathway. ω3 PUFAs markedly influenced the composition of membrane fatty acids, significantly increasing the ω3 PUFA content, decreasing the ω6/ω3 PUFA ratio, and increasing membrane fluidity. Notably, ω3 PUFAs reduced lipid peroxidation in both plasma and cell membranes while enhancing antioxidant capacity in the membranes. Moreover, alterations in phospholipids and membrane function were significantly correlated with improvements in depressive symptoms and cognitive function. Importantly, ω3 PUFA supplementation resulted in greater improvement in clinical symptoms compared to the non-supplemented group exclusively in the subgroup with high baseline oxidative damage levels. This study suggests that ω3 PUFAs promoted phospholipid integration and alleviated oxidative stress, which may account for their antidepressant effects. Lipid oxidation biomarkers could help identify patients likely to benefit from ω3 PUFA supplementation. These findings advance our understanding of the mechanism and clinical application of ω3 PUFAs in treating adolescent depression.

Mental Ill-Health in young people with systemic autoinflammatory disease - a scoping review

Systemic autoinflammatory disorders (SAID), immune dysregulation disorders with onset frequently occurring in youth, are defined by unprovoked inflammation. Research suggest inflammation is associated with the pathogenesis of mental ill-health. Separately, research has identified that mental ill-health is prevalent in people with immune dysregulation disorders compared to healthy controls or those with other chronic diseases, and the psychosocial impacts of these diseases on quality of life can be debilitating. This review aimed to broadly identify the extent and nature of research involving young people with SAIDs and mental ill-health. A scoping review was conducted across 6 databases of peer-reviewed articles referring to SAIDs and mental ill-health in young people. Of 727 studies, 41 met the inclusion criteria. Thirty-seven were observational studies, including 18 case studies or series. Four studies were treatment trials. Fourteen observational studies investigated the prevalence of mental ill-health in a SAID population with large sample sizes. Most studies were conducted in Türkiye, involving Behçet's syndrome or familial Mediterranean fever and anxiety, depression, and psychosis were strongly represented. Findings suggest an association between mental ill-health and SAID activity in young people. Anxiety and depression were associated with some specific SAIDs duration, symptom severity, SAID flare recency and frequency, and SAID treatment effects. Co-occurrence and resolution of SAID flares and mental ill-health with treatment were frequent themes in case studies of some SAIDs. Further research is required on the prevalence and risk of developing mental ill-health among young people with SAIDs, along with associations between mental ill-health, other SAIDs and disease activity, other participant variables, and appropriate management of mental ill-health in this population.

A Novel Diathesis-Stress Model of Comorbid Early Onset Psychiatric Disorders

Importance

Psychiatric comorbidity is the norm. Identifying transdiagnostic risk factors will inform our understanding of developmental pathways and early intervention targets.

Objective

We recently reported that many psychiatric outcomes are predicted by a three-factor model composed of adolescent externalizing (EXT) behaviors, early life adversity, and dopamine autoreceptor availability. Here, we investigated whether this model could be reproduced in a large population-based sample using functional magnetic resonance imaging (fMRI) instead of positron emission tomography.

Design

Data were collected by the IMAGEN consortium beginning in 2010 when cohort members were 14 years old, with follow-up testing at ages 16 and 19. These longitudinal data were used to predict psychiatric disorders by 19 years of age.

Setting

Participants were recruited from secondary schools across Europe.

Participants

Adolescents (n = 1338) with fMRI, behavioural, diagnostic, and early life trauma data.

Main Outcomes and Measures

Binary regression models tested whether a combination of EXT behaviors, childhood trauma, and mesocorticolimbic reward anticipation responses at age 14 or 19 predicted the presence of a disorder by age 19.

Results

A total of 1338 participants had the required data (52.4% female). In all models, EXT and adversity scores were significant predictors (p < 0.001). Reward anticipation responses in the ventral striatum, caudate, putamen, and anterior cingulate cortex (ACC) at age 14 (p ≤ 0.05) and in the ventral striatum at age 19 (p ≤ 0.029) were predictors in their respective models. The three-factor models overall were highly significant (p < 1.0 × 10-21), yielding greater predictive strength than each factor alone. They had an accuracy of nearly 75%, accounting for ≥ 11% (Nagelkerke R2) of the variance in psychiatric disorders. The relationship between trauma and diagnoses was partially mediated by higher EXT (indirect path B = 0.0535, 95% CI = 0.0301-0.0835), and moderated by fMRI responses in the ACC (p = 0.0038) and putamen (p = 0.0135) at age 14.

Conclusions and Relevance

The results extend our previous findings, increasing confidence in a novel diathesis-stress model of commonly comorbid early onset psychiatric disorders. The results have implications for diagnostic classification schemes and pleiotropic views of psychiatric disorder etiology.

Association of Psychological Problems for Which Help Was Sought With Physical Illness

INTRODUCTION

Persons with mental disorders are at increased risk for physical illness. Individuals who seek help for psychological problems might benefit from timely support and interventional approaches. This study aimed to explore the associations between psychological problems for which help was sought and physical illness.

METHODS

The 7th survey of the Tromsø Study, which included 21,083 participants aged ≥40 years, was used in the study. The main exposure was psychological problems for which help was sought. Main outcomes were lifetime prevalence and time to onset of physical illness. Associations between psychological problems and physical illness were analyzed using logistic regression and survival analysis and adjusted for sex, birth year, smoking, education, and income. Data were collected in 2015-2016 and analyzed in 2023-2024.

RESULTS

Psychological problems were associated with smoking and having lower income but higher educational attainment. Psychological problems were associated with lifetime prevalence of hypertension, coronary artery disease, heart failure, atrial fibrillation, stroke, kidney disease, chronic obstructive pulmonary disease, asthma, arthrosis, migraine, chronic pain, and cancer; ORs ranged from 1.15 (95% CI=1.04, 1.27) to 2.15 (95% CI=1.76, 2.62). Survival analysis demonstrated that individuals with psychological problems are at increased risk for subsequent physical illness; hazard ratios ranged from 1.18 (95% CI=1.06, 1.32) to 2.74 (95% CI=2.06, 3.65).

CONCLUSIONS

This study found that psychological problems with or without a diagnosis of mental disorder might be an important marker of increased risk for physical illness.

Biomarker identification in bipolar disorder

Bipolar disorder (BD) is a severe psychiatric condition whose pathophysiology is complex and multifactorial. Genetic, environmental and social risk factors play a role in its development as well as in its progressive course. Research is currently focusing on the identification of the biological basis underlying these processes in order to suggest novel biomarkers capable to predict BD etiopathogenesis and staging. Staging has been recognized as of great value for the treatment and management of many illnesses and might also be suitable for mental health issues, particularly in disorders like BD, which progress from an initial mild phase to a more severe and thus difficult-to-treat situation. Thus, it would be of great help the characterization of to suggest better treatment requirements and improve prognosis across the different stages of the illness. Here, we summarize current research on the biological hypotheses of BD and the biomarkers associated with its progression, reviewing clinical studies available in the literature.

Age of onset of cannabis use and substance use problems: A systematic review of prospective studies

BACKGROUND

The association between the age of cannabis use (CU) onset and substance use (SU) problems has been extensively studied, yet findings remain inconsistent.

AIMS

This systematic review aimed to examine prospective studies on the association between age of CU onset and later SU problems, controlling for key individual, social, and SU-related risk factors.

METHODS

PsycINFO, Web of Science and PubMed were searched for studies published between January 2000 and December 2024. Studies were included if they: 1) were prospective; 2) measured CU onset during adolescence; 3) measured CU or SU problems after CU onset, 4) examined whole plant or phytocannabinoids. Studies were excluded if they exclusively focused on high-risk samples. Risk of bias was assessed using the Risk of Bias in Non-randomised Studies-of Interventions tool. The review was registered with PROSPERO, number CRD42022332092.

RESULTS

Sixteen studies met eligibility criteria. Earlier age of CU onset was associated with CU disorder (CUD) and CU negative consequences, with mixed findings for other SU problems (e.g., alcohol). CU frequency accounted for a significant portion of the risk for CU negative consequences, but the association with CUD remained independent of frequency. Only one study had low risk of bias, while seven had some concerns, and eight had a high or very high risk of bias.

CONCLUSIONS

Findings suggest that early age of CU onset is a specific risk factor in the development of CUD, but not other SU problems. Prevention approaches should aim to delay the onset and reduce the frequency of CU among youth to reduce risk of the development of CUD.

Beyond case-control study in neuroimaging for psychiatric disorders: Harmonizing and utilizing the brain images from multiple sites

Recent magnetic resonance imaging (MRI) research has advanced our understanding of brain pathophysiology in psychiatric disorders. This progress necessitates re-evaluation of the diagnostic system for psychiatric disorders based on MRI-based biomarkers, with implications for precise clinical diagnosis and optimal therapeutics. To achieve this goal, large-scale multi-site studies are essential to develop a standardized MRI database, with the analysis of several thousands of images and the incorporation of new data. A critical challenge in these studies is to minimize sampling and measurement biases in MRI studies to accurately capture the diversity of disease-derived biomarkers. Various techniques have been employed to consolidate datasets from multiple sites in case-control studies. Traveling subject harmonization stands out as a powerful tool that can differentiate measurement bias from sample variety and sampling bias. A non-linear statistical model for a normative trajectory across the lifespan also strengthens the database to mitigate sampling bias from known factors such as age and sex. These approaches can enhance the alterations between psychiatric disorders and integrate new data and follow-up scans into existing life-course trajectory, enhancing the reliability of machine learning classification and subtyping. Although this approach has been developed using T1-weighted structural image features, future research may extend this framework to other modalities and measures. The required sample size and methodological establishment are needed for future investigations, leading to novel insights into the brain pathophysiology of psychiatric disorders and the development of optimal therapeutics for bedside clinical applications. Sharing big data and their findings also need to be considered.

Global, regional, and national burden of major depressive disorders in adults aged 60 years and older from 1990 to 2021, with projections of prevalence to 2050: Analyses from the Global Burden of Disease Study 2021

AIMS

To estimate the burden of major depressive disorder (MDD) among older adults and project its prevalence through 2050.

METHODS

Using data from the Global Burden of Disease Study 2021, we calculated age-standardized rates (ASRs) for the incidence, prevalence, and years lived with disability (YLDs) of MDD among people aged ≥60 years from 1990 to 2021. Trends were analyzed using average annual percentage changes (AAPCs). Polynomial regressions were utilized to assess the relationship between economic levels and MDD burden. Prevalence of MDD was forecasted to 2050 using a mixed-effects model with Socio-demographic Index as the predictor.

RESULTS

Globally, the ASRs for incidence, prevalence and YLDs of MDD in older adults increased annually by 0.24 % (95 % CI: 0.18-0.31), 0.25 % (0.19-0.30), and 0.24 % (0.18-0.30), respectively. The fastest growth was observed in adults aged 60-69 years. The burden of MDD among females was approximately 1.5 times higher than males, although rates grew faster among males. Lower-income countries, particularly in sub-Saharan Africa, exhibited the highest burden and growth rates. By 2050, global MDD cases are projected to reach 97.04 million (95 % uncertainty interval [UI]: 71.27-129.85), with an ASR of 4.53 % (3.33-6.07).

CONCLUSIONS

The global burden of MDD among older adults has increased since 1990 and its prevalence is projected to continue increasing through 2050. Increments were faster in males, younger-old adults and people living in lower-income countries. Comprehensive and integrated management systems at nation, community and individual levels for MDD among older adults are essential to mitigate this growing burden and promote healthy aging.

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Eating disorders and psychiatric comorbidity among first-year university students in Sweden: Prevalence and risk factors

BACKGROUND

This study explored eating disorders (ED) prevalences, comorbidity of ED with other mental disorders, and risk factors for ED among university students. ED included binge eating disorder (BED), bulimia nervosa (BN), or other specified feeding and eating disorders (OSFED).

METHODS

A total of 3425 first-year university students in Sweden completed an online survey covering a range of criteria for psychiatric diagnoses, within the World Mental Health International College Student (WMH-ICS) initiative. Pearson's χ2 -tests were used to compare algorithm-based diagnostic prevalences for eating disorders and other comorbid psychiatric disorders between three groups: students with ED with or without other comorbid psychiatric disorders (A), students with psychiatric disorders but no ED comorbidity (B), and students with no psychiatric disorders (C). Multinomial logistic regression was used to calculate between-group comparisons of odds ratios for independent risk factors, where group B served as the reference group for comparisons with groups A and C.

RESULTS

Of the total sample, 75% had at least one psychiatric disorder and 28% had at least one lifetime ED diagnosis. Students with ED (group A) reported higher prevalences for comorbid anxiety disorders, depression, suicidal behavior, and non-suicidal self-injury compared to students with psychiatric disorders but no ED (group B). Group A participants exhibited a higher risk of hazardous drinking, were more likely to have received medical treatment, and to identify as bisexual. Compared to group B, students with no psychiatric disorders (group C) were more likely to report better mental and physical health, but less likely to engage in hazardous drinking, and to have sought mental health treatment.

CONCLUSIONS

A large proportion of students with ED had additional psychiatric disorders, indicating that individuals with ED suffer from multiple mental health problems. It is crucial that student health services acquire competency to offer effective ED assessment and treatment.

Prevalence and Geographic Variation of Serious Mental Illness Among Young Adults Enrolled in Medicaid in New York State

PURPOSE

To estimate the prevalence and geographic variation of serious mental illness (SMI) among young adults enrolled in Medicaid and to identify individual and community-level factors associated with SMI.

METHODS

We used New York Medicaid data for over 1.6 million young adults aged 18-34 years with continuous Medicaid enrollment from April 2021 through March 2022. We merged 3 additional county and zip code-level datasets, including the Distressed Communities Index, Area Health Resource File, and New York homelessness data. We used descriptive analyses, data visualization methods, and multivariable logistic regression to estimate the prevalence of SMI and identify individual- (sex, race and ethnicity, age, disability aid, and homelessness) and community-level (geography, community distress, number of hospital beds, and community mental health centers per capita) factors associated with SMI.

RESULTS

The 12-month prevalence of SMI was 8.3% in New York State, with wide geographic variation by zip codes, ranging from 0% to 39%. Young adults identifying as Asian, Black, and Latinx (compared to White), and those living in zip codes with the most community distress were associated with lower odds of SMI, odds ratios (OR) ranged from 0.47 (Asian) (95% confidence interval [CI] [0.46-0.49]) to 0.95 (Latinx) (CI [0.93-0.97]). Young adults identifying as female (compared to male), receiving disability, experiencing homelessness, and rural residence were associated with higher odds of SMI, ORs ranged from 1.64 (female) (95% CI [1.62-1.66]) to 5.49 (homelessness) (95% CI [5.33-5.66]).

DISCUSSION

SMI prevalence varies by individual- and community-level factors, including homelessness and rural residence, signaling the need for specific interventions and policies.

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

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

Resilience of young adults living with mental disorders in the City of Tshwane, South Africa

Background

The challenges that young adults encounter today present greater risks to their mental wellbeing compared to those experienced by previous generations. For those young adults living with mental health disorders, they suffer even more when having to deal with its burdens. Many of these young adults face floods of negative and powerful emotions, discrimination and isolation; however, they are likely to cope well with these difficult situations if they are resilient.

Aim

This study purported to report on resilience among young adults living with mental disorders in the City of Tshwane.

Setting

The study was conducted in Atteridgeville in the City of Tshwane, Gauteng province in South Africa.

Methods

A qualitative exploratory and descriptive research was conducted among 10 purposefully sampled young adults aged between 18 years and 34 years old. Data were collected using individual, semi-structured interviews in primary healthcare clinics and analysed using Tesch's method.

Results

Two themes, namely, harnessing purpose in building resilience and confidence enhances positive interactions along with four related sub-theme emerged from the results. The themes indicated how a sense of purposefulness and confidence help young adults living with mental health disorders build resilience.

Conclusion

For young adults to be resilient, approaches such as psychotherapy for treating mental health issues need to incorporate strategies to develop a sense of purpose and confidence.

Contribution

This study elucidated the role of purposefulness and confidence in building resilience, and further provided some suggestions on strategies that could be used to build resilience in conjunction with medical management of mental health disorders among young adults.

Mental health of university students twenty months after the beginning of the full-scale Russian-Ukrainian war

BACKGROUND

Russia's full-scale military invasion of Ukraine on February 24, 2022 led to an increase of anxiety and depressive states, psychosomatic manifestations, and a tendency to abuse alcohol and psychoactive substances in the population. The aim of this paper is to examine the mental health burden among university students twenty months after war and to identify risk and protective factors for mental health problems.

METHODS

A cross-sectional study was conducted among Ukrainian students in October 2023 (n = 1398). The online survey included sociodemographic data collection, evaluation of psychological well-being and measured depression, anxiety, PTSD symptoms and insomnia. Normality of included variables was verified by Kolmogorov-Smirnov test. An independent-samples t-test, Mann-Whitney U-test, χ2 test and analysis of variance were used to compare the data. Differences in PHQ-9 and GAD-7 levels based on sociodemographic characteristics were analyzed using ANOVA. Correlation between variables was calculated with Pearson correlation, adjusted with Benjamini-Hochberg procedure. To develop the predictive model the XGBoost algorithm was employed, additionally, the SHAP algorithm was utilized.

RESULTS

Symptoms of PTSD, as well as moderate and severe symptoms of anxiety, depression, and insomnia, were reported by 48.1%, 34.1%, 33.6%, and 19.3% of students, respectively. The severity of these symptoms varied based on factors such as sex, age, prior trauma experiences, and living conditions. Additionally, the type of relocation (within Ukraine or abroad) significantly influenced mental health outcomes. A majority of participants (68.5%) reported the experience of war-related traumatic events. Factors linked to higher depression symptom scores included lower initial well-being, greater social media use, female gender, exposure to multiple traumatic events, experiences of assault or sexual violence, the loss of a loved one, pre-existing and ongoing mental health treatment during the war, and the use of psychotropic medications.

CONCLUSIONS

Ukrainian university students face a significant mental health burden due to the ongoing war, with high rates of reported PTSD, anxiety, depression, and insomnia symptoms. These findings highlight the importance of tailored mental health interventions through different stakeholders that take into account individual needs, past experiences, burdens and social media usage.

Obsessive-compulsive disorder in the World Mental Health surveys

Background

National surveys have suggested that obsessive-compulsive disorder (OCD) is a prevalent and impairing condition. However, there are few cross-national data on OCD, with data particularly scarce in low- and middle-income countries. Here we employ data from the World Mental Health surveys to characterize the onset, course, severity, and treatment of OCD across a range of countries in different geographic regions of the world.

Methods

Data came from general population surveys carried out in 10 countries using a consistent research protocol and interview. A total of 26,136 adults were assessed for OCD in face-to-face interviews and were included in the present analyses. We examined lifetime and 12-month prevalence as well as age of onset, persistence, severity, and treatment of DSM-IV OCD in six high-income countries (HICs) and four low- or middle-income countries (LMICs). We also investigated socio-demographic variables and temporally prior mental disorders as predictors of OCD onset, persistence, severity, and treatment.

Results

Across the 10 countries surveyed, OCD has a combined lifetime prevalence of 4.1%. The 12-month prevalence (3.0%) is nearly as high, suggesting a highly persistent course of illness. Age of onset is early, with more than 80% of OCD cases beginning by early adulthood. Most OCD cases in the community are mild (47.0%) or very mild (27.5%), with a smaller percentage designated as moderate (22.9%) or severe (2.7%) by the Yale-Brown Obsessive-Compulsive Scale. Only 19.8% of respondents with OCD received any mental health treatment in the past year, with treatment rates much higher in HICs (40.5%) than LMICs (7.0%). Cross-nationally, OCD commonly emerges in adolescence or early adulthood against a backdrop of earlier-occurring mental disorders. With few exceptions (e.g., marital status, prior social phobia), the socio-demographic and psychopathological risk factors for OCD onset, persistence, severity, and treatment are distinct.

Conclusions

These cross-national data underscore clinical lessons regarding the importance of early diagnosis of OCD and comprehensive evaluation of comorbidity; draw attention to OCD as an undertreated disorder, particularly in LMIC contexts; and emphasize the public health significance of this often-overlooked condition.

Amplify and Advocate: Implementing a Youth Mental Health Advocacy Project, a Collaborative Rights-Based Approach Using COM-B, APEASE, and the Lundy Model

The Amplify and Advocate programme was designed to implement youth-led advocacy campaigns across Ireland, addressing gaps in early intervention, service accessibility and youth participation in mental health policy. Grounded in participatory, rights-based approaches, the project aimed to empower young people to influence mental health services and policies. Using the Lundy Model of Participation, World Café methodology, and COM-B and APEASE frameworks, the programme delivered co-designed advocacy training and supported young people in developing and implementing community-based campaigns. Participants engaged in local needs assessments, action planning, stakeholder engagement and policy advocacy. Eleven youth-led advocacy campaigns were launched, focusing on early intervention, equitable access, community collaboration, service integration, increased funding and amplifying youth voice. Evaluations indicated improved advocacy skills, increased engagement in policy discussions, and strengthened partnerships with service providers and policymakers. Findings demonstrate the effectiveness of participatory, youth-led advocacy in shaping mental health services and influencing policy. The project highlights the importance of structured advocacy training, stakeholder collaboration and sustainability planning to maintain long-term impact. Recommendations focus on integrating youth-led advocacy within policy frameworks and ensuring ongoing investment in participatory mental health initiatives.

The weight of office? A scoping review of mental health issues and risk factors in elected politicians across democratic societies

BACKGROUND

The mental health and capacity to govern of democratically-elected politicians have become burgeoning topics of interest. Notably, in fulfilling demanding and high-stress roles, political officeholders could encounter distinctive risk factors, yet existing research literature about these subpopulations remains underexplored.

AIMS

This scoping review aimed to systematically examine the breadth of available evidence on mental health issues and risk factors affecting democratically-elected politicians internationally and to identify future research needs.

METHODS

Using pre-defined eligibility criteria based on JBI guidelines, a systematic keyword search was conducted in May 2024 of MEDLINE, Scopus, and APA PsycNet, supplemented by snowballing techniques. Only those studies reporting primary, empirical evidence on mental ill-health or risk factors with psychological correlates from serving politicians in "Full" or "Flawed" democracies (per Democracy Index) were included from 1999 to 2024. Titles and abstracts were screened and the full-texts of potentially eligible literature were assessed before extraction and synthesis.

RESULTS

Eighteen sources met the eligibility criteria, cumulatively encompassing ~3,500 national, state, and municipal politicians across seven democracies (Australia, Canada, the Netherlands, Norway, New Zealand, the United Kingdom, and the United States). Cross-sectional surveys were predominantly utilized, with lesser use of mixed-methods approaches, qualitative interviews, and longitudinal cohorts. Violence emerged as a key concept, with twelve sources (66.7%) underlining its psychological toll and certain data indicating a disproportionate impact on female officeholders. Furthermore, four sources (22.2%) explored general psychopathology trends, revealing varying but sizeable mental ill-health and high-risk alcohol consumption rates, and two studies (11.1%) demonstrated adverse effects from specific occupational conditions.

CONCLUSIONS

Current literature suggests that democratically-elected politicians can face complex mental health challenges. However, significant research gaps remain, including a paucity of prevalence estimates, longitudinal data, and intervention studies. Equally, the underrepresentation of most democratic countries accentuates the need for a more diverse evidence-base to better support the mental wellbeing of politicians worldwide.

Blood cytokines in major depressive disorder in drug-naïve adolescents: A systematic review and meta-analysis

BACKGROUND

Major depressive disorder (MDD) is the most common mental health problem worldwide. Increased levels of inflammation are associated with MDD, though this relationship has been suggested to be bidirectional. The first incidence of a depressive episode usually occurs during adolescence. Hence, examining depressed, drug-naïve adolescents is important to understand the role of inflammation in the pathophysiology of MDD. Cytokines might play a crucial role in inflammation associated with MDD. Therefore, this article aims to investigate the changes in the levels of peripheral blood cytokines in adolescents with MDD.

METHODS

We conducted a systematic review and meta-analysis to assess the changes in peripheral blood cytokines in drug-naïve adolescents (10-18 years) with MDD. A comprehensive search across four databases was performed to identify original research articles. Studies in which the diagnosis of MDD was set by semi-structured interview were included.

RESULTS

Of 2291 articles, 12 met the inclusion criteria for the review, with seven suitable for meta-analysis & including up to five studies per cytokine. The meta-analysis revealed significant associations between tumor necrosis factor (TNF)-α (n = 222, Hedge's g = 0.51, p <0.01) and MDD in adolescents compared to healthy individuals. However, other blood cytokines, including interleukin (IL)-1β, IL-4, IL-6, IL-8, and interferon (IFN)-γ, did not significantly correlate with MDD in adolescents.

CONCLUSION

TNF-α was significantly elevated in drug-naïve adolescents with MDD. To further understand the role of TNF-α in MDD, a thorough investigation is required, taking into account the diversity, subtypes, chronicity, and severity of MDD.

Genomics yields biological and phenotypic insights into bipolar disorder

Bipolar disorder is a leading contributor to the global burden of disease1. Despite high heritability (60-80%), the majority of the underlying genetic determinants remain unknown2. We analysed data from participants of European, East Asian, African American and Latino ancestries (n = 158,036 cases with bipolar disorder, 2.8 million controls), combining clinical, community and self-reported samples. We identified 298 genome-wide significant loci in the multi-ancestry meta-analysis, a fourfold increase over previous findings3, and identified an ancestry-specific association in the East Asian cohort. Integrating results from fine-mapping and other variant-to-gene mapping approaches identified 36 credible genes in the aetiology of bipolar disorder. Genes prioritized through fine-mapping were enriched for ultra-rare damaging missense and protein-truncating variations in cases with bipolar disorder4, highlighting convergence of common and rare variant signals. We report differences in the genetic architecture of bipolar disorder depending on the source of patient ascertainment and on bipolar disorder subtype (type I or type II). Several analyses implicate specific cell types in the pathophysiology of bipolar disorder, including GABAergic interneurons and medium spiny neurons. Together, these analyses provide additional insights into the genetic architecture and biological underpinnings of bipolar disorder.

Cognitive behavioural therapy for internalizing symptoms in LGBTQ+ people: a preliminary meta-analysis

Internalizing disorders are common in lesbian, gay, bisexual, transgender, queer, questioning, and otherwise non-heterosexual or non-cisgender (LGBTQ+) people. Few studies have evaluated the efficacy of cognitive behavior therapy (CBT), a well-established treatment for internalizing disorders, in LGBTQ+ people. The current study quantitatively synthesized outcomes from existing trials of CBT for internalizing disorders in LGBTQ+ people. Seven databases were searched, identifying 14 relevant studies with a total of 414 participants. A medium within-group effect size was found for depressive symptoms from pre-treatment to post-treatment (k = 14; g = 0.60; 95% CI: 0.44-0.76; I2 = 71.59) and pre-treatment to 2-6-month follow-up (k = 7; g = 0.63; 95% CI: 0.40-0.86; I2 = 71.59). For anxiety and related disorder symptoms, a medium within-group effect size was found from both pre-treatment to post-treatment (k = 10; g = 0.73; 95% CI: 0.47-0.99; I2 = 71.59) and to 3-9-month follow-up (k = 5; g = 0.70; 95% CI: 0.54-0.87; I2 = 36.04). Exploratory analyses indicated small between-group effects at post-treatment between intervention and control groups. Effect sizes were comparable to those in the general population, indicating preliminary support for treating internalizing disorders in LGBTQ+ people with CBT.

Prevalence, age-of-onset, and course of mental disorders among 72,288 first-year university students from 18 countries in the World Mental Health International College Student (WMH-ICS) initiative

BACKGROUND

The college years are a developmentally sensitive period for mental disorder onset. Reliable epidemiological data are critical for informing public health responses. This study aimed to estimate prevalence and socio-demographic distributions of common DSM-5 mental disorders among first-year university students from 77 universities across 18 countries.

METHODS

Data were collected 2017-2023 in the World Mental Health International College Student Initiative with n = 72,288 university students. Online surveys assessed alcohol use, attention-deficit/hyperactivity, bipolar, drug use, generalized anxiety, major depression, panic, and post-traumatic stress disorders with validated screening scales. Socio-demographics included student age, sex at birth, gender modality, sexual orientation, and parent education.

RESULTS

The weighted mean response rate was 20.8%. Data were calibrated for differential response rates by sex at birth and age. 65.2% of respondents screened positive for lifetime mental disorders and 57.4% for 12-month mental disorders. Females had higher prevalence of internalizing disorders and males of substance and attention-deficit/hyperactivity disorders. Older age was associated with lower prevalence of most 12-month but not lifetime mental disorders. Non-heterosexual sexual orientation and identifying as transgender were associated with highest prevalence of most mental disorders. Parent education was for the most part uncorrelated with prevalence.

CONCLUSIONS

Although prevalence might have been overestimated due to the low response rate and possible screening scale miscalibration, results nonetheless suggest that mental disorders are highly prevalent among first-year university students worldwide and are widely distributed with respect to socio-demographic characteristics. These findings highlight the need to implement effective interventions to better support first-year university student mental health.

Exploring the interplay of mental health knowledge, stigma, and social distance among clinical nurses: a study in Liaoning, China

Background

Stigma related to mental health conditions has a negative impact on both the nursing staff and their patients. Most of the current research on stigma explores the impact of single factors on stigma and does not explore the relationship between knowledge, social distance and stigma among clinical nurses.

Methods

A convenience sampling method was used to conduct a questionnaire survey among 628 nurses from five hospitals in Liaoning Province in March 2021 and June 2021 using a combination of online and offline methods. To study the negative attitudes toward patients with mental illness among clinical nurses and to analyze the relationship between mental ill health stigma, social distancing, and mental health knowledge among nurses. The questionnaire includes Sociodemographic data, Scale for Assessing the Stigma of Mental Illness in Nursing (score range: 20~100, the higher the score, the less stigma attached to mental ill health), Mental Illness Social Distance Scale (score range: 6~30, the higher the score, the greater the social distance) and Mental Health and Mental Health Knowledge Questionnaire (score range: 0~25, the higher the score, the higher the knowledge level).

Results

The nurses' mental ill health stigma score was 58.96 ± 9.38 points, the mean scores of psychiatric and general nurses were 58.86 ± 9.33 and 59.41 ± 9.58 points, respectively. Willingness to become a psychiatric nurse is a factor influencing the stigma of mental illness. The stigma of mental ill health, social distance and mental health knowledge of nurses are positively correlated (P<0.01). The mediation analysis demonstrated that mental health stigma significantly mediated the relationship between mental health knowledge and social distance (a= 0.599, P<0.001; b= -0.194, P<0.001). After accounting for stigma, the direct effect of mental health knowledge on social distance was no longer significant (c'=-0.007, P=0.078), highlighting the central role of stigma in this relationship.

Conclusions

Nurses mental ill health stigma is moderate and is the main mediating effect between mental health knowledge and social distancing. The pivotal role of mental health knowledge in shaping nurses' attitudes and behaviors pertaining to social distancing in the context of mental illness. By combating stigma and enhancing mental health literacy among healthcare practitioners, we can foster environments that promote inclusive and compassionate care practices, thereby ameliorating patient outcomes and redressing disparities in mental health treatment.

Indirect Interventions: Lifestyle Options to Treat Mental Disorders

Mental disorders are highly prevalent worldwide. Unfortunately, most people with these disorders do not receive any treatment. This is due in part to a large set of barriers (e.g., no access to therapists or clinics, lack of insurance, stigma) that impede seeking and obtaining mental health services. Many lifestyle interventions that are not part of traditional mental health services have indirect effects on reducing symptoms of mental disorders. These are interventions that target a direct focus (e.g., physical health, socialization, general well-being) but also have indirect and significant impact on reducing mental disorders. This article discusses indirect interventions as an additional way of reaching people in need of help with mental health problems. Interventions such as physical activity and exercise, diet, addressing sleep problems, yoga, tai chi, qigong, and volunteering have indirect beneficial effects. This article highlights the scope of mental illness as a background, introduces indirect interventions, and details three illustrations with evidence that targeting one focus with indirect effects on improving mental disorders. The interventions point to a category of interventions are not systematically used in the care of mental health problems. Among their many advantages is the prospect of their use at the levels of individuals and populations. Indirect interventions do not replace any of the current advances in treatment but add to ways of reaching people in need.

Patients with Mood Disorders Have Higher Rates of Healthcare Utilization, Medical Complications, Opioid Prescriptions, and Subsequent Knee Surgery after Arthroscopic Partial Meniscectomy

PURPOSE

To compare rates of post-operative complications, healthcare utilization, opioid prescribing patterns, and secondary knee surgery in patients with versus without a preexisting anxiety or depressive disorder (ADD) undergoing isolated primary arthroscopic partial meniscectomy (APM).

METHODS

The TriNetX database was queried from inception to compare patients over 18-years-old who underwent isolated primary APM with versus without a pre-existing ADD. Patients were matched in a 1:1 ratio based on demographic factors and comorbidities, including diabetes and hypertension. The following outcomes were collected: 1) post-operative complications and healthcare utilization within ninety days, 2) proportion of patients prescribed an opioid within one year, and 3) subsequent knee surgery within two years, specifically ipsilateral or contralateral meniscus surgery or total knee arthroplasty. Two subgroup analyses were conducted. Opioid naive patients with and without an ADD were compared based on the proportion of patients prescribed an opioid within one year of APM. Rates of revision meniscus surgery on the ipsilateral knee were also compared within two years of APM.

RESULTS

Within 90 days, patients with a pre-existing ADD (n=26,507), compared to those without (n=26,507), had higher rates of healthcare utilization, including readmission (p<0.001), and medical complications, like cerebrovascular accident (p=0.002). A greater proportion of patients with an ADD were prescribed opioids at all chosen time points within one year of APM. Similarly, a greater proportion of opioid naive patients with an ADD were prescribed opioids within six months (p<0.001) and one year (p<0.001). Patients with an ADD also had higher rates of total knee arthroplasty (p=0.001) and ipsilateral revision meniscus surgery (left knee: p=0.020; right knee: p=0.019) within two years.

CONCLUSION

Patients with an anxiety or depressive disorder have higher rates of healthcare utilization, medical complications, opioid prescriptions, and subsequent knee surgery after isolated primary arthroscopic partial meniscectomy.

LEVEL OF EVIDENCE

III, retrospective cohort study.

Prediction of early-onset bipolar using electronic health records

BACKGROUND

Early identification of bipolar disorder (BD) provides an important opportunity for timely intervention. In this study, we aimed to develop machine learning models using large-scale electronic health record (EHR) data including clinical notes for predicting early-onset BD.

METHODS

Structured and unstructured data were extracted from the longitudinal EHR of the Mass General Brigham health system. We defined three cohorts aged 10-25 years: (1) the full youth cohort (N = 300,398); (2) a subcohort defined by having a mental health visit (N = 105,461); and (3) a subcohort defined by having a diagnosis of mood disorder or ADHD (N = 35,213). By adopting a prospective landmark modeling approach that aligns with clinical practice, we developed and validated a range of machine learning models, across different cohorts and prediction windows.

RESULTS

We found the two tree-based models, random forests (RF) and light gradient-boosting machine (LGBM), achieving good discriminative performance across different clinical settings (area under the receiver operating characteristic curve 0.76-0.88 for RF and 0.74-0.89 for LGBM). In addition, we showed comparable performance can be achieved with a greatly reduced set of features, demonstrating computational efficiency can be attained without significant compromise of model accuracy.

CONCLUSIONS

Good discriminative performance for models predicting early-onset BD can be achieved utilizing large-scale EHR data. Our study offers a scalable and accurate method for identifying youth at risk for BD that could help inform clinical decision-making and facilitate early intervention. Future work includes evaluating the portability of our approach to other healthcare systems and exploring considerations regarding possible implementation.

MIR218 polygenic risk score is associated with cognitive function and neurochemical metabolites among patients with depressed bipolar disorders

BACKGROUNDS

Evidence from animal and population studies has consistently revealed that microRNA 218 (MIR218) is involved in susceptibility to depression and cognitive functions. Nevertheless, few studies have evaluated the association between MIR218 and clinical features in patients with depressed bipolar disorder (BD).

METHODS

A total of 66 patients with depressed BD and 49 healthy controls (HCs) were recruited for this study. MIR218 polygenic risk score (PRS) was used to assess the addictive effects of the MIR218 regulated genes. We compared the MIR218 PRS between patients with depressed BD and HCs to investigate whether it can be used to predict the risk of BD, and further explored the association between MIR218 PRS and cognitive performance as well as neurochemical metabolites among depressed BD.

RESULTS

We found that there was a significant difference in MIR218 PRS between patients with depressed BD and HCs. The correlation analysis indicated that MIR218 PRS was negative associated with the number of disease onset (r = -0.311, P = 0.033) and choline (Cho)/creatine (Cr) in right thalamus (r = -0.285, P = 0.021). Additionally, as supported by previous findings, patients with lower MIR218 PRS presented more domains of impaired cognitive function than those with higher scores.

CONCLUSION

These findings suggested MIR218 PRS might be useful in differentiating patients with depressed BD from HCs. Moreover, depressed BD with lower MIR218 PRS showed more pronounced cognitive impairment than those with higher scores, which may be associated with disease recurrence and Cho metabolism in right thalamus.

Promoting Resilience in Youth through Mindfulness mEditation (PRYME): Study protocol for a randomized controlled trial investigating the effects of mindfulness training as add-on to care-as-usual on internalizing problems, mental illness development, and associated brain and cognitive processes in help-seeking youth

BACKGROUND

Internalizing problems, such as worrying, anxiety and low mood, are increasingly common in youth and may constitute an early stage of mental illness development. There is thus an urgent need for effective measures to address mental health complaints as they develop and to prevent progression into more serious mental illness. Enhanced understanding of early-stage mental illness development, associated cognitive and brain processes, and their amenability to early intervention is crucial to this effort. Mindfulness-based interventions offer an accessible intervention option with demonstrated positive effects on internalizing disorders such as depression. Furthermore, mindfulness-based interventions may modulate cognitive processes and brain activity patterns associated with internalizing disorders. This study aims to determine how early-stage mindfulness-based intervention impacts internalizing symptom development, associated cognitive and brain processes, and mental illness progression in help-seeking youth.

METHODS

This longitudinal two-arm randomized controlled trial will be conducted in 155 help-seeking youth between 16 and 25 years of age. The investigational treatment, the Learning to Offset Stress program, is an adaptation of existing mindfulness-based programs. Developed for youth with internalizing problems, the training combines mindfulness exercises with mindful physical activity and yoga in 8 weekly 2-hour sessions. Participants are randomized to either Learning to Offset Stress program as an add on to care-as-usual, or care-as-usual-only. Assessments take place at baseline, end of treatment, and 2 months and 6 months after completion of treatment. The primary outcome is the level of internalizing problems measured with the internalizing subscale of the Adult Self Report questionnaire at end of treatment. Secondary outcomes include measures of self-compassion, rumination, experiential avoidance, and well-being. In addition, (functional) magnetic resonance imaging and computerized cognitive tasks are conducted at baseline and at end of treatment.

DISCUSSION

The current randomized controlled trial aims to enhance our understanding of the trajectory of emerging mental illness, associated cognitive and brain processes, and their modulation by early-stage mindfulness-based intervention.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05916651. Registered on 23 June 2023.

Friendship buffering effects on mental health symptoms before and during the COVID-19 pandemic: A UK longitudinal study of young people with childhood adversity

Young people with childhood adversity (CA) were at increased risk to experience mental health problems during the COVID-19 pandemic. Pre-pandemic research identified high-quality friendship support as a protective factor that can buffer against the emergence of mental health problems in young people with CA. This longitudinal study investigated friendship buffering effects on mental health symptoms before and at three timepoints during the pandemic in 102 young people (aged 16-26) with low to moderate CA. Multilevel analyses revealed a continuous increase in depression symptoms following the outbreak. Friendship quality was perceived as elevated during lockdowns and returned to pre-pandemic baseline levels during reopening. A stress-sensitizing effect of CA on social functioning was evident, as social thinning occurred following the outbreak. Bivariate latent change score modeling revealed that before and during the pandemic, young people with greater friendship quality self-reported lower depression symptoms and vice versa. Furthermore, sequential mediation analysis showed that high-quality friendships before the pandemic buffered depression symptoms during the pandemic through reducing perceived stress. These findings highlight the importance of fostering stable and supportive friendships in young people with CA and suggest that through reducing stress perceptions high-quality friendships can mitigate mental health problems during times of multidimensional stress.

Barriers to 12-month treatment of common anxiety, mood, and substance use disorders in the World Mental Health (WMH) surveys

BACKGROUND

High unmet need for treatment of mental disorders exists throughout the world. An understanding of barriers to treatment is needed to develop effective programs to address this problem.

METHODS

Data on barriers were obtained from face-to-face interviews in 22 community surveys across 19 countries (n = 102,812 respondents aged ≥ 18 years, 57.7% female, median age [interquartile range]: 43 [31-57] years; 68.5% weighted average response rate) in the World Mental Health (WMH) surveys. We focus on the n = 5,136 respondents with 12-month DSM-IV anxiety, mood, or substance use disorders with perceived need for treatment. The n = 2,444 such respondents who did not receive treatment were asked about barriers to receiving treatment, whereas the n = 926 respondents who received treatment with a delay were asked about barriers leading to delays. Consistent with previous research, we distinguished five broad classes of barriers: low perceived disorder severity, two types of barriers in the domain of predisposing factors (beliefs/attitudes about treatment ineffectiveness and stigma) and two types in the domain of enabling factors (financial and nonfinancial). Baseline predictors of receiving treatment found in a prior report (i.e., comparing the n = 2,692 respondents who received treatment with the n = 2,444 who did not) were examined as predictors of barriers, while barriers were examined as mediators of associations between these predictors and treatment.

RESULTS

Most respondents reported multiple barriers. Barriers among respondents who did not receive treatment included low perceived severity (52.9%), perceived treatment ineffectiveness (44.8%), nonfinancial (40.2%) and financial (32.9%) barriers in the domain of enabling factors, and stigma (20.6%). Barriers causing delays in treatment had a similar rank-order but were reported by higher proportions of respondents (X21 = 3.8-199.8, p = 0.050- < 0.001). Barriers were predicted by low education, disorder type, age, employment status, and financial obstacles. Predictors varied as a function of barrier type.

CONCLUSIONS

A wide range of barriers to treatment exist among people with mental disorders even after a need for treatment is acknowledged. Most such individuals have multiple barriers. These results have important implications for the design of programs to decrease unmet need for treatment of mental disorders.

New diagnosis in psychiatry: beyond heuristics

BACKGROUND

Diagnosis in psychiatry faces familiar challenges. Validity and utility remain elusive, and confusion regarding the fluid and arbitrary border between mental health and illness is increasing. The mainstream strategy has been conservative and iterative, retaining current nosology until something better emerges. However, this has led to stagnation. New conceptual frameworks are urgently required to catalyze a genuine paradigm shift.

METHODS

We outline candidate strategies that could pave the way for such a paradigm shift. These include the Research Domain Criteria (RDoC), the Hierarchical Taxonomy of Psychopathology (HiTOP), and Clinical Staging, which all promote a blend of dimensional and categorical approaches.

RESULTS

These alternative still heuristic transdiagnostic models provide varying levels of clinical and research utility. RDoC was intended to provide a framework to reorient research beyond the constraints of DSM. HiTOP began as a nosology derived from statistical methods and is now pursuing clinical utility. Clinical Staging aims to both expand the scope and refine the utility of diagnosis by the inclusion of the dimension of timing. None is yet fit for purpose. Yet they are relatively complementary, and it may be possible for them to operate as an ecosystem. Time will tell whether they have the capacity singly or jointly to deliver a paradigm shift.

CONCLUSIONS

Several heuristic models have been developed that separately or synergistically build infrastructure to enable new transdiagnostic research to define the structure, development, and mechanisms of mental disorders, to guide treatment and better meet the needs of patients, policymakers, and society.

Long-term physical health conditions and youth anxiety and depression: Is there a causal link?

BACKGROUND

The prevalence of youth anxiety and depression has increased globally, with limited causal explanations. Long-term physical health conditions (LTCs) affect 20-40% of youth, with rates also rising. LTCs are associated with higher rates of youth depression and anxiety; however, it is uncertain whether observed associations are causal or explained by unmeasured confounding or reverse causation.

METHODS

Using data from the Norwegian Mother, Father, and Child Cohort Study (MoBa) and Norwegian National Patient Registry, we investigated phenotypic associations between childhood LTCs, and depression and anxiety diagnoses in youth (<19 years), defined using ICD-10 diagnoses and self-rated measures. We then conducted two-sample Mendelian Randomization (MR) analyses using SNPs associated with childhood LTCs from existing genome-wide association studies (GWAS) as instrumental variables. Outcomes were: (i) diagnoses of major depressive disorder (MDD) and anxiety disorders or elevated symptoms in MoBa, and (ii) youth-onset MDD using summary statistics from a GWAS in iPSYCH2015 cohort.

RESULTS

Having any childhood LTC phenotype was associated with elevated youth MDD (OR = 1.48 [95% CIs 1.19, 1.85], p = 4.2×10-4) and anxiety disorder risk (OR = 1.44 [1.20, 1.73], p = 7.9×10-5). Observational and MR analyses in MoBa were consistent with a causal relationship between migraine and depression (IVW OR = 1.38 [1.19, 1.60], pFDR = 1.8x10-4). MR analyses using iPSYCH2015 did not support a causal link between LTC genetic liabilities and youth-onset depression or in the reverse direction.

CONCLUSIONS

Childhood LTCs are associated with depression and anxiety in youth, however, little evidence of causation between LTCs genetic liability and youth depression/anxiety was identified from MR analyses, except for migraine.

Potential common targets of music therapy intervention in neuropsychiatric disorders: the prefrontal cortex-hippocampus -amygdala circuit (a review)

As life becomes more stressful, neurological disorders, psychiatric disorders, and comorbidities of the two are becoming more and more of a concern. Multiple neuropsychiatric disorders share the same mental and somatic dysfunction and may involve common brain circuits and mechanistic targets. Music therapy, as an art form with proven efficacy, low cost and few side effects, is promoted for use in interventions for neuropsychiatric disorders. This may be closely related to the release of signaling molecules such as monoamine neurotransmitters, the glutamatergic system, the gut-microbiota-brain axis, pro-inflammatory cytokines and the endogenous opioid peptide system. However, fewer studies have mentioned the main targets of music to promote functional changes in brain regions. Therefore, this paper is a review of the mechanisms by which music therapy interacts with the prefrontal cortex-hippocampus-amygdala circuit through the aforementioned molecules. It is also hypothesized that glial cells, mitochondria and microRNAs are microscopic targets for musical intervention in neuropsychiatric disorders. The aim is to give new ideas for future research into the biological mechanisms of music therapy intervention in neuropsychiatric disorders.

Shared Patterns of Cognitive Control Behavior and Electrophysiological Markers in Adolescence

Behavioral parameters obtained from cognitive control tasks have been linked to electrophysiological markers. Yet, most previous research has investigated only a few specific behavioral parameters at a time. An integrated approach with simultaneous consideration of multiple aspects of behavior may better elucidate the development and function of cognitive control. Here, we aimed to identify shared patterns between cognitive control behavior and electrophysiological markers using stop-signal task data and EEG recordings from an adolescent sample (n = 193, aged 11-25 years). We extracted behavioral variables covering various aspects of RT, accuracy, inhibition, and decision-making processes, as well as amplitude and latency of the ERPs N1, N2, and P3. To identify shared patterns between the two sets of variables, we employed a principal component analysis and a canonical correlation analysis. First, we replicated previously reported associations between various cognitive control behavioral parameters. Next, results from the canonical correlation analysis showed that overall good task performance was associated with fast and strong neural processing. Furthermore, the canonical correlation was affected by age, indicating that the association varies depending on age. The present study suggests that although distributional and computational methods can be applied to extract specific behavioral parameters, they might not capture specific patterns of cognitive control or electrophysiological brain activity in adolescents.