Individuals with first-episode psychosis (FEP) face markedly increased excess mortality, yet the long-term trends and key contributing factors remain insufficiently characterized. This study aimed to examine long-term mortality patterns, standardized mortality ratios (SMRs), and associated factors in a FEP cohort.

This population-based cohort study included 1,389 individuals diagnosed with FEP, followed for up to 25 years. Mortality outcomes were obtained from Hong Kong’s centralized hospital database (CMS) and coroner’s court reports, with SMRs calculated. Baseline sociodemographic and clinical, as well as long-term treatment-related factors of all-cause, natural, and unnatural mortality were analyzed.

Among 1,389 participants, 137 deaths (9.86%) occurred during the follow-up period with the overall SMR of 6.56 (95% CI, 5.50–7.71). The cumulative incidence rate of unnatural mortality increased sharply over the first 10 years and that of the natural cause of death started to increase after the first decade of the illness. Male gender and poorer social functioning were associated with increased all-cause mortality risk, while male gender, lower education, and baseline hospitalization raised unnatural mortality risk. Greater monthly antipsychotic variability during the first 10 years increased all-cause mortality risk in the period after the initial 10 years.

This 25-year follow-up study of FEP highlighted the changes in the long-term mortality pattern of FEP and thus the phase-specific needs of individuals with FEP. Therefore, it is important to integrate physical care into mental health services, as well as stage-specific and individualized care for patients with psychotic disorders to reduce long-term excess mortality.

Major depressive episodes (MDEs) are highly recurrent in clinical samples. However, the course of MDEs and predictors of their endurance are unclear in the general youth population.

We investigated prospective factors associated with enduring MDE (the presence of 12-month DSM-IV MDE at baseline and 1 year using the Composite International Diagnostic Interview–Screening Scales) in 1,833 participants of a 1-year epidemiological youth cohort study in Hong Kong. Multivariable logistic regression models were used to examine the influences of a range of personal and environmental factors.

At baseline, 13.7% participants had MDEs, among whom 21.1% presented enduring MDEs. More severe symptoms of post-traumatic stress disorder (adjusted odds ratio [aOR] = 5.54, confidence interval [CI] = 2.14–14.38), depression (aOR = 3.92, CI = 1.79–8.62), and generalized anxiety (aOR = 2.27, CI = 1.21–4.25) at baseline were among the strongest associated factors for enduring MDE, with trends of associations observed for psychotic-like experiences (aOR = 1.98, CI = 0.98–4.02) and eating disorder symptoms (aOR = 1.88, CI = 0.90–3.95). Among various types of stressors, only dependent stressors at follow-up showed a clear association with enduring MDE (aOR = 4.22, CI = 1.81–9.83). Those with enduring MDE showed poorer functioning and mental health-related quality of life at follow-up, with only 35.6% having sought any psychiatric/psychological help during the past year.

Detecting comorbid symptoms in those with prior MDEs and reducing the impact of dependent stressors may help reduce their long-term implications. Enhancing the accessibility and acceptability of youth-targeted mental health services would also be crucial to improve help-seeking.

Trauma exposure has been associated with the development of psychotic disorders in adolescence and young adulthood. Trauma can compromise the sense of agency, a predictor of psychosis. Symptoms of post-traumatic stress disorder (PTSD) after trauma may also imply significant cognitive impairments that predispose young people to psychotic-like experiences (PLEs). This study investigates whether the two senses of agency subtypes – positive and negative agency, and PTSD symptoms mediated PLEs in youths after trauma.

The study aimed to explore the mediation of the sense of agency and post-traumatic stress symptoms in the development of psychotic-like experiences after trauma.

Participants were Hong Kong youths aged 12 to 25 who completed surveys online from May 2022 to May 2024. Self-report sense of agency, PLEs and related distress, potentially traumatic life events and PTSD symptoms from 517 youths with a mean age of 20.22 and 72.0% female were analysed. 283 participants (54.7%) experienced at least one potentially traumatic event.

A series of regression analyses revealed that a positive sense of agency mediated the effect of trauma on PLEs and related distress in the full sample. In the subgroup of 283 trauma-exposed youths, PTSD symptoms but not sense of agency mediated the effect of trauma on PLEs and related distress.

The presence of traumatic experiences can increase PLEs by reducing positive agency in community youths. Among trauma-exposed youths, the effect of various traumatic experiences on PLEs may be better explained by PTSD symptoms. Limitations of the study and future directions are discussed.

Significant changes in Taiwan’s psychiatric services over recent decades include expansion of community-based clinics and implementation of the Schizophrenia Pay-for-Performance programme.

This study aimed to assess the trend of the quality of healthcare for individuals with schizophrenia, using various indicators of the treatment process and outcomes between 2010 and 2019.

Individuals with schizophrenia were identified using Taiwan’s National Health Insurance claims database. The quality of healthcare for individuals with schizophrenia was assessed using treatment process and outcome indicators, including antipsychotic types, medication adherence, daily dose for antipsychotics and concurrent use of other psychotropic agents. Outcome indicators included all-cause mortality, suicide deaths, psychiatric hospitalisation, emergency department visits and employment status.

Antipsychotic medication usage has shifted towards second-generation antipsychotics (SGAs) and long-acting injectable antipsychotics (LAIs), with declines in first-generation antipsychotics. The percentage of medication adherence declined, while that of individuals with an adequate daily dose increased. Concurrently, anticholinergic and benzodiazepine use decreased while antidepressant and mood stabiliser use increased. Outcome indicators showed no significant change in all-cause mortality or suicide rates over time, but there were reductions in psychiatric hospitalisations and emergency department visits. Employment rates increased overall, particularly in urban areas.

The quality of healthcare for individuals with schizophrenia, as measured by treatment process and outcome indicators, improved alongside changes in Taiwan’s psychiatric services; however, causality cannot be inferred from our findings. Future research should evaluate the effectiveness of psychiatric service policies and continuously monitor healthcare quality to further enhance the lives of individuals with schizophrenia.

This study aimed to compare changes in the level of health technology assessment (HTA) development from 2016 to 2021, and to inform policies and decisions to promote further development of HTA in China.

We conducted a cross-sectional and anonymous web-based survey to relevant stakeholders in China in 2016 and 2021 respectively. The mapping of the HTA instrument was used to reflect the HTA development from eight domains. To reduce the influence of confounders and to compare the mapping outcomes between 2016 and 2021 groups, we performed 1:1 propensity score matching methodology in this study. Univariate analysis was performed to compare the differences in these two groups. We also compared the overall results with that of a mapping study that included ten countries.

A total of 212 and 255 respondents completed the survey in 2016 and 2021 respectively. After propensity score matching methodology, 183 cases from the 2016 group and 2021 group were matched. Overall, the mean score of 2021 in most of the domains was higher than in 2016 in China (p < 0.05), matching the level of HTA institutionalization and dissemination strategy, except for the assessment domain. Although China scored significantly lower among the three developed countries, the overall HTA development score for China was comparable among the ten countries.

Our study suggested the level of HTA development in China has made great progress from 2016 to 2021. Prior to HTA activities, the researcher or policy makers should first formulate an explicit assessment goal and scope, and during the assessment process, more attention should be paid to the clinical effectiveness and cost-effectiveness indicator to ensure a higher quality of HTA evidence.

We explored long-term employment status and income before and after depression diagnosis among men and women and at different working ages in Taiwan.

Data from 2006 to 2019 were obtained from the National Health Insurance Research Database (NHIRD). Individuals with newly diagnosed depressive disorder aged 15 to 64 years during the study period were identified. An equal number of individuals without depression were matched for their demographic and clinical characteristics. Employment outcomes included employment status, which was categorized into employed or unemployed, and annual income. Based on the occupation categories and monthly insurance salary recorded in the Registry for Beneficiaries of the NHIRD, a subject was defined as unemployed if he or she differed from the income earner or the occupation category was unemployed. Monthly income was defined as zero for unemployed subjects and proxied as monthly insurance salary for others. Annual income was the sum of monthly income in each observation year.

A total of 420,935 individuals with depressive disorder were included in the study, and an equal number of individuals with not diagnosed depression served as controls. Employment rate and income were lower in the depression group than in the control group before the year of diagnosis, with a difference of 5.7% in employment rate and USD 1,173 in annual income. This gap increased considerably after the year of diagnosis (7.3% in employment rate and USD 1,573 in annual incomes) and further widened in the subsequent years (8.1% in employment rate and USD 2,006 in annual incomes in the 5th following year). The drops in the employment rate and income caused by depression were more evident in men and older age groups than in women and younger age groups, respectively. However, the reduction in employment rate and income in the following years after the diagnosis was more considerable among younger age groups.

The effect of depression on employment status and income was significant during the year of diagnosis and continued afterwards. The effect on employment outcomes varied between genders and across all age groups.

Genetic mutations of fused in sarcoma (FUS) causing amyotrophic lateral sclerosis (ALS) may disrupt mRNA splicing events. For example, the FUS c.1394-2delA variant was reported in two western ALS patients, but its molecular mechanism is unclear. In this study, we aim to investigate FUS splice site mutations in Chinese ALS patients.

Sanger sequencing was used to identify FUS splicing mutations in Chinese ALS patients. We combined a deep learning tool (SpliceAI), RNA sequencing, and RT-PCR/RT-qPCR to analyze the effect of FUS c.1394-2delA mutation on RNA splicing and expression. AlphaFold was used to predict the protein structure of mutant FUS. In transfected cell lines, we used immunofluorescence to assess cytoplasmic mislocalization of mutant FUS protein.

We identified a de novo FUS splice acceptor site mutation (c.1394-2delA, p. Gly466Valfs*14) in one Chinese sporadic ALS patient, which is linked to exon 14 skipping, and upregulated total FUS mRNA expression. The FUS splice site mutation was predicted to be translated into a truncated protein product at C-terminal. In vitro studies revealed that the FUS mutation increased cytoplasmic mislocalization in both HEK293T and SH-SY5Y cells.

We identified a de novo FUS splicing mutation (c.1394-2delA, p. Gly466Valfs*14) in 1 out of 233 Chinese ALS patients. It caused abnormal RNA splicing, upregulated gene expression, truncated FUS translation, and cytosolic mislocalization. Our findings suggested that FUS splice site mutation is rare in Chinese ALS patients and extended our knowledge of molecular mechanisms of the FUS c.1394-2delA mutation.

Bipolar disorder is a chronic mental disorder related to cognitive deficits. Low serum vitamin D levels are significantly associated with compromised cognition in neuropsychiatric disorders. Although patients with bipolar disorder frequently exhibit hypovitaminosis D, the association between vitamin D and cognition in bipolar disorder, and their neuroaxonal integrity, is unclear.

To investigate the interaction effects between vitamin D and neurofilament light chain (NfL) levels on cognitive domains in bipolar disorder.

Serum vitamin D and NfL levels were determined in 100 euthymic patients with bipolar disorder in a cross-sectional study. Cognitive function was measured with the Brief Assessment of Cognition in Affective Disorders. We stratified by age groups and used general linear models to identify associations between vitamin D and NfL levels and their interaction effects on cognitive domains.

The mean vitamin D and NfL levels were 16.46 ng/nL and 11.10 pg/mL, respectively; 72% of patients were vitamin D deficient. In the older group, more frequent hospital admissions and lower physical activity were identified in the group with versus without vitamin D deficiency. The age-modified interaction effect of vitamin D and NfL was associated with composite neurocognitive scores and verbal fluency in both age groups, and with processing speed domain in the younger group.

We observed a high vitamin D deficiency prevalence in bipolar disorder. We identified the interaction of vitamin D and NfL on cognitive domains, and the effect was modified by age. Longitudinal or randomised controlled studies enrolling patients with various illness durations and mood statuses are required to validate our findings.

Contrasting the well-described effects of early intervention (EI) services for youth-onset psychosis, the potential benefits of the intervention for adult-onset psychosis are uncertain. This paper aims to examine the effectiveness of EI on functioning and symptomatic improvement in adult-onset psychosis, and the optimal duration of the intervention.

360 psychosis patients aged 26–55 years were randomized to receive either standard care (SC, n = 120), or case management for two (2-year EI, n = 120) or 4 years (4-year EI, n = 120) in a 4-year rater-masked, parallel-group, superiority, randomized controlled trial of treatment effectiveness (Clinicaltrials.gov: NCT00919620). Primary (i.e. social and occupational functioning) and secondary outcomes (i.e. positive and negative symptoms, and quality of life) were assessed at baseline, 6-month, and yearly for 4 years.

Compared with SC, patients with 4-year EI had better Role Functioning Scale (RFS) immediate [interaction estimate = 0.008, 95% confidence interval (CI) = 0.001–0.014, p = 0.02] and extended social network (interaction estimate = 0.011, 95% CI = 0.004–0.018, p = 0.003) scores. Specifically, these improvements were observed in the first 2 years. Compared with the 2-year EI group, the 4-year EI group had better RFS total (p = 0.01), immediate (p = 0.01), and extended social network (p = 0.05) scores at the fourth year. Meanwhile, the 4-year (p = 0.02) and 2-year EI (p = 0.004) group had less severe symptoms than the SC group at the first year.

Specialized EI treatment for psychosis patients aged 26–55 should be provided for at least the initial 2 years of illness. Further treatment up to 4 years confers little benefits in this age range over the course of the study.