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

Effectiveness of an intensive outpatient treatment programme combining prolonged exposure and EMDR therapy for adolescents and young adults with PTSD in a naturalistic setting

Background: Psychotherapeutic interventions aimed at treating posttraumatic stress disorder (PTSD) in adolescents and young adults are hampered by high dropout rates. Looking at the results from adult treatments, short, intensive, outpatient treatment programmes may offer a promising alternative, but it has yet to be tested in this young population.Objective: To assess the results of a six-day intensive outpatient trauma-focused treatment programme for young individuals (12-25 years) with PTSD. The treatment combined prolonged exposure and EMDR therapy, supplemented with physical activity and the participation of relatives and/or friends. Treatment was performed by a rotating team of therapists.Methods: Seventy-four adolescents and young adults (89% women, mean age = 18.6 years, 36 patients aged 12-17 and 38 patients aged 18-25; SD = 3.1) with PTSD and a minimum of four memories of A-criterion traumatic events participated in the programme. PTSD symptoms, depressive symptoms, and the perceived burden of trauma symptoms were assessed before treatment, at the start and one month after treatment.Results: Patients showed a significant reduction in PTSD symptoms from pre-treatment to one month after treatment (Cohen's d = 1.66). Of all patients, 52 (70%) showed a clinically meaningful response, and 48 (65%) no longer met the diagnostic criteria for PTSD one month after treatment. Depressive symptoms also decreased significantly (Cohen's d = 1.02). The dropout rate was 4% (N = 3). None of the patients experienced an adverse event or worsening of symptoms.Conclusions: Results suggest that a short, intensive, outpatient therapy programme combining prolonged exposure, EMDR therapy, physical activity, and participation of relatives and friends, is well-tolerated, and an effective and safe treatment alternative for adolescents and young adults with PTSD due to multiple traumatization.

The neural mechanisms subserving the adaptiveness of emotion regulation flexibility and its link to depression

Emotion Regulation Flexibility (ERF) is defined as an individual's ability to adaptively respond to changing situations and goals. Deficits in the adaptiveness of ERF have been linked to depression, suggesting a critical relationship between emotional processing and mental health. The objective of the present study was to investigate how variations in situational and goal-related contexts influence the association between ERF adaptiveness and depression. We employed functional magnetic resonance imaging (fMRI) and behavioral tasks to explore this relationship. Participants completed tasks designed to provoke changing situations and changing goals, while fMRI captured neural activity. Our findings revealed a significant negative correlation between depression scores and ERF adaptiveness. Specifically, during changing-situations, activation was observed in temporal and limbic regions, while changing-goals engaged prefrontal and parietal regions. Correlation analyses indicated that the adaptiveness of ERF was supported by distinct neural contributions: the temporoparietal junction (TPJ) in the changing-situations condition and the dorsolateral prefrontal cortex (dlPFC) in the changing-goals condition. Furthermore, the functional coupling between the dlPFC and the ventromedial prefrontal cortex (vmPFC) mediated the relationship between ERF adaptiveness and depression during changing-goals, but not during changing-situations. These findings elucidate the neural mechanisms of ERF adaptiveness and its implications for understanding and addressing depression.

Is one additional phone call enough? - Effectiveness of additional human support to reduce dropout from an internet-based intervention for depressive symptoms: A randomized-controlled trial

Background

Internet-Based Interventions (IBIs) are effective treatments for mental disorders, but their implementation faces challenges, particularly in addressing high dropout rates. Adding more human support or guidance might reduce treatment dropout rates in IBIs, but it may also limit scalability. Therefore, small, easy-to-implement, guidance-based add-on interventions are warranted to reduce dropout rates. This study tests if offering one additional brief phone contact reduces treatment dropout rates in an IBI for depressive symptoms with written guidance.

Methods

We analyze data from N = 394 individuals participating in an IBI for depression. The intervention comprises seven CBT-based modules with module-wise written semi-standardized feedback from psychotherapists (guided IBI). Previous research applying the same IBI in adults with self-reported symptoms of depression found increased dropout rates after the second module. In the study group, therapists offered an additional brief phone call after the second module (n = 206). In the control group, no additional phone calls were offered (n = 188). We present descriptive statistics regarding the intervention course for both groups. We conducted a logistic regression to examine the preventive effect of the additional phone call on treatment dropout.

Results

Pooled dropout rates in the study group were 30.5 % (n = 63), and in the control group 36.1 % (n = 68), with a risk difference of about 6 % points favoring the study group. The odds ratios ranged from 1.25 to 1.33, and the relative risks ranged from 1.08 to 1.10. However, all confidence intervals overlap zero, indicating that all effect estimates are statistically non-significant.

Conclusion

We tested a strategy of additional human contact to reduce treatment dropout rates in a guided IBI for depressive symptoms. All estimates descriptively favored the study group, but were small and non-significant. Further research is needed to determine how additional contact can be employed to reduce treatment dropout.

Abnormal interbrain coupling in individuals with childhood adversity may underlie their difficulties in benefiting from social interactions

BACKGROUND

While adverse childhood experiences (ACEs) such as abuse or neglect are linked to lifelong interpersonal challenges, it's uncertain whether individuals with ACEs can effectively draw on others for distress relief and whether neural dyadic processes in these exchanges are compromised.

METHOD

To address this gap, here we examined interbrain coupling between 'targets' (adults with a varying history of ACEs) and 'regulators' (unacquainted individuals without a history of ACEs) during two conditions: (i) distressing condition: where the target shares with the regulator a distressing biographical event; (ii) neutral condition: where the target shares with the regulator a neutral biographical event. After screening 534 participants, 58 dyads were simultaneously scanned with functional near-infrared spectroscopy (fNIRS), during the distress/neutral conditions to investigate interbrain coupling in the dorsolateral pre-frontal cortex (DLPFC), a core region of the emotion regulation network.

RESULTS

Consistent with our hypothesis that individuals with high ACEs have difficulty relying on social support, we observed a significant negative relationship between targets' cumulative ACEs and distress relief during the distressing condition. Neuroimaging revealed that higher ACEs scores were significantly linked to differential interbrain coupling patterns in the DLPFC: increased coupling during the distressing condition and decreased coupling during the neutral condition.

CONCLUSIONS

Among higher ACEs dyads, hyper interbrain coupling during distress may suggest heightened yet unsuccessful efforts to regulate distress, while hypo interbrain coupling in non-distressing situations may indicate poor connectedness in neutral social interactions. Therefore, abnormal interbrain coupling may underlie the difficulties high ACEs individuals face in benefiting from supportive interactions.

Psychometric evaluation of the HFDD, PROMIS SD SF 8b, and MENQOL questionnaire in women experiencing vasomotor symptoms associated with menopause

BACKGROUND

Vasomotor symptoms (VMS; hot flashes) associated with menopause have significant impacts on health-related quality of life and are a leading cause for women seeking medical attention. Patient-reported outcome (PRO) instruments are commonly used to assess treatment benefit in VMS clinical trials and must demonstrate supportive evidence of measurement properties within the context of use. This study evaluated the measurement properties of scores from the Hot Flash Daily Diary (HFDD), PROMIS Sleep Disturbance Short Form 8b (PROMIS SD SF 8b) and Menopause-Specific Quality of Life (MENQOL) for measuring treatment efficacy in VMS clinical trials.

METHODS

Measurement properties of the HFDD, PROMIS SD SF 8b, and MENQOL scores were assessed using data (n = 400 participants) from a randomized, placebo-controlled, phase 3 study evaluating the efficacy and safety of elinzanetant for the treatment of VMS in postmenopausal women (OASIS 2). Analyses assessed distributional properties, reliability, validity, responsiveness, and thresholds for meaningful change.

RESULTS

Minimal floor and ceiling effects were found across the instruments at baseline. Inter-item correlations, and confirmatory factor analysis or item-response theory supported dimensionality and scoring for the MENQOL and PROMIS SD SF 8b, respectively. Test-retest reliability between Weeks 8 and 12 was good to excellent for HFDD Frequency and Severity of moderate-to-severe hot flashes scores, PROMIS SD SF 8b T-score and MENQOL Total score (intra-class correlation coefficients 0.835-0.971). Convergent and divergent correlations with instruments assessing similar or distinct constructs were consistent with pre-specified hypotheses. Known-groups validity was supported by significant differences (p < 0.0001) between subgroups hypothesized a priori as being clinically distinct. Responsiveness was indicated by consistent and statistically significant differences (p < 0.0001) in mean changes from baseline to Week 4 and 12 between groups of participants classified as 'improved', 'stable' and 'worsened' (effect sizes for improvement 0.81-4.62). Triangulation of estimates from multiple anchor-based analyses derived meaningful within-individual change thresholds for the HFDD, PROMIS SD SF 8b and MENQOL scores that were likely to exceed measurement error.

CONCLUSIONS

Findings provide evidence that HFDD, PROMIS SD SF 8b, and MENQOL scores are valid, reliable and responsive to change, supporting their use for assessing key efficacy endpoints in VMS clinical trials.

Effects of peppermint (Mentha piperita L.) oil in cardiometabolic outcomes in participants with pre and stage 1 hypertension: Protocol for a placebo randomized controlled trial

BACKGROUND

Hypertension is the predominant risk factor for cardiovascular disease morbidity and mortality, with significant healthcare utilization and expenditure. Pharmaceutical management is habitually adopted; although its long-term effectiveness remains ambiguous, and accompanying adverse effects are disquieting. Peppermint owing to its abundance of menthol and flavonoids, possesses a range of potential hypertensive benefits.

RATIONALE

Our previous trial has shown that peppermint is able to mediate significant improvements in systolic blood pressure in healthy individuals. But there has yet to be any randomized placebo-controlled studies, examining the efficacy of peppermint supplementation in hypertensive individuals.

OBJECTIVE

This study proposes a placebo randomized controlled trial, exploring the effects of daily peppermint oil supplementation on outcomes pertinent to hypertensive disease in individuals with pre and stage 1 hypertension.

METHODS AND ANALYSES

This 20-day, parallel randomized, placebo-controlled trial will recruit 40 individuals, assigned to receive either 100μL per day of either Peppermint oil or a peppermint flavoured placebo. The primary trial outcome will be the between-group difference in systolic blood pressure from baseline to post-intervention. Secondary outcome measurements will be between-group differences in anthropometric, haematological, diastolic blood pressure/ resting heart rate, psychological wellbeing, and sleep efficacy indices. Statistical analysis will be conducted on an intention-to-treat basis using linear mixed effects models to contrast differences in the changes from baseline to 20-days between the two trial arms.

ETHICS AND DISSEMINATION

Ethical approval has been granted by the University of Central Lancashire (HEALTH 01074) and the study has formally been registered as a trial (NCT05561543). Dissemination of the trial findings will be through publication in a peer-reviewed journal.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05561543.

ETHICS

HEALTH 01074.

Climate change news and doomscrolling: An examination of influencing factors and psychological effects

INTRODUCTION

Climate change is one of the greatest threats to human life, and news about it can significantly impact mental health. Furthermore, doomscrolling, that is habitual negative consumption, may further exacerbate these effects. Understanding the associated risks and protective factors is crucial for supporting the most affected groups. However, no research has examined the relationship between doomscrolling and climate change news.

METHOD

We employed a cross-sectional design to investigate the relationship between general doomscrolling and climate change-specific doomscrolling in a sample of 365 participants. Furthermore, we examined the influence of demographic factors, risk factors (anxiety and depression), and protective factors (social support and coping skills) on both types of doomscrolling.

RESULTS

Analyses of the final sample revealed a significant positive correlation between general doomscrolling and climate change-specific doomscrolling. Additionally, the study suggests a gender difference, with females exhibiting a greater propensity for doomscrolling behavior. Risk factors for doomscrolling were explored, with both anxiety and depressive symptoms demonstrating positive associations. Depression correlated positively with doomscrolling for females, and it displayed a negative correlation for males. Anxiety consistently demonstrated a positive association with general and climate change-specific doomscrolling. Social support did not significantly protect against either form of doomscrolling. Conversely, the study identified coping skills as a potential protective factor, albeit with a modest effect size.

CONCLUSION

Given climate change's continued prominence within the news cycle, developing effective coping mechanisms becomes increasingly crucial. This study underscores the importance of designing interventions that empower individuals to navigate the negativity inherent in news consumption.

Efficacy and safety of antidepressant in post-myocardial infarction associated depression: a meta-analysis and systematic review

OBJECTIVE

This study aimed to summarize the available data and assess whether antidepressants are effective and well-tolerated in the treatment of post-myocardial infarction (MI)-associated depression.

MATERIALS AND METHODS

A comprehensive search of public databases (PubMed, Embase, Web of Science, Ovid, EBSCO, and the Cochrane Library) was conducted for publications on interventions for post-MI depression before October 2024. Keywords included post-myocardial infarction depression, antidepressants, myocardial infarction, and depression. Pooled data were analyzed using Stata software.

RESULTS

A total of twelve studies were included. At baseline, no significant difference was observed in depression severity between the antidepressant treatment and control groups (pooled SMD = -0.022, 95% CI: -0.087-0.044). Antidepressant treatment significantly reduced depression scores after long-term follow-up (pooled SMD = -1.023, 95% CI: -1.671- -0.375). The incidence of adverse cardiac events was not significantly higher in the treatment group compared to the control group (pooled HR = 0.893, 95% CI: 0.793-1.005). Antidepressants did not increase the risk of all-cause mortality (pooled HR = 0.957, 95% CI: 0.699-1.311), and there was no significant difference in the risk of rehospitalization for heart disease (pooled HR = 1.070, 95% CI: 0.820-1.398). Antidepressant treatment was associated with a reduced risk of MI recurrence (pooled HR = 0.787, 95% CI: 0.693-0.894) and revascularization procedures (pooled HR = 0.858, 95% CI: 0.755-0.975). Moderate-certainty evidence (GRADE assessment) supports antidepressant efficacy in improving depressive symptoms, while low-certainty evidence suggests potential cardiac risk reduction.

CONCLUSION

This meta-analysis demonstrates that antidepressants are effective and well-tolerated in the treatment of post-MI depression. Antidepressants can improve depressive symptoms without adversely affecting long-term prognosis. The clinical application of these findings should consider the moderate certainty for symptom improvement and low certainty for MI recurrence benefits.

Brain morphology in adolescent girls with first-onset anorexia nervosa

This study aimed to assess whether a young, first-onset cohort of girls with anorexia nervosa (AN) demonstrate similar findings of reduced gray and white matter volume reductions as reported in older women with chronic AN. We compared adolescents and young adults with first-onset AN to typically developing (TD) girls and investigated associations between brain volume measures and clinical symptoms. Whole-brain T1-weighted structural imaging was performed in 58 young persons with AN and 63 age, sex-, and education-matched TD participants. Participants with AN were further divided into underweight (undAN) and restored weight (restAN) groups based on body mass index length/weight standard deviation score (BMI-SDS). Eating disorder symptoms were measured by the Eating Disorder Examination (EDE) and the Eating Disorder Inventory-3 (EDI-3). Differences in brain volume measures were analyzed using separate linear regression analyses. Within the AN group, associations between brain volumes, BMI-SDS, and EDE/EDI-3 scores were analyzed. The undAN group showed significant reductions in total and cortical gray matter volumes compared to the TD group, primarily in the frontal and parietal cortices. No significant associations were found between brain volume and BMI-SDS or EDE/EDI-3 scores. Frontal and parietal cortices in adolescents and young adults with undAN are particularly affected by malnutrition, showing gray matter volume reductions even in early stages of AN. Longitudinal studies are needed to explore the effects of malnutrition on brain development and its association with clinical features of AN over time.

Possible Significance of Neutrophil-Hemoglobin Ratio in Differentiating Progressive Supranuclear Palsy from Depression: A Pilot Study

BACKGROUND

Research has associated chronic inflammation with the evolution of neurological and psychiatric disorders. Neurodegenerative diseases, including Parkinson's Disease (PD), Alzheimer's Disease (AD), and less common ones such as Progressive Supranuclear Palsy (PSP), are commonly linked to depression. However, the pathomechanisms and the role of neuroinflammation in these disorders remain unclear; therefore, interest is increasing in easily accessible inflammatory morphological assessments of blood samples, such as the neutrophil-to-lymphocyte ratio (NLR), the neutrophil-to-monocyte ratio (NMR), and the neutrophil-to-hemoglobin ratio (N/HGBR).

METHODS

The authors analyzed 15 age-matched controls and 21 patients with PSP; the PSP group was additionally divided into 11 patients without depression (PSP) and 10 with depression (Beck Depression Inventory [BDI] ≥ 14) (PSP-D).

RESULTS

In the PSP-D group, the level of N/HGBR was significantly lower than in the controls (p = 0.01), but there were no significant differences in any other neutrophil-derived parameters or comparisons of morphological blood assessment. Patients with PSP-D exhibited a marginally significant decrease in neutrophil levels compared to the controls.

CONCLUSIONS

This is the first study highlighting the possible significance of peripheral inflammatory factors in patients with PSP affected by depression. It highlights possible tendencies in the area of non-specific inflammatory markers and suggests their relation to affective disorders in PSP.

IRT analysis of the BDI-II for early online depression detection: validation in a Mexican population

Introduction

Identifying factors associated with depression is crucial to addressing the global rise in mental health needs. The Beck Depression Inventory II (BDI-II) has shown robustness in assessing depression, even in digital contexts. However, psychometric evidence is essential to support its use in online self-diagnosis, particularly in regions where it has not been widely employed for this purpose.

Objective

This study aimed to evaluate the psychometric properties of the BDI-II for online self-diagnosis among Mexican adults.

Method

Data from 58,456 medical records were analysed using Item Response Theory (IRT).

Results

A good fit was found for a hierarchical confirmatory model with 1 s-order factor (overall severity) and two first-order factors (cognitive and somatic symptoms), as well as optimal accuracy estimates in both the IRT and the Classical Test Theory (CTT).

Discussion

These findings support the use of the BDI-II as a reliable online screening tool for depression in self-diagnosis settings for Mexican adults.

The Effect of an EEG Neurofeedback Intervention for Corneal Neuropathic Pain: A Single-Case Experimental Design with Multiple Baselines

Corneal neuropathic pain is a complex condition, rarely responsive to current treatments. This trial investigated the potential effect of a novel home-based self-directed EEG neurofeedback intervention on corneal neuropathic pain using a multiple-baseline single-case experimental design. Four Participants completed a predetermined baseline of 7, 10, 14, and 17 days, randomly assigned to each participant, followed by 20 intervention sessions over four weeks. Two one-week follow-ups occurred immediately and five weeks post-intervention during which participants were encouraged to practice mental strategies. Daily pain severity and pain interference observations were the outcome measures, while anxiety, depression, or sleep problems were the generalisation measures. The results showed a medium effect on pain severity and interference across participants when comparing baseline to five-week post-intervention according to Tau-U effect sizes. At the individual level, both Tau-U and NAP effect sizes indicated significant reductions in pain severity and interference for three participants when comparing baseline to five-week post-intervention. However, the reductions indicated by the visual inspection were not considered clinically meaningful. This single-case experimental design study raises the possibility that the intervention may improve pain severity and interference for some individuals, variability in outcomes highlights the need for future research to better understand individual responses and optimize the intervention effect. REGISTRATION: Australian New Zealand Clinical Trial Registry ACTRN12623000173695 PERSPECTIVE: This trial demonstrates the potential of EEG neurofeedback to reduce pain severity and interference in individuals with corneal neuropathic pain. It also highlights user preferences for technology-based interventions, emphasizing ease of use, accessibility, and self-administration to enhance adherence, especially for individuals with limited mobility or restricted healthcare access.

Beck Depression Inventory-II Response Following Parathyroidectomy for Primary Hyperparathyroidism: A Systematic Review and Meta-Analyses

BACKGROUND

There is currently a lack of consensus regarding neuropsychiatric symptoms as an indication for parathyroidectomy in primary hyperparathyroidism (pHPT). The purpose of this study is to perform a systematic review and meta-analyses of pre- and postoperative Beck Depression Inventory-II (BDI-II) scores in patients with pHPT undergoing parathyroidectomy.

METHODS

A search of the literature was performed using Embase, PubMed, Web of Science, PsycINFO, and OvidAll EBM Reviews. Studies were included if they evaluated BDI-II scores in pHPT patients before and after parathyroidectomy.

RESULTS

The literature search returned 1554 studies, of which nine articles met criteria for inclusion. Baseline BDI-II scores were significantly higher in pHPT patients compared to control patients. pHPT patients experienced a statistically significant decrease in BDI-II scores at ≤ 1 and 6 months postoperatively.

CONCLUSIONS

Based on the results of this study, a BDI-II score ≥ 14 could potentially advocate for parathyroidectomy in patients with pHPT.

A Double-Blind Randomized Study of Two Doses of Oral Isotretinoin in the Treatment of Recalcitrant Facial Flat Warts: Impact on Quality of Life, Anxiety, and Depression

Background and Aims

Recalcitrant facial flat warts are caused by human papillomavirus and may persist for years despite treatment. Oral isotretinoin administered at a dose of 0.5 mg/kg/day is effective and safe. However, the adverse effects reported are dose-dependent behaviors and they could limit their use. We aim to compare the efficacy and safety of two doses of oral isotretinoin for the treatment of recalcitrant facial flat warts and to assess the quality of life, anxiety, and depression in the individuals studied.

Methods

Isotretinoin 0.3 mg/kg/day or isotretinoin 0.5 mg/kg/day was administered to 21 and 19 adult patients, respectively, in a double-blind, randomized fashion for 12 weeks. Cutaneous lesions were assessed, and adverse events, including serologic changes, were recorded. It is considered that warts were recalcitrant if the patient was treated for at least 3 years with at least two of the following options: retinoids, 5-fluorouracil, imiquimod, and cryotherapy. In addition, quality of life, anxiety, and depression were assessed at the beginning and end of follow-up.

Results

In the isotretinoin 0.3 mg/kg/day group, 35% of the patients had a complete response, and 66% had a partial response, while in the isotretinoin 0.5 mg/kg/day group, 73.7% presented a complete response, and 26.31% presented a partial response (p = 0.015). The most frequent adverse event was cheilitis. There was an elevation of aspartate aminotransferase (p = 0.020) and total bilirubin (p = 0.015) in the isotretinoin 0.5 mg/kg/day group. Improvement in the quality-of-life score (p = 0.0001) and a reduction in the anxiety (p = 0.00) score was observed in both groups.

Conclusion

Oral isotretinoin at a dose of 0.5 mg/kg/day is safe and effective for the treatment of recalcitrant facial flat warts in adults, with lower recurrence rates than 0.3 mg/kg/day. Prolonged treatment with isotretinoin for over 12 weeks in adults can increase the overall response rate. Trial Registration: Registry of ClinicalTrials.gov identifier: NTC04290572; https://classic.clinicaltrials.gov/.

Network analysis of central symptoms in Chinese young adults with subthreshold depression

Subthreshold depression (SD) is a prevalent condition among young adults, significantly increasing the risk of developing major depressive disorder (MDD). While the symptoms of MDD are well-documented, the network structure and key symptoms of SD, which forms a complex, interdependent system, have not been fully elucidated. This study sought to identify the central symptoms and their interconnections within the depressive symptom network in young adults with SD. A total of 834 Chinese young adults with SD completed the 21-item Beck Depression Inventory 2nd version (BDI-II) and were included in this study. Network analysis was employed to identify central symptoms (nodes) and associations between symptoms (edges) as assessed by the BDI-II. Additionally, centrality indicators for network robustness underwent assessment through stability and accuracy tests. The analysis revealed that Loss of interest was the most central node in the SD symptom network, with Tiredness/fatigue and Agitation following closely. Significant associations were observed between Loss of energy and Concentration difficulties, Agitation and Irritability, Guilty feelings and Self-dislike, as well as Tiredness and Loss of pleasure. The network demonstrated robustness across stability and accuracy assessments. Loss of interest, Tiredness/fatigue, and Agitation were pivotal symptoms within the depressive symptom network of SD in young adults. These symptoms may serve as critical targets for therapeutic interventions and should be prioritized in future psychological and neurobiological research to advance our understanding of SD.

Interpersonal problems as a predictor of treatment outcome in adult depression: An individual participant data meta-analysis

OBJECTIVES

Interpersonal problems are a fundamental feature of depression, but study-level meta-analyses of their association with treatment outcome have been limited by heterogeneity in primary studies' analyses and reported results. We conducted a pre-registered individual participant data meta-analysis (IPD-MA) to examine this relationship for adult depression. This meta-analytic strategy can reduce variability by standardizing data analysis across primary studies.

METHODS

We included studies examining the efficacy of five treatments for adult depression and assessing interpersonal problems at baseline. One-stage IPD-MA was conducted with three-level mixed models to determine whether baseline overall interpersonal distress, agency, and communion predicted depressive symptom level at post-treatment, 12-month, and 24-month follow-up. The moderating effect of treatment type was also investigated.

RESULTS

Ten studies (including n = 1282 participants) met inclusion criteria. Only overall interpersonal distress was negatively related with outcomes at post-treatment (γ = 0.11, CI95[0.06, 0.16], r = 0.11), 12-month follow-up (γ = 0.17, CI95[0.08, 0.25], r = 0.17), and 24-month follow-up (γ = 0.16, CI95[0.05, 0.26], r = 0.16), indicative of smaller effect sizes. The agency and communion dimensions were not significantly related to outcome. Treatment type did not significantly moderate interpersonal distress-outcome associations.

DISCUSSION

Results show a small association between patient baseline overall interpersonal distress and subsequent depression treatment outcome in brief treatments for depression. Further studies might require to account for therapist effects. Registration number osf.io/u46t7.

Antidepressant intervention to possibly delay disease progression and frailty in elderly idiopathic pulmonary fibrosis patients: a clinical trial

BACKGROUND

Idiopathic pulmonary fibrosis (IPF) is more likely to occur in the elderly population, and these patients often become depressed. It has been recognized that psychological disorders are not conducive to the control of many diseases. Thus, this study aims to determine whether alleviating depression can delay the progression of IPF and frailty in elderly patients with IPF.

METHODS

IPF patients over 60 years old were included in the study. None had a prior history of psychological disorders. All developed depression after being diagnosed with IPF. During the 12-month follow-up, some patients received anti-depression interventions and the rest didn't. Depression, IPF, frailty and peripheral inflammation at baseline and after follow-up were evaluated by indicators and scales such as BDI-II, FVC %pred, 6MWT, mMRC, CFS, TFI, SGRQ, K-BILD, IL-6, and TNF-α. Multivariate logistic regression was employed for data analysis.

RESULTS

There were 213 elderly patients with IPF. Among the 89 patients who received anti-depression interventions, the above-mentioned indicators and scales did not deteriorate during the follow-up period (P > 0.05). Among the remaining 124 patients, the FVC %pred, and 6MWT levels decreased, and the mMRC grade, CFS, TFI, SGRQ and K-BILD scores, and peripheral IL-6 and TNF-α levels increased during the follow-up period (P < 0.05).

DISCUSSION

Compared with non-intervened IPF patients, those receiving anti-depression interventions seemed to maintain a certain stability in IPF, frailty, and peripheral inflammation over a period.

CONCLUSION

Improving depression may help delay the deterioration of patients' IPF and frailty at certain stages.

TRIAL REGISTRATION

Registration on UMIN-CTR.

REGISTRATION NUMBER

UMIN000057161. Date of registration: February 27th, 2025.

Neurodevelopmental Impact of Maternal Postnatal Depression: A Systematic Review of EEG Biomarkers in Infants

BACKGROUND/OBJECTIVES

Postpartum depression (PPD) significantly impacts maternal well-being and child neurodevelopment. While the etiology of PPD is well understood, the precise neurodevelopmental consequences, particularly differentiating prenatal and postnatal effects, remain unclear. This systematic review aims to synthesize the existing literature on the neurophysiological effects of maternal PPD on infant neurodevelopment, focusing on electroencephalography (EEG) biomarkers to identify consistent patterns and potential mediating factors.

METHODS

A comprehensive literature search across PubMed/MEDLINE, Web of Science, and Scopus identified studies investigating infants (0-12 months) exposed to maternal depressive symptoms (assessed via validated psychometric instruments) with quantitative EEG data. Study quality was assessed using the Newcastle-Ottawa Scale.

RESULTS

Twelve studies met the inclusion criteria. Eleven investigated EEG asymmetry, predominantly frontal alpha asymmetry (FAA). The findings consistently showed greater right FAA in the infants of mothers with PPD, suggesting increased negative affectivity and avoidance behaviors. This association was stronger with prolonged or combined prenatal/postnatal exposure. However, EEG power and connectivity findings were less consistent, with some studies reporting altered occipital power at 1 month and frontal power at 3 months in the infants of depressed mothers. No significant associations were found between maternal depression and functional connectivity.

CONCLUSIONS

This review demonstrates a robust association between maternal PPD and altered infant EEG patterns, particularly increased right FAA. However, methodological heterogeneity necessitates future research with standardized protocols and longitudinal designs to establish causality and investigate long-term effects. Further research should also explore the underlying neural mechanisms and evaluate the efficacy of targeted interventions. These findings underscore the need for early identification and intervention to mitigate the negative impact of PPD on infant neurodevelopment.

Association of sleep quality and its change with the risk of depression in middle-aged and elderly people: A 10-year cohort study from England

BACKGROUND

Persistently poor sleep quality in young adults is linked to a higher risk of depression. However, the impact of changes in sleep quality on depression risk in middle-aged and older adults remain unclear. This study investigates the association between sleep quality, its changes, and the risk of depression in middle-aged and elderly people.

METHODS

We included 4007 participants (mean age 63.0 ± 7.6 years, 53.0 % women) from the English Longitudinal Study of Ageing. Sleep quality was assessed using the Jenkins Sleep Problems Scale and a global sleep quality question. Depression was evaluated with the Center for Epidemiological Studies Depression Scale and self-reported doctor-diagnosed depression. Multivariable logistic regression, restricted cubic spline curve, and mediation analysis was employed.

RESULTS

After 10 years of follow-up, 777 individuals developed depression. Sleep quality scores positively correlated with depression risk. Among those with good sleep quality, worsening sleep quality increased depression risk (OR = 1.67, 95 % CI: 1.21-2.31). For those with intermediate sleep quality, improved sleep quality reduced depression risk (OR = 0.70, 95 % CI: 0.50-0.98). Conversely, worsening sleep quality increased depression risk (OR = 2.11, 95 % CI: 1.47-3.02). Pain and functional disability partially mediated the association between intermediate/poor sleep quality and depression (9.8 % and 4.2 %, respectively).

LIMITATIONS

Sleep quality is based on self-reported.

CONCLUSIONS

Intermediate, poor, and worsening sleep quality are linked to higher depression risk. Improving sleep quality mitigates depression risk in those with intermediate sleep quality. Sleep quality may influence depression indirectly through pain and functional disability.

Brain dopamine responses to ultra-processed milkshakes are highly variable and not significantly related to adiposity in humans

Ultra-processed foods high in fat and sugar have been theorized to be addictive due to their purported ability to induce an exaggerated post-ingestive brain dopamine response akin to drugs of abuse. Using [11C]raclopride positron emission tomography (PET) displacement methods used to measure brain dopamine responses to addictive drugs, we measured striatal dopamine responses beginning 30 min after ingesting an ultra-processed milkshake high in fat and sugar in 50 young, healthy adults over a wide body mass index (BMI) range (20-45 kg/m2). Surprisingly, milkshake consumption did not result in a significant post-ingestive dopamine response in the striatum (p = 0.62) nor in any striatal subregion (p > 0.33), and the highly variable interindividual responses were not significantly related to adiposity (BMI: r = 0.076, p = 0.51; % body fat: r = 0.16, p = 0.28). Thus, post-ingestive striatal dopamine responses to an ultra-processed milkshake were likely substantially smaller than for many addictive drugs and below the limits of detection using standard PET methods.

Symptoms of ADHD and Other Common Mental Disorders Influence Academic Success in South African Undergraduates

OBJECTIVE

ADHD symptoms are highly prevalent among university students. These symptoms, particularly the inattentive cluster, predispose students to poorer academic performance and worse academic adjustment. Moreover, ADHD symptoms are often comorbid with other common mental disorders; this comorbidity also leads to poor outcomes. South African students often have fewer resources to successfully transition to university. Hence, our longitudinal study used data from a sample of South African first-year undergraduate students to investigate (a) associations between ADHD symptoms and academic performance/adjustment, (b) separate influences of the inattentive and hyperactivity-impulsivity clusters on academic performance/adjustment, and (c) the influence of the combination of ADHD and psychiatric comorbidities on academic performance/adjustment.

METHOD

We collected data three times through the first semester of 2023. Predictors within our regression models included sociodemographic variables, psychological variables (self-reported symptoms of ADHD, depression, anxiety, and risky alcohol use), and high school academic performance. Outcomes were first-semester GPA and self-reported academic adjustment (magnitude of change across the semester and overall adjustment at the end of the semester).

RESULTS

Analyses showed that, unlike academic performance (N = 506), magnitude of change in academic adjustment (N = 180) was significantly predicted by ADHD symptoms and the combination of ADHD (p = .02), depression (p < .001), and anxiety symptoms (p = .01). Inattentive ADHD symptoms predicted both academic performance and magnitude of change in academic adjustment.

CONCLUSIONS

Our findings suggest that the presence of ADHD symptoms (both with and without other common mental disorders) is associated with a smaller magnitude of academic adjustment, and that the presence of inattentive symptoms of ADHD is associated with both poorer academic performance and smaller magnitude of academic adjustment. These findings are significant in informing future interventions targeting the academic outcomes of first-year university students.

Focusing on post-COVID syndrome fatigue

INTRODUCTION

More than 100 million people worldwide have been infected by SARS-CoV-2 virus, the virus responsible for the acute disease COVID-19. Multiple studies have shown how various symptoms in these patients can persist for several months after resolution of the acute process, a phenomenon known as post-COVID syndrome. Neurological symptoms are varied, but the great majority of patients present fatigue.

OBJECTIVE

To analyse post-COVID fatigue.

METHODS

We present a prospective, single-centre, case-control study comparing patients with fatigue in the context of post-COVID syndrome with patients with history of COVID-19 but without post-COVID fatigue. Data were recorded at baseline (April 2021) and at 6 months. Data were recorded on clinical variables, fatigue questionnaires, sleep disorders, depression, anxiety, cognitive impairment, and quality of life. Basic laboratory analysis was performed with blood samples collected at the 2 visits. In addition, a substudy of proinflammatory (IL-6, IL-1β, TNF-α) and anti-inflammatory (IL-10) cytokines was performed.

RESULTS

Fatigue as measured by the Chalder Fatigue Scale was mixed (physical and psychological) and of moderate intensity. At 6 months, physical fatigue improved, but psychological fatigue did not. Significant differences were found in sleepiness, cognitive impairment, anxiety, and quality of life. Significant alterations were observed in TNF-α levels, but not in the remaining cytokines.

CONCLUSIONS

Patients with fatigue presented a poorer quality of life, with an improvement being observed at 6 months, which suggests a course that may be self-limiting; however, this will have to be confirmed with longer studies.

Mental Health After Childbirth in Women with Previous Bariatric Surgery: The SPOtMom Pilot Study

Currently, no data are available using standardized instruments for evaluating the postpartum mental health of women with previous bariatric surgery. The aim of this pilot study was to assess postpartum mental health in women following bariatric surgery and to establish appropriate tools for a prospective registry study in the future. In this survey, the mental health of 22 women during the first weeks postpartum was examined (T1) and their status at least 6 months after childbirth was prospectively assessed (T2). Symptoms of depression and anxiety were evaluated with standardized questionnaires and depression was diagnosed with structured diagnostic interviews (SCID-5). At T1, 3/22 women (14%) reported depressive or anxiety symptoms, and in these women, the diagnosis of depression was established. In comparison with T1, at T2, symptomatology for depression or anxiety increased to 32% and 27% of patients, respectively, but only one woman was diagnosed with depression. In comparison to patients without symptoms, patients with signs of depression or anxiety or both had lower total body weight loss and, more often, a personal or family history of depressive disorders. Our pilot study suggests that the rate of postpartum depression in women after BS might be higher than in the general population. High symptom levels of depression and anxiety emphasize the necessity of long-term bariatric follow-up care. Further research is needed to evaluate if prevalence of depression or anxiety disorder or both is higher in this patient group as compared to other patients after bariatric surgery.

Prevalence of the generalized anxiety disorder in Tunisia: A study of 707 primary care outpatients

OBJECTIVE

This study examined the prevalence and correlates of generalized anxiety disorder (GAD) among primary care outpatients.

METHOD

A multicenter, cross-sectional study was conducted that included 707 primary care outpatients being seen at 20 primary healthcare centers in Tunis and Sfax, Tunisia. The Mini International Neuropsychiatric Interview was used to identify a diagnosis of GAD. The Beck Depression Inventory was used to assess depressive symptom severity, and the Sheehan Disability Scale (SDS) was used to measure functional impairment.

RESULTS

The prevalence of GAD was 11%. GAD was positively correlated with female gender (P = .005), family history of psychiatric disorder (P < .001), personal history of suicide attempt (P = .019), and depressive symptoms (P < .001). Based on the SDS, severe to very severe functional limitations were reported at work (56.4%), in social life (60.2%), and family life (73.1%) among GAD patients.

CONCLUSION

This study indicated a relatively high prevalence of GAD among primary care patients in Tunisia. Risk factors were also determined that may help to identify these patients. This information may help primary care physicians recognize this diagnosis and provide timely referrals to mental health professionals to prevent complications and maximize quality of life.

Is Pilates effective in improving depressive disorders? A comprehensive overview

Depressive disorders are disabling conditions that account for high social costs. Pilates demonstrated to have several beneficial effects on health. Objective of this manuscript was to systematically review the literature about the effects of Pilates on depressive disorders. A bibliographic search was conducted in the main database sources (Pubmed, Medline, and Scopus). The inclusion criteria consisted of articles written in English language about the effectiveness of Pilates on depressive symptoms. Most of included studies are randomized controlled trials (10 out of 12). The available literature agrees in indicating that Pilates is effective in improving depressive symptoms especially when compared to inactivity and when this practice is administered for a medium-long period (8-16 weeks). In addition, Pilates seems to have at least comparable effectiveness than aerobic exercise. Pilates can be considered a reliable complementary treatment for people with depressive disorders. These findings should be interpreted considering the different types of practice administered as well as the different duration of the programs or rating scales used to assess mood symptoms. Studies with a more homogenous design are needed to confirm and make generalizable the results presented in this review.

Prospective Association of Psychological Distress and Sexual Quality of Life Among Hematopoietic Stem Cell Transplant Survivors

Sexual health concerns are one of the most common late effects facing hematopoietic stem cell transplant (HSCT) survivors. The current study tested whether self-reported depression and anxiety symptoms before transplant were associated with embedded items assessing two specific areas of sexual health-sexual interest and sexual satisfaction-one year post-HSCT. Of the 158 study participants, 41% were diagnosed with a plasma cell disorder (n = 60) and most received autologous transplantation (n = 128; 81%). At post-HSCT, 21% of participants reported they were not at all satisfied with their sex life, and 22% were not at all interested in sex. Greater pre-HSCT depressive symptomology was significantly predictive of lower sexual interest (β = -.27, p < .001) and satisfaction (β = -.39, p < .001) at post-HSCT. Similarly, greater pre-HSCT trait anxiety was significantly predictive of lower sexual interest (β = -.19, p = .02) whereas higher levels of state and trait anxiety were both predictive of lower satisfaction (β = -.22, p = .02 and β = -.29, p = .001, respectively). Participant sex significantly moderated the relationship between state anxiety and sexual satisfaction (b = -.05, t = -2.03, p = .04). Additional research examining the factors that contribute to sexual health post-HCST is needed to inform and implement clinical interventions to address these commonly overlooked survivorship concerns.

The Effects of Combined Scutellaria and Saffron Supplementation on Mood Regulation in Participants with Mild-to-Moderate Depressive Symptoms: A Randomized, Double-Blind, Placebo-Controlled Study

Background/Objectives: The global prevalence of mental health disorders, particularly anxiety and depression, has increased significantly, with rates further elevated by the COVID-19 pandemic. Conventional pharmacological treatments, while effective, often lead to side effects that can impact patient adherence and quality of life. This has driven interest in safer, natural adjunctive therapies. Crocus sativus L. (Iridaceae) (saffron) and Scutellaria baicalensis Georgi (Lamiaceae) (scutellaria) have individually shown potential, in humans and animals, respectively, as mood regulators, with bioactive compounds that modulate neurotransmitter systems and possess anti-inflammatory and anxiolytic effects. This study aimed (1) to explore the efficacy and safety of scutellaria extracts in humans and (2) to test a possible synergistic effect when combining scutellaria and saffron on mood regulation in individuals experiencing mild-to-moderate depressive symptoms. Methods: In a randomized, double-blind, placebo-controlled trial, 180 participants with mild-to-moderate depressive symptoms were assigned to receive either scutellaria extract alone (SCUTELL'UP®), saffron extract alone (SAFFR'ACTIV®), a combination of scutellaria and saffron extracts (SAFFR'UP®), or a placebo for six weeks. The primary outcome was assessed using a standardized depression scale (Beck Depression Inventory). The secondary outcomes, including anxiety, emotional state, well-being level, and sleep quality, were all assessed using validated questionnaires. Safety and tolerability were evaluated throughout the study period. Results: The results confirmed the beneficial effects of saffron extract on depressive and anxious symptoms, as well as its role in improving sleep quality. For the first time in humans, scutellaria extract demonstrated a positive effect on mood regulation. Furthermore, a synergistic effect of the combination of these two extracts was identified, leading to enhanced improvements in depressive and anxious symptoms and emotional well-being among individuals with mild-to-moderate depression, compared to the placebo group. Minimal adverse effects were reported across all treatment groups. Conclusions: This natural adjunctive nutritional strategy offers a promising alternative for individuals seeking safer options for mental health support. Further research is warranted to exclude potential long-term side effects and to explore potential mechanisms of this combined supplementation.

Effectiveness of rTMS compared to SSRI as early treatment of depression - study protocol of a randomized controlled trial (Early-TMS)

Psychotherapy and antidepressant medication are considered first-line treatment options for major depressive disorder (MDD). However, a high proportion of patients do not respond to initial treatment, underlining the need for alternative treatment methods. Repetitive transcranial magnetic stimulation (rTMS) has been established in the treatment of MDD, but the available evidence is limited to forms of MDD with varying degrees of treatment resistance. Randomized-controlled trials (RCT) investigating first-line treatment with rTMS in comparison with first-line antidepressant medication are warranted to further position rTMS within current treatment algorithms for MDD. In this two-stage, therapy response-adapted, randomized multi-center phase 2 rater blinded trial, 106 medication-naïve patients suffering from MDD will be enrolled. In Stage I, participants receive one of the two treatment options for four weeks: either daily bilateral theta burst stimulation (TBS), a patterned and time-saving form of rTMS, or antidepressant medication with selective serotonin reuptake inhibitors (SSRI). The allocation to Stage II occurs therapy response-adapted. Therefore, patients either receive maintenance treatment or will be switched to the respective other treatment arm. Primary outcome is the comparison between the two study arms with regard to therapy response measured by the Montgomery-Asberg Depression Rating Scale (MADRS) after 4 weeks at the end of Stage I. The aim of the study is to provide reliable first evidence and effect size measures of rTMS as first-line treatment compared to SSRI treatment. Positive results will help to implement rTMS in early stages of MDD. Trial registration: ClinicalTrials.gov ID: NCT06545474, August 15, 2024.

Non-modifiable and modifiable factors affecting anxiety and depressive symptoms in young athletes

OBJECTIVES

The aim of the present study was to verify the association between non-modifiable (age categories, sex and race/ethnicity) and modifiable (sport modality, socioeconomic, training load, sleep, and eating disorder) factors with anxiety and depressive symptoms in young athletes.

METHODS

The sample was composed of 168 athletes engaged in national competitions from individual sports [swimming (n = 26) and badminton (n = 53)] and team sports [soccer (n = 28) and handball (n = 61)]. The coaches monitored the training load throughout the training week, and athletes completed self-reported questionnaires to assess sociodemographic data, sleep quality, eating disorders, and symptoms of anxiety and depression on the recovery day after a full week of pre-season training.

RESULTS

The prevalence of anxiety and depressive symptoms in young athletes were 14.3% and 25.6%, respectively, and female athletes presented higher rates of anxiety symptoms than males (30.8% vs. 11.3%; p = 0.015). Athletes from individual sports and athletes with 18 years or older showed higher depressive symptoms than younger (32.3% vs. 17.3%; p = 0.021). Athletes from the minority group showed higher depressive symptoms compared to the dominant group (41.9% vs. 20%; p = 0.005). The quality of sleep also influenced both anxiety (β = 5.430 [95%CI: 1.896 to 15.553]) and depressive symptoms (β = 5.292 [95%CI: 2.211 to 12.664)] in young athletes.

CONCLUSION

In short, non-modifiable factors, such as sex and age categories, should be considered when anxiety and depressive symptoms are examined in young athletes. Modifiable factors such as sports modality and sleep quality impact depressive symptoms in this population.

Efficacy of Transcranial Direct Current Stimulation (tDCS) on Neuropsychiatric Symptoms in Substance Use Disorder (SUD)-A Review and Insights into Possible Mechanisms of Action

Introduction: Substance use disorder (SUD) is a significant global clinical issue marked by the excessive consumption of alcohol, nicotine, and various psychoactive substances, leading to impaired social, cognitive, and occupational functioning. Individuals with SUD frequently experience depression and anxiety disorders, which exacerbate their prognosis and contribute to substantial health and social burdens. The pathophysiology of SUD and its associated conditions is multifaceted, involving multiple dysfunctions in the brain. This complexity underscores an urgent need for the development of noninvasive treatments that can directly target the brain. One of them is transcranial direct current stimulation (tDCS), an intensively studied technique for safely modulating cortical excitability. The aim of this study is to investigate the effectiveness of tDCS in treating symptoms of depression and anxiety in SUD. Methods: With an emphasis on the underlying mechanisms of action, this mechanistic review investigates the effectiveness of tDCS in treating anxiety and depression in SUD patients. Literature searches were conducted using the PubMed/Medline, ResearchGate, Cochrane, and Google Scholar databases. Results: The review identified 12 relevant studies. The results showed that left dorsolateral prefrontal cortex (DLPFC) stimulation is an effective treatment option for depression in SUD. In anxiety disorders, left and right DLPFC stimulation is effective, with better results observed with right DLPFC stimulation. However, the included studies differed in their methodology, sample characteristics, and measurement methods, which could have influenced the final results of the analysis. The central focus of this mechanistic review is to discuss the potential mechanisms of action of tDCS in treating depression and anxiety in SUD. These mechanisms include the modulation of brain networks, a reduction in neuroinflammation, an enhancement in neuroplasticity, and an increase in P300 amplitude. We also discuss the limitations of the included studies and propose ways to address them in future research. Conclusions: This review provides evidence that tDCS is an effective treatment option for anxiety and depression in SUD. Stimulation of the left DLPFC reduces symptoms of depression, while stimulation of the right DLPFC reduces symptoms of anxiety. However, future research is required to confirm these findings and to deepen our understanding of the mechanisms through which tDCS exerts its effects in this context. Neuroimaging methods (fMRI and EEG) and blood tests could be particularly useful.

Mental states and temperaments contributing to suicidal crisis in psychiatric inpatients: a cross-sectional and validation study

BACKGROUND

A suicide crisis represents a psychological state preceding a suicide behavior and occurs when an individual experiences intolerable emotions. Only a few instruments have been developed so far to assess cognitions and emotions associated with a specific interpretative model of the suicide crisis.

OBJECTIVES

We aimed to (1) evaluate the psychometric properties of a new questionnaire (Suicidal Crisis Evaluation Scale, SCES) that could potentially assess cognitions and emotions relevant to the suicide crisis; (2) evaluate whether cognitions and emotions investigated with the SCES were characteristics of psychiatric patients at greater risk for suicide; (3) investigate whether the presence and severity of suicide-relevant cognitions and mental states could be associated with affective temperaments; and (3) study whether the severity of current depression at least partially mediated the association between affective temperaments and negative mental states.

METHODS

We included 188 adult psychiatric inpatients admitted to the Sant'Andrea Hospital psychiatric inpatient unit in Rome. We administered the SCES and questionnaires to measure current depression, and affective temperaments.

RESULTS

A common factor explained around 70% of SCES variance, and SCES scores were significantly higher in patients with a recent suicide attempt than in other patients. Part of the variance in common between some affective temperaments and SCES scores was explained by the presence and severity of current depressive symptoms.

CONCLUSION

Psychiatric patients need to be assessed for the presence and severity of cognitions and emotions present during the suicide crisis for a better understanding of the complex architecture of suicide risk. The SCES is a valid and reliable measure that could capture such mental states. More studies are necessary to confirm and expand our results in independent samples.

An Analysis of Primary Hyperparathyroidism in Association with Depression or Anxiety

BACKGROUND

Non-classical manifestations such as neuropsychiatric manifestations in primary hyperparathyroidism (PHPT) have long been documented as symptoms of PHPT and are commonly reported by these patients, despite this connection still being a matter of debate, and they (per se) do not represent an indication of parathyroidectomy.

OBJECTIVE

We aimed to overview the most recent findings regarding the link between depression and/or anxiety (D/A) in subjects confirmed with PHPT, including the impact of the surgery in improving their outcome.

METHODS

This was a comprehensive review of English-based original studies published between January 2020 and October 2024.

RESULTS

The studies (n = 16) included a total of 10,325 patients and an additional 152,525 patients with hypercalcemia (out of whom 13,136 had a PHPT diagnosis and 45,081 were at risk of PHPT diagnosis). Out of these subjects with PHPT, 10,068 underwent parathyroidectomy. Female prevalence was between 62.5 and 92%. Most individuals were over 50, with the youngest studied population having a mean age of 52.7 ± 13.8 years, and the oldest had a median of 71. Depression was documented based on ICD-10 codes (n = 3) and patients' records (n = 2), Depression Anxiety Stress Scales (DASS) (n = 2), Beck Depression Inventory (BDI) (n = 3), BDI-II (n = 3), Symptom Check List 90-revised (SCL) (n = 1), Hamilton Depression Rating Scale (HAM-D) (n = 2), HADS (n = 2), Patient Health Questionnaire-9 (n = 1), and European Quality of Life 5 Dimensions 3-Level Version (EuroQOL-5D-3L) (n = 1). Patient records' (n = 1) and ICD-10 codes (n = 2) were also used for anxiety. Most studies used questionnaires to identify anxiety in PHPT: DASS (n = 2), SCL90R (n = 1), Generalized Anxiety Disorder-7 (n = 1), HADS (n = 2), EuroQOL-5D-3L (n = 1), and State-Trait Anxiety Inventory (n = 1). Depression prevalence varied from 20-36.6% to 65.7% (scale-based assessment) and to 10.5% upon ICD-10. A rate of newly onset depression was reported of 10.7% and of 0.2% with concern to the prevalent suicidal ideation (an incidental rate of 0.4% after a median follow-up of 4.2 years). Most studies identified a moderate depression (when assessing its severity), affecting approximately one third of the surgery candidates. The prevalence of anxiety in PHPT varied between 10.4% and 38.6% (n = 8). Discordant results were generated when applying distinct questionnaires for the same population, and this might come as a potential bias. Other confounding factors are generated by the sub-population referred for surgery that typically displays a more severe parathyroid condition or non-endocrine overlapping conditions (e.g., related to the social or familial status).

CONCLUSION

The modern approach of the patient with PHPT should be complex and go beyond the traditional frame. D/A had a high prevalence in the mentioned studies, associated with increased medication use. Yet, the underlying pathogenic mechanisms remain incompletely elucidated. No correlations between D/A and serum calcium levels were confirmed, while PTH had a slight positive correlation with depression. Parathyroid surgery appears to be beneficial for D/A as it improves the scores, prevalence, and severity. Cinacalcet might reduce depression scores, although more evidence is needed. Women are prone to both PHPT and D/A. The optimal method of D/A screening in PHPT remains to be determined, and the current scales need validation and perhaps adjustment for this specific population sub-group, while PHPT management should be refined upon D/A identification.

Comparative effectiveness of short-term psychodynamic psychotherapy and cognitive behavioral therapy for major depression in psychiatric outpatient clinics: a randomized controlled trial

BACKGROUND

More studies with low risk of bias on the effectiveness of cognitive behavioral therapy (CBT) and short-term psychodynamic psychotherapy (STPP) for major depressive disorder (MDD) are needed. This study compares the outcome of CBT and STPP and examines the improvements in each treatment, focusing on effect sizes, reliable change, dropout rates, and remission rates, using broad inclusion criteria (e.g. participants using antidepressants or with strong suicidal ideation).

METHODS

One hundred patients were randomly allocated to CBT or STPP. All patients were offered either 16 weekly sessions followed by 3 monthly booster sessions in CBT, or 28 weekly sessions in STPP. Primary outcome measures were Hamilton Depression Rating Scale (HDRS) and Beck's Depression Inventory-II (BDI-II). Secondary outcome measures were Work and Social Adjustment Scale (WSAS), Generalized Anxiety Disorder-7 (GAD-7), Global Assessment of Functioning (GAF) and Short Form Health Survey-12 (SF-12).

RESULTS

No significant differences in outcomes were found between the two treatment groups on any of the measures. The within-group effects were large (> 0.8) for the primary outcome measures and moderate to large for the secondary outcome measures. According to the reliable change index (RCI), 79% of patients reliably improved on HDRS and 76% improved on BDI-II, whereas respectively 6% and 10% reliably deteriorated.

CONCLUSIONS

These findings support the assumption that CBT and STPP are equally effective treatments for patients with depressive disorders in psychiatric outpatient clinics. Additionally, they strengthen the evidence for the effectiveness of both CBT and STPP in these settings, while also highlighting that not all depressed patients respond to short-term treatment.

CLINICAL TRIAL REGISTRATION

Clinical Trial gov. Identifier: NCT03022071. Date of registration: 2016-11-14.

People with symptoms of depression and those at significant risk of suicide show differences in their personality profile and sense of meaning in life

Introduction

Medical students are exposed to various stressors. Among the many factors that determine the possibility of a mental crisis, there is also a personality profile and a sense of meaning in life.

Materials and methods

Sets of anonymous surveys were distributed among medical students of different years studying at the Medical University of Lodz. The set of surveys included a sociodemographic survey, Beck's Depression Inventory version II (BDI-II), the NEO Five Factory Inventory (NEO-FFI), Reker's Life Attitude Profile - Revised questionnaire (LAP-R), Osman's Suicidal Behavior Questionnaire (SBQ-R).

Results

The study cohort comprised of 276 students (mean age 21.7 years). According to the BDI-II, 79 participants (28.4%) were identified as having depressive symptoms. Additionally, 80 participants (28.9%) were assessed to be at significant risk of suicide according to the SBQ-R scale. Based on the results of these questionnaires, we identified four groups: 1. Participants with depressive symptoms (D). 2. Participants with suicide risk (SR), 3. Participants with both depressive symptoms with suicide risk (D and SR), 4. A control group. Students from D and D and SR groups, exhibited higher neuroticism scores compared to those with suicide risk alone (SR) and the control group. In terms of extroversion, the control and SR groups scored higher compared to the D with SR group. Participants with SR and those with D and SR had higher openness scores compared to the D and control groups. D and SR group obtained statistical lower score then control group in the terms of conscientiousness. In life control score, participants in D and D with SR group has significant lower score then SR and control group. The conditions: personal meaning index and life attitude balance in the control group achieved significantly higher values compared to all other groups.

Conclusion

People with depressive symptoms, suicide risk and both of these variables simultaneously differed in terms of personality profile and components influencing the meaning of life.

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

BACKGROUND

Chronic kidney disease is a progressive disorder often leading to End-stage renal disease, necessitating hemodialysis treatment. Mild depression is prevalent among hemodialysis patients, adversely affecting their quality of life. This study aimed to evaluate the effect of a smartphone-based recreational therapy intervention on mild depression in hemodialysis patients.

METHODS

This randomized controlled trial was conducted at Montaserieh Hospital, Mashhad, Iran, involving 72 patients undergoing hemodialysis. Participants were randomly assigned to either the intervention group, receiving a custom-designed recreational therapy mobile app (including music, comedy, exercise, and educational content), or the control group, receiving standard care. The trial was registered with the Iranian Registry of Clinical Trials (IRCT20220803055608N1). Outcome assessors and statisticians were blinded to minimize bias. Sample size was calculated for an expected effect size of 0.90 with 80% power, resulting in 36 participants per group, adjusted for a 6% attrition rate. Depression levels were assessed using the Beck Depression Inventory-II (BDI-II) at baseline and after a 30-day intervention.

RESULTS

A total of 72 patients (36 per group) completed the analysis. The intervention group showed a significant decrease in depression scores compared to the control group (mean BDI-II score reduction: intervention group = 10.3 ± 4.1, control group = 4.6 ± 3.8; p < 0.001). Post-intervention, 86.1% of patients in the intervention group exhibited minimal depression (BDI-II score ≤ 13), compared to 61.1% in the control group (p = 0.005).

CONCLUSION

The smartphone-based recreational therapy intervention significantly reduced mild depression in hemodialysis patients. This approach can serve as a valuable complementary strategy to manage mild depression in this population. Further research is warranted to explore the long-term sustainability of these benefits and the intervention's impact on other patient-reported outcomes.

TRIAL REGISTRATION

This study was registered in the Iranian Registry of Clinical Trials (no. IRCT20220803055608N1) on 28/08/2022.

Identity change and the transition to university: Implications for cortisol awakening response, psychological well-being and academic performance

The social identity model of identity change (SIMIC) posits that social group memberships protect well-being during transitional periods, such as the transition to university, via two pathways - maintaining previously held social group memberships (social identity continuity) and gaining new social group memberships (social identity gain). Breaking new ground, this study investigates how these processes can influence an important biomarker of stress - cortisol awakening response (CAR). A total of 153 first year undergraduate students (69.3% female) completed measures (group memberships, depression, life satisfaction) at the beginning of the academic year (October, time 1; T1), of which 67 provided a saliva sample for CAR assessment. Seventy-nine students completed the time 2 (February, T2) measures 4 months later (41 provided saliva). Academic performance was assessed objectively through end-of-academic year university grade data (June, T3). At T1, students who maintained and gained social group memberships reported lower depressive symptoms and greater life satisfaction. Across the academic year, social identity gain was associated with a larger post-awakening cortisol response at T2, indicative of a better ability to cope with stress. Thus, gaining new social group memberships during the transition to university was associated with a better ability to cope with stress.

Methodological challenges in using screening tools for depression in migraine: A systematic review

BACKGROUND

Depression is frequently described to occur in migraine, and depression screening questionnaires are commonly used to evaluate depressive symptoms in patients with migraine. The present study aimed to investigate how the most common depression screening tools are used in migraine studies to determine whether they are applied and interpreted correctly.

METHODS

PubMed was systematically searched, and we included any study using the Beck Depression Inventory (BDI), Patient Health Questionnaire-9 (PHQ-9), Hospital Anxiety Depression Scale (HADS) or Hamilton Depression Rating Scale (HAM-D). The study included adults diagnosed with migraine based on the International Classification of Headache Disorders (ICHD-2 or ICHD-3).

RESULTS

The literature search generated 78 studies. Thirty-five (45%) of the included studies used a depression screening tool as evidence of depression. This applied to 53, 46, 47 and 13% of studies using PHQ, BDI, HADS and HAM-D, respectively. Only one study out of 35 confirmed the diagnosis with a diagnostic interview. The data presentation and interpretation across the studies was highly heterogeneous.

CONCLUSIONS

Screening tools as evidence of depression in patients with migraine may lead to inaccurate estimates of depression among migraine patients. There is a need for guidelines on and validation of depression screening tools in patients with migraine.

Medication adherence, depression levels, and quality of life among young people with depression in Indonesia: a mixed method study

BACKGROUND

Limited information is available on medication adherence, depression levels, and quality of life (QoL) among young individuals with depression in Indonesia.

OBJECTIVES

This study examined factors associated with medication adherence, depression severity, and QoL in young Indonesians with depression. It also explored (1) reasons for good or poor adherence and (2) participants' perceived QoL.

METHODS

A mixed-methods sequential explanatory design was employed from January to June 2022. A national cross-sectional survey of 681 participants was conducted, followed by qualitative interviews with 40 participants.

RESULTS

Low medication adherence was observed in 76.2% of participants. Higher adherence was associated with a bachelor's degree. Lower depression levels were linked to older age, female gender, longer treatment duration, and a family history of psychiatric disorders (p < 0.05). QoL significantly declined among people with higher income, the presence of family psychiatric disorders, lower adherence, and more severe depression level. Qualitative findings highlighted inadequate mental health literacy, marital status, low income, lack of support, and side effects as barriers to adherence. Financial stability and positive social support were critical for better QoL.

CONCLUSION

Key factors influencing medication adherence among young Indonesians with depression included income, national health insurance coverage, mental health literacy, and social support. Strengthening communication between patients and mental health providers, particularly psychiatrist, is essential to optimize treatment plans and improve outcomes.

Identification and validation of depression-associated genetic variants in the UK Biobank cohort with transcriptome and DNA methylation analyses in independent cohorts

Depression is one of the most common psychiatric conditions resulting from a complex interaction of genetic, epigenetic and environmental factors. The present study aimed to identify independent genetic variants in the protein-coding genes that associate with depression and to analyze their transcriptomic and methylation profile. Data from the GWAS Catalogue was used to identify independent genetic variants for depression. The identified genetic variants were validated in the UK Biobank cohort and used to calculate a genetic risk score for depression. Data was also used from publicly available cohorts to conduct transcriptome and methylation analyses. Eight SNPs corresponding to six protein-coding genes (TNXB, NCAM1, LTBP3, BTN3A2, DAG1, FHIT) were identified that were highly associated with depression. These validated genetic variants for depression were used to calculate a genetic risk score that showed a significant association with depression (p < 0.05) but not with co-morbid traits. The transcriptome and methylation analyses suggested nominal significance for some gene probes (TNXB- and NCAM1) with depressed phenotype. The present study identified six protein-coding genes associated with depression and primarily involved in inflammation (TNXB), neuroplasticity (NCAM1 and LTBP3), immune response (BTN3A2), cell survival (DAG1) and circadian clock modification (FHIT). Our findings confirmed previous evidence for TNXB- and NCAM1 in the pathophysiology of depression and suggested new potential candidate genes (LTBP3, BTN3A2, DAG1 and FHIT) that warrant further investigation.

Resting-state functional brain connectivity in female adolescents with first-onset anorexia nervosa

OBJECTIVE

Women with anorexia nervosa (AN) have been shown to demonstrate differences in functional connectivity in brain regions associated with cognitive control, somatosensory processing, and emotion regulation. However, previous studies have been conducted on small samples and have inconsistent findings. Therefore, this study aimed to identify aberrant brain networks related to the core clinical symptoms of AN and to explore the longitudinal association with clinical outcome in a large population of adolescents experiencing their first episode of AN.

METHODS

Functional MRI (fMRI) of brain resting-state functional connectivity (RS-FC) of female adolescents with first-onset AN (n = 56) were compared to age- and education-matched typically developing (TD) adolescents (n = 64). To account for the severity of underweight, separate analyses were performed to investigate differences in RS-FC between underweight AN participants and TD adolescents, as well as between underweight (n = 30) and weight-restored AN (n = 26) participants. Clinical outcomes, i.e. body mass index and eating disorder (ED) symptoms, were assessed at baseline and one-year follow-up. Independent component analyses (ICA) were used to extract the brain networks of interest: the default mode (DMN), left and right frontoparietal (FPN), and the insular (IN) networks. Linear regression analyses were conducted to assess differences in RS-FC between AN and TD participants, as well as to assess whether RS-FC was associated with clinical symptoms at baseline and at one-year of follow-up. Two statistical models were used: model 1 adjusted for age and socioeconomic status (SES), and model 2 additionally adjusted for baseline anxiety and depressive symptoms.

RESULTS

Underweight AN participants had lower RS-FC between the DMN-IN, as well as between the FPN-IN compared to the TD adolescents. After correction for multiple testing, no significant differences in RS-FC were found between underweight AN participants and weight-restored AN participants, as well as between the whole AN group and the TD group. RS-FC was not associated with the severity of clinical symptoms at baseline nor at one-year of follow-up.

CONCLUSION

AN is associated with changes in RS-FC between the FPN-IN and DMN-IN during the underweight state. These changes in RS-FC were no longer observed in weight-restored AN participants, emphasizing the impact of underweight on RS-FC in AN. Changes in these brain networks may partly explain the impaired cognitive control and difficulties with emotion and behavioral regulation in individuals with AN during the underweight state.

Effect of group exercise on quality of life for Parkinson disease: systematic review and meta-analysis

PURPOSE

Motor and non-motor symptoms can negatively affect quality of life (QoL) for people with Parkinson Disease (PD). Our purpose was to investigate the effects of group exercise (GE) compared to individual exercise (IE) and usual care (UC) on QoL for people with PD. A systematic review and meta-analysis were performed with randomized controlled trials that studied the effects of GE compared to IE and UC on QoL for people with PD.

MATERIALS AND METHODS

The systematic search was performed in EBSCO, PubMed, and Science Direct databases. Quality of methodology was assessed using the Cochrane GRADE approach. Thirteen studies met all inclusion criteria and were included in the analysis.

RESULTS

No significant difference was found on QoL between GE and IE; however, QoL was significantly improved with GE compared to UC. Results were based on low to moderate quality of evidence.

CONCLUSIONS

Based on low to moderate quality of evidence, GE has a similar effect on QoL when compared to IE and has a small and statistically significant effect when compared to UC, regardless of the patient reported outcome measure used or the total volume of exercise prescribed. GE may be an appropriate option for people with PD to improve their QoL.

Sleep Duration and Quality in Adolescents: Associations With Suicidal Ideation

INTRODUCTION

Inadequate sleep duration and sleep-related problems are highly prevalent among adolescents and pose a significant health risk during a critical development stage. This study seeks to explore associations between sleep and suicidal ideation among adolescents.

METHODS

Cross-sectional questionnaire data from the baseline wave (2016-2018) of a cohort of 12- to 16-year-old Swedish adolescents (n = 4433, 50.39% girls) were analyzed. A split-sample approach was used for exploratory analyses and model selection. Logistic regression was used to estimate the associations between suicidal ideation and self-reported sleep parameters (weekday sleep duration, sleep quality), both adjusted and unadjusted for depression.

RESULTS

Adolescents with suicidal ideation slept on average 60 min less on weekdays and reported worse sleep quality compared to those without suicidal ideation. Suicidal ideation was significantly associated with weekday sleep duration (p = 0.0267) and self-perceived sleep quality (p = 0.0003). Associations remained after controlling for depression.

CONCLUSIONS

Sleep problems in adolescents are associated with suicidal ideation, beyond the effect of depression. Findings may have implications for screening and suicide prevention among clinical populations of adolescents, as well as for public health interventions aimed at promoting sleep and mental health in adolescents.

Perinatal Depression, Labor Anxiety and Mental Well-Being of Polish Women During the Perinatal Period in a War and Economic Crisis

Objective: The armed conflict in Ukraine and its impact on Europe's economy have led to an war and economic crisis, potentially affecting the mental health of women during the perinatal period. This study aimed to assess the severity of depressive symptoms and labor anxiety among Polish women in perinatal period during this crisis.

Methods: From June 2, 2022, to April 11, 2023, 152 women completed three sets of online surveys-two during pregnancy (before 33 weeks and/or between 33 and 37 weeks) and one postpartum (4 weeks after childbirth). The questionnaires used to evaluate the anxiety and depressive symptoms included Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory (BDI-2), Labor Anxiety Questionnaire (LAQ), and team-developed questionnaires evaluating war-related anxiety (WAQ) and global situation anxiety (GSAQ) Statistical analyses included U-Mann Whitney, Kruskal-Wallis, Wilcoxon signed-rank, Friedman tests and Spearman's correlations, with a significance level set at p < .05.

Results: Among Polish pregnant women aged 23-43, 31.6% of participants experienced depressive symptoms, while 70.4% reported increased labor-related anxiety. Additionally, 24.3% experienced significant anxiety due to the war, and 25% suffered from severe anxiety related to the global situation. Positive correlations were noted between EPDS and GSAQ scores (R = 0.34, p < .001) and LAQ and WAQ scores (R = 0.21, p = .008).

Conclusions: The prevalence of perinatal depression is high during war and economic crisis, underscoring the urgent need to improve screening for perinatal depression in Poland. Further, the manuscript did not discuss symptom patterns across the three time points.

Efficacy of brief behavioral and sleep hygiene education with mindfulness intervention on sleep, social jetlag and mental health in adolescence: a pilot study

OBJECTIVES

Sleep is often compromised in adolescents, affecting their health and quality of life. This pilot-study was conducted to evaluate if implementing brief-behavioral and sleep-hygiene education with mindfulness intervention may positively affect sleep-health in adolescents.

METHOD

Participants in this community-based non-randomized cohort-study volunteered for intervention (IG)- or control-group (CG). Sleep was recorded during regular school-schedule for 3-school-nights and 2-non-school-nights with an FDA-cleared/EU-Medical Device Regulation (CE-2862) compliant home sleep test, and Questionnaires were utilized to evaluate chronotype, sleepiness, insomnia-, anxiety- and depression-symptoms. The four-week intervention included sleep-hygiene education, mindfulness- and breathing-practices for one-hour, twice weekly. Data was collected during the last-week of February and first two-weeks of March 2023 and repeated after intervention.

RESULTS

Fifty-five participants completed the study, IG (86%) and CG (77%). Average age was 17.3-years and prevalence of severe social-jetlag (SJL) 72%. Participants who quit participation (n = 10) after baseline data-collection all females (3-IG/7-CG) in comparison to participants who completed the study were sleepier than the IG and CG (+ 2.6-p = 0.04; + 3.8-p = 0.001), with more symptoms of insomnia- (+ 3.8-p = 0.002; + 4.7-p < 0.0001), and depression (+ 16.7-p < 0.0001; + 19.6-p < 0.0001), and report being later-chronotypes, (-18.2, p < 0.0001;-13.1, p < 0.0001). On average the IG advanced sleep-onset (32-min; p = 0.030), decreased SJL (37-min; p = 0.011) and increased total sleep time (TST, 29-min; p = 0.088) compared to the CG. Average sleep duration did not differ significantly comparing IG and CG after intervention. Stratifying participants with severe SJL (> 2-h) at baseline; 1) responders (61%) advanced sleep-onset on non-school-nights (96-min) and decreased SJL (103-min; p < 0.001) 2) non-responders (39%) increased sleep-duration on school-nights (36-min) and non-school-nights (63-min) but maintained severe-SJL.

CONCLUSION

Teacher-lead sleep-education and mindfulness program can improve TST and SJL in adolescence.

Measuring psychache as a suicide risk variable: A Mokken analysis of the Holden's Psychache Scale

BACKGROUND

The Psychache Scale (PAS) is a questionnaire measuring trait-level psychological pain with satisfactory internal consistency and a strong correlation with suicidal ideation severity. However, inconsistent results have been reported for the PAS dimensionality. In the present study we used a non-parametric item response theory model, called Mokken Scale Analysis (MSA), to refine an unidimensional version of the PAS.

METHODS

The sample was composed of 400 Italian adults (312 females and 88 males) nonrandomly recruited from the general population.

RESULTS

A final set of 10 items satisfied the unidimensionality, local independence, and monotonicity assumptions, although it did not satisfy the double monotonicity assumption. The internal consistency of the PAS-10 was satisfactory (ordinal alpha = 0.98, ω = 0.97, and AVE = 0.82), and ROC curves analysis indicated good discriminant validity when differentiating participants with higher suicide risk from those with lower suicide risk.

LIMITATIONS

Structural invariance between nonclinical and clinical samples was not investigated, and the presence of suicide ideation and behaviors was assessed with self-report measures with potential under-reporting of the phenomenon.

CONCLUSION

The PAS-10 resulted to be a potentially valid and unidimensional measure of psychological pain (i.e., psychache) that could be used to screen adults at higher risk for suicide. Future studies are needed to investigate psychometric properties of the PAS-10 in clinical samples and to replicate results in independent samples.

Internet-based therapist-supported interpersonal psychotherapy for depression: A randomized controlled trial

BACKGROUND

Depression is a common disorder for which there are several treatments options including different psychological treatments. The aim of this study was to investigate the effects of internet-based interpersonal psychotherapy (IPT) for symptoms of depression in randomized controlled trial.

METHODS

Following recruitment via advertisement a total of 113 participants with mild to moderate symptoms of depression were included and randomized to either a ten-week internet-based IPT with weekly therapist guidance or a waitlist control condition. The primary outcome was symptoms of depression measured weekly with the Montgomery Åsberg Depression Rating Scale (MADRS-S) and at pre- and post-treatment assessment with the Beck's Depression Inventory (BDI-II). Secondary outcomes were self-rated quality of life and symptoms of generalized anxiety disorder. We also measured therapeutic alliance and treatment credibility. Outcomes were evaluated with a latent growth curve model (for MADRS-S) and robust linear regression models (for the other measures). The trial was conducted during the Covid-19 pandemic in the spring of 2021.

RESULTS

Significant differences favoring the treatment group were found on three of the four outcomes: BDI-II, quality of life ratings, and ratings of generalized anxiety. Between-group effect sizes for these outcomes were moderate (BDI-II, quality of life) or small (generalized anxiety). The latent growth curve model did not indicate a significant difference on the weekly MADRS-S ratings. Exploratory analyses did not show an association between therapeutic alliance, treatment credibility and outcome.

LIMITATIONS

Missing data at post-treatment was high in the treatment group (37 %), though the missingness was not significantly related to observed ratings at pre-treatment or estimated trajectories during the treatment. Few participants completed all modules. The Covid-19 pandemic situation may have affected both effects and dropout rates.

CONCLUSIONS

Internet-based IPT can lead to significant improvements, though the reductions in symptoms of depression were not consistent across the two measures used. Completion rates and dropout patterns suggest a need for improved acceptability.

TRIAL REGISTRATION

The trial was preregistered at Clinicaltrials.gov (Identifier: NCT04721678). Registered January 2021.https://clinicaltrials.gov/study/NCT04721678.

Sex hormone-dependent host-microbiome interactions and cardiovascular risk (XCVD): design of a longitudinal multi-omics cohort study

INTRODUCTION

Cardiovascular diseases (CVDs) present differently in women and men, influenced by host-microbiome interactions. The roles of sex hormones in CVD outcomes and gut microbiome in modifying these effects are poorly understood. The XCVD study examines gut microbiome mediation of sex hormone effects on CVD risk markers by observing transgender participants undergoing gender-affirming hormone therapy (GAHT), with findings expected to extrapolate to cisgender populations.

METHODS AND ANALYSES

This observational, longitudinal cohort study includes baseline, 1- and 2-year follow-ups with transgender participants beginning GAHT. It involves comprehensive phenotyping and microbiome genotyping, integrating computational analyses of high-dimensional data. Microbial diversity will be assessed using gut, skin, and oral samples via 16S rRNA and shotgun metagenomic sequencing of gut samples. Blood measurements will include sex hormones, CVD risk markers, cardiometabolic parameters, cytokines, and immune cell counts. Hair samples will be analysed for cortisol. Participants will complete online questionnaires on physical activity, mental health, stress, quality of life, fatigue, sleep, pain, and gender dysphoria, tracking medication use and diet to control for confounders. Statistical analyses will integrate phenomic, lifestyle, and multi-omic data to model health effects, testing gut microbiome mediation of CVD risk as the endocrine environment shifts between that typical for cisgender men to women and vice versa.

ETHICS AND DISSEMINATION

The study adheres to Good Clinical Practice and the Declaration of Helsinki. The protocol was approved by the Charité Ethical Committee (EA1/339/21). Signed informed consent will be obtained. Results will be published in peer-reviewed journals and conferences and shared as accessible summaries for participants, community groups, and the public, with participants able to view their data securely after public and patient involvement review for accessibility.

TRIAL REGISTRATION NUMBER

The XCVD study was registered on ClinicalTrials.gov (NCT05334888) as 'Sex-differential host-microbiome CVD risk - a longitudinal cohort approach (XCVD)" on 4 April 2022. Data set link can be found at https://classic.

CLINICALTRIALS

gov/ct2/show/NCT05334888.

Impact of a Long-Term Home-Based Rehabilitation Program on Quality of Life, Balance, and Autonomy in Adults with Disabilities

BACKGROUND

Rehabilitation is a critical process for enhancing functionality, independence, and quality of life in individuals with disabilities. Grounded in the biopsychosocial model, it addresses physical, emotional, and social dimensions through personalized, evidence-based interventions. By integrating standardized assessments and continuous evaluation, rehabilitation has the potential to promote recovery and support active participation in society.

OBJECTIVES

This study evaluated the impact of a long-term, multidisciplinary, home-based rehabilitation program on quality of life, balance, and functional autonomy in adults with neuromusculoskeletal disabilities.

METHODS

A total of 559 participants received individualized interventions from a team of physical therapists, occupational therapists, psychologists, and other health professionals. Functional independence, balance, depressive symptoms, and quality of life were assessed using the Barthel Index, Berg Balance Scale, Beck Depression Inventory, and SF-36 questionnaire, respectively.

RESULTS

A longitudinal analysis comparing pre- and post-intervention outcomes revealed statistically significant improvements (p < 0.001) across all metrics. The Barthel Index median increased from 85 to 90 points, indicating greater functional independence, while the Berg Balance Scale improved from 39 to 47 points, reflecting reduced fall risk. Depressive symptoms decreased, with Beck Depression Inventory scores dropping from 12 to 9, and both physical and mental health components of the SF-36 showed marked enhancements.

CONCLUSIONS

These findings demonstrate the program's effectiveness in addressing both physical and emotional needs, emphasizing the value of extended, personalized, home-based care in improving health, autonomy, and overall quality of life for individuals with disabilities. This study underscores the potential of multidisciplinary approaches to support long-term rehabilitation in diverse populations.

Alternations of interhemispheric functional connectivity in patients with acute acquired concomitant esotropia: a resting state fMRI study using voxel-mirrored homotopic connectivity

Purpose

To investigate the changes in cerebral hemispheric functional connections in patients with acute acquired concomitant esotropia (AACE) and their relationship with clinical manifestations, utilizing voxel-mirrored homotopic connectivity (VMHC).

Methods

A prospective, observational study was conducted involving 32 AACE patients and 31 age-, sex-, and education-matched healthy controls (HC). The resting-state functional magnetic resonance imaging (rs-fMRI) signals, binocular vision function, and psychometric scale scores were collected rs-fMRI data and structural image data were analyzed for VMHC, and a two-sample t-test was used to analyze the differences in VMHC between groups. Spearman correlation analysis evaluated the relationship between fMRI indicators and clinical features.

Results

There was no statistical difference between the two groups concerning sex, age, height and weight. VMHC levels in the superior frontal gyrus and anterior cingulate were significantly lower in the AACE group (p < 0.05). In the AACE group, the VMHC values of the left caudate positively correlated with near vision work duration (r = 0.381, p = 0.034), the deviation angles at near (r = 0.428, p = 0.015) and at distance (r = 0.416, p = 0.018). The VMHC values in the bilateral olfactory cortex also positively correlated with the near vision work duration (Right: r = 0.389, p = 0.031; Left: r = 0.372, p = 0.039) while Beck Depression Inventory (BDI) scores negatively correlated with the VMHC values of the left olfactory cortex (r = -0.359, p = 0.048).

Conclusion

The dysfunction of the medial frontal gyrus and anterior cingulate gyrus is the underlying neuropathological mechanism of AACE, and these dysfunctions may be related to poor eye habits and the severity of deviation.