Evidence from observational studies and clinical experiments suggests a close association between plasma lipidome and psychiatric disorders. However, the causal relationship between plasma lipidome and psychiatric disorders remains insufficiently determined. Plasma lipidome are relatively easy to measure and regulate clinically, and they play a crucial role in neuronal signal transduction, making them a focus of interest as potential therapeutic targets for psychiatric disorders.

In this study, we utilized the latest Finnish population-based genome-wide association study (GWAS) data on 179 lipid species. We downloaded data on five psychiatric disorders from the IEU database, including schizophrenia, bipolar disorder, depression, autism from the PGC consortium, and anxiety disorder from the Neale lab. Using two-sample bidirectional Mendelian randomization (MR) analysis, we assessed the relationship between these 179 lipid species and the risk of the five psychiatric disorders. To validate the assumptions of Mendelian randomization, we conducted tests for horizontal pleiotropy and heterogeneity.

After applying FDR correction to assess the relationship between 179 lipid species traits and the risk of five psychiatric disorders, our analysis provided evidence of a causal relationship specifically between genetic susceptibility in the plasma lipidome and bipolar disorder. This relationship notably involves eight phosphatidylcholines (PCs) and two sterols, with PCs displaying a dual and complex role in the disorder. Reverse Mendelian randomization (MR) analysis did not reveal a significant causal impact of psychiatric disorders on the plasma lipidome.

Despite using two-sample bidirectional Mendelian randomization analysis, the complex biological pathways and potential confounding factors may still affect the accuracy of the causal relationships. The impact of genetic variations on the lipidome and psychiatric disorders may involve multiple mechanisms, which cannot be fully elucidated in this study.

This study identified a causal relationship between genetic susceptibility in plasma lipidome and bipolar disorder, indicating that plasma lipidome may influence the risk of psychiatric disorders and providing direction for exploring them as potential intervention targets. The findings not only deepen our understanding of the etiology of psychiatric disorders but also provide a critical theoretical foundation for future clinical interventions and prevention strategies, potentially contributing to the development of novel therapeutic approaches.

There is growing evidence that tobacco smoking causes depression, but it is unclear which constituents of tobacco smoke (e.g. nicotine, carbon monoxide) may be responsible. We used Mendelian randomisation (MR) to measure the independent effect of nicotine on depression, by adjusting the effect of circulating nicotine exposure [via nicotine metabolite ratio (NMR)] for the overall effect of smoking heaviness [via cigarettes per day (CPD)] to account for the non-nicotine constituents of tobacco smoke.

Univariable MR and multivariable MR (MVMR) were used to measure the total and independent effects of genetic liability to NMR and CPD on major depressive disorder (MDD). Our primary method was inverse variance weighted (IVW) regression, with other methods as sensitivity analyses.

For the exposures, we used genome-wide association study (GWAS) summary statistics among European ancestry individuals for CPD (n = 143 210) and NMR (n = 5185). For the outcome, a GWAS of MDD stratified by smoking status was conducted using individual-level data from UK Biobank (n = 35 871-194 881).

Genetic variants associated with NMR (n = 6) and CPD (n = 53).

Univariable MR-IVW indicated a causal effect of CPD on MDD [odds ratio (OR) = 1.13, 95% confidence interval (CI) = 1.04-1.23, P = 0.003] but no clear evidence for an effect of NMR on MDD (OR = 0.98, 95% CI = 0.97-1.00, P = 0.134). MVMR indicated a causal effect of CPD on MDD when accounting for NMR (IVW: OR = 1.19, 95% CI = 1.03-1.37, P = 0.017; Egger: OR = 1.13, 95% CI = 0.89-1.43, P = 0.300) and weak evidence of a small effect of NMR on MDD when accounting for CPD (IVW: OR = 0.98, 95% CI = 0.96-1.00, P = 0.057; Egger: OR = 0.98, 95% CI = 0.96-1.00, P = 0.038).

The role of nicotine exposure in risk of depression cannot be entirely dismissed. However, the causal effect of tobacco smoking increasing depression risk appears to be largely independent of circulating nicotine exposure, which implies the role of alternative causal pathways.

Depression can lead to reduced physical activity, reduced quality of life, and self-sadness or even suicide, resulting in a huge burden of disease and financial loss.

To study the associated factors of depressive symptoms in adult couples over the age of 50.

The study collected data from the Survey of Health, Ageing and Retirement in Europe (SHARE) in 2013, 2015, 2017 and 2019/2020, and extracted couples over the age of 50. Logistic regression was used to analyze the associated factors of depressive symptoms in couples.

Binary Logistic regression showed the husbands' age (OR: 1.41, 95%CI: (1.11, 1.80)) and social activities (OR: 0.60, 95%CI: (0.45, 0.79)) were associated with depressive symptoms in wives. Wives' education level (OR: 0.62, 95%CI: (0.46, 0.85)), life satisfaction (OR: 0.57, 95%CI: (0.39, 0.84)) and number of chronic diseases (OR: 1.38, 95%CI: (1.10, 1.73)) were associated with depressive symptoms in husbands. Multinomial logistic regression found that couple's age "≥ 65 years" (OR: 1.45, 95%CI: (1.11, 1.90)), "low" education level (OR: 1.64, 95%CI: (1.07, 2.52)), self-rated health "good" (OR: 0.48, 95%CI: (0.29, 0.80)), life satisfaction "very satisfied" (OR: 0.48, 95%CI: (0.31, 0.75)) and "having" social activities (OR: 0.34, 95%CI: (0.19, 0.60)) were associated with the risk of depressive symptoms in couples. Having "≥ 2" chronic diseases (OR: 1.94, 95%CI: (1.22, 3.10)) was also associated with depressive symptoms in couples.

Age, education level, social activities, life satisfaction, self-rated health and number of chronic diseases were associated with depressive symptoms in both individuals and couples.

Congenital adrenal hyperplasia (CAH), predominantly caused by 21-hydroxylase deficiency (21-OHD) due to CYP21A2 mutations, disrupts cortisol synthesis and adrenal androgen homeostasis. Observational studies suggest CAH patients exhibit elevated risks of neuropsychiatric disorders, but causal mechanisms remain unestablished. We hypothesized that reduced CYP21A2 expression, reflecting CAH, differentially influences psychiatric outcomes via tissue-specific pathways.

Using two-sample Mendelian randomization (MR), we analyzed tissue-specific CYP21A2 expression quantitative trait loci (eQTLs) from adrenal (GTEx v8) and whole blood (GTEx v8 and eQTLGen meta-analysis). Genetic instruments were validated via positive control MR with classical CAH biomarkers. Associations with ten neuropsychiatric disorders were assessed using inverse-variance-weighted MR, supplemented by sensitivity analyses (LCV, SMR) and LD score regression.

Adrenal-derived CYP21A2 downregulation reduced Alzheimer's disease (AD) risk (discovery: OR = 1.245, replication: OR = 1.100) but increased autism spectrum disorder (ASD) susceptibility (discovery: OR = 0.766, replication: OR = 0.659). Conversely, blood-derived eQTLs showed opposing effects that decreased ASD risk (discovery: OR = 1.072, replication: OR = 1.071) and elevated AD risk (OR = 0.968 for both discovery and replication). Both tissues linked reduced CYP21A2 expression to elevated bioavailable testosterone (adrenal: OR = 0.972, p = 0.04; blood: OR = 0.983, p = 0.01), consistent with CAH pathophysiology.

Our research indicates that adrenal-driven pathways of CYP21A2 deficiency may reduce the risk of AD while increasing the ASD risk. These findings underscore the pivotal role of endocrine mechanisms in the pathogenesis of neuropsychiatric disorders and advocate for personalized CAH management integrating mental health monitoring.

Mental health disorders represent a substantial global health concern, impacting millions and placing a significant burden on public health systems. Natural Language Processing (NLP) has emerged as a promising tool for analyzing large textual datasets to identify and predict mental health challenges. The aim of this scoping review is to identify the Arabic NLP techniques employed in mental health research, the specific mental health conditions addressed, and the effectiveness of these techniques in detecting and predicting such conditions. This scoping review was conducted according to the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) framework. Studies were included if they focused on the application of NLP techniques, addressed mental health issues (e.g., depression, anxiety, suicidal ideation) within Arabic text data, were published in peer-reviewed journals or conference proceedings, and were written in English or Arabic. The relevant literature was identified through a systematic search of four databases: PubMed, ScienceDirect, IEEE Xplore, and Google Scholar. The results of the included studies revealed a variety of NLP techniques used to address specific mental health issues among Arabic-speaking populations. Commonly utilized techniques included Support Vector Machine (SVM), Random Forest (RF), Decision Tree (DT), Recurrent Neural Network (RNN), and advanced transformer-based models such as AraBERT and MARBERT. The studies predominantly focused on detecting and predicting symptoms of depression and suicidality from Arabic social media data. The effectiveness of these techniques varied, with trans-former-based models like AraBERT and MARBERT demonstrating superior performance, achieving accuracy rates of up to 99.3% and 98.3%, respectively. Traditional machine learning models and RNNs also showed promise but generally lagged in accuracy and depth of insight compared to transformer models. This scoping review highlights the significant potential of NLP techniques, particularly advanced transformer-based models, in addressing mental health issues among Arabic-speaking populations. Ongoing research is essential to keep pace with the rapidly evolving field and to validate current findings.

This study sought to deliver a prevalence, incidence, and Disability-Adjusted Life Years (DALYs) of bipolar disorder in Iran, covering both national and subnational scales. The results were broken down by age group and sex, alongside an analysis of trends in bipolar disorder from 1990 to 2021. The estimates gathered were further compared to global averages to offer deeper insights into the prevalence and impact of bipolar disorder in Iran.

This study analyzed data from the Global Burden of Disease 2021 framework to assess various health metrics. Key indicators such as prevalence, incidence, and Disability-Adjusted Life Years (DALYs) were examined using all-age count estimates and age-standardized rates per 100,000 individuals. The analysis spanned the years 1990 to 2021, with results categorized by sex, age group, and geographic location. Furthermore, percentage changes over this period were calculated. To enhance the reliability of the findings, all reported estimates included a 95 % uncertainty interval.

In 1990, the age-standardized prevalence rate of bipolar disorder in Iran was 770.09 per 100,000 individuals [95 % UI: 657 to 902], and by 2021, it slightly increased to 780 per 100,000 [95 % UI: 667 to 915]. The percentage change over the period from 1990 to 2021 was 0.01 %. In 2021, the total number of bipolar disorder cases in Iran was reported at 724,891, with a 95 % uncertainty interval ranging from 614,626 to 848,263. Among these cases, 376,813 were observed in females and 348,077 in males. Notably, individuals aged 10 to 24 accounted for 127,388 of the overall cases, making this age group the most affected. The age-standardized incidence rate (per 100,000) of bipolar disorder was estimated to be 52 [95 % UI: 44 to 61] in 1990 and 53 [95 % UI: 45 to 62] in 2021, reflecting a minimal change of 0.01 % over this period. Similarly, the age-standardized disability-adjusted life years (DALYs) rate (per 100,000) for bipolar disorder was recorded at 164 [95 % UI: 107 to 240] in 1990 and 166 [95 % UI: 109 to 241] in 2021, with an equivalent negligible change of 0.01 % from 1990 to 2021.

In Iran, the burden of bipolar disorder has been found to exceed global averages, and due to demographic changes, young population, regional stressors this burden has grown significantly over the past three decades. Therefore, it remains crucial to focus increasing access to mental health care by increasing mental health care infrastructure in the country, especially in densely populated areas.

Accurate baseline information about the proportion of people with mental disorders who receive effective treatment is required to assess the success of treatment quality improvement initiatives.

To examine the proportion of mental and substance use disorders receiving guideline-consistent treatment in multiple countries.

In this cross-sectional study, World Mental Health (WMH) surveys were administered to representative adult (aged 18 years and older) household samples in 21 countries. Data were collected between 2001 and 2019 and analyzed between February and July 2024. Twelve-month prevalence and treatment of 9 DSM-IV anxiety, mood, and substance use disorders were assessed with the Composite International Diagnostic Interview. Effective treatment and its components were estimated with cross-tabulations. Multilevel regression models were used to examine predictors.

The main outcome was proportion of effective treatment received, defined at the disorder level using information about disorder severity and published treatment guidelines regarding adequate medication type, control, and adherence and adequate psychotherapy frequency. Intermediate outcomes included perceived need for treatment, treatment contact separately in the presence and absence of perceived need, and minimally adequate treatment given contact. Individual-level predictors (multivariable disorder profile, sex, age, education, family income, marital status, employment status, and health insurance) and country-level predictors (treatment resources, health care spending, human development indicators, stigma, and discrimination) were traced through intervening outcomes.

Among the 56 927 respondents (69.3% weighted average response rate), 32 829 (57.7%) were female; the median (IQR) age was 43 (31-57) years. The proportion of 12-month person-disorders receiving effective treatment was 6.9% (SE, 0.3). Low perceived need (46.5%; SE, 0.6), low treatment contact given perceived need (34.1%; SE, 1.0), and low effective treatment given minimally adequate treatment (47.0%; SE, 1.7) were the major barriers, but with substantial variation across disorders. Country-level general medical treatment resources were more important than mental health treatment resources. Other than for the multivariable disorder profile, which was associated with all intermediate outcomes, significant predictors were largely mediated by treatment contact.

In addition to the gaps in treatment quality, these results highlight the importance of increasing perceived need, the largest barrier to effective treatment; the importance of training primary care treatment clinicians in recognition and treatment of mental disorders; the need to improve the continuum of care, especially from minimally adequate to effective treatment; and the importance of bridging the effective treatment gap for men and people with lower education.

We explored how adherence to the Mediterranean diet (MedDiet) and leisure-time physical activity (LTPA) impact psychoactive medication use in older adults.

We assessed the cumulative MedDiet adherence and LTPA's impact on mental health medication initiation in older individuals at high risk of chronic disease. Associations between the cumulative average of MedDiet adherence (per one-point increase in the adherence score) and LTPA (per increase in 20 metabolic equivalents of task-minute/day [METs-min/day]) with drug initiation were assessed by multivariable Cox regressions. We explored non-linear exposure-outcome associations using smoothed cubic splines and the multiplicative interaction between MedDiet and LTPA.

A total of 5940-6896 participants (mean age 67, 58% women) over 4.2-4.7 years, each point increase in MedDiet adherence decreased the initiation of antidepressants by 23-28% (HR 0.72, 95% CI 0.67-0.77), anxiolytics (HR 0.75, 0.70-0.81), antipsychotics (HR 0.77, 0.65-0.91), and antiseizures (HR 0.77, 0.69-0.85). Associations for anxiolytics and antiseizures were strong at low MedDiet adherence levels. Relationships between LTPA and initiation of antidepressants and anxiolytics were linear in the lowest LTPA values (0-150 METs-min/day); every 20 METs-min/day increases were associated with 20% lower risk of initiating antidepressants (HR 0.80, 0.75-0.86) and 15% less risk in anxiolytics (HR 0.85, 0.79-0.90). Association with antiseizures was linear (+20 METs-min/day: HR 0.96, 0.94-0.99), and no associations were found for antipsychotics. High MedDiet adherence (≥10) and LTPA (≥150 METs-min/day) reduced psychoactive drug initiation by 42%-59%. Combination was additive for antidepressants, antipsychotics and antiseizures and synergistic for anxiolytics.

MedDiet and LTPA adherence reduced psychoactive drugs initiation in older adults.

Type 2 diabetes mellitus (T2DM) is increasingly affecting people aged 15-34, posing a serious public health challenge due to its faster progression and higher complication risks. This study examines the global, regional, and national burden of early-onset T2DM from 1990 to 2021, emphasizing trends and disparities across different sociodemographic contexts.

Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we analyzed incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) in people aged 15-34. Stratifications included age, sex, and the Socio-Demographic Index (SDI). Joinpoint regression significant temporal shifts, and decomposition analysis attributed changes in T2DM burden to factors such as prevalence, population growth, aging, and case fatality rates. Inequality was assessed with the Slope Index of Inequality and Concentration Index.

From 1990 to 2021, early-onset T2DM incidence and prevalence rose significantly worldwide, especially in high-SDI regions. Although global mortality and DALYs appeared relatively stable, low-SDI regions showed worrisome increases. Rising T2DM prevalence was the principal driver of mortality and DALYs, notably in low- and middle-SDI regions. Inequality analyses indicated widening disparities, with higher incidence and prevalence in high-SDI countries and more severe outcomes in low-SDI countries.

The global burden of early-onset T2DM among youths is escalating, with significant disparities across different sociodemographic levels. The findings underscore the urgent need for targeted public health interventions. Future research should focus on the underlying factors driving these trends and explore strategies for effective prevention and management of early-onset T2DM.

Psilocybin shows significant therapeutic potential for psilocybin-assisted psychotherapy in addressing various psychiatric conditions. The biosynthetic approach promises rapid and efficient production of psilocybin. Understanding the enzymes that contribute to the biosynthesis of psilocybin can enhance its production process. In this study, we elucidate the crystal structures of L-tryptophan-specific decarboxylase PsiD in both its apo and tryptamine-bound states, the 4-hydroxytryptamine kinase PsiK bound to its substrate, and several forms of the methyltransferase PsiM in either apo or substrate-bound forms derived from the psychedelic mushroom. Structure-based evaluations reveal the mechanisms of self-cleavage and self-inhibition in PsiD, along with the sequential catalytic steps from 4-hydroxytryptamine to the final compound, psilocybin. Additionally, we showcase the antidepressant properties of biosynthetic intermediates of psilocybin on female mice experiencing depression-like behaviors induced by sub-chronic variable stress. Our studies establish a structural basis for the future biosynthetic production of psilocybin using these enzymes and emphasize the clinical potential of norbaeocystin.

Large language models (LLMs) are increasingly used in mental health, showing promise in assessing disorders. However, concerns exist regarding their accuracy, reliability, and fairness. Societal biases and underrepresentation of certain populations may impact LLMs. Because LLMs are already used for clinical practice, including decision support, it is important to investigate potential biases to ensure a responsible use of LLMs. Anorexia nervosa (AN) and bulimia nervosa (BN) show a lifetime prevalence of 1%-2%, affecting more women than men. Among men, homosexual men face a higher risk of eating disorders (EDs) than heterosexual men. However, men are underrepresented in ED research, and studies on gender, sexual orientation, and their impact on AN and BN prevalence, symptoms, and treatment outcomes remain limited.

We aimed to estimate the presence and size of bias related to gender and sexual orientation produced by a common LLM as well as a smaller LLM specifically trained for mental health analyses, exemplified in the context of ED symptomatology and health-related quality of life (HRQoL) of patients with AN or BN.

We extracted 30 case vignettes (22 AN and 8 BN) from scientific papers. We adapted each vignette to create 4 versions, describing a female versus male patient living with their female versus male partner (2 × 2 design), yielding 120 vignettes. We then fed each vignette into ChatGPT-4 and to "MentaLLaMA" based on the Large Language Model Meta AI (LLaMA) architecture thrice with the instruction to evaluate them by providing responses to 2 psychometric instruments, the RAND-36 questionnaire assessing HRQoL and the eating disorder examination questionnaire. With the resulting LLM-generated scores, we calculated multilevel models with a random intercept for gender and sexual orientation (accounting for within-vignette variance), nested in vignettes (accounting for between-vignette variance).

In ChatGPT-4, the multilevel model with 360 observations indicated a significant association with gender for the RAND-36 mental composite summary (conditional means: 12.8 for male and 15.1 for female cases; 95% CI of the effect -6.15 to -0.35; P=.04) but neither with sexual orientation (P=.71) nor with an interaction effect (P=.37). We found no indications for main effects of gender (conditional means: 5.65 for male and 5.61 for female cases; 95% CI -0.10 to 0.14; P=.88), sexual orientation (conditional means: 5.63 for heterosexual and 5.62 for homosexual cases; 95% CI -0.14 to 0.09; P=.67), or for an interaction effect (P=.61, 95% CI -0.11 to 0.19) for the eating disorder examination questionnaire overall score (conditional means 5.59-5.65 95% CIs 5.45 to 5.7). MentaLLaMA did not yield reliable results.

LLM-generated mental HRQoL estimates for AN and BN case vignettes may be biased by gender, with male cases scoring lower despite no real-world evidence supporting this pattern. This highlights the risk of bias in generative artificial intelligence in the field of mental health. Understanding and mitigating biases related to gender and other factors, such as ethnicity, and socioeconomic status are crucial for responsible use in diagnostics and treatment recommendations.

Mental health conditions represent a significant global public health issue, affecting millions of people worldwide. To meet the increasing demands on mental health services in Switzerland, the development of a competence centre for mental health can provide the necessary structures and resources for a comprehensive and innovative approach to mental health care. This paper outlines the participatory process used in the development and implementation of a competence centre for mental health in Eastern Switzerland for the promotion of positive mental health.

The process was conducted using a participatory design and a co-creation approach. This involved the collaborative engagement of all relevant mental health stakeholders, working together as equals throughout all stages of the process. A key stakeholder group was established with N = 10 individuals, including persons with lived experience, (mental) health care professionals, researchers, educators, and decision-makers at institutional and regional levels. Between March 2020 and June 2021, four conceptualisation meetings were conducted using participatory methods and tools to facilitate collaborative, reflexive, and innovative engagement.

The participatory process resulted in a framework for a competence centre for mental health, informed by the needs and experiences of key mental health stakeholders. Three main areas were identified in which the competence centre could effect change for the promotion of positive mental health and the improvement of mental health services in Eastern Switzerland: (1) Academic teaching of future health professionals; (2) further education for current health professionals; and (3) a research agenda that provides a scientific contribution to the improved mental health care of the population.

The co-creation process resulted in an inclusive, practice-oriented framework for a competence centre for mental health at the intersection of research, education, and practice. By continuing to adopt a participatory approach, the competence centre can provide evidence-based training for health professionals, foster innovative and needs-based models of care, advocate for policy change, and promote best practices for the promotion and recovery of mental health. The successful development and implementation of the competence centre using a co-creation process provides encouraging support for the use of participatory approaches in the field of mental health.

Psychiatric nurses are instrumental in enhancing accessibility to care and addressing the mental health care needs of individuals. However, the field faces a significant shortage of nurses coupled with a high turnover rate. Developing policies to attract or retain psychiatric nurses is imperative, but little is known about the preferences of psychiatric nurses regarding the economic and non-economic attributes of work. Here, a discrete choice experiment (DCE) was used to explore psychiatric nurses' job preferences.

A survey instrument was developed adhering to the design-principles of DCE. Psychiatric nurses were surveyed nationwide based on convenience sampling. A mixed logit model was used to estimate the psychiatric nurses' preferences. Willingness to pay was calculated and the change in the probability of psychiatric nurses accepting a job when attribute levels changed was simulated.

The attribute level most valued by respondents was 'violent coping strategies-impeccable' (coefficient = 1.002, p < 0.01) and willingness to pay for it is 4476.5323 CNY. The most important attribute level for psychiatric nurses living in cities was 'respect-high' (coefficient = 0.505, p < 0.01), and for psychiatric nurses living in town is 'study assistance for children-thorough' (coefficient = 0.620, p < 0.01). Notably, psychiatric nurses with less than ten years of work experience exhibited significant preferences for 'opportunity to upgrade-sufficient' (coefficient = 0.417, p < 0.01), whereas this preference was insignificant among those with ten years or more of experience (p > 0.05). Changing 'violence coping strategies' from 'without' to 'impeccable' increased the probability of psychiatric nurses accepting the job by 37.04%. The optimal job increased the probability of psychiatric nurses accepting the job by 86.06%.

Psychiatric nurses would prefer jobs with higher income, more respect, better coping strategies with violence, better opportunities for promotion, and a good working atmosphere. Psychiatric nurses with different seniority and residence had different preferences.

Blended mobile health (mHealth) interventions - combining self-guided and human support components - could play a major role in preventing non-communicable diseases (NCDs) and common mental disorders (CMDs). This protocol describes a sequential, multiple assignment, randomised trial aimed at (i) evaluating the effectiveness and cost-effectiveness of LvL UP, an mHealth lifestyle intervention for the prevention of NCDs and CMDs, and (ii) establishing the optimal blended approach in LvL UP that balances effective personalised lifestyle support with scalability.

LvL UP is a 6-month mHealth holistic intervention targeting physical activity, diet, and emotional regulation. In this trial, young and middle-aged Singaporean adults at risk of developing NCDs or CMDs will be randomly allocated to one of two initial conditions ('LvL UP' or 'comparison'). After 4 weeks, participants categorised as non-responders from the LvL UP group will be re-randomised into second-stage conditions: (i) continuing with the initial intervention (LvL UP) or (ii) additional motivational interviewing (MI) support sessions by trained health coaches (LvL UP + adaptive MI). The primary outcome is mental well-being. Secondary outcomes include anthropometric measurements, resting blood pressure, blood metabolic profile, health status, and health behaviours (physical activity, diet). Outcomes will be measured at baseline, 6 months (post-intervention), and 12 months (follow-up).

In addition to evaluating the effectiveness of LvL UP, the proposed study design will contribute to increasing evidence on how to introduce human support in mHealth interventions to maximise their effectiveness while remaining scalable.

The LvL UP Pilot trial was prospectively registered with ClinicalTrials.gov (NCT06360029).

This paper aims to analyse depression incidence and recurrence rates in a Spanish adult cohort, while also investigating associated risk factors based on depression status at baseline.

Longitudinal, prospective study data of the Edad con Salud cohort was used, which comprises a sample representative of the non-institutionalized adult populace at the national level with a final sample size of 2655 Spanish adults. Competing risk regression models were estimated to determine the main risk factors for incident and recurrent depression.

The study found depression incidence at 6.11 per 1,000 person years, with recurrence rates up to 47.8 and 21.3 per 1,000 person years in those with depression at baseline and only history of depression, respectively, with higher rates found among women. Sociodemographic factors were found to primarily predict incident depression, while health and mental health indicators were significant predictors for recurrent depression.

Our results confirm the augmented risk of experiencing a new episode among individuals with proximal depression, where different risk factors seemed to play a role depending on episode type and depression proximity. These findings provide valuable insights for developing preventive strategies for depression in both the general population and those at risk.

Limited evidence exists for strategic actions in improving mental health at the youth population-level, particularly in low- and middle-income countries. This study investigates the health and economic impacts of intersectoral mental health programs to inform the optimal suite of interventions for young people in Bogotá, Colombia, where many are at risk of mental disorders and lack access to appropriate health services.

This study evaluated 9 interventions compared with business as usual over a projected 10-year time horizon using a system dynamics model developed through a participatory process involving diverse local stakeholders. Sensitivity analyses were performed to account for uncertainties from a healthcare payer perspective.

Anti-bullying, community-based rehabilitation, and online mental health programs were dominant. General practitioner mental health training and gatekeeper suicide prevention training could significantly improve mental health outcomes at an incremental cost-effectiveness ratio below the threshold of US dollars $4890/quality-adjusted life-years. Nevertheless, simultaneously implementing all 9 strategies could produce a synergistic effect, yielding the greatest benefit relative to business as usual with an incremental net monetary benefit of $465 million and an incremental cost-effectiveness ratio of $586 per quality-adjusted life-years gained.

Combined intersectoral mental health strategies were synergistic and resulted in optimal health outcomes relative to business as usual. The system dynamics approach offers additional attributes to economic evaluation in mental health settings by considering capacity constraints, unintended consequences, and interactions between multiple interventions. It is a valuable approach for decision-makers to effectively and efficiently prioritize and allocate scarce resources in complex public health systems.

An important contributor to the decreased life expectancy of individuals with schizophrenia is sudden cardiac death. Arrhythmic disorders may play an important role herein, but the nature of the relationship between schizophrenia and arrhythmia is unclear.

To assess shared genetic liability and potential causal effects between schizophrenia and arrhythmic disorders and electrocardiogram (ECG) traits.

We leveraged summary-level data of large-scale genome-wide association studies of schizophrenia (53 386 cases, 77 258 controls), arrhythmic disorders (atrial fibrillation, 55 114 cases, 482 295 controls; Brugada syndrome, 2820 cases, 10 001 controls) and ECG traits (heart rate (variability), PR interval, QT interval, JT interval and QRS duration, n = 46 952-293 051). We examined shared genetic liability by assessing global and local genetic correlations and conducting functional annotation. Bidirectional causal relations between schizophrenia and arrhythmic disorders and ECG traits were explored using Mendelian randomisation.

There was no evidence for global genetic correlation, except between schizophrenia and Brugada syndrome (rg = 0.14, 95% CIs = 0.06-0.22, P = 4.0E-04). In contrast, strong positive and negative local correlations between schizophrenia and all cardiac traits were found across the genome. In the most strongly associated regions, genes related to immune and viral response mechanisms were overrepresented. Mendelian randomisation indicated that liability to schizophrenia causally increases Brugada syndrome risk (beta = 0.14, CIs = 0.03-0.25, P = 0.009) and heart rate during activity (beta = 0.25, CIs = 0.05-0.45, P = 0.015).

Despite little evidence for global genetic correlation, specific genomic regions and biological pathways emerged that are important for both schizophrenia and arrhythmia. The putative causal effect of liability to schizophrenia on Brugada syndrome warrants increased cardiac monitoring and early medical intervention in people with schizophrenia.

Alcohol use disorder (AUD) is a major public health concern and cause of mortality and morbidity. Alcohol-associated liver disease (ALD) is a debilitating complication of AUD, mitigated by abstinence from alcohol use. Deep brain stimulation (DBS) is emerging as a potential treatment for AUD. However, its cost-effectiveness compared to the standard medical treatment is unclear.

To estimate the cost-effectiveness of DBS compared to medical management for patients with AUD and ALD.

We utilized a decision analytic model based on published literature to conduct a cost-effectiveness analysis of costs and health outcomes for DBS and medical management in patients with AUD and ALD. We also carried out a threshold analysis to determine the probability of success necessary for DBS to be cost-effective. Costs were measured in 2024 US dollars and effectiveness in quality-adjusted life years (QALYs). We used a time horizon of 1-2 years and adopted a societal perspective.

Our results show that for AUD patients in general, DBS is not cost-effective at any DBS success rate. However, for advanced ALD patients, defined as fibrosis stage 3 or beyond DBS becomes cost-effective. For these patients, DBS is cost-effective over a two-year period at a $100,000 willingness-to-pay threshold at DBS success rates greater than 53 %. For advanced decompensated ALD patients, DBS is cost-effective over a one-year period at DBS success rate greater than 35 %.

Should it prove efficacious, DBS may be cost-effective for patients with AUD and ALD. Thus, future randomized controlled trials to evaluate its efficacy are warranted.

The purpose of this study is to provide a comprehensive overview of the epidemiology of traumatic craniofacial injuries in the U.S. that occur in the context of drugs and/or alcohol. The National Electronic Injury and Surveillance System (NEISS) database was queried from 2019 to 2022 to identify all emergency department (ED) patients with reported traumatic injuries involving craniofacial anatomy. Clinical and demographic variables were assessed between cases that involved drugs/alcohol and those that did not, utilizing two-proportion z-tests. In total, 441,764 patients with traumatic craniofacial injuries were identified, with 20,285 cases involving drugs and/or alcohol. Cases involving drugs/alcohol had a significantly higher frequency of internal injuries (45.3% vs. 34.9%, p < 0.001), fractures (7.0% vs. 3.4%, p < 0.001), and hematomas (4.6% vs. 2.5%, p < 0.001) than those that did not. Craniofacial injuries involving drugs/alcohol also had a significantly higher frequency of falls to the floor (19.2% vs. 11.8%, p < 0.001) and down stairs/steps (18.3% vs. 6.6%, p < 0.001) and resulted in a significantly greater odds of hospital admission after ED presentation (OR 3.75, 95% CI: 3.63-3.88, p < 0.001). Ultimately, these epidemiological findings can be leveraged to provide clinicians invaluable qualitative context for the most frequent presentations of craniofacial injuries they can anticipate to treat among intoxicated patients.

Psychiatric disorders are among the leading causes of disease burden worldwide. Despite their significant impact, their diagnosis remains challenging due to symptom heterogeneity, psychiatric comorbidity, and the lack of objective diagnostic tests and well-defined biomarkers. Leveraging genomic, epigenomic, and fragmentomic technologies, circulating cell-free DNA (ccfDNA)-based liquid biopsies have emerged as a potential non-invasive diagnosis and disease-monitoring tool. ccfDNA is a DNA species released into circulation from all types of cells through passive and active mechanisms and can serve as a biomarker for various diseases, namely, cancer. Despite their potential, the application of ccfDNA in neuropsychiatry remains underdeveloped. In this review, we provide an overview of liquid biopsies and their components, with a particular focus on ccfDNA. With a summary of pre-analytical practices and current ccfDNA technologies, we highlight the current state of research regarding the use of ccfDNA as a biomarker for neuropsychiatric disorders. Finally, we discuss future steps to unlock ccfDNA's potential in clinical practice.

Major Depressive Disorder (MDD) directly impacts the lives of countless individuals worldwide, yet its causes remain incompletely understood. However, it is recognized that a deficiency in monoamines, including dopamine, may contribute to this disorder. N-(3-((3-(trifluoromethyl)phenyl)selenyl)prop-2-yn-1-yl) (CF3SePB) is an organoselenium compound that presented antidepressant-like effect in mice related to modulation of serotonergic, but not noradrenergic system. To expand the knowledge about CF3SePB mechanisms of action, this study aimed to evaluate the involvement of dopaminergic system in its antidepressant-like effect. Male Swiss mice were pre-treated with the haloperidol (0.05 mg/kg, i.p., a non-selective D2 receptor antagonist), SCH 23390 (0.01 mg/kg, s.c., a D1 receptor antagonist), and sulpiride (50 mg/kg, i.p., a D2 receptor antagonist) 15 min before CF3SePB (50 mg/kg, i.g.), and after 30 min of CF3SePB administration the forced swimming test (FST) was performed. CF3SePB presented an anti-immobility effect in the FST, demonstrated by increase in the latency to first episode of immobility and reduction of total immobility of mice, and the pre-treatment of mice with haloperidol, SCH 23390 and sulpiride prevented these effects, showing that the antidepressant-like effect of CF3SePB is related to the modulation of the dopaminergic system, specifically the D1 and D2 receptors. In addition, in silico pharmacokinetic profiling of CF3SePB predicted its low likelihood of inducing adverse effects and potential to cross the blood-brain barrier. These results expand the understanding of CF3SePB mechanisms for its antidepressant-like effect, reinforcing the potential of this organonoselenium compound for developing new antidepressants.

Dissecting the exposome linked to mental health outcomes can help identify potentially modifiable targets to improve mental well-being. However, the multiplicity of exposures and the complexity of mental health phenotypes pose a challenge that requires data-driven approaches.

Guided by our previous systematic approach, we conducted hypothesis-free exposome-wide analyses to identify factors associated with 7 psychiatric diagnostic domains and 19 symptom dimensions in 157,298 participants from the UK Biobank Mental Health Survey. After quality control, 294 environmental, lifestyle, behavioral, and economic variables were included. An Exposome-Wide Association Study was conducted per outcome in two equally split datasets. Variables associated with each outcome were then tested in a multivariable model.

Across all diagnostic domains and symptom dimensions, the top three exposures were childhood adversities and traumatic events. Cannabis use was associated with common psychiatric disorders (depressive, anxiety, psychotic, and bipolar manic disorders), with ORs ranging from 1.10 to 1.79 in the multivariable models. Additionally, differential associations were identified between specific outcomes-such as neurodevelopmental disorders, eating disorders, and self-harm behaviors-and exposures, including early life experiences (being adopted), lifestyle (time spent using computers), and dietary habits (vegetarian diet).

This comprehensive mapping of the exposome revealed that several factors, particularly in the domains of those previously well-studied were shared across mental health phenotypes, providing further support for transdiagnostic pathoetiology. Our findings also showed that distinct relations might exist. Continued exposome research through multimodal mechanistic studies guided by the transdiagnostic mental health framework is required to better inform public health policies.

The proliferation of chatbots in the digital mental health sector is gaining momentum, offering a promising solution to address the pressing shortage of mental health professionals. By providing accessible and convenient mental health services and support, chatbots are poised to become a primary technological intervention in bridging the gap between mental health needs and available resources.

This study undertakes a thorough bibliometric analysis and discourse on the applications of chatbots in mental health, with the objective of elucidating the underlying scientific patterns that emerge at the intersection of chatbot technology and mental health care on a global scale.

The bibliometric software Biblioshiny and VOSviewer were used to conduct a comprehensive analysis of 261 scientific articles published in the Web of Science Core Collection between 2015 and 2024. Publications distribution are analyzed to measure productivity on countries, institutions, and sources. Scientific collaboration networks are generated to analyze the influence as well as communications between countries and institutions. Research topics and trends are formulated by using a keyword co-occurrence network.

Over the last decade, researches on utilization of chatbots in mental health has appeared to be increasing steadily at an annual rate of 46.19%. The United States have made significant contributions to the development and expansion of publications, accounting for 27.97% of the total research output with 2452 citation counts. England came second to the US in terms of publications and citations, and followed by Australia, China, and France. National Center for Scientific Research in France ranked first among all institutions, followed by Imperial College London and University of Zurich. The number of articles published in Journal of Medical Internet Research was exceptionally high, accounting for 12.26% of the total number of articles, and JMIR Mental Health is the most influential publication sources in terms of average citations per article. Collaboration among universities in the USA, United Kingdom, Switzerland, and Singapore demonstrated a high level. The keyword co-occurrence network highlights the prominent techniques in this multidisciplinary area and reveals 5 research topics, showing a significant overlap between clusters. High-frequency terms such as "ChatGPT", "machine learning", and "large language models" underscore the current state of research, highlighting the cutting-edge advancements and frontiers in this field.

This study provides an in-depth analysis of the most prominent countries, institutions, publications, collaboration status, and research topics associated with utilization of chatbots in mental health over the last decade. It offers insights to mental health professionals without an AI background and individuals interested in the development of mental health chatbots. The findings suggest that chatbots hold a significant role in promoting mental health well-being and exhibit considerable potential in demonstrating empathy, curiosity, understanding, and collaborative capabilities with users.

An increasing number of observational studies have reported associations between frailty and mental disorders, but the causality remains ambiguous.

To assess the bidirectional causal relationship between frailty and nine mental disorders.

We conducted a bidirectional two-sample Mendelian randomisation on genome-wide association study summary data, to investigate causality between frailty and nine mental disorders. Causal effects were primarily estimated using inverse variance weighted method. Several secondary analyses were applied to verify the results. Cochran's Q-test and Mendelian randomisation Egger intercept were applied to evaluate heterogeneity and pleiotropy.

Genetically determined frailty was significantly associated with increased risk of major depressive disorder (MDD) (odds ratio 1.86, 95% CI 1.36-2.53, P = 8.1 × 10-5), anxiety (odds ratio 2.76, 95% CI 1.56-4.90, P = 5.0 × 10-4), post-traumatic stress disorder (PTSD) (odds ratio 2.56, 95% CI 1.69-3.87, P = 9.9 × 10-6), neuroticism (β = 0.25, 95% CI 0.11-0.38, P = 3.3 × 10-4) and insomnia (β = 0.50, 95% CI 0.25-0.75, P = 1.1 × 10-4). Conversely, genetic liability to MDD, neuroticism, insomnia and suicide attempt significantly increased risk of frailty (MDD: β = 0.071, 95% CI 0.033-0.110, P = 2.8 × 10-4; neuroticism: β = 0.269, 95% CI 0.173-0.365, P = 3.4 × 10-8; insomnia: β = 0.160, 95% CI 0.141-0.179, P = 3.2 × 10-61; suicide attempt: β = 0.056, 95% CI 0.029-0.084, P = 3.4 × 10-5). There was a suggestive detrimental association of frailty on suicide attempt and an inverse relationship of subjective well-being on frailty.

Our findings show bidirectional causal associations between frailty and MDD, insomnia and neuroticism. Additionally, higher frailty levels are associated with anxiety and PTSD, and suicide attempts are correlated with increased frailty. Understanding these associations is crucial for the effective management of frailty and improvement of mental disorders.

To investigate differences in the prevalence of positive depression screens before and during the COVID-19 pandemic within primary care and assess patient characteristics based on depression screen results in both time periods.

This was a retrospective cohort study of patients ages 12-21 years-old from two urban primary care clinics seen for well-child visits and who had completed depression screens before and during the pandemic. Additional variables evaluated included demographics, substance use, and mental health (MH) conditions such as anxiety, depression, and suicidal ideation (SI). Paired analyses using McNemar's Chi-squared test and paired t-test evaluated differences in variables between time periods. Patients were also categorized into four groups determined by their depression screen result in each period and characteristics between the four groups were compared using the Fisher's exact test.

Of 1621 patient charts reviewed with documented depression screens, there were 232 patients who had screens completed during both time periods. Twenty three (9.9%) patients screened positive for depressive symptoms before the pandemic and 38 (16.4%) screened positive during the pandemic. More patients had SI, depression, anxiety, and substance use during the pandemic. Patients who had at least one positive depression screen had more MH conditions than patients who had negative depression screens during both time periods.

Among a cohort of adolescents seen in primary care before and during the pandemic, more patients screened positive for depression and there were more MH conditions during the pandemic, demonstrating a need to prioritize MH resources for adolescents in the primary care setting.

Fear learning processes are believed to play a crucial role in the development and maintenance of anxiety and stress-related disorders. To integrate results across different studies, we conducted a systematic meta-analysis following PRISMA guidelines to examine differences in fear conditioning during fear acquisition, extinction, and extinction recall between individuals with anxiety-related or stress-related disorders and healthy participants. This analysis updates the work of Duits et al. (2015) while also refining distinctions between physiological and behavioral outcomes and examining extinction recall. Our meta-analysis encompasses 77 studies published from 1986 to 2022, involving 2052 patients with anxiety disorders, obsessive-compulsive disorder, or post-traumatic stress disorder, and 3258 healthy controls. The results indicate significant differences in fear acquisition, extinction, and recall between the two groups. Specifically, during acquisition patients exhibited heightened physiological and behavioral responses to the CS- and reported increased affect ratings for the CS+ . During extinction and extinction recall, patients continue to show heightened threat expectancy and negative affect ratings towards the CS- and increased affect ratings towards the CS+ . No differences were found in CS+ /CS- differentiation between groups. These findings imply that individuals with anxiety and stress-related disorders may exhibit amplified responses to safety cues and stronger reactions to threat cues during fear conditioning, lasting through extinction and extinction recall. These changes may lead to increased sensitivity in detecting fear and slower extinction process, resulting in more enduring anxiety responses. We discuss these results in the context of existing literature on fear and safety learning and consider potential underlying mechanisms.

Evidence is scarce on the mechanisms involved in the relationship between dietary inflammatory index and mental health in adolescents. This study aimed to assess the association between children-DII (C-DII) and depressive and anxiety disorder symptoms in adolescents and to explore whether inflammation and cardiometabolic risk factors mediate this association.

The study was conducted at the Ankara City Hospital Pediatrics Polyclinic and 304 adolescents. In cross-sectional study, adolescents were asked general information questions. Anthropometric measurements were performed and some biochemical parameters and inflammation (C-reactive protein (CRP)) were obtained. The C-DII score was calculated from 24-h dietary recalls. Depression and anxiety levels of the participants were assessed by self-report. Structural equation modelling analyzed how cardiometabolic risk factors and inflammation mediate the relationship between mental health and dietary inflammation.

C-DII scores were positively associated with depression and anxiety score (β [95% confidence interval (CI)] = 0.224 [0.08-0.25] for depression; 0.923 [0.04-1.67] for anxiety). Except for dietary inflammation with anxiety in girls, these relationships remained statistically significant in all subgroups by sex. It was determined that CRP partially mediated the relationship between dietary inflammation and depression and anxiety. It was determined that body mass index (BMI)-z score and waist circumference (WC) mediated the relationship between dietary inflammation and depression scores.

Our findings indicate that the higher pro-inflammatory potential of diet is associated with a higher risk of depression and anxiety, and this association may be mediated by CRP for depression and anxiety, WC, and BMI-z score for only depression. Further research is required to verify our findings and clarify the latent mechanism in larger populations.

The impact of the COVID-19 pandemic on the epidemiological characteristics of depression among adults in the U.S. remains unclear. This study aims to analyze trends in depression prevalence over time and quantify the effect of the COVID-19 pandemic on its prevalence. Using data from 2007 to 2023 provided by the National Health and Nutrition Examination Surveys (NHANES), this study examined 36,472 participants. Results revealed an increasing trend in depression prevalence among U.S. adults from 2007 to 2023. Notably, the overall weighted prevalence of depression following the COVID-19 pandemic (12.4%, 95% CI: 10.6-14.1%) was significantly higher than in all years prior to the pandemic. Subgroups such as females, Mexican Americans, and young adults experienced particularly pronounced increases. By analyzing data from two survey cycles close to the onset of the COVID-19 outbreak, the study identified a significant impact of the pandemic on depression prevalence, with an adjusted odds ratio of 1.58 (95% CI: 1.28-1.94). Individuals with lower socioeconomic status and those without pre-existing conditions exhibited greater increases in depression prevalence, whereas the emotional health of individuals who smoke appeared unaffected by the pandemic.

There has been a global increase in the use of cannabinoids as a treatment for mental health (MH) and substance use disorders (SUD). In 2016, an Australian government-funded review found that although medicinal cannabinoids accounted for a small reduction in MH symptoms, the results varied according to study design. There has since been a rise in randomised controlled trials (RCTs) aiming to examine the efficacy of cannabinoids for the treatment of MH and SUD. Therefore, the current systematic review will (a) identify all RCTs examining the efficacy of cannabinoids in treating MH and SUD, (b) provide a quantitative or narrative synthesis of the evidence examining efficacy, and (c) synthesise adverse event data to examine evidence of harm. Electronic databases (Ovid MEDLINE, PsychINFO, Cochrane Central Register of Controlled Clinical Trials, Cochrane Database of Systematic Reviews, and Embase) were searched from 1980 to 24 May 2023. The study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Guidelines. Articles will be screened to capture peer-reviewed RCTs evaluating the efficacy of plant-based and pharmaceutical cannabinoids in reducing or treating MH and SUD among people of any age. The Cochrane risk of bias tool 2.0 will be used to assess bias, while the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) tool will be used to assess the quality of evidence for each outcome. Study findings will be disseminated through published manuscripts, conferences, and health policy guidelines.Systematic review registration PROSPERO CRD42023392718.

Anxiety disorders are the second most common mental health disorders in terms of disability-adjusted life years and years of life lost across all age groups. A bidirectional relationship between anxiety disorders and diabetes mellitus has been documented. This study aimed to determine the prevalence of anxiety and its associated factors among patients with diabetes receiving care at public primary care clinics in Kuwait during the first quarter of 2024.

A cross-sectional study was conducted in the first quarter of 2024 at three primary healthcare centres within the Capital Governate in Kuwait City. Adults with diabetes mellitus for longer than six months duration were requested to participate by the health promoters and the Generalised Anxiety Disorder questionnaire was shared via a mobile link/QR scan. Data were collected through self-or interviewer-administered surveys, cleaned and coded in Microsoft Excel, and analysed using STATA version 18. Descriptive analysis was initially conducted followed by bivariate and multivariate analysis with a p < 0.05 and a 95% confidence interval used to determine the association between demographic and clinical factors and GAD.

A total of 554 patients participated, yielding an 80% response rate. Anxiety symptoms were observed in 48% of respondents, though only 4% (n = 25) had a GAD score > 10. Among participants with moderate-to-severe anxiety (n = 21), 52% were aged 50-59 years, 90% were non-native Kuwaiti citizens, and 62% had an HbA1C measurement > 7 mmol/L. Multivariate analysis indicated that non-native Kuwait citizens were significantly more likely to have moderate-to-severe anxiety (AOR: 6.99, 95% CI: 1.42-34.43) compared to Kuwaiti nationals. Conversely, participants attending clinic visits every two months were less likely (AOR: 0.30, 95% CI: 0.00-0.50) to report moderate-to-severe anxiety symptoms than those attending monthly.

While nearly half of patients with diabetes displayed anxiety symptoms, only a small proportion (4%) experienced moderate-to-severe anxiety. Non-native Kuwaiti residents were significantly more likely to have GAD scores > 10. Integrating anxiety screening into diabetes care may improve outcomes for this high-risk group.

Alexithymia is characterized by difficulty identifying and/or describing emotions, reduced imaginal processes, and externally oriented thinking. High levels of alexithymia may increase the challenge of supporting individuals with co-occurring depression and hazardous alcohol use. This secondary analysis sought to investigate whether or not alexithymia moderated the outcomes of an online intervention for depression and alcohol use.

As part of a randomized controlled trial, 988 participants were randomly assigned to receive an intervention dually focused on depression and alcohol use, or an intervention only focused on depression. The pre-specified mediation hypothesis was that changes in drinking at 3 months follow-up would effect the association between the intervention and change in depression at 6 months. This secondary analysis extends the investigation by adding alexithymia as a moderator.

The current analysis demonstrated that including alexithymia as a moderator resulted in a conditional direct effect. Specifically, there was an intervention effect where participants who received the combined depression and alcohol intervention had larger improvements in their depression scores at 6 months, but this was only when their alexithymia score at baseline was also high (60.5 or higher).

These results suggest that treatment planning and intervention effectiveness could be informed and optimized by taking alexithymia severity into consideration. This is especially merited as alexithymia can contribute to the weaker therapeutic alliance, more distress and dysphoria, shorter periods of abstinence, and more severe depression, compounding the complexity of supporting individuals with comorbid conditions. More research is needed to systematically investigate these possible modifying effects.

Does difficulty identifying/describing emotions or externally-oriented thinking influence the effectiveness of an intervention among people with both depression and hazardous alcohol use?

In task-shared, mental health, and psychosocial support interventions, monitoring the quality of delivery (fidelity and competence) of nonspecialist providers is critical. Quality of delivery is frequently reported in brief, summary statistics, and while both fidelity and competence scores tend to be high, rarely have factors associated with quality of delivery in low-resource, mental health, and psychosocial support interventions been examined using inferential statistics. Understanding both modifiable and non-modifiable predictors of quality of delivery is important for adapting training and supervision approaches throughout intervention delivery. In this study, we use a parallel process latent growth model to examine the association of non-modifiable, demographic characteristics of nonspecialists and changes in both fidelity and competence over time. We find that nonspecialist age is significantly associated with higher initial fidelity and competence scores and smaller improvements in fidelity and competence over time, although this finding is interpreted in the presence of ceiling effects. In addition, nonspecialists in a certain district were more likely to have higher initial fidelity and competence scores but also see smaller changes over time. Fidelity and competence were found to significantly co-vary. This study provides conceptual and measurement guidance regarding quality of delivery, suggesting that fidelity and competence are theoretically distinct and must be measured separately, but linked together under the umbrella of quality of delivery. This study also has implications for recruiting, training, and supporting nonspecialists delivering behavioral interventions, suggesting that future implementation teams can further contribute to research on how to better support high-quality training, supervision, and personal and professional growth among the growing nonspecialist workforce globally.

Drug use disorder (DUD) poses a major public health crisis globally, necessitating immediate attention to global trends and future projections to develop effective health policies and interventions. Thus, we aimed to estimate the global trends in DUD mortality rates from 1990 to 2021 and future projections of DUD deaths until 2040 across 73 countries.

In this time-series analysis and modelling study, we investigated the global trends in DUD mortality rates from 1990 to 2021 using the WHO Mortality Database and forecasted future trends through 2040. Global trend analysis was analysed using a locally weighted scatter plot smoother (LOESS) curve, and future projections were calculated based on a Bayesian age-period-cohort analysis. In addition, we performed a decomposition analysis to identify the variations in DUD deaths, specifically examining factors such as population growth, ageing, and epidemiological changes.

Of the 73 countries included in the analysis of DUD mortality, 45 were high-income countries (HICs), and 28 were low to middle-income countries (LMICs). The LOESS estimates of the global DUD mortality rate were 1.84 deaths per 1,000,000 people (95% CI, -0.44 to 4.12) in 1990 and 13.09 deaths per 1,000,000 people (95% CI, 10.74-15.43) in 2021. Notably, HICs showed a significant increase in DUD mortality from 1.43 deaths per 1,000,000 people (95% CI, -1.55 to 4.42) in 1990 to 17.19 deaths per 1,000,000 people (95% CI, 13.84-20.53) in 2021. A significant increase in DUD mortality was observed among individuals aged 25-64 and males. Our analysis also identified associations between DUD mortality rates and several log-transformed parameters, including Human Development Index (β, 14.92; p < 0.0001), Socio-demographic Index (β, 11.80; p < 0.0001), reverse Gender Gap Index (β, -12.02; p < 0.0001), and Gini coefficient (β, -1.84; p < 0.0001). From 1990 to 2021, the increase in the number of DUD deaths globally can be attributed to two prominent factors: epidemiological change and population growth. In HICs, the impacts of epidemiological changes for increasing DUD mortality rates were particularly prominent compared to other factors. In the Bayesian age-period-cohort models, the predicted number of global DUD deaths up to 2040 were estimated to increase from 25.95 deaths per 1,000,000 people (95% credible interval [CrI], 24.72-27.28) in 2021 to 38.45 (95% CrI, 30.48-49.33) in 2030, and 42.43 (95% CrI, 23.67-77.77) in 2040.

An increasing trend in global DUD mortality was observed from 1990 to 2021, especially in HICs. Future DUD deaths were also predicted to increase until 2040 at the global level. Therefore, these findings suggest urgent and proactive strategies for DUD to reduce the mortality rates related to DUD are needed. However, further prospective research that accounts for potential confounding factors, such as socioeconomic variables and the quality of reporting data from individual countries, is imperative for more accurate estimation.

National Research Foundation and Ministry of Science and ICT of South Korea.

The stigma of nursing students towards people with mental illness (PMI) creates significant barriers to diagnosis, treatment, and recovery for those with PMI. It can also have a significant impact on the future career choices of nursing students in the field of psychiatry. Current research has found various influencing factors, including personal characteristics and educational influences. However, a comprehensive analysis that encompasses all aspects is lacking. The aim of the study was to conduct a convergent mixed-method systematic review to synthesize the influencing factors of the stigma of nursing students towards PMI according to Framework Integrating Normative Influences on Stigma (FINIS) at micro, meso, and macro levels. PubMed, Web of Science, Cochrane Library, EMBASE, CINAHL and PsycINFO were searched from 1990 to 31 December 2023. The reference lists of the included literature were further checked to identify potentially relevant articles. Two authors independently screened all titles, abstracts, and full-text articles and extracted data. Study quality was assessed by two authors using the Mixed Method Appraisal Tool (MMAT). A total of 4865 articles were initially retrieved, and 73 of these articles were included. The results suggested that the stigma towards PMI by nursing students was influenced by micro, meso and macro levels. At each FINIS level, the most frequent influencing factors are personal characteristics, the treatment system and media images. Numerous interconnected factors exert an influence on the stigma towards PMI among nursing students. Our research can be used to identify barriers and facilitators to nursing students' stigma towards PMI and to provide supporting information for interventions designed to reduce this stigma.

This study aimed to assess its relationship between physical activity with health-related indicators in older population of the China. Cross-sectional data of 1,327 individuals aged 60-79 years were analyzed. Based on the Fifth National Physical Fitness Monitoring Program, depressive symptom and loneliness were measured using the Patient Health Questionnaire-9 and Emotional versus Social Loneliness Scales, respectively. Sleep quality was evaluated through self-designed questionnaire and hypertension was defined as blood pressure > 140/90 mmHg. International Physical Activity Questionnaire-Long Form was conducted to assess the physical activity (minutes and frequency) in different domains (domestic, transport, work, and leisure). Multivariable-adjusted binary logistic regression models estimated for the prevalence of health-related indicators, considering PA level, duration, frequency, and combinations of different domains of PA. In the study, favorable associations were observed between moderate to high level PA and reductions in 4 health-related indicators, especially for active frequency. Moreover, a combination of transport, domestic, and leisure PA was found to be a general protective factor for health-related indicators. In summary, this study highlights the positive impact of PA on older adults' health and provides valuable insights into the role of different PA patterns, offering a theoretical basis for developing PA guidelines, policies, and health interventions.

This study aimed to investigate the interplay between genetic susceptibility and socioeconomic disparities on psychiatric disorders.

In this study, we utilized data from the UK Biobank to analyze the Generalized Anxiety Disorder (GAD)-7 scale (N = 74,425) and the Patient Health Questionnaire (PHQ)-9 (N = 74,101), along with the Index of Multiple Deprivation (IMD). The polygenic risk score (PRS) was calculated to assess the genetic risk associated with GAD-7/PHQ-9 scores, and the individuals were classified into low, medium, and high genetic risk groups according to tertiles of PRSs related to the GAD-7/PHQ-9. Linear regression models were used to explore the relationships between GAD-7/PHQ-9 scores and IMD scores in patients with different genetic susceptibilities.

Disadvantaged socioeconomic status was associated with the risk of anxiety and depression across all strata of genetic risk, and stronger associations were shown for individuals with greater genetic susceptibility. From low to high genetic risk, the risk of psychiatric disorders increased for the GAD-7 (β = 0.002 to 0.032) and PHQ-9 (β = 0.003 to 0.045) scores. In addition, strong associations of high genetic risk with anxiety (β = 0.875) and depression (β = 1.152) were detected in the IMD quartile 4 group compared with the least deprivation quartile group. Furthermore, income and employment were estimated to contribute strongly to anxiety (βemployment = 7.331, βincome = 4.492) and depression (βemployment = 9.951, βincome = 6.453) in the high genetic risk group.

The results suggest that we should pay more attention to psychiatric disorders with high genetic susceptibility and try to improve their socioeconomic status to prevent the development of psychiatric disorders.

Currently, 30-50 % of individuals with depression and 40 % with anxiety-collectively referred to as common mental disorders (CMDs), exhibit inadequate responses to antidepressant treatments.

To assess the effectiveness and safety of drug-metabolizing enzyme pharmacogenetic variation informed treatment (PGxIT) versus usual antidepressant treatment (UT) in patients with CMDs.

A literature search was conducted in the MEDLINE, Scopus, and Cochrane Library databases from inception until January 30, 2024.

Studies were selected based on CMD diagnoses, reporting on the genetic variations of drug-metabolizing enzyme (DME) genes in relation to antidepressants, involving PGxIT and UT groups with human subjects, and published in English.

Data extraction and quality assessment were performed independently by two authors. A pooled risk ratio (RR) with 95 % CI was estimated using both random and fixed-effect models, and heterogeneity was assessed using Cochran's Q test and the I2 statistic. The publication bias of eligible studies was assessed using post hoc Doi plots and the LFK index.

This systematic review included 18 studies (n = 7021). The PGxIT demonstrated greater efficacy in the remission of symptoms of depressive disorder at 8 weeks (RR 1.523 [95 % CI: 1.255-1.843]; I2 = 48 %) and 12 weeks (RR 1.631 [95 % CI: 1.001-2.657]; I2 = 86 %; p < 0.01), and symptoms of anxiety disorder compared to UT. Additionally, the risk of adverse drug events (ADEs) was significantly lower in the PGxIT group (RR = 0.65 [95 % CI: 0.52-0.82]; I2 = 0 %) than in the UT group. The certainty of evidence for both outcomes was moderate.

This systematic review and meta-analysis suggest that pharmacogenetically guided antidepressant treatment, based on genetic variation in drug-metabolizing enzymes, is associated with superior efficacy in the remission of symptoms for patients with depressive disorders and a reduction in ADEs compared to usual treatment and the findings of the systematic review for remission in anxiety disorders indicate that, PGx guided treatment is also associated with increased remission of symptoms in anxiety disorders compared to usual treatment.