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This chapter begins with reference to Les Murray’s impressiveness as a reader of his own work. It illustrates the distinctiveness and variety of Murray’s poetry, celebrating its avoidance of predictable forms, topics and ideas. The chapter also observes the difference in the reception of Murray’s work in the global North and the global South. It points to the ways in which Murray’s poems don’t seem to end in conventional or predictable ways, but seem unending. The chapter discusses ‘The Buladelah-Taree Holiday Song Cycle’ as possibly Murray’s greatest poem, for its all-encompassingness. It cites Murray’s anti-modernism and his membership of the diasporic super-group of English-language poets, including Brodsky, Walcott and Heaney. The chapter concludes with a reflection on how the flavour and nature of Murray’s poetry changed in the last twenty years of his life.
Neuropsychiatric symptoms (NPS) are prevalent in dementia and can include depression, anxiety, agitation, aggression, disinhibition, apathy, psychosis, compulsions, eating disorders, and sleep disturbances. These symptoms can occur at different stages of the disease and vary in frequency and severity between different types of dementia. The underlying pathology of each disease can affect different brain structures, leading to overlapping symptoms and syndromes. Treatment options for NPS are limited and often based on trial and error. Nonpharmacological interventions, such as cognitive behavioral therapy and lifestyle modifications, can be effective in some cases. Pharmacological interventions, including antidepressants, antipsychotics, and stimulants, may also be used, but their efficacy is variable, and they can have side effects. Further research is needed to better understand the underlying mechanisms of NPS in dementia and to develop more effective treatment strategies.
Epilepsy affects ~50 million people worldwide and is associated with increased psychiatric comorbidities, including depression, anxiety, psychosis and suicidality. Despite this, current epilepsy management primarily focusses on seizure control, potentially overlooking mental health concerns. This article explores the challenges of integrating psychiatric care into epilepsy treatment and proposes solutions for a more holistic approach. Using a consensus development panel method, a multidisciplinary team of neurologists, psychiatrists and a lived-experience expert identified key challenges to optimising the mental health of people living with epilepsy, such as healthcare system fragmentation, underdiagnosis of mental health conditions and inadequate resources. Among the proposed solutions, the need for routine mental health screening, interdisciplinary support and collaboration, and increased research into the neuropsychiatric aspects of epilepsy were highlighted. A shift from a seizure-centric model to a patient-centred approach is advocated, emphasising biopsychosocial care and improved access to psychiatric services. We also discuss prospective practical strategies to tackle the issues identified, including collaborative care models, structured decision trees and AI-driven screening tools, to enhance diagnosis and treatment. Addressing these challenges through systemic change, research investment and service innovation should significantly improve the care and quality of life for individuals with an epilepsy and co-occurring mental health disorders.
As a result of its complexity, integration of multiple functions and brain regions, and prolonged development, decision-making is particularly vulnerable to deficit or dysfunction. Decision-making deficits have been described in schizophrenia, psychopathy, autism and depression. A commonality in proposed explanations is that of differences in the way networks associated with decision-making are structured. In some cases it may be over-connection, in others under-connection.
With the Depression, the rise of fascism, and ongoing, even more dire civil rights struggles, patriarchal power seemed more than ever a race-work imperative. “Bad girls” offered diversions while Black female civil rights leaders garnered acclaim, but the New Negro hero who led the race forward, was, in the Pittsburgh Courier’s pages, more emphatically and presumptively male.
Sexual minorities have continuously been found to experience poorer mental health compared to the general population, despite promising changes in attitudes and legislation throughout the 21st century in many Western countries. The present study is one of the first to assess group-level changes over time in mental health among sexual minorities compared to their heterosexual counterparts.
Methods
We used four waves of a Finnish population-based survey spanning 16 years (2006–2022) to compare heterosexual and sexual minority adults on depression and anxiety symptoms, alcohol use, and sexual distress.
Results
Sexual minority individuals reported more depression and anxiety symptoms, sexual distress, and alcohol use relative to their heterosexual counterparts at all time points. There were no group differences in the direction or rate of change in group means from 2006 to 2022. Depression and anxiety symptoms showed equally large increases, and alcohol use showed equally large decreases among both heterosexual and sexual minority participants.
Conclusions
Contrary to our expectations based on minority stress theory, differences in mental health between sexual minority and heterosexual individuals persist despite changes in the sociolegal status of sexual minorities during the first two decades of the 21st century. Our findings align with the increasing general trend in anxiety and depression symptoms, which seems to affect the whole population regardless of sexual orientation. We conclude that the effect of legislative societal improvements seems to be small, and the mental health gap between sexual minority and heterosexual adults is likely maintained by factors not included in our study.
Anhedonia and depression symptoms have been linked to potential deficits in reward learning. However, how anhedonia impacts the ability to adjust and learn about the effort required to obtain rewards remains unclear.
Methods
We examined young people (N = 155, 16–25 years) with a range of depression and anhedonia symptoms using a probabilistic instrumental reward and effort learning task. Participants were asked to learn which options to choose to maximize reward or minimize effort for reward. We compared the exerted effort (button pressing speed) for high (puppy images) vs low (dog images) rewards and collected subjective reports of “liking,” “wanting,” and “willingness to exert effort.” Computational models were fit to the learning data and estimated parameter values were correlated with depression and anhedonia symptoms.
Results
As depression symptoms and consummatory anhedonia increased, reward liking decreased, and as anticipatory anhedonia increased, liking, wanting, and willingness to exert effort for reward decreased.
Participants exerted more effort for high rewards than for low rewards, but anticipatory anhedonia diminished this difference.
Higher consummatory anhedonia was associated with poorer reward and effort learning, and with increased temperature parameter values for both learning types, indicating a higher tendency to make exploratory choices. Higher depression symptoms were associated with lower reward learning accuracy.
Conclusion
We provide novel evidence that anhedonia is associated with difficulties in modulating effort as a function of reward value and with the underexploitation of low effort and high reward options. We suggest that addressing these impairments could be a novel target for intervention in anhedonic young people.
Relative to the general population, autistic adults are at elevated risk for depression. Factors related to this risk are poorly understood, yet identifying such factors is important for improving mental health in autistic people. Emotion regulation (ER) challenges may be one such factor. However, few studies have examined ER challenges and depression in autistic adults. We examined ER challenges, depressive symptomatology and their associations in 775 (aged 18–83 years) autistic adults using network analysis, a method that permits identification of key components of ER and depression and their interrelatedness. Three non-regularized weighted undirected networks were estimated: ER challenges, depressive symptomatology, and combined ER-depressive challenges. Community structures revealed in the ER challenges and depressive symptomatology networks align with theoretical/nosological models of ER challenges/depressive symptoms as well as extant research using network analysis to examine these constructs. The combined ER challenges-depressive symptomatology network indicated that ER challenges and depressive symptomatology are interrelated but distinct constructs. These preliminary findings using cross-sectional data provide a first step in understanding associations between a candidate factor in depression vulnerability in autistic adults – ER challenges – and identify important future research directions.
Fine particulate matter (PM2.5) exposure and unfavourable lifestyle are both significant risk factors for mental health disorders, yet their combined effects on adolescent depression and anxiety remain poorly understood. This study aims to determine whether PM2.5 exposure and lifestyle are independently associated with adolescent depression and anxiety, and whether there are joint effects between these factors on mental health outcomes.
Methods
In this cross-sectional study, 19852 participants were analysed. PM2.5 concentrations were obtained from the ChinaHighAirPollutants (CHAP) dataset. Lifestyle factors were assessed through self-reported questionnaires, and a healthy lifestyle score was developed based on eight lifestyle risk factors. Depression and anxiety were assessed using the PHQ-9 and GAD-7 scales. Restricted cubic spline analysed dose–response relationships between PM2.5 exposure and mental health outcomes. The independent and joint effects were assessed using logistic regression models. Both multiplicative and additive interactions (relative excess risk due to interaction, RERI) were examined. Multiple classification approaches were incorporated to ensure robust results.
Results
The study included 19852 participants with a mean age of 15.16 years (SD 1.60), comprising 9886 (49.8%) males and 9966 (50.2%) females. Depression and anxiety were identified in 3845 (19.37%) and 3230 (16.27%) participants, respectively. PM2.5 exposure showed a linear dose-response relationship with depression and anxiety. Joint effects analysis at the 75th percentile of PM2.5 with a lifestyle risk score of 4 revealed the strongest associations, with adjusted odds ratios of 4.49 (95% CI: 3.79–5.33) for depression, 4.01 (95% CI: 3.36–4.78) for anxiety and 4.24 (95% CI: 3.52–5.10) for their comorbidity. Simultaneously, significant additive interactions (RERI > 0) between high levels of PM2.5 exposure and unfavourable lifestyle factors were detected, suggesting synergistic effects on mental health outcomes. Subgroup and sensitivity analyses confirmed the robustness of these findings.
Conclusions
High PM2.5 exposure and unfavourable lifestyle factors demonstrated significant independent and joint effects on depression and anxiety among adolescents. These findings highlight that implementing stringent air pollution control measures, combined with promoting healthy lifestyle practices, may be crucial for protecting adolescent mental health.
This study examined whether childhood adversity, specifically threat-related adversity, was associated with within-person changes in the cortisol awakening response (CAR) and diurnal cortisol slope (DCS), and whether these changes predicted increased depressive symptoms during adolescence. We also explored sex differences. In total, 283 first-year secondary school students in Belgium (M = 12.48 years; SD = 0.39; 42.8% female) participated in six assessments over 2.5 years. Childhood adversity (psychological, physical, and sexual victimization) reported at the first three waves was averaged. CAR and DCS latent residual change scores were derived from salivary cortisol samples collected during waves 1 and 3. Depressive symptom changes were assessed in linear growth curve models using self-reports from waves 3 to 6. The childhood adversity × sex interaction significantly predicted CAR and DCS changes, indicating a blunted CAR across waves for victimized boys, and a blunted DCS for victimized girls. Childhood adversity predicted the depressive symptoms intercept. No other predictors were associated with the depressive symptoms intercept, and none were linked to the depressive symptoms slope. Thus, childhood adversity may be linked to changes in diurnal cortisol patterns that differ by sex. Evidence for diurnal cortisol changes as a pathway to increased depressive symptoms remains inconclusive.
Previous studies have indicated that depression is common among young adults. However, these studies have mainly focused on risk factors rather than protective factors, especially in the context of Vietnam.
Aims
To explore protective factors such as self-compassion and the mediating role of gratitude, crucial for informing targeted interventions aimed at reducing depression in this population.
Method
A cross-sectional study was conducted in September 2023 using convenience sampling of individuals aged 18–25 years (n = 356, mean age 21.23 years) living in Ho Chi Minh City, Vietnam, recruited via online surveys distributed through social networks. The required sample size was determined using Monte Carlo power analysis to ensure adequate statistical power for mediation analysis. Data were analysed to examine the mediating role of gratitude (Gratitude Questionnaire – Six Item Form, GQ-6) in the relationship between self-compassion (Self-Compassion Scale – Short Form, VSCS-SF) and depression (Patient Health Questionnaire-9, PHQ-9).
Results
Self-compassion showed a significant negative association with depression (β = −0.50, t = −11.42, p < 0.001), accounting for 27% of the variance in depression scores. Gratitude significantly mediated this relationship, with an indirect effect of a × b = −0.07 (s.e. = 0.02, 95% CI −0.11 to −0.04]). Specifically, self-compassion positively predicted gratitude (β = 0.34, t = 6.80, p < 0.001), and gratitude, in turn, negatively predicted depression (β = −0.20, t = −4.42, p < 0.001). The direct effect of self-compassion on depression remained significant after controlling for gratitude (β = −0.43, t = −9.52, p < 0.001), indicating a complementary partial mediation. Bootstrap analysis with 5000 resamples further confirmed the robustness of the indirect effect.
Conclusions
The pivotal roles of self-compassion and gratitude in mitigating depression among young adults were explored, informing tailored intervention strategies for mental health practitioners.
To investigate potential contributors to mental fatigue after aneurysmal subarachnoid hemorrhage (aSAH) and angiographically negative subarachnoid hemorrhage (anSAH), with a focus on information processing speed, attentional control, and psychological distress.
Method:
This observational study included 101 patients (70 aSAH, 31 anSAH) and 86 controls. Neuropsychological assessments and questionnaires were conducted five months post-SAH. Mental and physical fatigue were assessed with the Dutch Multifactor Fatigue Scale, information processing speed and attentional control with the Trail Making Test and Vienna Test System Reaction Time and Determination Test, and psychological distress with the Hospital Anxiety and Depression Scale.
Results:
Patients reported significantly higher mental and physical fatigue than controls (p < .001) and information processing speed and attentional control were significantly lower (p < .05), with no differences between aSAH and anSAH groups. Severe mental fatigue was present in 55.7% of patients with aSAH and 61.3% of patients with anSAH, significantly exceeding the prevalence of severe physical fatigue (p < .05). Higher mental fatigue correlated with worse attentional control in aSAH and with lower information processing speed in anSAH. Both mental and physical fatigue correlated with psychological distress, particularly after anSAH.
Conclusions:
The factors related to mental fatigue appear to differ based on the type of SAH, potentially involving problems in information processing speed and attentional control, psychological distress, or both. This study emphasizes the need for individualized rehabilitation strategies addressing both cognitive and psychological factors in managing mental fatigue after SAH.
This study was conducted to examine the relationship between cancer patients’ spiritual needs and their quality of life and depression levels.
Methods
This cross-sectional, exploratory study was conducted between March 2023 and November 2024. The study population consisted of cancer patients hospitalized in medical oncology departments at a university hospital in eastern Turkey. The sample consisted of 250 patients, determined by power analysis. To collect data, the “Demographic Information Form,” “Spiritual Needs Assessment Scale,” “EORTC QLQ-C30 Version 3.0 Quality of Life Scale,” and “Beck Depression Scale” were used to evaluate the patients’ sociodemographic characteristics and disease process.
Results
There was a weak, negative, statistically significant relationship between patients’ spiritual needs and the subdimensions of the quality of life scale, specifically the general perceived health status (r = −0.297, p < 0.001), physical (r = −0.446, p < 0.001), role (r = −0.423, p < 0.001), emotional (r = −0.472, p < 0.001), cognitive (r = −0.458, p < 0.001) and social (r = −0.443, p < 0.001) functions, and finally, a weak positive correlation was found between the symptoms experienced (r = 0.376, p < 0.001) and depression levels. Additionally, a weak positive correlation between spiritual needs and depression level (r = 0.374, p < 0.001) was identified. Functional areas, depression, education level, diagnosis duration, and symptoms were identified as variables predicting spiritual needs.
Significance of results
In conclusion, it was determined that as the spiritual needs of cancer patients increased, their quality of life decreased and the severity of depression increased.
Growing evidence has linked both the onset and symptoms of various mental disorders to lifestyle factors such as diet, exercise and sleep. The link between diet and mental health in particular in depressive disorders has gained interest in recent years. Previous reviews assessing the link between the Mediterranean diet (MedDiet) and mental health predominantly focused on depression, whilst others failed to integrate a summary of possible underlying mechanisms related to a link between MedDiet and mental health to complement their findings. In the present review, we provide a comprehensive synthesis of evidence on the MedDiet and diverse mental health outcomes complemented by narration of potential mechanisms involved. A literature search was conducted across MEDLINE, PsycINFO, Scopus, Cochrane library, Google scholar, CINAHL and Embase database. A total of 10,249 articles were found through the primary literature search and 104 articles (88 observational and 16 interventional studies) were eligible for inclusion. The Mediterranean diet (MedDiet) has been associated with favourable mental health outcomes in adult populations, including reduced depressive and anxiety symptoms, lower perceived stress, and improved quality of life and overall well-being, both in healthy individuals and those with comorbidities, across diverse geographical settings. Mechanisms involved include anti-oxidant, anti-inflammatory potential of MedDiet and its effect on gut microbiota. Further research is warranted to rigorously establish causal inferences and to guide the optimal incorporation of Mediterranean diet principles into comprehensive prevention and treatment strategies aimed at improving mental health outcomes.
Nutraceuticals are increasingly of interest in nutritional psychiatry, where creatine has been investigated in several randomised trials for its effects on depressive symptoms. However, these findings have not yet been systematically synthesised. We conducted a systematic review to assess the effects of creatine supplementation on symptoms of depression. Four databases were searched up to February 2025 for trials comparing creatine with placebo in individuals with or without depression. Study selection, data extraction and risk of bias assessment (RoB 2) were conducted independently, and certainty of evidence was evaluated using GRADE. Random-effects meta-analyses with Hartung-Knapp-Sidik-Jonkman adjustment including 11 trials (1,093 participants) found a standardised mean difference (SMD) of -0.34 (95% CI, -0.70 to -0.00; GRADE: very low quality of evidence), equivalent to 2.2 points on the 17-item Hamilton Depression Rating Scale, below the minimal important difference of 3.0 points. Confidence intervals include non-clinically important effects and heterogeneity was substantial (I2 = 71.3%). While effects appeared larger in clinically-depressed populations, subgroup analyses and trim-and-fill adjustments indicated substantial bias favouring creatine. Results for secondary endpoints were significant for remission (3 trials, OR 3.60, 95% CI 1.76 to 7.56), but not for treatment response (2 trials, OR 0.72, 95% CI 0.28 to 1.88). Our findings suggest creatine may offer a small-to-moderate benefit for individuals with depression, but average effects were not clinically important and the true effect may be trivial or null. The evidence on which these results are based is very uncertain. Larger, more rigorous randomised trials are required to draw definitive conclusions.
Adolescence is a critical period for brain maturation, influenced by stress and hormonal changes. Chronic stress can lead to increased allostatic load (AL), a cumulative measure of multisystem dysregulation, and insulin resistance (IR), both of which are linked to mental health disorders. We hypothesized that heightened AL and IR during adolescence (age 17) would predict the emergence of mood and psychotic symptoms in young adults.
Methods
This study used data from the Avon Longitudinal Study of Parents and Children, a population cohort from Bristol, United Kingdom.
Results
Our results showed that elevated AL at age 17 was significantly associated with the development of mood disorder symptoms (MDS) and psychotic disorder symptoms (PDS) and the co-occurrence of mood and psychotic disorder symptoms (MPDS) at age 24 (p < 0.001). Mean AL increased progressively across these symptom groups, indicating a dose–response relationship between physiological dysregulation and mental health burden (MDS = 3.67, PDS = 3.89, and MPDS = 4.03). We also observed that IR was significantly elevated in the MDS, PDS, and MPDS groups compared to healthy controls (HCs). IR was most prevalent in the PDS group, suggesting a possible association between metabolic dysfunction and psychosis risk.
Conclusion
This study demonstrated that multisystem dysregulation in late adolescence precedes the onset of mood and psychotic symptoms in early adulthood. These results support the use of AL and metabolic markers as early indicators of psychiatric vulnerability and highlight the potential for early intervention targeting systemic dysregulation to prevent the onset of mental health disorders.
Suicide and self-harm in people with depression are major public health concerns; electroconvulsive therapy (ECT) is a treatment recommended in UK clinical guidelines for severe mood disorders. We aimed to investigate published literature on the effect of ECT on the incidence of suicide, self-harm, and the recorded presence of suicidal thoughts (suicide-related outcomes). We hypothesized that ECT would be associated with a reduced incidence of suicide-related outcomes and all-cause mortality. We reviewed systematically all eligible studies as specified in our protocol (PROSPERO 293393). We included studies that compared ECT against a comparator treatment, and which included suicide-related outcomes or mortality. We searched Medline, EMBASE, and PsycINFO on January 24, 2022, updated to February 12, 2025. We identified 12,313 records and, after deduplication, screened 8,281 records on title and abstract and 212 on full-text, identifying 17 eligible studies. Studies showed significant heterogeneity in methodology, outcomes, time points chosen, and study populations. Three included studies investigated change in the suicidality domain on psychological rating scales: two showed a reduction in the ECT group; the other was underpowered for this outcome. Meta-analysis of suicide outcomes showed significant statistical heterogeneity and did not detect differences in a consistent direction. Meta-analysis of other mortality outcomes showed reductions in the risk of all-cause mortality (log relative risk [logRR]: −0.29; 95% CI: −0.53, −0.05) and non-suicide mortality (logRR: −0.21; 95% CI: −0.35, −0.07). Further high-quality studies are needed, which should seek to minimize biases (particularly confounding by indication) and report a wider range of suicide-related outcomes.
Mood disorders are a leading cause of illness and disability in children and adolescents. Effective treatment is available, and early identification and intervention improves prognosis. This chapter provides a comprehensive summary of the epidemiology, aetiology and clinical features of depression and bipolar disorder in young people. We provide evidence-based recommendations for the prevention and treatment of mood disorders in children and adolescents, including psychological and pharmacological interventions, and novel and emerging treatment options. We present research on predictors of treatment outcome and prognosis of mood disorders in young people, and highlight areas for further research. This chapter will help clinicians identify and treat young people with mood disorders in a range of clinical settings.