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The high level of psychological distress in young people is a growing concern. However, there are few national surveys that describe the trajectories of mental health and wellbeing through adolescence into early adulthood. Further, existing research has largely focused exclusively on mental ill-health, with little focus on positive mental health. This study provides the first national profile of the mental health and wellbeing of Australians aged 12–25 years.
Methods
Participants completed the National Youth Mental Health survey in 2018 (n1 = 3832), 2020 (n2 = 974) or 2022 (n3 = 961). We applied Keyes’ Complete Mental Health (CMH) framework to derive categories of mental health and wellbeing, and examine rates of CMH over time, by age and gender.
Results
While approximately half of those surveyed reported flourishing (high wellbeing without mental illness), rates of flourishing declined between 2018 and 2022. Rates of flourishing generally decreased with age, and flourishing was more prevalent amongst males than females.
Conclusions
The findings provide a unique contrast of youth mental health pre-, during and post- the COVID-19 pandemic. While rates of psychological distress are consistently high, the proportion of youth reporting flourishing highlights the need to consider all aspects of psychological functioning to accurately understand and respond to the mental health needs of young people.
The comparability between self-reports and clinician-rated scales for measuring depression following treatment has been a long-standing debate, with studies finding mixed results. While the use of self-reports in psychotherapy trials is very common, it has been widely assumed that these tools pose a validity threat when masking of participants is not possible. We conducted a meta-analysis across randomized controlled trials (RCTs) of psychotherapy for depression to examine if treatment effect estimates obtained via self-reports differ from clinician-rated outcomes.
Methods
We identified studies from a living database of psychotherapies for depression (updated to 1 January 2023). We included RCTs measuring depression at post-treatment with both a self-report and a clinician-rated scale. As our main model, we ran a multilevel hierarchical meta-analysis, resulting in a pooled differential effect size (Δg) between self-reports and clinician ratings. Moderators of this difference were explored through multimodel inference analyses.
Results
A total of 91 trials (283 effect sizes) were included. In our main model, we found that self-reports produced smaller effect size estimates compared to clinician-rated instruments (Δg= 0.12; 95% CI: 0.03–0.21). This difference was very similar when only including trials with masked clinicians (Δg= 0.10; 95% CI: 0.00–0.20). However, it was more pronounced for unmasked clinical ratings (Δg= 0.20; 95% CI: −0.03 to 0.43) and when trials targeted specific population groups (e.g., perinatal depression) (Δg= 0.20; 95% CI: 0.08–0.32). Effect sizes between self-reports and clinicians were identical in trials targeting general adults (Δg= 0.00; 95% CI: −0.14 to 0.14).
Conclusions
Self-report instruments did not overestimate the effects of psychotherapy for depression and were generally more conservative than clinician assessments. Patients’ perception of improvement should not be considered less valid by default, despite the inherent challenge of masking in psychotherapy.
Antidepressants are essential in managing depression, including treatment-resistant cases. Public perceptions of these medications, shaped by social media platforms like X (formerly Twitter), can influence treatment adherence and outcomes. This study explores public attitudes toward antidepressants through sentiment and topic modeling analysis of tweets in English and Spanish from 2007 to 2022.
Methods
Tweets mentioning antidepressants approved for depression were collected. The analysis focused on selective serotonin reuptake inhibitors (SSRIs) and glutamatergic drugs. Sentiment analysis and topic modeling were conducted to identify trends, concerns, and emotions in discussions across both languages.
Results
A total of 1,448,674 tweets were analyzed (1,013,128 in English and 435,546 in Spanish). SSRIs were the most mentioned antidepressants (27.9% in English, 58.91% in Spanish). Pricing and availability were key concerns in English tweets, while Spanish tweets highlighted availability, efficacy, and sexual side effects. Glutamatergic drugs, especially esketamine, gained attention (15.61% in English, 25.23% in Spanish), evoking emotions such as fear, sadness, and anger. Temporal analysis showed significant increases in discussions, with peaks in 2012 and 2021 for SSRIs in Spanish, and exponential growth from 2018 to 2021 for glutamatergic drugs. Emotional tones varied across languages, reflecting cultural differences.
Conclusions
Social media platforms like X provide valuable insights into public perceptions of antidepressants, highlighting cultural variations in attitudes. Understanding these perceptions can help clinicians address concerns and misconceptions, fostering informed treatment decisions. The limitations of social media data call for careful interpretation, emphasizing the need for continued research to improve pharmacovigilance and public health strategies.
Opioid use disorder (OUD) is a devastating condition with frequent suicidality, contributing to overdose deaths. Theta burst stimulation (TBS) to the dorsolateral prefrontal cortex (DLPFC) is used to treat major depressive disorder (MDD) and is effective in treating suicidal ideation. We piloted a randomized, double-blind, sham-controlled trial of bilateral rTMS for patients with OUD and MDD experiencing suicidality.
Methods
Sequential bilateral TBS was delivered guided by structural neuroimaging: continuous TBS to the right then intermittent TBS to the left DLPFC, daily (20 treatments). The primary objective was to determine the feasibility of this population. The primary clinical outcome was the scale for suicidal ideation (SSI), secondary outcomes included depressive symptoms and opioid cue-induced craving. ClinicalTrials.gov: NCT04785456.
Results
Eighty-seven individuals were pre-screened. The most common reasons for ineligibility included being unreachable by the study team, difficulty with scheduling/travel requirements, and medical/psychiatric instability. Six participants (5:1 M:F) were enrolled (3/arm), four had a fentanyl use history; two completed per protocol (1/arm). Of the participants with follow-up data, SSI scores decreased in 2/3 in the sham arm and 2/2 in the active arm; depression and opioid craving scores decreased in all participants.
Conclusion
We present the first data piloting a structural neuroimaging-guided, multi-session rTMS treatment course in outpatients with suicidality and OUD in the current North American context. Recruitment and retention were the main challenges given the highly unstable medical and psychosocial context of this patient population. Future trials should consider a suitable environment to improve the feasibility of delivering this treatment.
This paper reports the methods and preliminary findings of Germina, an ongoing cohort study to identify biomarkers and trajectories of executive functions and language development in the first 3 years of life. 557 mother-infant dyads (mean age of mothers 33.7 years, 65.2% white, 48.7% male infants) have undergone baseline and are currently collecting data for other timepoints. A linear regression was used to predict baseline Bayley-III using scores derived from data-driven sparse partial least squares utilizing a multiple holdout framework of 15 domains. Significant associations were found between socioeconomic/demographic characteristics (B = 0.29), epigenetics (B = 0.11), EEG theta (B = 0.14) and beta activity (B = 0.11), and microbiome functional pathways (B = 0.08) domains, and infant development measured by the Bayley-III at T1, suggesting potential interventions to prevent impairments.
Depression and anxiety are widespread globally, with significant treatment gaps in low-resource settings. In Pakistan, where prevalence is high and specialists are scarce, brief psychological interventions by trained lay counsellors show promise. DIALOG+ is a novel technology-assisted, solution-focused approach for leveraging resource-oriented approaches in routine community mental health treatment.
Aims
To explore the feasibility and acceptability of using DIALOG+ for community-based treatment of common mental disorders delivered by non-specialist lay counsellors in a low-resource setting (trial registration: ISRCTN14528579).
Method
An open, uncontrolled trial in community settings in Karachi, Pakistan, was conducted with 40 patients with depression and anxiety visiting two primary care clinics between June 2019 and February 2020. Patients were enrolled for monthly sessions delivered over 6 months by lay counsellors. Subjective quality of life along with symptoms of depression and anxiety were measured at baseline and endline (following the 6-month intervention) on the Manchester Short Assessment of Quality of Life (MANSA) and Aga Khan University Anxiety and Depression Scale (AKUADS). Changes in measures were evaluated before and after the intervention using a t-test analysis. Post-intervention, in-depth interviews were held with patients and lay counsellors to gather insights into their experience of the intervention.
Results
In total, 146 DIALOG+ sessions were conducted with 40 patients. At the 6-month post-intervention assessment, 33 patients showed improved subjective quality of life and reduced self-reported depression and anxiety scores. Patients reported that the intervention helped strengthen the therapeutic relationship with their lay counsellors, helped them track their progress through therapy and enhanced their self-management of negative emotions and behaviours.
Conclusions
Structured communication can help strengthen lay counsellors’ ability to improve therapeutic outcomes of people with common mental disorders in resource-constrained community settings. Future clinical trials are recommended to further evaluate the long-term impact of the DIALOG+ intervention on mental health outcomes.
Natoli et al present a comprehensive higher level framework aligning dimensional personality pathology assessment with treatment delivery through a hierarchical model. Their approach integrates common therapeutic factors with trait-specific interventions, offering a promising pathway for clinical implementation. Despite strong evidence supporting the superiority of dimensional models and the field's shift towards dimensional classification, they remain largely unused in clinical practice after a decade, despite evidence of clinical utility and learnability. Although the authors’ framework demonstrates how dimensional approaches could work in practice, particularly through matching severity to treatment intensity and traits to specific interventions, healthcare systems require evidence of improved clinical outcomes before undertaking systemic change. Without controlled trials demonstrating enhanced treatment effectiveness, dimensional models risk remaining theoretically superior but practically unused. While healthcare systems remain tethered to categorical diagnostic approaches, the authors’ framework offers a practical pathway for implementing dimensional models – one that now requires testing in real-world settings.
Childhood maltreatment, a significant distal risk factor for individual development, is potentially linked to maladaptive cognitive emotion regulation strategies (MCERS) and increased internalizing problems (i.e., depression and anxiety). Prior research has widely identified that MCERS mediate the link between childhood maltreatment and internalizing problems. However, this result overlooks the potential bidirectional relationship between MCERS and internalizing problems. In this study, we aim to explore whether childhood maltreatment longitudinally linked to internalizing problems through the mediating role of MCERS, or, conversely, was related to subsequent MCERS through internalizing problems. Gender differences in the associations between these variables were also examined. Participants were 892 adolescents from a longitudinal design with two waves (487 females, 405 males; Mage = 15.36, SDage = 1.43). Our results indicated that childhood maltreatment was longitudinally related to MCERS and internalizing problems. T1 MCERS mediated the relationship between T1 child maltreatment and T2 internalizing problems, while T1 internalizing problems also played a mediating role between T1 child maltreatment and T2 MCERS. These findings were also equivalent across genders. Taken together, childhood maltreatment was longitudinally associated with internalizing problems through MCERS, and also related to subsequent MCERS through internalizing problems.
‘Complex emotional needs’ has emerged in the UK as a label to refer to individuals given a diagnosis of a personality disorder. We argue that this name change is insufficient to address the harms associated with the personality disorder construct; rather, it risks broadening its scope, and thereby the construct’s harms.
In the UK, Black doctors experience higher levels of discrimination, bullying and harassment compared with other doctors. This study aims to explore the impact of this on perceived well-being and mental health. A UK survey of 109 Black psychiatrists asked about racism, othering, microaggressions, bullying and harassment, plus any links to career progression or mental well-being.
Results
Sixty-three survey participants (57.8%) had faced workplace microaggressions, 44 (40.4%) had experienced workplace bullying and 41 (37.6%) had faced workplace harassment. Forty-seven (43.1%) participants reported a detrimental impact on their mental health, with 35 (32.1%) considering quitting and 24 (22%) reporting a poorer work performance.
Clinical implications
These experiences are unacceptable and can be traumatic. The impact of racism and discrimination can also undermine effective service delivery. Barriers to reporting can prolong mistreatment and deter professional aspirations among Black psychiatrists. Collective action is needed to drastically improve the workplace environment, including the widespread institutional adoption of an anti-discriminatory stance.
This article explores the potential of 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy to enhance exposure and response prevention in obsessive–compulsive disorder treatment. We discuss the mechanisms of MDMA, including fear extinction, psychological flexibility, and empathogenic effects that may improve adherence and efficacy, as well as highlighting important safety considerations for further research.
Independence in everyday functioning has been associated with successful aging and declines in functioning may be indicative of pathological cognitive decline. Social determinants of health, like economic status and access to health care, a]lso play a role in everyday functioning. Understanding these factors are of particular importance for older Black adults who have had long-standing disparate access to care, education, and treatments. The current study aimed to evaluate social determinants of health, more specifically social engagement, as moderators of the association between cognition and everyday functioning.
Method:
A sample of 930 older Black adults from Rush University: The Memory and Aging Project, African American Clinical Core, and Minority Adult Research Study were used. Participants completed a battery of neuropsychological testing as well as questionnaires about their everyday functioning and social behaviors. Hierarchical linear regressions were utilized to determine to what extent social factors moderated the relationship between cognition and everyday functioning.
Results:
Late life social activity reduced the effect of global cognition on everyday functioning and was independently associated with everyday functioning. Social network size was associated with increased impairment.
Conclusion:
Results from the current study provide novel information regarding the role of social interaction on cognition in an older Black adult sample. Future interventions may benefit from an emphasis on increasing social engagement.
To examine the clinical and demographic profile of inpatient psychosis admissions in Ireland.
Methods:
Anonymised data was extracted from the Health Research Board (HRB) National Psychiatric Inpatient Reporting System (NPIRS) from 2013–2022. The NPIRS database is maintained by the HRB and records all admissions to inpatient units and hospitals on the register of approved centres under the Mental Health Act 2001. Data was reviewed and analysed using SPSS V26.
Results:
There were 43,963 psychosis admissions over the 10-year period corresponding to 26% of all psychiatric admissions. Males accounted for 58% of psychosis admissions. The median age at first admission was 36 years of age for males and 42 years of age for females. Median length of stay in days was longer for psychosis admissions (median = 20 days IQR = 8–43) than for other mental health disorders (median = 13 days IQR = 4.0–33).
Conclusions:
Understanding the clinical and demographic profile of psychosis related inpatient psychiatric admissions in Ireland provides insights that can inform effective service planning and care delivery. The findings of this study have particular relevance for the implementation and evolution of the Health Service Executive Early Intervention in Psychosis Clinical Programme.
In this study, network analysis was conducted using an exploratory approach on the variables of self-efficacy, academic resilience (AR), cognitive test anxiety and academic achievement (ACH), which are frequently examined in educational research. Data were collected from a total of 828 Turkish secondary school adolescents (51.9% female), using three different self-reported scales for self-efficacy, AR and cognitive test anxiety, as well as an ACH scale. The data were analyzed using regularized partial correlation network analysis (EBICglasso). The results show that academic self-efficacy (ASE) stands out among the variables of the study and that there is a positive relationship between ASE and all other variables except cognitive test anxiety. Besides, increasing students’ ASE and AR levels plays a notable role in increasing their ACH levels. By providing new evidence on the relationships among these variables, this study offers insights that may inspire educational policy interventions.
The choroid plexus produces cerebrospinal fluid, which is crucial for glymphatic system function. Evidence suggests that changes in the volume of the choroid plexus may be associated with glymphatic system function. Therefore, this study aimed to investigate alterations in choroid plexus volume in patients with migraines compared with healthy controls.
Methods:
We enrolled 59 patients with migraines (39 and 20 with episodic and chronic migraines, respectively) and 61 healthy controls. All participants underwent brain magnetic resonance imaging, including three-dimensional T1-weighted imaging. We analyzed and compared choroid plexus volumes between patients with episodic migraines, those with chronic migraines and healthy controls. Additionally, we evaluated the association between choroid plexus volume and the clinical characteristics of patients with migraine.
Results:
The choroid plexus volume in patients with chronic migraines was higher than that in healthy controls (2.018 vs. 1.698%, p = 0.002) and patients with episodic migraines (2.018 vs. 1.680%, p = 0.010). However, no differences were observed in choroid plexus volumes between patients with episodic migraine and healthy controls. Choroid plexus volume was positively correlated with age in patients with migraines (r = 0.301, p = 0.020) and in healthy controls (r = 0.382, p = 0.002).
Conclusion:
We demonstrated significant enlargement of the choroid plexus in patients with chronic migraine compared with healthy controls and those with episodic migraine. This finding suggests that chronic migraine may be associated with glymphatic system dysfunction.
The post-traumatic stress disorder (PTSD) diagnosis encompasses heterogeneous presentations, many of the diagnostic criteria are not trauma-related and almost all PTSD symptoms are common to several psychiatric diagnoses. Flashbacks are the only symptom unique to PSTD. However, the absence of a consensus definition of flashbacks means that this term means different things to different people, causing misunderstanding and miscommunication, and presumably affecting treatment. This Refreshment discusses how flashbacks are defined in DSM-5-TR and ICD-11 (essentially, as reliving/re-experiencing when awake) and briefly describes the dual representation theory's account of flashbacks. In discussing what flashbacks are and are not, it aims to promote improved understanding, assessment and diagnosis of PTSDs.