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Social determinants of health (SDHs) exert a significant influence on various health outcomes and disparities. This study aimed to explore the associations between combined SDHs and mortality, as well as adverse health outcomes among adults with depression.
Methods
The research included 48,897 participants with depression from the UK Biobank and 7,771 from the US National Health and Nutrition Examination Survey (NHANES). By calculating combined SDH scores based on 14 SDHs in the UK Biobank and 9 in the US NHANES, participants were categorized into favourable, medium and unfavourable SDH groups through tertiles. Cox regression models were used to evaluate the impact of combined SDHs on mortality (all-cause, cardiovascular disease [CVD] and cancer) in both cohorts, as well as incidences of CVD, cancer and dementia in the UK Biobank.
Results
In the fully adjusted models, compared to the favourable SDH group, the hazard ratios for all-cause mortality were 1.81 (95% CI: 1.60–2.04) in the unfavourable SDH group in the UK Biobank cohort; 1.61 (95% CI: 1.31–1.98) in the medium SDH group and 2.19 (95% CI: 1.78–2.68) in the unfavourable SDH group in the US NHANES cohort. Moreover, higher levels of unfavourable SDHs were associated with increased mortality risk from CVD and cancer. Regarding disease incidence, they were significantly linked to higher incidences of CVD and dementia but not cancer in the UK Biobank.
Conclusions
Combined unfavourable SDHs were associated with elevated risks of mortality and adverse health outcomes among adults with depression, which suggested that assessing the combined impact of SDHs could serve as a key strategy in preventing and managing depression, ultimately helping to reduce the burden of disease.
Lurasidone is a second-generation antipsychotic with antidepressant properties, but its effect on depressive symptoms across diagnostic domains is not known.
Aims
This systematic review aims to synthesise the evidence for the transdiagnostic efficacy of lurasidone in reducing depressive symptoms.
Method
Electronic databases were searched up to October 2024 to identify randomised controlled trials comparing the effects of lurasidone and placebo on depressive symptoms, as measured by any standardised scale, in populations with different psychiatric diagnoses. Acceptability, tolerability and safety were also measured. The Cochrane risk of bias tool was used to assess study quality, and the GRADE tool to evaluate certainty of evidence. A random-effects meta-analysis was performed to estimate standardised mean differences (SMDs, for continuous outcomes) or relative risks (for dichotomous outcomes) with 95% CI.
Results
Fourteen trials met inclusion criteria. Pooled analysis of 5239 participants found lurasidone to be more efficacious than placebo in improving depression scores (SMD −0.26, 95% CI −0.37, −0.15) across multiple diagnoses (including schizophrenia, bipolar disorder and major depressive disorder). Secondary analyses showed better acceptability (relative risk 0.55, 95% CI 0.43, 0.71) and safety (relative risk 0.73, 95% CI 0.58, 0.91) and comparable tolerability (relative risk 0.74, 95% CI 0.54, 1.02) between lurasidone and placebo. The main limitations were the high risk of bias of several included studies and the high heterogeneity observed in our findings.
Conclusion
Lurasidone is a potentially efficacious and safe strategy for reducing depressive symptomatology across a range of psychiatric diagnoses. Further long-term, robust trials employing precision psychiatry methods are needed to support its broader use to target depressive symptoms transdiagnostically.
Psychiatric disorders are a major risk factor for suicidal behaviors. However, increasing attention is being given to anxiety disorders, which have also been associated with suicidal risk.
Aims
This study aims to examine the prevalence of social anxiety disorder (SAD) among university students, explore its association with suicidal risk and assess the role of depression as a potential confounding factor in this relationship.
Method
We conducted a cross-sectional, multicentre study involving students from Abdelmalek Essaâdi University. Data were collected face-to-face using a structured questionnaire designed on the REDCap platform. The Moroccan Arabic version of the MINI (Mini International Neuropsychiatric Interview) was used to assess SAD, depression and suicidal risk. All students present and consenting were included. Data were analysed using descriptive statistics and multivariate logistic regression to evaluate the independent association between SAD and suicidal risk.
Results
Among the 1168 students surveyed, 59.1% were women, and the average age was 20.63 years. The prevalence of social anxiety was 9.9% (95% CI: 8.3–11.8). Social anxiety disorder is an independent risk factor for suicide, even after adjustment for other well-known variables such as depression, with an adjusted odds ratio of 1.84 (95% CI: 1.12–3.04).
Conclusion
SAD is a major risk factor for suicidal behaviors. These results highlight the importance of early identification and appropriate management of SAD among students in order to prevent suicidal risks.
Depression and anxiety are prevalent mental health disorders. While sleep duration has been extensively studied, sleep regularity may play a critical role. We aimed to examine associations between objectively measured sleep regularity and incident depression and anxiety and to investigate whether meeting recommended sleep duration modifies these associations.
Methods
In 79,666 UK Biobank participants without baseline depression or anxiety, wrist accelerometers worn for 7 days yielded a sleep regularity index (SRI) and average sleep duration. SRI was categorized as irregular (≤51), moderately irregular (52–70), or regular (≥71). Sleep duration was classified by age-specific recommendations (7–9 hours for ages 18–64 years; 7–8 hours for over 65 years). Cox regression models assessed associations between sleep parameters and mental health outcomes.
Results
During a median follow-up of 7.5 years, 1,646 participants developed depression, and 2,097 developed anxiety. Compared to irregular sleepers, regular sleepers had a 38% lower depression risk (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.52–0.73) and a 33% lower anxiety risk (HR, 0.67; 95%CI, 0.58–0.77). Participants with both irregular sleep and nonrecommended duration exhibited the highest risks (depression HR, 1.91; 95%CI, 1.55–2.35; anxiety HR, 1.61; 95%CI, 1.35–1.93). Notably, irregular sleepers who met duration guidelines still faced elevated risks (depression HR, 1.48; 95%CI, 1.18–1.86; anxiety HR, 1.35; 95%CI, 1.11–1.64).
Conclusions
Greater sleep regularity is independently associated with lower depression and anxiety risk regardless of sleep duration, suggesting that sleep–wake consistency should be considered in mental health promotion strategies alongside traditional sleep duration recommendations.
Increasing numbers of children and young people (CYP) are presenting with common mental health difficulties. In 2017, the UK government outlined a service transformation plan which led to the development and implementation of Mental Health Support Teams (MHSTs), to deliver evidence-based interventions in schools for mild to moderate mental health difficulties. This service evaluation aimed to evaluate the effectiveness of individual interventions delivered by MHST practitioners trained to deliver low-intensity cognitive behavioural interventions to CYP with mild to moderate mental health difficulties, within one service based in the South East of England. Four hundred and fifty-nine CYP engaged in an individual intervention delivered by MHST practitioners between January 2021 and December 2022. Interventions were delivered either online via video call or face-to-face. All children and their parents/carers were invited to complete two routine outcome measures (Revised Children’s Anxiety and Depression Scale (RCADS), and Strengths and Difficulties Questionnaire (SDQ)) at baseline and post-intervention. Outcome data demonstrated significant improvements across all child- and parent-rated RCADS anxiety and depression scales. Significant improvements were also shown for both child- and parent-rated SDQ total difficulties and impact scores. These all showed effect sizes ranging from medium to large. Girls presented higher scores pre- and post-intervention compared with boys apart from the OCD subscale; gender was not a predictor of improvement in the majority of analyses. Individual, low-intensity cognitive behavioural interventions delivered in this MHST service were effective in reducing symptoms of emotional and behavioural difficulties in CYP with mild to moderate mental health difficulties.
Key learning aims
(1) Understand the context of Mental Health Support Teams (MHSTs) as an early intervention service within school settings.
(2) Learn about the impact of MHST-delivered interventions on symptoms of emotional and behavioural difficulties in children and young people.
(3) To gain an understanding of how boys and girls may respond differently to MHST-delivered interventions.
Noradrenergic activation in the central and peripheral nervous systems is a putative mechanism explaining the link between hypertension and affective disorders.
Aims
We investigated whether these stress-sensitive comorbidities may be dependent on basal noradrenergic activity and whether vascular responses to centrally acting stimuli vary according to noradrenergic activity.
Method
We examined the relation of affective disorders and stress-mediated vascular responses to plasma concentrations of normetanephrine, a measure of noradrenergic activity, in subjects with primary hypertension (n = 100, mean ± s.d. age 43 ± 11 years, 54% male). The questionnaires Patient Health Questionnaire-9 (PHQ-9), 16-item Quick Inventory of Depressive Symptomatology-Self Report (QIDSSR-16) and Generalized Anxiety Disorder-7 (GAD-7) were used for evaluation of symptoms of depression and anxiety. Forearm blood flow (strain gauge plethysmography) was used to assess vascular responses to mental stress and to device-guided breathing (DGB), interventions that respectively increase or decrease noradrenergic activity in the prefrontal cortex and locus coeruleus.
Results
Low mood and high anxiety were two- to threefold higher for hypertensive subjects in the highest compared with the lowest normetanephrine tertiles (each P < 0.005). Forearm vasodilator responses to mental stress and vasoconstrictor responses to DGB were attenuated in those with high compared with low normetanephrine (28.3 ± 21% v. 47.1 ± 30% increases for mental stress and 3.7 ± 21% v. 18.6 ± 15% decreases for DGB for highest versus lowest tertiles of normetanephrine, each P ≤ 0.01).
Conclusions
A hyperadrenergic state in hypertension is associated with mood disturbance and impaired stress-modulated vasomotor responses. This association may be mediated by chronic stress impinging on pathways regulating central arousal and peripheral sympathetic nerve activity.
There is little visibility for the voices of indigenous and Afro-descendant women in Latin America and the Caribbean (LAC), meaning that few studies offer information on mental health for this group. This study takes the Living Well (Buen Vivir) approach as a basis to examine the prevalence of depressive symptoms and their associated individual physical and social/cultural dimensions. Based on a national study involving the participation of a majority of Chilean peoples, 774 women identifying as indigenous (569 Andean indigenous and 146 other indigenous people) and Afro-descendant (59) were interviewed. The findings show that Andean and Afro-descendant women are more at risk of suffering depressive symptoms and that in general terms mental health should be understood from a holistic perspective, in addition to its being underpinned by several associations. Lower levels of depression were associated with older age, having a partner, independence in activities of daily living, social support from partner and being resilient. In contrast, higher levels of depression were associated with health problems, poor-quality relationship with grandchildren and loneliness. Out of the dimensions examined, resilience had a key influence on mental health among women. The findings are discussed in the context of a comprehensive view of wellbeing among ethnic minorities.
Cognitive impairment represents a central component of major depressive disorder (MDD), affecting a large proportion of people living with MDD and showing a consistent negative impact on social, interpersonal, and occupational functioning and subjective quality of life. Cognitive remediation (CR) is a training-based psychosocial intervention targeting cognitive performance and psychosocial functioning that has shown consistent evidence of effectiveness in individuals with schizophrenia and that could provide significant benefits also in people with MDD: this study aimed to assess the effects of a computerized CR intervention in adults living with MDD.
Methods
Participants recruited in this single blind multicentric randomized controlled trial were allocated to receive a computerized CR intervention delivered by an active and trained therapist or to an active control condition (computer games – CG). Outcomes were measured with validated instruments by blind assessors and included cognitive performance, depressive symptoms, and psychosocial functioning. Outcomes were assessed using mixed models for repeated measures, considering baseline and end-of-treatment scores.
Results
Hundred and one participants (CR=52 and CG=49) were included and 81 (CR=45 and CG=36) completed the study. CR produced superior results in clinician-rated depressive symptoms (p=0.023, d=042), global clinical severity (p=0.025, d=0.39), subjective depressive symptoms (p=0.005, d=0.45), working memory performance (p=0.004, d=0.34), executive functions/cognitive flexibility (p=0.020, d=0.43), and subjective cognitive impairment (p=0.006, d=0.48).
Conclusions
CR represents an effective intervention in MDD, improving clinical outcomes and cognitive performance in a clinician-rated and in a subjective manner, which should be more consistently implemented in clinical practice and included in MDD treatment recommendations.
The use of artificial intelligence (AI) in psychiatry holds promise for diagnosis, therapy, and the categorization of mental disorders. At the same time, it raises significant theoretical and ethical concerns. The debate appears polarized, with proponents and critics seemingly irreconcilably opposed. On the one hand, AI is heralded as a transformative force poised to revolutionize psychiatric research and practice. On the other hand, it is depicted as a harbinger of dehumanization. To better understand this dichotomy, it is essential to identify and critically examine the underlying arguments. To what extent does the use of AI challenge the theoretical assumptions of psychiatric diagnostics? What implications does it have for patient care, and how does it influence the professional self-concept of psychiatrists?
Methods
To explore these questions, we conducted 15 semi-structured interviews with experts from psychiatry, computer science, and philosophy. The findings were analyzed using a structuring qualitative content analysis.
Results
The analysis focuses on the significance of AI for psychiatric diagnosis and care, as well as on its implications for the identity of psychiatry. We identified different lines of argument suggesting that expert views on AI in psychiatry hinge on the types of data considered relevant and on whether core human capacities in diagnosis and treatment are viewed as replicable by AI.
Conclusions
The results provide a mapping of diverse perspectives, offering a basis for more detailed analysis of theoretical and ethical issues of AI in psychiatry, as well as for the adaptation of psychiatric education.
Literature has shown that a significant minority of bereaved people are at risk of prolonged grief disorder (PGD). However, studies on its prevalence and correlates within Italian samples remain scarce.
Aims
This study aimed to explore the prevalence and correlates of PGD symptom severity among 1603 bereaved Italian adults.
Method
Self-reported data on PGD, suicidal ideation, depression, anxiety and stress were gathered. Descriptive characteristics and bereavement-related information were also collected.
Results
Among participants who lost a close other person at least 12 months prior, the prevalence of probable PGD and severe suicidal ideation was 7.7% (n = 104) and 0.7% (n = 9), respectively. The overall prevalence of severe suicidal ideation in the sample was 4.5%, rising to 18.2% among those with probable PGD. The probable PGD diagnosis showed minimal agreement with reported depression (phi = 0.25), anxiety (phi = 0.19), and stress (phi = 0.26), suggesting potentially limited overlap and supporting their distinctiveness. The severity of PGD symptoms was significantly positively associated with older age and suicidal ideation, and negatively associated with lower educational background and time since loss. PGD severity also varied by kinship, cause of death and place of residence. Specifically, bereaved individuals who lost a grandparent due to natural causes associated with ageing and lived in small- to medium-sized cities reported lower PGD symptom severity relative to others.
Conclusions
These findings contribute to the understanding of PGD symptomatology in bereaved individuals in Italy, although the results may not generalise to the entire Italian population.
Chapter 1 provides an overview of the central argument of the book. Medical anthropology, psychology, and psychiatry must steer a course between realism and constructivism, integrating the useful features of both perspectives. Metaphor theory and 4-E cognitive science provide ways of integrating cognitive and socio-cultural processes. Metaphor production and comprehension involves cognitive and emotional processes embodied and enacted through rhetoric and social discourse. These practices constitute a hermeneutic circle that can be traced from body to person to social world and back. They show how symbols and things live in the same world. This work has implications for understanding the ways illness experience and healing practices are embedded in larger systems of knowledge/power. The metaphors that arise in individuals’ struggles to make sense of their predicaments and to heal from affliction are borrowed from everyday concepts of mind and body, as well as the political language of power, resistance, and dissent. Every metaphor lends power to a particular view of the world. We must judge the value of metaphors on their moral, political, aesthetic, and pragmatic implications.
Depressive symptoms are highly prevalent in first-episode psychosis (FEP) and worsen clinical outcomes. It is currently difficult to determine which patients will have persistent depressive symptoms based on a clinical assessment. We aimed to determine whether depressive symptoms and post-psychotic depressive episodes can be predicted from baseline clinical data, quality of life, and blood-based biomarkers, and to assess the geographical generalizability of these models.
Methods
Two FEP trials were analyzed: European First-Episode Schizophrenia Trial (EUFEST) (n = 498; 2002–2006) and Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) (n = 404; 2010–2012). Participants included those aged 15–40 years, meeting Diagnostic and Statistical Manual of Mental Disorders IV criteria for schizophrenia spectrum disorders. We developed support vector regressors and classifiers to predict changes in depressive symptoms at 6 and 12 months and depressive episodes within the first 6 months. These models were trained in one sample and externally validated in another for geographical generalizability.
Results
A total of 320 EUFEST and 234 RAISE-ETP participants were included (mean [SD] age: 25.93 [5.60] years, 56.56% male; 23.90 [5.27] years, 73.50% male). Models predicted changes in depressive symptoms at 6 months with balanced accuracy (BAC) of 66.26% (RAISE-ETP) and 75.09% (EUFEST), and at 12 months with BAC of 67.88% (RAISE-ETP) and 77.61% (EUFEST). Depressive episodes were predicted with BAC of 66.67% (RAISE-ETP) and 69.01% (EUFEST), showing fair external predictive performance.
Conclusions
Predictive models using clinical data, quality of life, and biomarkers accurately forecast depressive events in FEP, demonstrating generalization across populations.
About one-third of South African women have clinically significant symptoms of postpartum depression (PPD). Several socio-demographic risk factors for PPD exist, but data on medical and obstetric risk factors remain scarce for low- and middle-income countries and particularly in sub-Saharan Africa. We aimed to estimate the proportion of women with PPD and investigate socio-demographic, medical and obstetric risk factors for PPD among women receiving private medical care in South Africa (SA).
Methods
In this longitudinal cohort study, we analysed reimbursement claims from beneficiaries of an SA medical insurance scheme who delivered a child between 2011 and 2020. PPD was defined as a new International Classification of Diseases, 10th Revision diagnosis of depression within 365 days postpartum. We estimated the frequency of women with a diagnosis of PPD. We explored several medical and obstetric risk factors for PPD, including pre-existing conditions, such as HIV and polycystic ovary syndrome, and conditions diagnosed during pregnancy and labour, such as gestational diabetes, pre-term delivery and postpartum haemorrhage. Using a multivariable modified Poisson model, we estimated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for factors associated with PPD.
Results
Of the 47,697 participants, 2,380 (5.0%) were diagnosed with PPD. The cumulative incidence of PPD increased from 0.8% (95% CI 0.7–0.9) at 6 weeks to 5.5% (5.3–5.7) at 12 months postpartum. PPD risk was higher in individuals with history of depression (aRR 3.47, 95% CI [3.14–3.85]), preterm delivery (1.47 [1.30–1.66]), PCOS (1.37 [1.09–1.72]), hyperemesis gravidarum (1.32 [1.11–1.57]), gestational hypertension (1.30 [1.03–1.66]) and postpartum haemorrhage (1.29 [0.91–1.85]). Endometriosis, HIV, gestational diabetes, foetal stress, perineal laceration, elective or emergency C-section and preeclampsia were not associated with a higher risk of PPD.
Conclusions
The PPD diagnosis rate was lower than anticipated, based on the PPD prevalence of previous studies, indicating a potential diagnostic gap in SA’s private sector. Identified risk factors could inform targeted PPD screening strategies.
Lesbian, gay, and bisexual (LGB) individuals are more than twice as likely to experience anxiety and depression compared with heterosexuals. Minority stress theory posits that stigma and discrimination contribute to chronic stress, potentially affecting clinical treatment. We compared psychological therapy outcomes between LGB and heterosexual patients by gender.
Methods
Retrospective cohort data were obtained from seven NHS talking therapy services in London, from April 2013 to December 2023. Of 100,389 patients, 94,239 reported sexual orientation, 7,422 identifying as LGB. The primary outcome was reliable recovery from anxiety and depression. Secondary outcomes were reliable improvement, depression and anxiety severity, therapy attrition, and engagement. Analyses were stratified by gender and employed multilevel regression models, adjusting for sociodemographic and clinical covariates.
Results
After adjustment, gay men had higher odds of reliable recovery (OR: 1.23, 95% CI: 1.13–1.34) and reliable improvement (OR: 1.16, 95% CI: 1.06–1.28) than heterosexual men, with lower attrition (OR: 0.88, 95% CI: 0.80–0.97) and greater reductions in depression (MD: 0.51, 95% CI: 0.28–0.74) and anxiety (MD: 0.45, 95% CI: 0.25–0.65). Bisexual men (OR: 0.67, 95% CI: 0.54–0.83) and bisexual women (OR: 0.84, 95% CI: 0.77–0.93) had lower attrition than heterosexuals. Lesbian and bisexual women, and bisexual men, attended slightly more sessions (MD: 0.02–0.03, 95% CI: 0.01–0.04) than heterosexual patients. No other differences were observed.
Conclusions
Despite significant mental health burdens and stressors, LGB individuals had similar, if not marginally better, outcomes and engagement with psychological therapy compared with heterosexual patients.
Auditory hallucinations (hearing voices in the absence of physical stimuli) are present in clinical conditions, but they are also experienced less frequently by healthy individuals. In the non-clinical population, auditory hallucinations are described more often as positive and not intrusive; indeed, they have received less attention.
Aims
The present study explores the phenomenology of non-clinical auditory hallucinations and their possible relationship with religiosity.
Method
Starting from previous findings suggesting that non-clinical auditory hallucinations are often described as a gift or a way to be connected with ‘someone else’, we administered standardised questionnaires to quantify proneness to experiencing auditory hallucinations, religiosity and anxiety/depression scores.
Results
Regression analysis carried out using an auditory hallucinations, index as the dependent variable on a final sample of 680 responders revealed that a total of 31% of the variance was explained by a five-steps model including demographic characteristics (i.e. being young, a woman and a non-believer) and negative (e.g. being afraid of otherworldly punishments) and positive (e.g. believing in benevolent supernatural forces) components of religiosity, anxiety and depression. Crucially, compared with believers, non-believers revealed higher scores in depression, anxiety and in a specific questionnaire measuring proneness to auditory hallucinations.
Conclusions
Results suggests that religiosity acts as a potential protective factor for proneness to paranormal experiences, but a complex relationship emerges between religious beliefs, mood alterations and unusual experiences.