International meta-analysis of PTSD genome-wide association studies identifies sex- and ancestry-specific genetic risk loci

The impact of trauma and how to intervene: a narrative review of psychotraumatology over the past 15 years

To mark 15 years of the European Journal of Psychotraumatology, editors reviewed the past 15-year years of research on trauma exposure and its consequences, as well as developments in (early) psychological, pharmacological and complementary interventions. In all sections of this paper, we provide perspectives on sex/gender aspects, life course trends, and cross-cultural/global and systemic societal contexts. Globally, the majority of people experience stressful events that may be characterized as traumatic. However, definitions of what is traumatic are not necessarily straightforward or universal. Traumatic events may have a wide range of transdiagnostic mental and physical health consequences, not limited to posttraumatic stress disorder (PTSD). Research on genetic, molecular, and neurobiological influences show promise for further understanding underlying risk and resilience for trauma-related consequences. Symptom presentation, prevalence, and course, in response to traumatic experiences, differ depending on individuals' age and developmental phase, sex/gender, sociocultural and environmental contexts, and systemic socio-political forces. Early interventions have the potential to prevent acute posttraumatic stress reactions from escalating to a PTSD diagnosis whether delivered in the golden hours or weeks after trauma. However, research on prevention is still scarce compared to treatment research where several evidence-based psychological, pharmacological and complementary/ integrative interventions exist, and novel forms of delivery have become available. Here, we focus on how best to address the range of negative health outcomes following trauma, how to serve individuals across the age spectrum, including the very young and old, and include considerations of sex/gender, ethnicity, and culture in diverse contexts, beyond Western, Educated, Industrialized, Rich, and Democratic (WEIRD) countries. We conclude with providing directions for future research aimed at improving the well-being of all people impacted by trauma around the world. The 15 years EJPT webinar provides a 90-minute summary of this paper and can be downloaded here [http://bit.ly/4jdtx6k].

Childhood maltreatment and mental health: causal links to depression, anxiety, non-fatal self-harm, suicide attempts, and PTSD

Background: This study aims to elucidate the causal relationship between childhood maltreatment (CM) and subsequent mental health outcomes, including major depressive disorder (MDD), anxiety (ANX), post-traumatic stress disorder (PTSD), suicide attempts, and non-fatal self-harm. Utilising Mendelian Randomisation (MR) and genome-wide association studies (GWAS) data from individuals of European descent, this research applies a rigorous analytical methodology to large-scale datasets, overcoming the confounding variables inherent in previous observational studies.Methods: Genetic data were obtained from publicly available GWAS on individuals of European ancestry, focusing on Childhood Maltreatment (CM), Major Depressive Disorder (MDD), Anxiety (ANX), Post-Traumatic Stress Disorder (PTSD), Age at First Episode of Depression, Number of Depression Episodes, Non-fatal self-harm, and Suicide Attempts. Mendelian Randomisation (MR) analyses were conducted to investigate the causal impact of CM on these outcomes. Sensitivity analyses included IVW, MR Egger, WM, and MR-PRESSO. FDR corrections were applied to account for multiple testing. Results were presented as odds ratios (ORs) with confidence intervals (CIs).Results: Significant associations were identified between CM and the likelihood of developing MDD (IVW: OR = 2.28, 95% CI = 1.66-3.14, PFDR < .001), ANX (IVW: OR = 1.01, 95% CI = 1.00-1.02, PFDR =.032), and PTSD (IVW: OR = 2.29, 95% CI = 1.43-3.67, PFDR =.001). CM was also linked to increased non-fatal self-harm (IVW: OR = 1.06, 95% CI = 1.04-1.08, PFDR <.001), higher frequency of depressive episodes (IVW: β=0.31, 95% CI = 0.17-0.46, PFDR <.001), and earlier onset of depression (IVW: β=-0.17, 95% CI = -0.32 to - 0.02, PFDR =.033). No significant association was found between CM and suicide attempts (IVW: OR = 1.09, 95% CI = 0.81-1.45, PFDR =.573).Conclusion: This study provides robust evidence that CM is a significant causal factor for MDD, ANX, PTSD, and non-fatal self-harming behaviours. It is associated with a higher frequency of depressive episodes and earlier onset of depression. These findings highlight the need for early intervention and targeted prevention strategies to address the long-lasting psychological impacts of CM.

Genetic insights into the role of mitochondria-related genes in mental disorders: An integrative multi-omics analysis

BACKGROUND

Mitochondrial dysfunction has been implicated in the development of mental disorders, yet the underlying mechanisms remain unclear. In this study, we employed summary-data-based Mendelian randomization (SMR) analysis to explore the associations between mitochondrial-related genes and seven common mental disorders across gene expression, DNA methylation, and protein levels.

METHOD

Summary statistics from genome-wide association studies were used for seven mental disorders, including attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, anxiety, bipolar disorder, major depressive disorder, post-traumatic stress disorder, and schizophrenia (SCZ). Instrumental variables associated with 1136 mitochondria-related genes were derived from summary statistics for DNA methylation, gene expression, and protein quantitative trait loci. SMR analyses and colocalization analyses were then conducted across these three biological levels to explore the associations with each of the seven mental disorders.

RESULTS

We identified mitochondria-related genes associated with mental disorders with multi-omics evidence: RMDN1 for ADHD, and ACADVL, ETFA, MMAB, and PPA2 for SCZ. Specifically, an increase of one standard deviation in the level of RMDN1 was linked to a 12 % decrease in the risk of developing ADHD (OR = 0.88, 95 % CI: 0.83-0.94). Increased levels of ETFA (OR = 1.79, 95 % CI: 1.24-2.60) and MMAB (OR = 1.10, 95 % CI: 1.05-1.16) were significantly associated with increased risk of SCZ. Conversely, high levels of ACADVL (OR = 0.50, 95 % CI: 0.33-0.77) and PPA2 (OR = 0.68, 95 % CI: 0.55-0.85) were associated with a reduced risk of SCZ.

CONCLUSIONS

These findings suggested that dysfunction in mitochondria-related genes may underlie the molecular mechanisms of ADHD and SCZ, providing novel biomarkers for diagnosis and therapeutic interventions.

Preliminary Insights Into the Relationship Between the Gut Microbiome and Host Genome in Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) may develop following trauma exposure; however, not all trauma-exposed individuals develop PTSD, suggesting the presence of susceptibility and resilience factors. The gut microbiome and host genome, which are interconnected, have been implicated in the aetiology of PTSD. However, their interaction has yet to be investigated in a South African population. Using genome-wide genotype data and 16S rRNA (V4) gene amplicon sequencing data from 53 trauma-exposed controls and 74 PTSD cases, we observed no significant association between the host genome and summed abundance of Mitsuokella, Odoribacter, Catenibacterium and Olsenella, previously reported as associated with PTSD status in this cohort. However, PROM2 rs2278067 T-allele was significantly positively associated with the summed relative abundance of these genera, but only in individuals with PTSD and not trauma-exposed controls (p < 0.014). Polygenic risk scores generated using genome-wide association study summary statistics from the PGC-PTSD Overall Freeze 2 were not predictive of gut microbial composition in this cohort. These preliminary results suggest a potential role for the interaction between genetic variation and gut microbial composition in the context of PTSD, underscoring the need for further investigation.

An Update on the Psychiatric Genomics of Posttraumatic Stress Disorder (PTSD)

Posttraumatic Stress Disorder (PTSD) is a prevalent psychiatric condition characterized by intrusive thoughts, hyperarousal, avoidance, and negative cognitive alterations following traumatic events. While a significant portion of individuals experience trauma, only 5% to 30% develop PTSD, with certain groups at higher risk. Research indicates that PTSD's pathophysiology involves altered fear processing, neuroendocrine dysfunction, and immune system changes. Genetic studies, particularly twin studies, suggest a heritability estimate of 30% to 40% for PTSD. Initially focused on gene-environment interactions, recent advancements in genome-wide association studies have identified significant genetic markers enhancing understanding of PTSD's genetic underpinnings.

Risk and Protective Factors in Dancers Exposed to Trauma

PURPOSE

This study examined risk and protective factors in dancers with/without posttraumatic stress disorder (PTSD) and with/without trauma exposure.

LITERATURE REVIEW

Exposure to traumatic events and developing PTSD can compromise daily functioning and performance ability. Despite exposure many dancers adapt, whereas others suffer psychopathology such as depression, anxiety, PTSD, and difficulties regulating emotions.

METHODS

Two hundred ninety two pre-professional/professional dancers provided informed consent (IRB approved) and completed 8 self-report measures. A subsample (66%) exposed to a significant traumatic event was evaluated for PTSD. Multivariate analyses of covariance (MANCOVA) were conducted to compare dancers with/without PTSD and with/without trauma exposure. A logistic regression analysis determined predictors of PTSD.

RESULTS

The MANCOVAs indicated that dancers exposed to trauma (66%) and who had PTSD (32%) had significantly more difficulty regulating emotions, engaged more emotion-oriented coping under stress, and had increased depression, trait anxiety, and cumulative trauma. In these group comparison analyses there were non-significant differences regarding flow experiences and task- and avoidance-oriented coping strategies. In the logistic regression analysis childhood physical and sexual abuse, childhood emotional neglect, mental illness within the family, and difficulty disclosing abuse experiences were predictors of PTSD. In the total sample 21% had PTSD.

DISCUSSION AND CONCLUSIONS

This study identified types of abuse/trauma, emotion regulation/coping, and psychopathology associated with PTSD in dancers exposed to trauma (66%) and with PTSD (32%). In the total sample 21% had PTSD. Regardless of exposure to trauma or PTSD, the non-significant findings indicated similarities for dancers for global and autotelic flow experiences and task- and avoidance-oriented coping strategies. These positive factors may mitigate trauma-related symptoms. It is recommended that dancers, educators, and clinicians understand the effects of trauma exposure and promote the development of effective coping strategies, emotion regulation, and flow states which may diminish the negative effects of PTSD.

Integrating brain imaging features and genomic profiles for the subtyping of major depression

BACKGROUND

Precise stratification of patients into homogeneous disease subgroups could address the heterogeneity of phenotypes and enhance understanding of the pathophysiology underlying specific subtypes. Existing literature on subtyping patients with major depressive disorder (MDD) mainly utilized clinical features only. Genomic and imaging data may improve subtyping, but advanced methods are required due to the high dimensionality of features.

METHODS

We propose a novel disease subtyping framework for MDD by integrating brain structural features, genotype-predicted expression levels in brain tissues, and clinical features. Using a multi-view biclustering approach, we classify patients into clinically and biologically homogeneous subgroups. Additionally, we propose approaches to identify causally relevant genes for clustering.

RESULTS

We verified the reliability of the subtyping model by internal and external validation. High prediction strengths (PS) (average PS: 0.896, minimum: 0.854), a measure of generalizability of the derived clusters in independent datasets, support the validity of our approach. External validation using patient outcome variables (treatment response and hospitalization risks) confirmed the clinical relevance of the identified subgroups. Furthermore, subtype-defining genes overlapped with known susceptibility genes for MDD and were involved in relevant biological pathways. In addition, drug repositioning analysis based on these genes prioritized promising candidates for subtype-specific treatments.

CONCLUSIONS

Our approach successfully stratified MDD patients into subgroups with distinct clinical prognoses. The identification of biologically and clinically meaningful subtypes may enable more personalized treatment strategies. This study also provides a framework for disease subtyping that can be extended to other complex disorders.

Stress dynamics that maintain posttraumatic stress disorder across 20 years

BACKGROUND

Posttraumatic stress disorder (PTSD) is often chronic and impairing. Mechanisms that maintain symptoms remain poorly understood because of heterogenous presentation. We parsed this heterogeneity by examining how individual differences in stress-symptom dynamics relate to the long-term maintenance of PTSD.

METHODS

We studied 7,308 trauma-exposed World Trade Center responders who self-reported PTSD symptoms and stressful life events at annual monitoring visits for up to 20 years (average = 8.8 visits; [range = 4-16]). We used multilevel structural equation models to separate the stable and time-varying components of symptoms and stressors. At the within-person level, we modeled stress reactivity by cross-lagged associations between stress and future symptoms, stress generation by cross-lagged associations between symptoms and future stress, and autoregressive effects represented symptom persistence and stress persistence. The clinical utility of the stress-symptom dynamics was evaluated by associations with PTSD chronicity and mental health care use.

RESULTS

Stress reactivity, stress generation, and symptom persistence were significant on average (bs = 0.03-0.16). There were significant individual differences in the strength of each dynamic (interquartile ranges = 0.06-0.12). Correlations among within-person processes showed some dynamics are intertwined (e.g. more reactive people also generate stress in a vicious cycle) and others represent distinct phenotypes (e.g. people are reactive or have persistent symptoms). Initial trauma severity amplified some dynamics. People in the top deciles of most dynamics had clinically significant symptom levels across the monitoring period and their health care cost 6-17× more per year than people at median levels.

CONCLUSIONS

Individual differences in stress-symptom dynamics contribute to the chronicity and clinical burden of PTSD.

Post-traumatic stress disorder, attention deficit and hyperactivity disorder, and 24 gastrointestinal diseases: Evidence from Mendelian randomization analysis

Post-traumatic stress disorder (PTSD) and Attention deficit and hyperactivity disorder (ADHD) are common mental illnesses. Observational studies have indicated that these conditions often co-occur with gastrointestinal diseases. However, the causal relationship between PTSD and ADHD with gastrointestinal diseases remain unclear. We conducted Mendelian randomization (MR) analysis to investigate these associations. We selected genetic instrument data with genome-wide significance levels for PTSD and ADHD from the psychiatric genomics consortium open genome-wide association study platform. Summary statistics for the 24 gastrointestinal diseases were obtained from the FinnGen study. We used the "TwoSampleMR" package in R to perform a 2-sample MR analysis and conducted sensitivity analysis of the results. We found that genetic susceptibility to PTSD was associated with 1 gastrointestinal disease, specifically pancreatic cancer (P = .003; odds ratios [OR] = 1.295; 95% CI, 1.094-1.531). Genetic susceptibility to ADHD was associated with 4 gastrointestinal diseases: gastroesophageal reflux (P = .014; OR = 1.100; 95% CI, 1.020-1.186), gastric ulcer (P = .004; OR = 1.208; 95% CI, 1.061-1.376), duodenal ulcer (P = .020; OR = 1.206; 95% CI, 1.029-1.413), and chronic gastritis (P = .021; OR = 1.122; 95% CI, 1.018-1.237). This study provides MR evidence supporting causal relationship between PTSD and ADHD with specific gastrointestinal diseases.

PTSD and epigenetic aging: a longitudinal meta-analysis

BACKGROUND

Posttraumatic stress disorder (PTSD) has been associated with advanced epigenetic age cross-sectionally, but the association between these variables over time is unclear. This study conducted meta-analyses to test whether new-onset PTSD diagnosis and changes in PTSD symptom severity over time were associated with changes in two metrics of epigenetic aging over two time points.

METHODS

We conducted meta-analyses of the association between change in PTSD diagnosis and symptom severity and change in epigenetic age acceleration/deceleration (age-adjusted DNA methylation age residuals as per the Horvath and GrimAge metrics) using data from 7 military and civilian cohorts participating in the Psychiatric Genomics Consortium PTSD Epigenetics Workgroup (total N = 1,367).

RESULTS

Meta-analysis revealed that the interaction between Time 1 (T1) Horvath age residuals and new-onset PTSD over time was significantly associated with Horvath age residuals at T2 (meta β = 0.16, meta p = 0.02, p-adj = 0.03). The interaction between T1 Horvath age residuals and changes in PTSD symptom severity over time was significantly related to Horvath age residuals at T2 (meta β = 0.24, meta p = 0.05). No associations were observed for GrimAge residuals.

CONCLUSIONS

Results indicated that individuals who developed new-onset PTSD or showed increased PTSD symptom severity over time evidenced greater epigenetic age acceleration at follow-up than would be expected based on baseline age acceleration. This suggests that PTSD may accelerate biological aging over time and highlights the need for intervention studies to determine if PTSD treatment has a beneficial effect on the aging methylome.

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

Importance

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

Objective

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

Design

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

Setting

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

Participants

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

Main Outcomes

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

Results

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

Conclusions and Relevance

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

KEY POINTS

Question

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

Findings

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

Meaning

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

A multi-omic approach implicates novel protein dysregulation in post-traumatic stress disorder

BACKGROUND

Post-traumatic stress disorder (PTSD) is a common and disabling psychiatric disorder. PTSD involves multiple brain regions and is often comorbid with other psychiatric disorders, such as major depressive disorder (MDD). Recent genome-wide association studies (GWASs) have identified many PTSD risk loci and transcriptomics studies of postmortem brain have found differentially expressed genes associated with PTSD cases. In this study, we integrated genome-wide measures across modalities to identify convergent molecular effects in the PTSD brain.

METHODS

We performed tandem mass spectrometry (MS/MS) on a large cohort of donors (N = 66) in two prefrontal cortical areas, dorsolateral prefrontal cortex (DLPFC), and subgenual prefrontal cortex (sgPFC). We also coupled the proteomics data with transcriptomics and microRNA (miRNA) profiling from RNA-seq and small-RNA sequencing, respectively for the same cohort. Additionally, we utilized published GWAS results of multiple psychiatric disorders for integrative analysis.

RESULTS

We found differentially expressed proteins and co-expression protein modules disrupted by PTSD. Integrative analysis with transcriptomics and miRNA data from the same cohort pointed to hsa-mir-589 as a regulatory miRNA responsible for dysregulation of neuronal protein networks for PTSD, including the gamma-aminobutyric acid (GABA) vesicular transporter, SLC32A1. In addition, we identified significant enrichment of risk genes for other psychiatric disorders, such as autism spectrum disorder (ASD) and major depressive disorder (MDD) within PTSD protein co-expression modules, suggesting shared molecular pathology.

CONCLUSIONS

We integrated genome-wide measures of mRNA and miRNA expression and proteomics profiling from PTSD, MDD, and control (CON) brains to identify convergent and divergent molecular processes across genomic modalities. We substantially expand the number of differentially expressed genes and proteins in PTSD and identify downregulation of GABAergic processes in the PTSD proteome. This provides a novel framework for future studies integrating proteomic profiling with transcriptomics and non-coding RNAs in the human brain studies.

Large-scale transcriptomic analyses of major depressive disorder reveal convergent dysregulation of synaptic pathways in excitatory neurons

Major Depressive Disorder (MDD) is a common, complex disorder that is a leading cause of disability worldwide and a significant risk factor for suicide. In this study, we have performed the largest molecular analysis of MDD in postmortem human brains (846 samples across 458 individuals) in the subgenual Anterior Cingulate Cortex (sACC) and the Amygdala, two regions central to mood regulation and the pathophysiology of MDD. We found extensive expression differences, particularly at the level of specific transcripts, with prominent enrichment for genes associated with the vesicular functioning, the postsynaptic density, GTPase signaling, and gene splicing. We find associated transcriptional features in 107 of 243 genome-wide significant loci for MDD and, through integrative analyses, highlight convergence of genetic risk, gene expression, and network-based analyses on dysregulated glutamatergic signaling and synaptic vesicular functioning. Together, these results provide an initial mechanistic understanding of MDD and highlight potential targets for novel drug discovery.

Causal relationships between hundreds of plasma metabolites and PTSD: a bidirectional mendelian randomization study

BACKGROUND

Recent studies have indicated a connection between plasma metabolites and Post-traumatic stress disorder (PTSD). Nevertheless, the precise causal relationship remains unclear.

METHODS

We performed bidirectional Mendelian Randomization (MR) using two metabolite and two PTSD GWAS datasets to examine causal relationships between PTSD and 1009 plasma metabolites. Forward MR tested metabolite causally effects on PTSD, while reverse MR assessed PTSD causally effects on metabolites. Primary analysis employed the IVW method, supported by four supplementary methods. Four IVW results per direction were meta-analyzed to identify high-credibility metabolites. Venn diagrams intersected results from the four IVW analyses, and this intersection was further compared with meta-analysis findings to generate a second Venn diagram. Sensitivity analyses addressed horizontal pleiotropy for robust results.

RESULTS

After sensitivity analyses, a robust set of 775 metabolites in the forward MR analysis and a set of 566 ones in the reverse process were identified. The meta-analysis of IVW method results (four results between two metabolites GWAS and two PTSD GWAS) revealed that 58 metabolites were significantly associated with the risk of PTSD (P < 0.05) in the forward MR analysis, and 19 metabolites might exhibit significant changes in PTSD (P < 0.05) in the reverse progress. Further Venn diagram intersection analysis among those four IVW results unveiled 4 metabolites with promoting or inhibiting effects on PTSD (P < 0.05) and 1 metabolites with notably increased plasma levels in PTSD (P < 0.05). The subsequent Venn diagram intersection analysis of the meta-analysis outcomes and the initial Venn diagram results identified 3 metabolites. In the forward analysis, 5-hydroxy-2-methylpyridine sulfate (OR = 1.05, P = 0.004) and levulinoylcarnitine (OR = 1.08, P = 0.005) from the Xenobiotics pathway were significantly associated with an increased risk of PTSD. Additionally, cysteinylglycine from the Amino Acid pathway significantly reduced the risk of PTSD (OR = 0.918, 95%CI: 0.868-0.971, P = 0.003). In the reverse analysis, no significant changes in plasma metabolites at the genetic level were found to causally influence the development of PTSD.

CONCLUSIONS

Our findings provide potential biomarkers for predicting and preventing PTSD, as well as possible therapeutic targets for that. However, further research is needed to confirm the clear mechanism.

Genetic causal effects of multi-site chronic pain on post-traumatic stress disorder: Evidence from a two-sample, two-step Mendelian randomization study

BACKGROUND

Existing evidence supports a correlation between multi-site chronic pain and post-traumatic stress disorder (PTSD), but it is yet to be determined if this correlation is causal and in what direction the causation works.

METHODS

Applying two-sample Mendelian randomization (MR) analysis to data from available genome-wide association studies in populations of European ancestry, we estimated the causal association between multi-site chronic pain and no pain versus PTSD. Moreover, we used multivariable and mediation MR analysis to assess the mediating effects of 13 lifestyle factors or diseases on the causal relationship between multi-site chronic pain and PTSD. The MR analyses were mainly conducted with the inverse variance weighted (IVW) method, followed by various sensitivity and validation analyses.

RESULTS

Multi-site chronic pain dramatically increases the risk of developing PTSD (odds ratio [OR]IVW = 2.39, 95 % confidence interval [CI] = 1.72-3.31, p = 2.10 × 10-7), and no pain significantly reduces the risk of developing PTSD (ORIVW = 0.12, 95 % CI = 0.05-0.30, p = 3.14 × 10-6). Multivariable MR found that 13 potential confounding factors do not influence the causal effect of multi-site chronic pain on PTSD. Moreover, body mass index (BMI) (6.98 %), educational attainment (8.79 %), major depressive disorder (MDD) (36.98 %) and insomnia (27.25 %) mediate the causal connection between multi-site chronic pain and PTSD.

CONCLUSION

Overall, individuals with multi-site chronic pain may be at a higher risk of developing PTSD, and this risk is partially influenced by the pathways involving BMI, educational attainment, MDD, and insomnia. These factors offer potential targets for therapeutic interventions.

Psychiatric genetics in the diverse landscape of Latin American populations

Psychiatric disorders are highly heritable and polygenic, influenced by environmental factors and often comorbid. Large-scale genome-wide association studies (GWASs) through consortium efforts have identified genetic risk loci and revealed the underlying biology of psychiatric disorders and traits. However, over 85% of psychiatric GWAS participants are of European ancestry, limiting the applicability of these findings to non-European populations. Latin America and the Caribbean, regions marked by diverse genetic admixture, distinct environments and healthcare disparities, remain critically understudied in psychiatric genomics. This threatens access to precision psychiatry, where diversity is crucial for innovation and equity. This Review evaluates the current state and advancements in psychiatric genomics within Latin America and the Caribbean, discusses the prevalence and burden of psychiatric disorders, explores contributions to psychiatric GWASs from these regions and highlights methods that account for genetic diversity. We also identify existing gaps and challenges and propose recommendations to promote equity in psychiatric genomics.

Association of Alzheimer's disease genetic risk with age-dependent changes in plasma amyloid-β42:40 in Veterans

BackgroundIdentifying biomarkers of Alzheimer's disease (AD) is critical for early diagnosis and AD risk assessment.ObjectiveWe examined the hypothesis that the plasma amyloid-β 42 and 40 (Aβ42:40) ratio has a curvilinear relationship with age among individuals who are at higher genetic risk for AD.MethodsThis study investigated the relationship between plasma amyloid-β 42 and 40 (Aβ42:40) ratio and age in 315 men and women Veterans, including those at genetic risk for AD. Hierarchical regression models investigated linear and nonlinear relationships between age, genetic risk, and Aβ42:40.ResultsWe observed a curvilinear relationship between age and Aβ42:40 in individuals with higher genetic risk, characterized by an increase in the Aβ42:40 during midlife followed by a decrease in older age.ConclusionsThese findings highlight distinct patterns in Aβ metabolism among genetically predisposed individuals, suggesting that early metabolic shifts may play a role in the progression of AD. Understanding these nuanced changes is essential for refining the use of Aβ42:40 ratio as a biomarker, potentially leading to more accurate risk stratification and earlier intervention strategies in AD.

Polygenic Risk Score Analysis of Antidepressant Treatment Outcomes: A CAN-BIND-1 Study Report: Analyse des résultats du traitement antidépresseur à l'aide des scores de risque polygéniques : Rapport sur l'étude CAN-BIND-1

ObjectiveThe genetic architecture of antidepressant response is poorly understood. This study investigated whether polygenic risk scores (PRSs) for major psychiatric disorders and a personality trait (neuroticism) are associated with antidepressant treatment outcomes.MethodsWe analysed 148 participants with major depressive disorder (MDD) from the Canadian Biomarker Integration Network for Depression-1 (CAN-BIND-1) cohort. Participants initially received escitalopram (ESC) monotherapy for 8 weeks. Nonresponders at week 8 received augmentation with aripiprazole (ARI), while responders continued ESC until week 16. Primary outcomes were remission status and symptom improvement measured at weeks 8 and 16. At week 16, post-hoc stratified analyses were performed by treatment arm (ESC-only vs. ESC + ARI). Eleven PRSs derived from genome-wide association studies of psychiatric disorders (e.g., MDD and post-traumatic stress syndrome (PTSD)) and neuroticism, were analysed for associations with these outcomes using logistic and linear regression models.ResultsAt week 8, a higher PRS for PTSD was nominally associated with a lower probability of remission (odds ratio (OR) = 0.08 [0.014-0.42], empirical p-value = 0.017) and reduced symptom improvement (beta (standard error) = -29.15 (9.76), empirical p-value = 0.019). Similarly, a higher PRS for MDD was nominally associated with decreased remission probability (OR = 0.38 [0.18-0.78], empirical p-value = 0.044). However, none of the results survived multiple testing corrections. At week 16, the stratified analysis for the ESC-only group revealed that a higher PRS for MDD was associated with increased remission probability (empirical p-value = 0.034) and greater symptom improvement (empirical p-value = 0.02). In contrast, higher PRSs for schizophrenia (empirical p-value = 0.013) and attention-deficit hyperactivity disorder (empirical p-value = 0.032) were associated with lower symptom improvement. No significant associations were observed in the ESC + ARI group.ConclusionsThese findings suggest that PRSs may influence treatment outcomes, particularly in ESC monotherapy. Replication in larger studies is needed to validate these observations.

Transdiagnostic Polygenic Risk Models for Psychopathology and Comorbidity: Cross-Ancestry Analysis in the All of Us Research Program

Psychiatric disorders exhibit substantial genetic overlap, raising questions about the utility of transdiagnostic genetic risk models. Using data from the All of Us Research Program (N=102,091), we evaluated common psychiatric genetic (CPG) factor-based polygenic risk scores (PRSs) compared to standard disorder-specific PRSs. The CPG PRS consistently outperformed disorder-specific scores in predicting individual disorder risk, explaining 1.07 to 24.6 times more phenotypic variance across 11 psychiatric conditions. Meanwhile, many disorder-specific PRSs retained independent but smaller contributions, highlighting the complementary nature of shared and disorder-specific genetic risk. While alternative multi-factor models improved model fit, the CPG PRS provided comparable or superior predictive performance across most disorders, including overall comorbidity burden. Cross-ancestry analyses however revealed notable limitations of European-centric GWAS datasets for other populations due to ancestral differences in genetic architecture. These findings underscore the potential value of transdiagnostic PRSs for psychiatric genetics while highlighting the need for more equitable genetic risk models.

Impact of Glucagon-like Peptide-1 Receptor Agonists on Mental Illness: Evidence from a Mendelian Randomization Study

Emerging evidence suggests that glucagon-like peptide-1 receptor (GLP1R) agonists may have potential benefits for mental illnesses. However, their exact effects remain unclear. This study investigated the causal relationship between glucagon-like peptide-1 receptor agonist (GLP1RA) and the risk of 10 common mental illnesses, including attention deficit and hyperactivity disorder, anorexia nervosa, anxiety disorder, autism spectrum disorder, bipolar disorder, major depressive disorder, post-traumatic stress disorder, schizophrenia, cannabis use disorder, and alcohol use disorder. We selected GLP1RA as the exposure and conducted a Mendelian randomization (MR) analysis. The cis-eQTLs of the drug target gene GLP1R, provided by eQTLGen, were used to simulate the pharmacological effects of GLP1RA. Type 2 diabetes and BMI were included as positive controls. Using data from both the Psychiatric Genomic Consortium and FinnGen, we conducted separate MR analyses for the same disease across these two independent databases. Meta-analysis was used to pool the results. We found genetic evidence suggesting a causal relationship between GLP1RA and a reduced risk of schizophrenia [OR (95% CI) = 0.84 (0.71-0.98), I2 = 0.0%, common effects model]. Further mediation analysis indicated that this effect might be unrelated to improvements in glycemic control but rather mediated by BMI. However, the findings of this study provide insufficient evidence to support a causal relationship between GLP1RA and other mental illnesses. Sensitivity analyses did not reveal any potential bias due to horizontal pleiotropy or heterogeneity in the above results (p > 0.05). This study suggests that genetically proxied activation of glucagon-like peptide-1 receptor is associated with a lower risk of schizophrenia. GLP1R is implicated in schizophrenia pathogenesis, and its agonists may exert potential benefits through weight management. Our study provides useful information for understanding the neuropsychiatric effects of GLP1RA, which may contribute to refining future research designs and guiding clinical management. Moreover, our findings could have significant implications for overweight individuals at high risk of schizophrenia when selecting weight-loss medications. Future research should further investigate the potential mechanisms underlying the relationship between GLP1RA and schizophrenia.

Intergenerational transmission of polygenic predisposition for neuropsychiatric traits on emotional and behavioural difficulties in childhood

Childhood emotional and behavioural difficulties tend to co-occur and often precede diagnosed neuropsychiatric conditions. Identifying shared and specific risk factors for early-life mental health difficulties is therefore essential for prevention strategies. Here, we examine how parental risk factors shape their offspring's emotional and behavioural symptoms (e.g. feelings of anxiety, and restlessness) using data from 14,959 genotyped family trios from the Norwegian Mother, Father and Child Cohort Study (MoBa). We model maternal reports of emotional and behavioural symptoms, organizing them into general and specific domains. We then investigate the direct (genetically transmitted) and indirect (environmentally mediated) contributions of parental polygenic risk for neuropsychiatric-related traits and whether these are shared across symptoms. We observe evidence consistent with an environmental route to general symptomatology beyond genetic transmission, while also demonstrating domain-specific direct and indirect genetic contributions. These findings improve our understanding of early risk pathways that can be targeted in preventive interventions aiming to interrupt the intergenerational cycle of risk transmission.

FKBP51 in glutamatergic forebrain neurons promotes early life stress inoculation in female mice

Early life stress (ELS) can increase vulnerability to psychiatric disorders, but also trigger resilience. FKBP51 has been associated with an increased risk for developing psychiatric disorders, specifically in interaction with ELS exposure. Here, the contribution of FKBP51 in glutamatergic forebrain neurons to the long-term consequences of ELS was investigated in both sexes. In female wild-type Fkbp5lox/lox mice, ELS exposure led to an anxiolytic phenotype and improved memory performance in a stressful context, however this ELS effect was absent in Fkbp5Nex mice. These interactive FKBP51 x ELS effects in female mice were also reflected in reduced brain region volumes, and on structural and electrophysiological properties of CA1 pyramidal neurons of the dorsal hippocampus. In contrast, the behavioral, structural and functional effects in male ELS mice were less pronounced and independent of FKBP51. RNA sequencing of the hippocampus revealed the transcription factor 4 (TCF4) as a potential regulator of the female interactive effects. Cre-dependent viral overexpression of TCF4 in female Nex-Cre mice led to similar beneficial effects on behavior as the ELS exposure. This study demonstrates a sex-specific role for FKBP51 in mediating the adaptive effects of ELS on emotional regulation, cognition, and neuronal function, implicating TCF4 as a downstream effector.

Association of Polygenic Risk for Psychiatric Disorders with Cardiometabolic Disease

IMPORTANCE

Clinical diagnoses of psychiatric disorders are associated with cardiometabolic diseases (CMDs) such as type 2 diabetes and ischemic heart diseases. Studying how genetic liability for psychiatric disorders relate to CMD risk will offer novel insight into the relationship between psychiatric disorders and CMDs.

OBJECTIVE

To evaluate the associations between psychiatric polygenic risk scores (PRSs) and clinically diagnosed CMDs while accounting for cross-disorder pleiotropy.

DESIGN SETTING AND PARTICIPANTS

This study computed PRSs for attention deficit-hyperactivity disorder (ADHD), major depressive disorder (MDD), anxiety disorder, post-traumatic stress disorder (PTSD), bipolar disorder, and schizophrenia. The analysis was conducted in three population-based Northern European cohorts: the Swedish Twin Registry (STR, N=17,378 genotyped samples), the Estonian Biobank (EstBB, N=208,383), and the Norwegian Mother, Father and Child Cohort Study (MoBa, N=129,398). Associations between psychiatric PRSs and clinical diagnoses of 10 major CMDs (including metabolic diseases such as hyperlipidemia, obesity, and type 2 diabetes, and cardiovascular diseases such as hypertensive disease, arteriosclerosis, ischemic heart disease, heart failure, thromboembolic disease, cerebrovascular disease, and arrhythmias) were estimated using models that mutually adjusted for all psychiatric PRSs. Supplementary analyses were performed by additionally controlling for self-reported body mass index (BMI). A discordant twin-pair analysis was conducted in the STR (N=70,619) to assess the association between self-reported lifetime MDD and subsequent CMD risk while adjusting for familial factors shared between monozygotic and dizygotic co-twins.

MAIN OUTCOMES AND MEASURES

Psychiatric PRSs were constructed based on both all available genetic risk variants and genome-wide significant risk variants from large-scale GWASs. Clinical diagnoses of psychiatric disorders and CMDs were ascertained through electronic health records (with primary care records used exclusively in the EstBB). Lifetime self-reported MDD in the STR was assessed via the Composite International Diagnostic Interview Short Form.

RESULTS

PRSs for ADHD and MDD were associated with increased risk of all CMDs. The ADHD PRS showed stronger associations with metabolic disease, whereas the MDD PRS showed stronger associations with cardiovascular diseases. PRSs for anxiety disorder, PTSD, and bipolar disorder showed only limited associations with CMDs, while increased levels of schizophrenia PRSs were associated with decreased risk of CMDs. These associations remained after adjustment for BMI. Finally, twins endorsing lifetime MDD were found to have an increased risk of subsequent CMD diagnoses compared to their unexposed co-twins.

CONCLUSIONS AND RELEVANCE

PRSs for ADHD and MDD showed robust associations with risk of CMDs and self-reported MDD was associated with subsequent CMD risk even after adjusting for familial factors shared between co-twins. These findings provide robust evidence for genetic overlap between ADHD and MDD with CMDs.

Implications of gene × environment interactions in post-traumatic stress disorder risk and treatment

Exposure to traumatic stress is common in the general population. Variation in the brain's molecular encoding of stress potentially contributes to the heterogeneous clinical outcomes in response to traumatic experiences. For instance, only a minority of those exposed to trauma will develop post-traumatic stress disorder (PTSD). Risk for PTSD is at least partially heritable, with a growing number of genetic factors identified through GWAS. A major limitation of genetic studies is that they capture only the genetic component of risk, whereas PTSD by definition requires an environmental traumatic exposure. Furthermore, the extent, timing, and type of trauma affects susceptibility. Here, we discuss the molecular mechanisms of PTSD risk together with gene × environment interactions, with a focus on how either might inform genetic screening for individuals at high risk for disease, reveal biological mechanisms that might one day yield novel therapeutics, and impact best clinical practices even today. To close, we discuss the interaction of trauma with sex, gender, and race, with a focus on the implications for treatment. Altogether, we suggest that predicting, preventing, and treating PTSD will require integrating both genotypic and environmental information.

Estudio De La Vida Bajo Estres: Methodological Overview and Baseline Data Analysis of a Case-Control Investigation of Risk and Resiliency Factors for Traumatic Stress in Colombia

The Estudio de la Vida Bajo Estres (My Life Under Stress [MI-VIDA] Study) aims to investigate risk and resilience factors associated with the development of PTSD in a trauma-exposed sample of more than 500 Colombian residents exposed to this country's armed conflict. The study utilised a longitudinal case-control design capturing psychosocial data over 18 months, in addition to baseline DNA samples for a parallel genomic analysis. This paper specifically provides an overview of the design and methodology of the wider investigation, and reports baseline characteristics including sociodemographic information and mental health outcome prevalences from this hard-to-reach and under-researched population. Results of baseline analysis suggested that one third (34.88%) of this trauma-exposed sample screened positively for PTSD. Participants endorsed high numbers of potentially traumatic experiences including Forced Displacement (88.61%), Exposure to Severe Human Suffering (53.91%), Combat Exposure (53.02%), and Physical Assault (51.78%). Participants also reported relatively high levels of mental ill-health including depression (29.90%) and anxiety (27.56%). The number of traumas experienced, and the reported comorbid difficulties were generally higher among those who screened positive for PTSD. These preliminary analyses detail the baseline characteristics, and the relative burden of mental ill-health in this trauma-exposed sample. The wider study comprising longitudinal measurement of these conditions has the potential to make a significant contribution to the understanding of risk and resiliency factors for posttraumatic stress in this unique Latin American context.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10862-025-10203-1.

Post-traumatic stress disorder and risk of systemic lupus erythematosus: Meta-analysis and Mendelian randomization study

OBJECTIVE

We conducted a meta-analysis and Mendelian randomization study to analyze the association and causal relationship of genetic prediction between post-traumatic stress disorder and the risk of systemic lupus erythematosus.

METHODS

A meta-analysis was conducted using hazard ratio, relative risk, odds ratio, and 95 % confidence intervals as effect measures. Summary data from genome-wide association studies on post-traumatic stress disorder and systemic lupus erythematosus were utilized to assess the causal relationship of genetic prediction between post-traumatic stress disorder and systemic lupus erythematosus using Mendelian randomization.

RESULTS

A meta-analysis showed that post-traumatic stress disorder was positively associated with the risk of systemic lupus erythematosus (RR = 1.85, 95 % CI = 1.61-2.12, p < 0.001). The results of Egger's test showed no publication bias (p = 0.823, p > 0.05). Sensitivity analysis showed that the meta-analysis results were stable (RR = 1.85, 95 % CI = 1.61-2.12). However, Mendelian Randomization analysis revealed no evidence of a causal relationship of genetic prediction between post-traumatic stress disorder and systemic lupus erythematosus (IVW OR: 1.001, 95 % CI: 0.805-1.245, p = 0.993).

CONCLUSION

There is a correlation between post-traumatic stress disorder and systemic lupus erythematosus, but Mendelian Randomization does not support a genetic causal effect of post-traumatic stress disorder on systemic lupus erythematosus. The potential causal relationship between the two factors may necessitate further in-depth research.

Human blood metabolites and risk of post-traumatic stress disorder: A Mendelian randomization study

BACKGROUND

Post-traumatic stress disorder (PTSD) is a debilitating chronic mental disorder that leads to reduced quality of life and increased economic burden. Observational studies have found an association between human blood metabolites and PTSD. Nonetheless, these studies have limitations and are subject to confounding factors as well as reverse causation. Herein, we employed a two-sample Mendelian randomization (MR) approach for the systematic analysis of the blood metabolites and PTSD causal link.

METHODS

Data for the human blood metabolome, cerebrospinal fluid (CSF) metabolome, and PTSD were obtained from publicly available summary-level genome-wide association studies (GWAS), respectively. The inverse variance weighted (IVW) approach represented the main analytic method for assessing exposure-outcome causal associations, employing multiple sensitivity analyses to verify the results' stability. In addition, replication and meta-analysis, steiger test and reverse MR analysis methods were performed to clarify further that these metabolites have independent causal effects on PTSD. Finally, the results of blood and CSF metabolomics analyses were synthesized to obtain biological markers with a causal link to PTSD.

RESULTS

Conclusively, we identified potential causal associations between six blood metabolites and PTSD. The sensitivity analyses elucidated the absence of pleiotropy or heterogeneity in the MR results. The Steiger test and reverse MR analysis did not reveal reverse causal associations, proving the robustness of our results. Combined blood and CSF metabolome analyses showed the same trend for theophylline.

CONCLUSION

This study reveals a strong causal link between metabolites and PTSD, which can be used as a biomarker for clinical PTSD disease screening and prevention. This study also provides a new perspective on the mechanism of metabolite-mediated PTSD development by combining genomics and metabolomics.

General practitioners' knowledge of psychotraumatism in Burkina Faso in a context of security challenges

Post-traumatic stress disorders are psychiatric disorders that arise after a traumatic event. They result in moral suffering and physical complications that profoundly alter personal, social and professional life. Our main objective was to study general practitioners (GP)' knowledge of psychotraumatism. This was a descriptive, cross-sectional study whose data collection took place from January 15 to September 15, 2023 in Burkina Faso. GP practicing in Burkina Faso were included. The minimum number of subjects to be included was 422. A Google Form ® questionnaire was administered to participants. Our study sample comprised 427 GP, 67% of whom were men (284/427). The mean age of the doctors was 32.4 ± 3.5 years. Doctors were married in 49% of cases (208/427) and single in 41% (174/427). Average professional experience was 3.8 ± 2.6 years. The largest number of GP (120) came from the Centre region. A minority of GP practiced in rural areas (7%). The majority of GP (63%) thought they had already dealt with a case of psychotraumatism. Our sample had received training in psychotraumatism during their medical studies in 26.9% of cases, and 17.8% had received continuing education. Considering the grading of GP' knowledge of psychotraumatism, 182 had an average score of 10 or above, i.e. 43% of our sample. Our study did not reveal any factors associated with better knowledge of psychotraumatism. A study on a larger population including nurses could enable us to better assess the level of knowledge in psychotraumatism.

Causal associations between posttraumatic stress disorder and type 2 diabetes

Posttraumatic stress disorder (PTSD) patients have a high comorbidity with type 2 diabetes (T2D). Whether PTSD influences the risk of diabetes is still not known. We used GWAS data from European ancestry of PTSD (23,121 cases and 151,447 controls) and T2D (80,154 cases and 853,816 controls) to investigate the bidirectional associations between PTSD and T2D by the Mendelian randomization (MR) analysis. We showed that PTSD was causally associated with higher odds of T2D (OR = 1.04, 95% CI: 1.01-1.06, P = 0.0086), but not vice versa. Our study suggests that PTSD may increase the risk of T2D. PTSD sufferers should be screened for T2D and its precursor known as metabolic syndrome.

Investigating shared risk variants and genetic etiology between Alzheimer's disease and three stress-related psychiatric disorders: a large-scale genome-wide cross-trait analysis

Introduction

Observational studies have reported that patients with Alzheimer's disease (AD) have a greater burden of comorbidities typically associated with stress-related psychiatric disorders. However, the contribution of hereditary factors to this comorbidity remains unclear. We evaluated phenotypic associations using observational data from the UK Biobank.

Method

Our study focused on investigating the shared risk variants and genetic etiology underlying AD and three stress-related psychiatric disorders: post-traumatic stress disorder, anxiety disorder, and major depressive disorder. By leveraging summary statistics from genome-wide association studies, we investigated global genetic correlations using linkage disequilibrium score regression, genetic covariance analysis, and high-definition likelihood. Genome-wide cross-trait analysis with association analysis based on subsets and cross-phenotype association were performed to discover genome-wide significant risk variants shared between AD and the three stress-related psychiatric disorders.

Results

A significant positive genetic correlation was observed between AD and major depressive disorder using linkage disequilibrium score regression (rg = 0.231; P = 0.018), genetic covariance analysis (rg = 0.138; P < 0.001), and high-definition likelihood (rg = 0.188; P < 0.001). Association analysis based on subsets and cross-phenotype association revealed thirteen risk variants in six genes shared between AD and post-traumatic stress disorder; seven risk variants in four genes shared between AD and anxiety disorder; and 23 risk variants in four genes shared between AD and major depressive disorder. Functional annotation and gene-set enrichment analysis indicated that 12 genes for comorbidity shared between patients with AD and all three stress-related psychiatric disorders were enriched in the spleen, pancreas, and whole blood.

Conclusion

These results advance our knowledge of the shared genetic origins of comorbidities and pave the way for advancements in the diagnosis, management, and prevention of stress-related AD.

Casual associations between frailty and nine mental disorders: bidirectional Mendelian randomisation study

BACKGROUND

An increasing number of observational studies have reported associations between frailty and mental disorders, but the causality remains ambiguous.

AIMS

To assess the bidirectional causal relationship between frailty and nine mental disorders.

METHOD

We conducted a bidirectional two-sample Mendelian randomisation on genome-wide association study summary data, to investigate causality between frailty and nine mental disorders. Causal effects were primarily estimated using inverse variance weighted method. Several secondary analyses were applied to verify the results. Cochran's Q-test and Mendelian randomisation Egger intercept were applied to evaluate heterogeneity and pleiotropy.

RESULTS

Genetically determined frailty was significantly associated with increased risk of major depressive disorder (MDD) (odds ratio 1.86, 95% CI 1.36-2.53, P = 8.1 × 10-5), anxiety (odds ratio 2.76, 95% CI 1.56-4.90, P = 5.0 × 10-4), post-traumatic stress disorder (PTSD) (odds ratio 2.56, 95% CI 1.69-3.87, P = 9.9 × 10-6), neuroticism (β = 0.25, 95% CI 0.11-0.38, P = 3.3 × 10-4) and insomnia (β = 0.50, 95% CI 0.25-0.75, P = 1.1 × 10-4). Conversely, genetic liability to MDD, neuroticism, insomnia and suicide attempt significantly increased risk of frailty (MDD: β = 0.071, 95% CI 0.033-0.110, P = 2.8 × 10-4; neuroticism: β = 0.269, 95% CI 0.173-0.365, P = 3.4 × 10-8; insomnia: β = 0.160, 95% CI 0.141-0.179, P = 3.2 × 10-61; suicide attempt: β = 0.056, 95% CI 0.029-0.084, P = 3.4 × 10-5). There was a suggestive detrimental association of frailty on suicide attempt and an inverse relationship of subjective well-being on frailty.

CONCLUSIONS

Our findings show bidirectional causal associations between frailty and MDD, insomnia and neuroticism. Additionally, higher frailty levels are associated with anxiety and PTSD, and suicide attempts are correlated with increased frailty. Understanding these associations is crucial for the effective management of frailty and improvement of mental disorders.

Multi-ancestral genome-wide association study of clinically defined nicotine dependence reveals strong genetic correlations with other substance use disorders and health-related traits

Genetic research on nicotine dependence has utilized multiple assessments that are in weak agreement. We conducted a genome-wide association study of nicotine dependence defined using the Diagnostic and Statistical Manual of Mental Disorders (DSM-NicDep) in 61,861 individuals (47,884 of European ancestry, 10,231 of African ancestry, 3,746 of East Asian ancestry) and compared the results to other nicotine-related phenotypes. We replicated the well-known association at the CHRNA5 locus (lead SNP: rs147144681, p =1.27E-11 in European ancestry; lead SNP = rs2036527, p = 6.49e-13 in cross-ancestry analysis). DSM-NicDep showed strong positive genetic correlations with cannabis use disorder, opioid use disorder, problematic alcohol use, lung cancer, material deprivation, and several psychiatric disorders, and negative correlations with respiratory function and educational attainment. A polygenic score of DSM-NicDep predicted DSM-5 tobacco use disorder and 6 of 11 individual diagnostic criteria, but none of the Fagerström Test for Nicotine Dependence (FTND) items, in the independent NESARC-III sample. In genomic structural equation models, DSM-NicDep loaded more strongly on a previously identified factor of general addiction liability than did a "problematic tobacco use" factor (a combination of cigarettes per day and nicotine dependence defined by the FTND). Finally, DSM-NicDep was strongly genetically correlated with a GWAS of tobacco use disorder as defined in electronic health records, suggesting that combining the wide availability of diagnostic EHR data with nuanced criterion-level analyses of DSM tobacco use disorder may produce new insights into the genetics of this disorder.

Sex-stratified Genomic Structural Equation Models of Posttraumatic Stress Inform PTSD Etiology: L'utilisation de la modélisation génomique par équations structurelles stratifiée par sexe du stress post-traumatique pour expliquer l'étiologie du TSPT

OBJECTIVE

Posttraumatic stress disorder (PTSD) affects 3.9%-5.6% of the worldwide population, with well-documented sex-related differences. While psychosocial and hormonal factors affecting sex differences in PTSD and posttraumatic stress (PTS) symptom etiology have been explored, there has been limited focus on the genetic bases of these differences. Many symptom combinations may confer a PTSD diagnosis. We hypothesized that these symptom combinations have sex-specific patterns, the examination of which could inform etiological differences in PTSD genetics between males and females.

METHODS

To investigate this, we performed a sex-stratified multivariate genome-wide association study (GWAS) in unrelated UK Biobank (UKB) individuals of European ancestry. Using GWAS summary association data, genomic structural equation modelling was performed to generate sex-specific factor models using 6 indicator variables: trouble concentrating, feeling distant from others, irritability, disturbing thoughts, upset feelings, and avoidance of places/activities which remind the individual of a traumatic event.

RESULTS

Models of male and female PTSD symptoms differed substantially (local standardized root mean square difference = 3.12) and significantly (χ2(5) = 28.03, P = 3.6 × 10-5). Independent 2-factor models best fit the data in both males and females; these factors were subjected to GWAS in each sex, revealing 3 genome-wide significant loci in females, mapping to SCAND3, WDPCP, and FAM120A. No genome-wide significant loci were identified in males. All 4 PTS factors (2 in males and 2 in females) were heritable.

CONCLUSIONS

By assessing the relationship between sex and PTSD symptoms, this study informs correlative and putatively causal etiological differences between males and females which support further investigation of sex differences in PTSD genetics.

Genetic architecture of RNA editing, splicing and gene expression in schizophrenia

Genome wide association studies (GWAS) have been conducted over the past decades to investigate the underlying genetic origin of neuropsychiatric diseases, such as schizophrenia (SCZ). While these studies demonstrated the significance of disease-phenotype associations, there is a pressing need to fully characterize the functional relevance of disease-associated genetic variants. Functional genetic loci can affect transcriptional and post-transcriptional phenotypes that may contribute to disease pathology. Here, we investigate the associations between genetic variation and RNA editing, splicing, and overall gene expression through identification of quantitative trait loci (QTL) in the CommonMind Consortium SCZ cohort. We find that editing QTL (edQTL), splicing QTL (sQTL) and expression QTL (eQTL) possess both unique and common gene targets, which are involved in many disease-relevant pathways, including brain function and immune response. We identified two QTL that fall into all three QTL categories (seedQTL), one of which, rs146498205, targets the lincRNA gene, RP11-156P1.3. In addition, we observe that the RNA binding protein AKAP1, with known roles in neuronal regulation and mitochondrial function, had enriched binding sites among edQTL, including the seedQTL, rs146498205. We conduct colocalization with various brain disorders and find that all QTL have top colocalizations with SCZ and related neuropsychiatric diseases. Furthermore, we identify QTL within biologically relevant GWAS loci, such as in ELA2, an important tRNA processing gene associated with SCZ risk. This work presents the investigation of multiple QTL types in parallel and demonstrates how they target both distinct and overlapping SCZ-relevant genes and pathways.

Associations between post-traumatic stress disorder and neurological disorders: A genetic correlation and Mendelian randomization study

BACKGROUND

Observational studies have reported a close relationship between post-traumatic stress disorder (PTSD) and neurological disorders, but the existence of a causal link remains uncertain. The aim of this study is to investigate these relationships and potential mediators via Mendelian randomization (MR) analysis.

METHODS

We sourced pooled data for genome-wide association study (GWAS) of PTSD (n = 1,222,882) from the psychiatric genomics consortium. Summary-level data for eight neurological traits were derived from large-scale GWASs. Genetic correlations were computed using linkage disequilibrium (LD) score regression. The inverse variance weighted (IVW) method served as the primary analysis method for MR. We employed a range of sensitivity analysis methods to ensure result robustness. A two-step approach was utilized to ascertain the effects and proportions of mediations.

RESULTS

We identified significant genetic associations between PTSD and any dementia, cognitive performance, multiple sclerosis, and migraine. MR analysis revealed a significant association between PTSD and an increased risk of migraine (P = 0.02). This was substantiated by the results of several sensitivity analyses. Notably, the robust association between PTSD and migraine persisted even after adjustment for major depressive disorder and anxiety. Mediation analysis revealed that both alcohol intake frequency and insomnia partially mediated the association between PTSD and migraine.

LIMITATIONS

Participants in the MR analysis were of European descent, and verification in other ethnicities was not possible due to data limitations.

CONCLUSION

Our findings indicate a close association between PTSD and migraine. Alcohol intake frequency and insomnia serve as intermediate factors, partially explaining the relationship between PTSD and migraine.

Genetic predisposition for negative affect predicts mental health burden during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic was accompanied by an increase in mental health challenges including depression, stress, loneliness, and anxiety. Common genetic variants can contribute to the risk for psychiatric disorders and may present a risk factor in times of crises. However, it is unclear to what extent polygenic risk played a role in the mental health response to the COVID-19 pandemic. In this study, we investigate whether polygenic scores (PGSs) for mental health-related traits can distinguish between four resilience-vulnerability trajectories identified during the COVID-19 pandemic and associated lockdowns in 2020/21. We used multinomial regression in a genotyped subsample (n = 1316) of the CovSocial project. The most resilient trajectory characterized by the lowest mental health burden and the highest recovery rates served as the reference group. Compared to this most resilient trajectory, a higher value on the PGS for the well-being spectrum decreased the odds for individuals to be in one of the more vulnerable trajectories (adjusted R-square = 0.3%). Conversely, a higher value on the PGS for neuroticism increased the odds for individuals to be in one of the more vulnerable trajectories (adjusted R-square = 0.2%). Latent change in mental health burden extracted from the resilience-vulnerability trajectories was not associated with any PGS. Although our findings support an influence of PGS on mental health during COVID-19, the small added explained variance suggests limited utility of such genetic markers for the identification of vulnerable individuals in the general population.

Genomics-driven integrative analysis highlights immune-related plasma proteins for psychiatric disorders

BACKGROUND

Genome-wide association studies (GWAS) have identified numerous variants associated with psychiatric disorders. However, it remains largely unknown on how GWAS risk variants contribute to psychiatric disorders.

METHODS

Through integrating two largest, publicly available, independent protein quantitative trait loci datasets of plasma protein and nine large-scale GWAS summary statistics of psychiatric disorders, we first performed proteome-wide association study (PWAS) to identify psychiatric disorders-associated plasma proteins, followed by enrichment analysis to reveal the underlying biological processes and pathways. Then, we conducted Mendelian randomization (MR) and Bayesian colocalization (COLOC) analyses, with both discovery and parallel replication datasets, to further identify protein-disorder pairs with putatively causal relationships. We finally prioritized the potential drug targets using Drug Gene Interaction Database.

RESULTS

PWAS totally identified 112 proteins, which were significantly enriched in biological processes relevant to immune regulation and response to stimulus including regulation of immune system process (adjusted P = 1.69 × 10-7) and response to external stimulus (adjusted P = 4.13 × 10-7), and viral infection related pathways, including COVID-19 (adjusted P = 2.94 × 10-2). MR and COLOC analysis further identified 26 potentially causal protein-disorder pairs in both discovery and replication analysis. Notably, eight protein-coding genes were immune-related, such as IRF3, CSK, and ACE, five among 16 druggable genes were reported to interact with drugs, including ACE, CSK, PSMB4, XPNPEP1, and MICB.

CONCLUSIONS

Our findings highlighted the immunological hypothesis and identified potentially causal plasma proteins for psychiatric disorders, providing biological insights into the pathogenesis and benefit the development of preventive or therapeutic drugs for psychiatric disorders.

Genetic evidence of the causal relationships between psychiatric disorders and cardiovascular diseases

OBJECTIVE

Our primary objective is to investigate the causal relationships between 12 psychiatric disorders (PDs) and atrial fibrillation (AF), coronary artery disease (CAD), myocardial infarction (MI), and heart failure (HF).

METHODS

Firstly, we used linkage disequilibrium score regression to calculate the genetic correlations between 12 PDs and 4 cardiovascular diseases (CVDs). Subsequently, we performed two-sample and bidirectional Mendelian randomization (MR) analyses of phenotypes with significant genetic correlations to explore the causal relationships between PDs and CVDs. Inverse variance weighted with modified weights (MW-IVW), Robust Adjusted Profile Score, Inverse Variance Weighted, weighted median and weighted mode were used to evaluate causal effects, with MW-IVW being the main analysis method. And to validate the MR results, we conducted the replicate analyses using data from the FinnGen database.

RESULTS

Conducting MR analyses in phenotypes with significant genetic correlations, we identified bidirectional causal relationships between depression (DEP) and MI (DEP as exposure: OR = 1.1324, 95 % confidence interval (CI): 1.0984-1.1663, P < 0.0001; MI as exposure: OR = 1.0268, 95 % CI: 1.0160-1.0375, P < 0.0001). Similar relationships were observed in Attention Deficit/Hyperactivity Disorder (ADHD) and HF (ADHD as exposure: OR = 1.0270, 95 % CI: 1.0144-1.0395, P < 0.0001; HF as exposure: OR = 1.0980, 95 % CI: 1.0502-1.1458, P < 0.0001).

CONCLUSIONS

In our study, we conducted the comprehensive analyses between 12 PDs and CVDs. By bidirectional MR analysis, we observed significant causal relationships between MI and DEP, HF and ADHD. These findings suggest possible complex causal relationships between PDs and CVDs.

Mapping the cellular etiology of schizophrenia and complex brain phenotypes

Psychiatric disorders are multifactorial and effective treatments are lacking. Probable contributing factors to the challenges in therapeutic development include the complexity of the human brain and the high polygenicity of psychiatric disorders. Combining well-powered genome-wide and brain-wide genetics and transcriptomics analyses can deepen our understanding of the etiology of psychiatric disorders. Here, we leverage two landmark resources to infer the cell types involved in the etiology of schizophrenia, other psychiatric disorders and informative comparison of brain phenotypes. We found both cortical and subcortical neuronal associations for schizophrenia, bipolar disorder and depression. These cell types included somatostatin interneurons, excitatory neurons from the retrosplenial cortex and eccentric medium spiny-like neurons from the amygdala. In contrast we found T cell and B cell associations with multiple sclerosis and microglial associations with Alzheimer's disease. We provide a framework for a cell-type-based classification system that can lead to drug repurposing or development opportunities and personalized treatments. This work formalizes a data-driven, cellular and molecular model of complex brain disorders.

Post-traumatic stress disorder: evolving conceptualization and evidence, and future research directions

The understanding of responses to traumatic events has been greatly influenced by the introduction of the diagnosis of post-traumatic stress disorder (PTSD). In this paper we review the initial versions of the diagnostic criteria for this condition and the associated epidemiological findings, including sociocultural differences. We consider evidence for post-traumatic reactions occurring in multiple contexts not previously defined as traumatic, and the implications that these observations have for the diagnosis. More recent developments such as the DSM-5 dissociative subtype and the ICD-11 diagnosis of complex PTSD are reviewed, adding to evidence that there are several distinct PTSD phenotypes. We describe the psychological foundations of PTSD, involving disturbances to memory as well as to identity. A broader focus on identity may be able to accommodate group and communal influences on the experience of trauma and PTSD, as well as the impact of resource loss. We then summarize current evidence concerning the biological foundations of PTSD, with a particular focus on genetic and neuroimaging studies. Whereas progress in prevention has been disappointing, there is now an extensive evidence supporting the efficacy of a variety of psychological treatments for established PTSD, including trauma-focused interventions - such as trauma-focused cognitive behavior therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR) - and non-trauma-focused therapies, which also include some emerging identity-based approaches such as present-centered and compassion-focused therapies. Additionally, there are promising interventions that are neither psychological nor pharmacological, or that combine a pharmacological and a psychological approach, such as 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy. We review advances in the priority areas of adapting interventions in resource-limited settings and across cultural contexts, and of community-based approaches. We conclude by identifying future directions for work on trauma and mental health.

Causal associations between immune cells and psychiatric disorders: a bidirectional mendelian randomization analysis

Extensive researches illuminate a potential interplay between immune traits and psychiatric disorders. However, whether there is the causal relationship between the two remains an unresolved question. We conducted a two-sample bidirectional mendelian randomization by utilizing summary data of 731 immune cell traits from genome-wide association studies (GCST90001391-GCST90002121)) and 11 psychiatric disorders including attention deficit/hyperactivity disorder (ADHD), anxiety disorder, autism spectrum disorder (ASD), bipolar disorder (BIP), anorexia nervosa (AN), major depressive disorder (MDD), obsessive-compulsive disorder (OCD), Tourette syndrome (TS), post-traumatic stress disorder (PTSD), schizophrenia (SCZ), and substance use disorders (cannabis) (SUD) from the Psychiatric Genomics Consortium (PGC). A total of four types of immune signatures (median fluorescence intensities [MFI], relative cell [RC], absolute cell [AC], and morphological parameters [MP]) were included. Effect estimates were obtained by using the inverse-variance-weighted (IVW), weighted median method, Mendelian randomization (MR)-Egger, and corrected by false discovery rate. Outliers were evaluated through the leave-one-out technique. Horizontal pleiotropy was assessed using the MR pleiotropy residual sum and outlier (MR-PRESSO) and MR-Egger intercept tests. MR analysis results suggested several immune cell subtypes were casually associated with psychiatric disorders. It was found that CD33br HLA DR + CD14 - AC (Myeloid cell, AC) may contribute to decreasing the risk of BIP (odds ratio [OR] = 0.9179, confidence interval [CI] = 0.8829-0.9542, PFDR = 7.06 × 10-3), and likewise, CD38 on transitional (B cell, MFI) also showed negative causal effect on SCZ risk (OR = 0.9551, CI = 0.9330-0.9776, PFDR = 0.0441). While IgD - CD27 - %lymphocyte (B cell, RC) has causal effect on increasing BIP risk (OR = 1.0184, CI = 1.0079-1.0291, PFDR = 0.0201). In addition, HLA DR + + monocyte %monocyte (TBNK, RC) is likely to increase AN onset (OR = 1.0746, CI = 1.0324-1.1186, PFDR = 0.0506), and CCR2 on CD14 - CD16 + monocyte (Monocyte, MFI) may contribute to PTSD (OR = 1.0591, CI = 1.0275-1.0917, PFDR = 0.0369). Sensitivity analysis revealed consistency of results. Our research elucidates there may be causal links between immune traits and the onset of psychiatric disorders, which established a groundwork for the prospective clinical utilization of immune cells as markers for the diagnosis and early intervention of psychiatric disorders.

Causal Impacts of Psychiatric Disorders on Cognition and the Mediating Effect of Oxidative Stress: A Mendelian Randomization Study

Many psychiatric disorders are associated with major cognitive deficits. However, it is uncertain whether these deficits develop as a result of psychiatric disorders and what shared risk factors might mediate this relationship. Here, we utilized the Mendelian randomization (MR) analysis to investigate the complex causal relationship between nine major psychiatric disorders and three cognitive phenotypes, while also examining the potential mediating role of oxidative stress as a shared biological underpinning. Schizophrenia (SZ), major depressive disorder (MDD), and attention deficit hyperactivity disorder (ADHD) showed a decreasing effect on cognitive performance, intelligence, and education, while bipolar disorder (BPD) increased educational attainment. MR-Clust results exhibit the shared genetic basis between SZ and other psychiatric disorders in relation to cognitive function. Furthermore, when oxidative stress was considered as a potential mediating factor, the associations between SZ and the three dimensions of cognition, as well as between MDD and intelligence and ADHD and intelligence, exhibited larger effect sizes than the overall. Mediation MR analysis also supported the causal effects between psychiatric disorders and cognition via oxidative stress traits, including carotene, vitamin E, bilirubin, and uric acid. Finally, summary-based MR identified 29 potential causal associations of oxidative stress genes with both cognitive performance and psychiatric disorders. Our findings highlight the importance of considering oxidative stress in understanding and potentially treating cognitive impairments associated with psychiatric conditions.

The left amygdala is genetically sexually-dimorphic: multi-omics analysis of structural MRI volumes

Brain anatomy plays a key role in complex behaviors and mental disorders that are sexually divergent. While our understanding of the sex differences in the brain anatomy remains relatively limited, particularly of the underlying genetic and molecular mechanisms that contribute to these differences. We performed the largest study of sex differences in brain volumes (N = 33,208) by examining sex differences both in the raw brain volumes and after controlling the whole brain volumes. Genetic correlation analysis revealed sex differences only in the left amygdala. We compared transcriptome differences between males and females using data from GTEx and characterized cell-type compositions using GTEx bulk amygdala RNA-seq data and LIBD amygdala single-cell reference profiles. We also constructed polygenic risk scores (PRS) to investigate sex-specific genetic correlations between left amygdala volume and mental disorders (N = 25,576~105,318) of Psychiatric Genomics Consortium and other traits of UKB (N = 347,996). Although there were pronounced sex differences in brain volumes, there was no difference in the heritability between sexes. There was a significant sex-specific genetic correlation between male and female left amygdala. We identified sex-differentiated genetic effects of PRSs for schizophrenia on left amygdala volume, as well as significant sex-differentiated genetic correlations between PRSs of left amygdala and six traits in UKB. We also found several sex-differentially expressed genes in the amygdala. These findings not only advanced the current knowledge of genetic basis of sex differences in brain anatomy, but also presented an important clue for future research on the mechanism of sex differences in mental disorders and targeted treatments.

Prenatal maternal stress: triangulating evidence for intrauterine exposure effects on birth and early childhood outcomes across multiple approaches

BACKGROUND

Maternal stress during pregnancy may impact offspring development via changes in the intrauterine environment. However, genetic and environmental factors shared between mothers and children might skew our understanding of this pathway. This study assesses whether prenatal maternal stress has causal links to offspring outcomes: birthweight, gestational age, or emotional and behavioral difficulties, triangulating across methods that account for various measured and unmeasured confounders.

METHODS

We used data from the Norwegian Mother, Father, and Child Cohort Study (MoBa), including maternal reports on prenatal stress at work, at home, and via stressful life events as exposures. Outcomes were children's birthweight and gestational age, from the Medical Birth Registry of Norway, and maternal reports on early offspring emotional and behavioral difficulties. We assessed associations using four approaches: sibling control analyses, gene-environment interaction analyses, intergenerational Mendelian randomization (MR), and negative control (i.e., postnatal stress) analyses.

RESULTS

Maternal prenatal stress was observationally associated with offspring lower birthweight (e.g., βwork = - 0.01 [95%CI: - 0.02, - 0.01]), earlier birth (e.g., βwork = - 0.04 [95%CI: - 0.04, - 0.03])), and more emotional (e.g., βevents = 0.08 [95%CI: 0.07, 0.09]) and behavioral difficulties (e.g., βrelationship = 0.08 [95%CI: 0.07, 0.09]) in the full sample (N = 112,784). However, sibling control analyses (N = 36,511) revealed substantial attenuation of all associations after accounting for familial factors. Gene-environment interaction models (N = 76,288) showed no clear evidence of moderation of associations by mothers' polygenic scores for traits linked to stress sensitivity. Intergenerational MR analyses (N = 29,288) showed no clear evidence of causal effects of maternal plasma cortisol on any offspring outcomes. Negative control exposure analyses revealed similar effect sizes whether exposures were measured prenatally or postnatally.

CONCLUSIONS

Our results indicate that links between prenatal maternal stress and variation in early offspring outcomes are more likely to be confounded than causal. While no observational study can rule out causality, the consistency of our findings across different approaches is striking. Other sources of prenatal stress or more extreme levels may represent intrauterine causal risk factors for offspring development. Nonetheless, our research contributes to identifying boundary conditions of the fetal programming and developmental origins of health and disease hypotheses, which may not be as universal as sometimes assumed.

Integrating genetics and transcriptomics to characterize shared mechanisms in digestive diseases and psychiatric disorders

Digestive and psychiatric disorders tend to co-occur, yet mechanisms remain unclear. Leveraging genetic and transcriptomic data integration, we conduct multi-trait analysis of GWAS (MTAG) and weighted gene co-expression network analysis (WGCNA) to explore shared mechanism between psychiatric and gastrointestinal disorders. Significant genetic correlations were found between these disorders, especially in irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), depression (DEP), and neuroticism (NE). MTAG identify 60 novel pleiotropic loci for IBS and 14 for GERD, predominantly located near genes associated with neurological pathways. Further WGCNA identifies multiple co-expression modules enriched with genes involved in neurological pathways in digestive tissues, with some modules strongly preserved across brain and digestive tissues. Moreover, our network analysis suggests BSN, CELF4, and NRXN1 as central players in the regulation of the gut-brain axis (GBA). This study enhances our understanding of the GBA and underscores BSN, CELF4, and NRXN1 as crucial targets for future research.

Transcranial magnetic stimulation for obsessive-compulsive disorder and post-traumatic stress disorder: A comprehensive systematic review and analysis of therapeutic benefits, cortical targets, and psychopathophysiological mechanisms

Transcranial magnetic stimulation (TMS) is a safe non-invasive treatment technique. We systematically reviewed randomised controlled trials (RCTs) applying TMS in obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) to analyse its therapeutic benefits and explore the relationship between cortical target and psychopathophysiology. We included 47 randomised controlled trials (35 for OCD) and found a 22.7 % symptom improvement for OCD and 29.4 % for PTSD. Eight cortical targets were investigated for OCD and four for PTSD, yielding similar results. Bilateral dlPFC-TMS exhibited the greatest symptom change (32.3 % for OCD, N = 4 studies; 35.7 % for PTSD, N = 1 studies), followed by right dlPFC-TMS (24.4 % for OCD, N = 8; 26.7 % for PTSD, N = 10), and left dlPFC-TMS (22.9 % for OCD, N = 6; 23.1 % for PTSD, N = 1). mPFC-TMS showed promising results, although evidence is limited (N = 2 studies each for OCD and PTSD) and findings for PTSD were conflicting. Despite clinical improvement, reviewed reports lacked a consistent and solid rationale for cortical target selection, revealing a gap in TMS research that complicates the interpretation of findings and hinders TMS development and optimisation. Future research should adopt a hypothesis-driven approach rather than relying solely on correlations from imaging studies, integrating neurobiological processes with affective, behavioural, and cognitive states, thereby doing justice to the complexity of human experience and mental illness.

Exploring the genetic landscape of the brain-heart axis: A comprehensive analysis of pleiotropic effects between heart disease and psychiatric disorders

BACKGROUND

The genetic links between heart disease and psychiatric disorders are complex and not well understood. This study uses genome-wide association studies (GWAS) and advanced multilevel analyses to explore these connections.

METHODS

We analyzed GWAS data from seven psychiatric disorders and five types of heart disease. Genetic correlations and overlaps were examined using linkage disequilibrium score regression (LDSC), high-definition likelihood (HDL), and Genetic analysis incorporating Pleiotropy and Annotation (GPA). Pleiotropic single-nucleotide variations (SNVs) were identified with pleiotropic analysis under the composite null hypothesis (PLACO) and annotated via Functional mapping and annotation of genetic associations (FUMA). Potential pleiotropic genes were identified using Multi-marker Analysis of GenoMic Annotation (MAGMA) and Summary data-based Mendelian Randomization (SMR).

RESULTS

Among 35 trait pairs, 32 showed significant genetic correlations or overlaps. PLACO identified 15,077 SNVs, with 287 recognized as pleiotropic loci and 20 colocalization sites. MAGMA and SMR revealed 75 potential pleiotropic genes involved in diverse pathways, including cancer, neurodevelopment, and cellular organization. Mouse Genome Informatics (MGI) queries provided evidence linking multiple genes to heart or psychiatric disorders.

CONCLUSIONS

This analysis reveals loci and genes with pleiotropic effects between heart disease and psychiatric disorders, highlighting shared biological pathways. These findings illuminate the genetic mechanisms underlying the brain-heart axis and suggest shared biological foundations for these conditions, offering potential targets for future prevention and treatment strategies.

Chronic overlapping pain conditions and nociplastic pain

Chronic overlapping pain conditions (COPCs) are a subset of chronic pain conditions commonly comorbid with one another and more prevalent in women and individuals assigned female at birth (AFAB). Pain experience in these conditions may better fit with a new mechanistic pain descriptor, nociplastic pain, and nociplastic pain may represent a shared underlying factor among COPCs. We applied GenomicSEM common-factor genome-wide association study (GWAS) and multivariate transcriptome-wide association (TWAS) analyses to existing GWAS output for six COPCs in order to find genetic variation associated with nociplastic pain, followed by genetic correlation (linkage disequilibrium score regression), gene set, and tissue enrichment analyses. We found 24 independent single nucleotide polymorphisms (SNPs), and 127 unique genes significantly associated with nociplastic pain, and showed nociplastic pain to be a polygenic trait with significant SNP heritability. We found significant genetic overlap between multisite chronic pain and nociplastic pain, and to a smaller extent with rheumatoid arthritis and a neuropathic pain phenotype. Tissue enrichment analyses highlighted cardiac and thyroid tissue, and gene set enrichment analyses emphasized potential shared mechanisms in cognitive, personality, and metabolic traits and nociplastic pain along with distinct pathology in migraine and headache. We used a well-powered network approach to investigate nociplastic pain using existing COPC GWAS output, and show nociplastic pain to be a complex, heritable trait, in addition to contributing to understanding of potential mechanisms in development of nociplastic pain.

Prevalence and correlates of common mental disorders among participants of the Uganda Genome Resource: Opportunities for psychiatric genetics research

Genetics research has potential to alleviate the burden of mental disorders in low- and middle-income-countries through identification of new mechanistic pathways which can lead to efficacious drugs or new drug targets. However, there is currently limited genetics data from Africa. The Uganda Genome Resource provides opportunity for psychiatric genetics research among underrepresented people from Africa. We aimed at determining the prevalence and correlates of major depressive disorder (MDD), suicidality, post-traumatic stress disorder (PTSD), alcohol abuse, generalised anxiety disorder (GAD) and probable attention-deficit hyperactivity disorder (ADHD) among participants of the Uganda Genome Resource. Standardised tools assessed for each mental disorder. Prevalence of each disorder was calculated with 95% confidence intervals. Multivariate logistic regression models evaluated the association between each mental disorder and associated demographic and clinical factors. Among 985 participants, prevalence of the disorders were: current MDD 19.3%, life-time MDD 23.3%, suicidality 10.6%, PTSD 3.1%, alcohol abuse 5.7%, GAD 12.9% and probable ADHD 9.2%. This is the first study to determine the prevalence of probable ADHD among adult Ugandans from a general population. We found significant association between sex and alcohol abuse (adjusted odds ratio [AOR] = 0.26 [0.14,0.45], p < 0.001) and GAD (AOR = 1.78 [1.09,2.49], p = 0.019) respectively. We also found significant association between body mass index and suicidality (AOR = 0.85 [0.73,0.99], p = 0.041), alcohol abuse (AOR = 0.86 [0.78,0.94], p = 0.003) and GAD (AOR = 0.93 [0.87,0.98], p = 0.008) respectively. We also found a significant association between high blood pressure and life-time MDD (AOR = 2.87 [1.08,7.66], p = 0.035) and probable ADHD (AOR = 1.99 [1.00,3.97], p = 0.050) respectively. We also found a statistically significant association between tobacco smoking and alcohol abuse (AOR = 3.2 [1.56,6.67], p = 0.002). We also found ever been married to be a risk factor for probable ADHD (AOR = 2.12 [0.88,5.14], p = 0.049). The Uganda Genome Resource presents opportunity for psychiatric genetics research among underrepresented people from Africa.