Withania somnifera (WS) is considered an adaptogen agent with reported antistress, cognition facilitating and anti-inflammatory properties, which may be beneficial in the treatment of mental disorders.

This systematic review investigated the efficacy and tolerability of Withania somnifera for mental health symptoms in individuals with mental disorders.

The protocol of this review was registered with PROSPERO (CRD42023467959). PubMed, Scopus, PsycINFO, CINAHL, Embase and CENTRAL were searched for randomised controlled trials comparing Withania somnifera to any comparator, in people of any age, with any mental disorder. The meta-analyses were based on standardised mean differences (SMDs) and odds ratios with 95% confidence intervals, estimated through frequentist and Bayesian-hierarchical models with random-effects.

Fourteen studies, corresponding to 360 people treated with Withania somnifera and 353 controls were included. Anxiety disorders were the predominant diagnostic category. Thirteen trials administered Withania somnifera orally (median dose 600 mg/day), one with Shirodhara therapy. The median follow-up time was 8 weeks. Although limited by the small number of studies, substantial between-study heterogeneity, and outlier effects, our investigation showed Withania somnifera effectiveness in improving anxiety (outlier-corrected SMD: −1.13 (95% CI: −1.65; −0.60), pooled SMD: −1.962 (95% CI: −2.66; −0.57)), depression (SMD: −1.28 (95% CI: −2.40; −0.16) and stress (SMD: −0.95 (95% CI: −1.46; −0.43) symptoms and sleep quality (SMD: −1.35 (95% CI: −1.79; −0.91). The effect size was confirmed using the Bayesian for anxiety but not for depression. No significant difference between Withania somnifera and the comparators was found for safety and tolerability.

We found evidence supporting the effectiveness of Withania somnifera in treating anxiety symptoms. Future trials should replicate this finding in larger samples and further clarify a possible Withania somnifera role in depression and insomnia treatment.

Financial strain is increasingly recognised as a contributor to psychological distress, which may in turn elevate the risk of developing mental disorder. However, few large-scale longitudinal studies have investigated its predictive role using diagnostic outcomes among higher education students.

To examine whether financial strain predicts a major depressive episode (MDE) one year later among Norwegian students, and whether associations are explained by sociodemographic factors or baseline psychological distress.

Data were drawn from the national Students’ Health and Wellbeing Study 2022 (SHoT2022) survey (N = 53 362), with a diagnostic follow-up one year later (N = 10 460) using the self-administered Composite International Diagnostic Interview version 5.0 (CIDI 5.0). Inverse probability weighted Poisson regression with robust standard errors estimated the risk of 30-day DSM-5-defined MDE for each financial indicator.

Financial strain was widespread: 6% reported frequent financial difficulties, 27% were unable to cover an emergency expense of 5000 Norwegian kroner (NOK; approximately €450/$500, and 35% spent 60% or more of their income on housing. Several indicators significantly predicted later MDE. Students frequently experiencing financial difficulties had a 3.55-fold increased risk (95% CI:2.97–4.22), attenuating to 1.53 (1.28–1.83) after full adjustment. Similar patterns emerged for most indicators. Associations were largely unaffected by sociodemographic adjustment, but were substantially reduced after accounting for baseline psychological distress.

Financial strain was associated with increased risk of MDE one year later, although much of the association was explained by baseline distress. Policies should address both financial and psychological vulnerabilities through strengthened financial support, alignment with living costs and targeted measures such as financial counselling and housing assistance.

Cardiovascular diseases (CVD) and depression frequently co-occur, yet the biological mechanisms underpinning this comorbidity remain poorly understood. This may reflect complex, non-linear associations across multiple biological pathways. We aimed to identify molecular biomarkers linking depressive symptoms and cardiovascular phenotypes using a network-based integrative approach.

Data were obtained from the Young Finns Study (N = 1,686; mean age = 37.7 years; 58.3% female), including 21 depressive symptoms (Beck Depression Inventory), 17 CVD-related indicators, 6 risk factors, 228 metabolomic, and 437 lipidomic variables. Mutual information was used to capture both linear and non-linear associations among variables. A multipartite projection network was constructed to quantify how depressive symptoms and cardiovascular phenotypes are biologically connected via shared metabolites and lipids. Biomarkers were ranked by their contribution to these projected associations. Results were validated in an independent cohort from the UK Biobank.

Specific depressive symptoms – crying, appetite changes, and loss of interest in sex – showed strong projected associations with diastolic blood pressure, systolic blood pressure, and cardiovascular health scores. Key mediators included creatinine, valine, leucine, phospholipids in very large HDL, triglycerides in small LDL, and apolipoprotein B. Important lipid mediators included sphingomyelins, phosphatidylcholines, triacylglycerols, and diacylglycerols. Replication analysis in the UK Biobank identified many overlaps in metabolite profiles, supporting generalizability.

This network-based analysis revealed symptom-specific biological pathways linking CVD and depression. The identified biomarkers may offer insights into shared mechanisms and support future prevention and treatment strategies for cardiometabolic–psychiatric comorbidity.

The association between geriatric depression and out-of-hospital cardiac arrest (OHCA) has not been fully clarified.

This study aimed to develop and validate a predictive model for OHCA in older patients through a longitudinal, population-based approach.

This study analysed data from the National Health Insurance Research Database for the period 2011–2020, focusing on older patients both diagnosed with depression and treated with antidepressant medications. A multivariate logistic regression model was used to identify potential predictors of OHCA. Considering the effect of COVID-19, data-sets from 2019 and 2020 were used as external validation. The model’s performance was evaluated using receiver operating characteristic (ROC) curves and confusion matrix metrics.

Out of 104 022 geriatric patients with depression, 2479 (2.4%) experienced OHCA. Significant predictors of OHCA included age, male gender, previous utilisation of medical resources, renal failure with haemodialysis, existing comorbidities, medication changes and recent psychotherapy. The ROC values for the predictive models ranged from 0.707 to 0.771 in the 2019 and 2020 external validations for 7-, 30- and 90-day OHCA. For 2019, the 7-day model demonstrated sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of 0.600, 0.718, 2.130, 0.560 and 3.840, respectively. For 2020, these metrics for the 7-day model were 0.775, 0.655, 2.250, 0.340 and 6.550, respectively.

This study developed and validated a predictive model for OHCA in older patients with depression. The model identified crucial predictors, providing valuable insights for psychiatrists and emergency clinicians to identify high-risk patients and implement early preventive measures.

While psychiatric disorders (e.g., depression, anxiety) are well-established predictors of suicidal ideation (SI) in individuals with traumatic brain injury (TBI), the roles of other psychological and cognitive factors remain underexplored. This study examined associations between SI and emotion-processing difficulties, coping strategies, psychological resilience, and cognitive functioning after moderate–severe TBI.

This was a secondary analysis of data from 106 individuals with moderate–severe TBI. SI and emotional distress were assessed using the Inventory of Depression and Anxiety Symptoms and Hospital Anxiety and Depression Scale, respectively. Participants also completed measures of emotional lability and detachment (Comprehensive Assessment of Traits Relevant to Personality Disorders [CAT-PD]), coping (Coping Scale for Adults), psychological resilience (Connor–Davidson Resilience Scale), and cognitive functioning, including subjective (CAT-PD, Brief Rating of Executive Function) and objective measures (Brief Test of Adult Cognition by Telephone). Spearman’s correlations and path models were used to examine psychological and cognitive correlates of SI.

SI was positively associated with emotional lability, emotional detachment, non-productive coping, and self-reported cognitive problems, and negatively associated with resilience. Path models indicated that emotional distress accounted for 76–100% of these associations. Conversely, SI was not significantly associated with adaptive coping or objective cognitive performance.

Emotion-processing difficulties, non-productive coping strategies, low resilience, and self-reported cognitive problems are linked to SI in individuals with moderate–severe TBI, primarily through their associations with emotional distress. Findings underscore the importance of addressing emotional distress, including depression and anxiety, and its underlying contributors in suicide prevention for this population.

Approximately 24% of stroke survivors develop post-stroke depression (PSD), which is associated with poor psychological recovery, identity disruption, and reduced self-esteem. Psychological interventions often fail to address these broader challenges. The Wisdom Enhancement Timeline technique, which facilitates autobiographical reflection, has shown promise for depression in older adults. It has not yet been studied in a post-stroke population.

This study evaluated the effectiveness of the Wisdom Enhancement Timeline technique in stroke. It was hypothesised that wisdom would improve first, followed by identity/self-esteem and mood.

A multiple-baseline single-case experimental design (SCED) was used across three stroke survivors. Daily visual analogue scale (VAS) ratings measured mood, identity, self-esteem, and wisdom during the trial. The Patient Health Questionnaire-9 (PHQ-9) measured depressive symptoms at pre- and post-intervention. Visual analysis, Tau-U, generalised least squares regression (adjusting for autocorrelation), and piecewise regression evaluated intervention effects.

Improvements were observed across all participants and outcomes. Tau-U analysis indicated small-to-large effect sizes across outcomes (effect size range: 0.30–0.92). Breakpoints confirmed wisdom improved first, followed by identity/self-esteem and mood last. Regression confirmed significant level shifts across all outcomes. All participants showed clinically meaningful reductions in PHQ-9 scores, operationalised as a shift from pre-intervention scores above 10 to post-intervention scores below 10.

Wisdom-based interventions could be beneficial in a stroke population, promoting improvements in mood, identity coherence, self-esteem and wisdom. The Wisdom Enhancement Timeline technique shows promise for PSD treatment, although further research is needed to validate these effects.

Suicide represents a significant public health concern. Suicide prevention strategies are shifting toward transdiagnostic perspectives examining interrelated risk factors, but their interrelationships remain unclear. This study investigated relationships between psychopathological dimensions, impulsivity, and childhood maltreatment in individuals with suicidal ideation (SI), comparing those with versus without intention to act using network analysis.

Data were obtained from the Suicide Prevention and Intervention Study project. Participants were categorized into two groups based on their intention to act according to the Columbia Suicide Severity Rating Scale. Psychological symptoms, impulsivity traits, and childhood maltreatment were assessed. Network analysis was performed, and centrality measures were computed.

A total of 1,265 individuals were categorized into the SI without intention to act (n = 345) and SI with intention to act (n = 920) groups. The former showed lower depression and hostility scores, and lower prevalence of major depressive and anxiety disorders. Network analyses revealed that in the SI without intention to act group, obsessive-compulsive symptoms were central, connecting to depression and anxiety, while negatively correlating with non-planning impulsivity. In contrast, the SI with intention to act group showed a more densely interconnected network where emotional abuse served as a bridge between childhood maltreatment and other psychopathological dimensions.

This study identifies symptom interaction patterns between individuals with SI without and with intention to act. Understanding these relationships may improve suicide risk assessment and inform personalized interventions, potentially reducing the transition from ideation to action. Trauma-focused approaches addressing emotional abuse may be especially relevant for individuals at high risk.

The COVID-19 pandemic exacerbated psychological distress, but limited information is available on the shifts in mental health symptoms and their associated factors across different stages. This study was conducted to more reliably estimate shifts in mental health impacts and to identify factors associated with symptoms at different pandemic stages.

We performed a national repeated cross-sectional study at stable (2021), recurrence (2022), and end-of-emergency (2023) stages based on representative general national population with extensive geographic coverage. Anxiety, depression, post-traumatic stress disorder (PTSD) and insomnia symptoms were evaluated by GAD-7, PHQ-9, IES-R and ISI scales, respectively, and their associated factors were identified via multivariable linear regression.

Generally, 42,000 individuals were recruited, and 36,218, 36,097 and 36,306 eligible participants were included at each stage. The prevalence of anxiety, depression and insomnia symptoms increased from 13.7–16.4% at stable to 17.3–22.2% at recurrence and decreased to 14.5–18.6% at end of emergency, while PTSD symptom continuously increased from 5.1% to 7.6% and 9.2%, respectively (all significant, P < 0.001). Common factors associated with mental health symptoms across all stages included centralized quarantine, frontline work and residence in initially widely infected areas. Centralized quarantine was linked to anxiety, depression, PTSD and insomnia during the stable, recurrence and end-of-emergency stages. Frontline workers exhibited higher risks of anxiety, depression and insomnia throughout these stages. Individuals in initially widely infected areas were more likely to experience depression and PTSD, particularly during the stable and recurrence stages. Stage-specific risk factors were also identified. Lack of outdoor activity was associated with anxiety, depression and insomnia during the stable and recurrence stages. Residents in high-risk areas during the recurrence stage correlated with increased anxiety and insomnia. Suspected infection was tied to anxiety and insomnia in the recurrence and end-of-emergency stages, while the death of family or friends was linked to PTSD during recurrence and to depression, PTSD and insomnia at the end-of-emergency stage.

Mental health symptoms increased when pandemic recurred, and could remain after end-of-emergency, requiring prolonged interventions. Several key factors associated with mental symptoms and their variations were identified at different pandemic stages, suggesting different at-risk populations.

Depression in individuals with type 2 diabetes mellitus (T2DM) is associated with worse clinical prognosis; however, evidence regarding the relationship between depression and hypoglycaemic risk remains limited and inconclusive.

Our study aimed to evaluate the association between depressive symptoms and hypoglycaemic events.

Depressive symptoms were assessed in participants of the ACCORD-HRQL study at baseline and during follow-up visits at 12, 36 and 48 months using the nine-item Patient Health Questionnaire (PHQ-9). Symptom severity was categorised into three levels: none (0–4 points), mild (5–9 points) or moderate to severe (10–24 points). The primary outcomes included hypoglycaemia requiring any assistance (HAA) and hypoglycaemia requiring medical assistance (HMA).

Over a median follow-up of 4.3 years, 220 individuals developed HAA (incidence rate: 27.0 per 1000 person-years) and 157 individuals experienced HMA (incidence rate: 18.8 per 1000 person-years). Depressive symptoms exhibited dynamic fluctuations during the study period, and participants with depression consistently demonstrated less effective glycaemic control compared to those without depression. However, each one-unit increase in PHQ-9 score was not associated with elevated risks of HAA (hazard ratio, 1.00; 95% CI, 0.97–1.03) or HMA (hazard ratio, 0.98; 95% CI, 0.95–1.02).

Depressive symptoms in individuals with T2DM are dynamic and correlate with suboptimal glycaemic control. However, no significant association was observed between depression severity and increased hypoglycaemic events. These findings highlight the importance of integrated clinical strategies for continuous mental health monitoring and glucose management in T2DM individuals.

Depression is characterized by divergent changes in positive and negative affect. Emerging roles of inflammation in depression portend avenues for novel immunomodulator-based monotherapy, targeting mechanistically distinct symptoms such as anhedonia and pessimism.

To investigate links between these divergent affective components and inflammation, we used a probabilistic reinforcement-learning fMRI paradigm, testing for evidence of hyposensitivity to reward, and hypersensitivity to punishment in low-inflammation depression cases (loCRP depression; CRP ≤ 3 mg/L; N = 48), high-inflammation depression cases (hiCRP depression; CRP > 3 mg/L; N = 31), and healthy controls (HC; CRP ≤ 3 mg/L; N = 45). We aimed to (i) determine whether depression cases with high and low inflammation showed aberrant neural activation to monetary gains and losses compared to controls, and (ii) examine if these alterations correlated with a continuous measure of C-reactive protein (CRP) in depression, as well as indices of anhedonia and pessimism derived from behavioral instruments in depression.

Voxel-wise activation was observed in key brain regions sensitive to monetary reward (ventromedial prefrontal cortex, vmPFC; nucleus accumbens, NAc) and punishment (insula) outcomes across all three groups. However, there was no significant difference in activation between groups. Within depression cases, increasing CRP scaled negatively with activation in the right vmPFC and left NAc but not insula cortex. However, there was no significant association between regional activation and severity of anhedonia or pessimism.

Our results support the previously reported association between CRP and striatal reward reactivity in depression but do not extend this to processing of negatively valenced information.

Motivational dysfunction is a core feature of depression and can have debilitating effects on everyday function. However, it is unclear which cognitive processes underlie impaired motivation and whether impairments persist following remission. Decision-making concerning exerting effort to obtain rewards offers a promising framework for understanding motivation, especially when examined with computational tools.

Effort-based decision-making was assessed using the Apple Gathering Task, where participants decide whether to exert effort via a grip-force device to obtain varying levels of reward; effort levels were individually calibrated and varied parametrically. We present a comprehensive computational analysis of decision-making, initially validating our model in healthy volunteers (N = 67), before applying it in a case–control study including current (N = 41) and remitted (N = 46) unmedicated depressed individuals and healthy volunteers with (N = 36) and without (N = 57) a family history of depression.

Four fundamental computational mechanisms that drive patterns of effort-based decisions, which replicated across samples, were identified: overall bias to accept effort challenges; reward sensitivity; and linear and quadratic effort sensitivity. Traditional model-agnostic analyses showed that both depressed groups showed lower willingness to exert effort. In contrast with previous findings, computational analysis revealed that this difference was primarily driven by lower effort-acceptance bias, but not altered effort or reward sensitivity.

This work provides insight into the computational mechanisms underlying motivational dysfunction in depression. Lower willingness to exert effort could represent a trait-like factor contributing to symptoms and a fruitful target for treatment and prevention.

Evidence on the effects of parental Adverse Childhood Experiences (ACEs) on adolescent mental health remains limited. This study investigates the associations between parental ACEs, children’s exposure to threat- and deprivation-related ACEs, and adolescent depression and anxiety using data from the Longitudinal Study of Australian Children.

We conducted a secondary analysis of the Longitudinal Study of Australian Children (LSAC), a population-based longitudinal cohort study. Parental ACEs were retrospectively reported by caregivers. Children’s exposure to ACEs was assessed from ages 4–17 years and categorised as threat-related ACEs (e.g., bullying, hostile parenting, unsafe neighbourhoods, family violence) or deprivation-related ACEs (e.g., financial hardship, parental substance abuse, parental psychological distress, death of a family member, parental separation, parental legal problems). Depressive and anxiety symptoms were self-reported by adolescents at ages between 12 and 17 years. Modified Poisson regression models were used to examine the independent and combined associations of parental ACEs and children’s threat- and deprivation-related ACEs (assessed before ages 12, 14, and 16 years) with depression and anxiety outcomes, including tests for interaction effects.

The analysis included 3,956 children aged 12–13 years, 3,357 children aged 14–15 years, and 3,089 children aged 16–17 years. Males comprised 50.8–59.8% and females 40.2–49.2% across all ages. By the age of 17, 30.4% and 9.4% of the adolescents had depression and anxiety, respectively. Parental ACEs (≥2) were associated with increased depression risk at ages 12 to 13 years (RR = 1.42; 95% CI: 1.10–1.84) and at 16–17 years (RR = 1.19; 95% CI: 1.02–1.39). Exposure to ≥ 2 deprivation-related ACEs significantly increased the risk of depression across all ages, with relative risks ranging from 1.31 to 2.18. High threat-related ACEs (≥2) were associated with increased depression risk only at 12 to 13 years (RR = 2.01; 95% CI: 1.28–3.17). No significant interactions were observed.

The findings reinforce the ACEs model by showing that, at the population level, early identification of children exposed to early life deprivations rooted in financial crisis or familial adversities, combined with targeted interventions for both children and parents and supportive social policies, can reduce long-term mental health risks.

To determine the prevalence and severity of anxiety and depression among health care professionals in Khyber Pakhtunkhwa and the impact of gender and professional roles on mental health outcomes.

A cross-sectional study was conducted between March and November 2023 using stratified random sampling among health care professionals, including doctors, nurses, paramedics, and emergency staff, across multiple hospitals. The Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were used to assess anxiety and depression. Data were analyzed using R/RStudio, employing descriptive statistics, chi-square tests, independent t-tests, Mann-Whitney U tests, and Pearson’s correlation coefficient.

Among 651 participants, 65% were male. Anxiety prevalence was significant, with 42% experiencing minimal anxiety, 35% mild, 16% moderate, and 7.7% severe. Depression prevalence included 10% with no depression with 7.8% moderately severe and 5.9% severe depression. Nurses (40%) and doctors (34%) had the highest depression rates. Females exhibited significantly higher anxiety and depression scores. Anxiety prevalence varied across hospitals (P = 0.024). A strong positive correlation was observed between GAD-7 and PHQ-9 scores.

Mental health challenges among frontline health care workers in Khyber Pakhtunkhwa are substantial, with anxiety and depression particularly prevalent among nurses and doctors. Female workers experience greater psychological distress. We recommend implementation of hospital-based mental health support systems, prioritizing interventions for female staff and high-burden departments. Policies ensuring regular psychological screening and peer support mechanisms are urgently needed.

Although mental disorders have long been considered complex dynamic systems, our understanding of the mutual interactions and temporal patterns of their symptoms remains limited.

In this longitudinal study, we examined the structure and dynamics of four key mental health indicators – depression, anxiety, post-traumatic stress disorder, and insomnia – in a representative sample of the Slovak population (effective N = 3,874) over 10 waves spanning 3.5 years. For each construct, a longitudinal panel network model was estimated.

The temporal relationships between symptoms were mostly weak, with the autoregressive effects typically being stronger. In depression, anxiety, and insomnia, some causal chains and feedback loops were identified. In all constructs, both contemporaneous and between-person networks showed dense connections.

The findings provide critical insights into the complexity of mental health development, offering potential targets for intervention and prevention strategies.

The co-occurrence of cannabis use and internalizing symptoms, such as depression and anxiety, during emerging adulthood (18–25 years) is well documented. However, while bidirectional relationships are often assumed, empirical evidence is mixed. This study investigates bidirectional longitudinal relationships between cannabis frequency and consequences and internalizing symptoms (depressive and anxiety) among high-risk emerging adults.

Data came from seven assessments collected over a 2-year period among 961 (54% female) high-risk emerging adults participating in two longitudinal cohorts (Ontario, Canada; Tennessee, USA). Assessments were at 4-month intervals spanning 2018–2020. Latent curve models with structured residuals were used to explore bidirectional between- and within-person relationships between cannabis-related variables and internalizing symptoms.

At baseline, higher levels of cannabis frequency and consequences were associated with higher internalizing symptoms. In between-person model components, cannabis-related and internalizing variables decreased across emerging adulthood. Significant within-person bidirectional relationships were observed, partially supporting both symptom-driven and substance-induced pathways, but the findings were specific to negative cannabis consequences, not frequency, and for depressive symptoms, not anxiety symptoms, for symptom-driven pathways. These bidirectional relationships were more pronounced among females and those surpassing clinical thresholds for internalizing symptoms at baseline.

This study found evidence of bidirectional relationships between cannabis consequences and internalizing symptoms across emerging adulthood, with the prevailing direction from cannabis-related negative consequences to increases in internalizing symptoms. These findings highlight the importance of cannabis intervention in emerging adults, both to reduce consequences and to prevent internalizing disorders, especially targeting females and those with clinically elevated internalizing symptoms.

Pharmacological efforts to treat anorexia nervosa (AN) have predominantly repurposed medications that treat conditions with overlapping symptoms and yielded generally disappointing results. Despite limited empirical support, SSRIs are often prescribed to patients with AN. Whether SSRIs are effective in a subgroup of individuals with AN, such as those with depression, is not known.

A secondary analysis of a randomized trial of fluoxetine versus placebo for relapse prevention in AN was conducted. Participants (n = 92) were weight-restored women with AN who completed the Beck Depression Inventory (BDI) at the time of randomization. BDI scores were dichotomized to reflect moderate/severe depression (BDI > 20, n = 26). A Cox Proportional Hazards model estimated the association of the level of depression, medication, and their interaction with time to relapse. Mixed effects models examined the effects of medication on symptom trajectories in high versus low depression groups and whether depression severity modified the effect of the drug on symptom trajectory.

There was a significant interaction between medication and depression severity in time to relapse (hazard ratio = 0.46, 95% CI: [0.25, 0.85], p = .01). Depression severity modified the effect of fluoxetine on the time course of symptoms of depression (β = −0.27, 95% CI: [−0.42,-0.12], p = 0.001) and bulimia (β = −0.15, 95% CI: [−0.25,-0.05], p = 0.004) in the twelve month follow-up period.

Fluoxetine was more effective than placebo in reducing relapse among more depressed, weight-restored individuals with AN. These results require replication but provide support for the use of antidepressant medication for patients with AN who remain depressed following weight restoration.