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It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.
To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.
Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment–covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.
IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = −0.48 to −0.27). Effects could not be ascertained up to 24 months (s.m.d. = −0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27–2.79), reliable improvement (relative risk = 1.38–3.17), deterioration (relative risk = 0.67–0.54) and close-to-symptom-free status (relative risk = 1.41–2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = −0.33 for PHQ-9 = 5).
Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.
Youth suicide rates have increased markedly in some countries. This study aimed to estimate the population-attributable risk of psychiatric disorders associated with suicide among Taiwanese youth aged 10–24 years.
Data were obtained from the National Death Registry and National Health Insurance (NHI) claims database between 2007 and 2019. Youth who died by suicide were included, and comparisons, 1:10 matched by age and sex, were randomly selected from the Registry for NHI beneficiaries. We used multivariable logistic regression to estimate suicide odds ratios for psychiatric disorders. The population-attributable fractions (PAF) were calculated for each psychiatric disorder.
A total of 2345 youth suicide and 23 450 comparisons were included. Overall, 44.8% of suicides had a psychiatric disorder, while only 7.9% of the comparisons had a psychiatric disorder. The combined PAF for all psychiatric disorders was 55.9%. The top three psychiatric conditions of the largest PAFs were major depressive disorder, dysthymia, and sleep disorder. In the analysis stratified by sex, the combined PAF was 45.5% for males and 69.2% for females. The PAF among young adults aged 20–24 years (57.0%) was higher than among adolescents aged 10–19 years (48.0%).
Our findings of high PAF from major depressive disorder, dysthymia, and sleep disorder to youth suicides suggest that youth suicide prevention that focuses on detecting and treating mental illness may usefully target these disorders.
During the first wave of the severe acute respiratory syndrome-coronavirus-2 epidemic in the Netherlands, notifications consisted mostly of patients with relatively severe disease. To enable real-time monitoring of the incidence of mild coronavirus disease 2019 (COVID-19) – for which medical consultation might not be required – the Infectieradar web-based syndromic surveillance system was launched in mid-March 2020. Our aim was to quantify associations between Infectieradar participant characteristics and the incidence of self-reported COVID-19-like illness. Recruitment for this cohort study was via a web announcement. After registering, participants completed weekly questionnaires, reporting the occurrence of a set of symptoms. The incidence rate of COVID-19-like illness was estimated and multivariable Poisson regression used to estimate the relative risks associated with sociodemographic variables, lifestyle factors and pre-existing medical conditions. Between 17 March and 24 May 2020, 25 663 active participants were identified, who reported 7060 episodes of COVID-19-like illness over 131 404 person-weeks of follow-up. The incidence rate declined over the analysis period, consistent with the decline in notified cases. Male sex, age 65+ years and higher education were associated with a significantly lower COVID-19-like illness incidence rate (adjusted rate ratios (RRs) of 0.80 (95% CI 0.76–0.84), 0.77 (0.70–0.85), 0.84 (0.80–0.88), respectively) and the baseline characteristics ever-smoker, asthma, allergies, diabetes, chronic lung disease, cardiovascular disease and children in the household were associated with a higher incidence (RRs of 1.11 (1.04–1.19) to 1.69 (1.50–1.90)). Web-based syndromic surveillance has proven useful for monitoring the temporal trends in, and risk factors associated with, the incidence of mild disease. Increased relative risks observed for several patient factors could reflect a combination of exposure risk, susceptibility to infection and propensity to report symptoms.
Introduction
The emergence and spread of savannas in Africa during the past five million years is often cited as a major factor in hominid evolution. Tropical savannas are different from forests in having less rainfall, which is strongly seasonal and often very unpredictable, even within seasons (Bourliere & Hadley 1983; Solbrig 1996). Human ancestors are thought to have moved into savannas as a response to cooling and drying climates, and the exigencies of the savanna environment – including the marked seasonal changes in plant food availability – are often cited as key selective pressures shaping the hominid lineage (see reviews and references in Foley [1987, 1993], Potts [1998a, 1998b], Klein [1999], and Chapters 4, 5, and 17). This scenario invites a careful examination of responses to seasonality in extant savanna-dwelling primates.
Like most vertebrates, the large majority of primate species exhibit reproductive seasonality that reflects the seasonality of their habitats (see review in Chapter 11). Indeed, among savanna-dwelling primates, there are only two exceptions to the rule of seasonal reproduction: humans and baboons (genus Papio). This shared characteristic – the ability to reproduce throughout the year in seasonal environments – may be related to the extraordinary success of these two genera. While only humans (and their commensals) have spread across the globe, baboons have achieved a nearly continental distribution in Africa.
The availability of a population of mostly known-age African elephants Loxodonta africana from Amboseli National Park, Kenya, provided a unique opportunity to assess the use of dung bolus diameter for estimating age. A predictive equation for estimating dung bolus diameters from elephants of known age was derived and was found to follow the typical growth pattern exhibited by changes in shoulder height and foot length. The relationship between measurements of dung bolus and age was particularly strong when growth rates were high (age 0–25 years). The dung bolus growth curve from Amboseli elephants was similar to that derived from another wild population of African elephants, suggesting that dung bolus diameter can be used to assess age structure in areas where it is impossible to construct independent prediction curves of age and dung bolus.
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