According to network theories, mental disorders, including prolonged grief disorder (PGD), comprise networks of dynamically connected symptoms. Examining how prolonged grief symptoms are connected over time could reveal the patterns driving their persistence. This study provides the first empirical investigation of prolonged grief symptom networks using self-reported data on prolonged grief assessed multiple times daily.
Methods
Adults whose partner, family member, or friend died on average 30 months ago (N = 229, 80 % women, Mage = 51) rated prolonged grief symptom intensity using 11 items (e.g., “In the past three hours, I found myself yearning for him/her”) five times per day for two weeks. We used a two-step multilevel vector autoregressive model to produce between-person, contemporaneous, and temporal networks.
Results
In the between-person network, yearning and sadness were the most strongly and positively connected symptoms. In the contemporaneous network, yearning, preoccupation, and sadness formed a cluster of positively connected symptoms. Simultaneously, difficulty reintegrating after the loss, emotional numbness, meaninglessness, and loneliness due to the loss formed another positively connected symptom cluster. In the temporal network, emotional numbness had the greatest positive influence on other prolonged grief symptoms at the subsequent timepoint.
Conclusion
We propose that targeting emotional suppression, promoting flexible emotion regulation, and supporting integrated continuing bonds (approach-behaviors) and targeting avoidance of the reality of the loss (avoidance-behaviors) may help people to adapt to loss.
{"title":"Dynamic networks of prolonged grief symptoms in daily life","authors":"Justina Pociūnaitė-Ott , Jorge Piano Simões , Talya Greene , Minita Franzen , Lonneke I.M. Lenferink","doi":"10.1016/j.comppsych.2025.152660","DOIUrl":"10.1016/j.comppsych.2025.152660","url":null,"abstract":"<div><h3>Background</h3><div>According to network theories, mental disorders, including prolonged grief disorder (PGD), comprise networks of dynamically connected symptoms. Examining how prolonged grief symptoms are connected over time could reveal the patterns driving their persistence. This study provides the first empirical investigation of prolonged grief symptom networks using self-reported data on prolonged grief assessed multiple times daily.</div></div><div><h3>Methods</h3><div>Adults whose partner, family member, or friend died on average 30 months ago (<em>N</em> = 229, 80 % women, <em>M</em><sub><em>age</em></sub> = 51) rated prolonged grief symptom intensity using 11 items (e.g., “In the past three hours, I found myself yearning for him/her”) five times per day for two weeks. We used a two-step multilevel vector autoregressive model to produce between-person, contemporaneous, and temporal networks.</div></div><div><h3>Results</h3><div>In the between-person network, yearning and sadness were the most strongly and positively connected symptoms. In the contemporaneous network, yearning, preoccupation, and sadness formed a cluster of positively connected symptoms. Simultaneously, difficulty reintegrating after the loss, emotional numbness, meaninglessness, and loneliness due to the loss formed another positively connected symptom cluster. In the temporal network, emotional numbness had the greatest positive influence on other prolonged grief symptoms at the subsequent timepoint.</div></div><div><h3>Conclusion</h3><div>We propose that targeting emotional suppression, promoting flexible emotion regulation, and supporting integrated continuing bonds (approach-behaviors) and targeting avoidance of the reality of the loss (avoidance-behaviors) may help people to adapt to loss.</div></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"145 ","pages":"Article 152660"},"PeriodicalIF":4.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-26DOI: 10.1016/j.comppsych.2025.152659
Nora de Bode, Emese Kroon, Jia Hua Hsieh, Janna Cousijn
Cannabis use is widely on the rise for recreational and medicinal purposes, with the latter often aimed at improving mental health and cognition. Simultaneously, the prevalence of cannabis-related health harms, such as cannabis use disorder (CUD), is increasing.
Product potency, route of administration, and preexisting mental health symptoms play a role in the effects of cannabis; however, there is limited research on how broader factors, such as local cannabis legislation and perceptions of use, may influence these outcomes. Moreover, knowledge remains sparse regarding the growing population of medicinal users, predominantly using without medical supervision. Altogether, this illustrates the need for ecologically valid ways to investigate individuals and their cannabis usage within real-world settings.
Therefore, this longitudinal, cross-cultural online study examines an international sample of regular recreational and medicinal users (aged 18–65) from different cannabis jurisdictions (e.g., the Netherlands, the United States, Brazil, Canada, and regions in Asia and Africa) in their natural environment via their mobile phone. By using the Experience Sampling Method (ESM), alongside a comprehensive battery of cognition and mental health related assessments over a 2-year period, we aim to gain insight into the short- and long-term mental health and cognitive determinants and consequences of cannabis use, and how these interact with broader, contextual factors, such as legislation. This is one of the first cross-cultural studies assessing both positive and negative effects of cannabis longitudinally, examining the full range of effects that cannabis may have on the individual.
{"title":"Blowing Minds: A cross-cultural, longitudinal investigation to unravel the highs and lows of recreational and medicinal cannabis users","authors":"Nora de Bode, Emese Kroon, Jia Hua Hsieh, Janna Cousijn","doi":"10.1016/j.comppsych.2025.152659","DOIUrl":"10.1016/j.comppsych.2025.152659","url":null,"abstract":"<div><div>Cannabis use is widely on the rise for recreational and medicinal purposes, with the latter often aimed at improving mental health and cognition. Simultaneously, the prevalence of cannabis-related health harms, such as cannabis use disorder (CUD), is increasing.</div><div>Product potency, route of administration, and preexisting mental health symptoms play a role in the effects of cannabis; however, there is limited research on how broader factors, such as local cannabis legislation and perceptions of use, may influence these outcomes. Moreover, knowledge remains sparse regarding the growing population of medicinal users, predominantly using without medical supervision. Altogether, this illustrates the need for ecologically valid ways to investigate individuals and their cannabis usage within real-world settings.</div><div>Therefore, this longitudinal, cross-cultural online study examines an international sample of regular recreational and medicinal users (aged 18–65) from different cannabis jurisdictions (e.g., the Netherlands, the United States, Brazil, Canada, and regions in Asia and Africa) in their natural environment via their mobile phone. By using the Experience Sampling Method (ESM), alongside a comprehensive battery of cognition and mental health related assessments over a 2-year period, we aim to gain insight into the short- and long-term mental health and cognitive determinants and consequences of cannabis use, and how these interact with broader, contextual factors, such as legislation. This is one of the first cross-cultural studies assessing both positive and negative effects of cannabis longitudinally, examining the full range of effects that cannabis may have on the individual.</div></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"145 ","pages":"Article 152659"},"PeriodicalIF":4.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-08DOI: 10.1016/j.comppsych.2025.152650
Duncan M Shields , Jan Klimas , Theo Niyonsenga , Kevin Lutz , Aynsley J. Wong , David Kuhl
Objectives
To assess the effects of a four-day, group-based residential treatment program focused on enhancing psychological health and social functioning of firefighter and police first responders in British Columbia, Canada.
Methods
Using a repeated-measures design, participants completed seven validated self-report questionnaires at baseline (pre-test T0), two weeks after the session (post-test T1), and six months follow-up (T2). A multilevel approach to the analysis of repeated measures examined the effects of the program on several indicators. These included symptoms of major depressive disorder, symptoms of generalized anxiety, symptoms of post-traumatic stress disorder, social role functioning, social support (giving and receiving), quality of life, and health related impairments.
Results
A total of 106 police and 114 firefighters undertook the program. The baseline measures were completed by 207 (94 %) participants and 175 (80 %) completed at least one questionnaire at the longest follow-up. All outcomes measured improved from baseline to two-weeks post intervention (T0 to T1, p < 0.001), and sustained reductions at six months follow-up (T0 to T2, p < 0.001), except for giving social support. The highest standardized effect size (Cohen's d) observed at six months (T2) was for symptoms of major depressive disorder (d = −0.90), followed by symptoms of generalized anxiety disorder (d = −0.75), symptoms of post-traumatic stress disorder (d = −0.69), symptom distress (d = −0.62), social role challenges (d = −0.58), quality of life (d = 0.44), interpersonal relations (d = −0.40), and receiving emotional support (d = 0.23).
Conclusion
Participation in this program appeared to improve subjective ratings of Canadian firefighter and police psychological health and social functioning. The results are promising and require further exploration with a randomized trial and longer-term follow-up.
{"title":"Evaluation of a residential group therapy program for Canadian first responders","authors":"Duncan M Shields , Jan Klimas , Theo Niyonsenga , Kevin Lutz , Aynsley J. Wong , David Kuhl","doi":"10.1016/j.comppsych.2025.152650","DOIUrl":"10.1016/j.comppsych.2025.152650","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess the effects of a four-day, group-based residential treatment program focused on enhancing psychological health and social functioning of firefighter and police first responders in British Columbia, Canada.</div></div><div><h3>Methods</h3><div>Using a repeated-measures design, participants completed seven validated self-report questionnaires at baseline (pre-test T0), two weeks after the session (post-test T1), and six months follow-up (T2). A multilevel approach to the analysis of repeated measures examined the effects of the program on several indicators. These included symptoms of major depressive disorder, symptoms of generalized anxiety, symptoms of post-traumatic stress disorder, social role functioning, social support (giving and receiving), quality of life, and health related impairments.</div></div><div><h3>Results</h3><div>A total of 106 police and 114 firefighters undertook the program. The baseline measures were completed by 207 (94 %) participants and 175 (80 %) completed at least one questionnaire at the longest follow-up. All outcomes measured improved from baseline to two-weeks post intervention (T0 to T1, <em>p</em> < 0.001), and sustained reductions at six months follow-up (T0 to T2, <em>p</em> < 0.001), except for giving social support. The highest standardized effect size (Cohen's <em>d</em>) observed at six months (T2) was for symptoms of major depressive disorder (<em>d</em> = −0.90), followed by symptoms of generalized anxiety disorder (<em>d</em> = −0.75), symptoms of post-traumatic stress disorder (<em>d</em> = −0.69), symptom distress (<em>d</em> = −0.62), social role challenges (<em>d</em> = −0.58), quality of life (<em>d</em> = 0.44), interpersonal relations (<em>d</em> = −0.40), and receiving emotional support (<em>d</em> = 0.23).</div></div><div><h3>Conclusion</h3><div>Participation in this program appeared to improve subjective ratings of Canadian firefighter and police psychological health and social functioning. The results are promising and require further exploration with a randomized trial and longer-term follow-up.</div></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"145 ","pages":"Article 152650"},"PeriodicalIF":4.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145718809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-31DOI: 10.1016/j.comppsych.2025.152661
Jiayi Zhu , Jianfei Xie , Gang Gan , Zitong Lu , Huiyi Zhang , Jingying Wang , Xiaoqian Dong , Qingcheng Zheng , Lijun Li , Yanan Zhang , Min Liu
Background
Depressive symptoms are common among kidney transplant recipients and are linked to adverse clinical and psychosocial outcomes. Chronotype may influence vulnerability to stress and emotional dysregulation, yet its psychosocial pathways to depression remain unclear. This study tested a stress process model to explain how chronotype, as a background factor, affects depressive symptoms through perceived stress, rumination, and sleep quality.
Methods
A multicenter cross-sectional study involving 508 kidney transplant recipients was conducted in southern China. Participants completed validated questionnaires assessing chronotype, perceived stress, rumination, sleep quality, and depressive symptoms. Structural equation modeling examined direct and indirect pathways among variables.
Results
The findings supported the hypothesized structural equation model. The total indirect effect of chronotype on depressive symptoms exceeded its direct effect. Significant indirect effects were observed through perceived stress (β = −0.14, 95 % CI [−0.28, −0.04]), rumination (β = −0.09, 95 % CI [−0.18, −0.01]), and sleep quality (β = −0.05, 95 % CI [−0.11, −0.03]), as well as sequential mediations involving perceived stress with rumination or sleep quality. In the extended model, the indirect pathways through perceived stress and reflection (β = −0.04, 95 % CI [−0.08, −0.01]) and through perceived stress, brooding, and sleep quality (β = −0.03, 95 % CI [−0.05, −0.01]) remained significant.
Conclusions
These findings highlight the need to incorporate chronotype assessment into post-transplant care. Interventions should emphasize circadian rhythm regulation, stress reduction, disruption of maladaptive rumination, and sleep improvement to prevent depressive symptoms among kidney transplant recipients.
{"title":"Depressive symptoms among kidney transplant recipients: Modeling stress-related pathways involving chronotype, perceived stress, rumination, and sleep quality","authors":"Jiayi Zhu , Jianfei Xie , Gang Gan , Zitong Lu , Huiyi Zhang , Jingying Wang , Xiaoqian Dong , Qingcheng Zheng , Lijun Li , Yanan Zhang , Min Liu","doi":"10.1016/j.comppsych.2025.152661","DOIUrl":"10.1016/j.comppsych.2025.152661","url":null,"abstract":"<div><h3>Background</h3><div>Depressive symptoms are common among kidney transplant recipients and are linked to adverse clinical and psychosocial outcomes. Chronotype may influence vulnerability to stress and emotional dysregulation, yet its psychosocial pathways to depression remain unclear. This study tested a stress process model to explain how chronotype, as a background factor, affects depressive symptoms through perceived stress, rumination, and sleep quality.</div></div><div><h3>Methods</h3><div>A multicenter cross-sectional study involving 508 kidney transplant recipients was conducted in southern China. Participants completed validated questionnaires assessing chronotype, perceived stress, rumination, sleep quality, and depressive symptoms. Structural equation modeling examined direct and indirect pathways among variables.</div></div><div><h3>Results</h3><div>The findings supported the hypothesized structural equation model. The total indirect effect of chronotype on depressive symptoms exceeded its direct effect. Significant indirect effects were observed through perceived stress (<em>β</em> = −0.14, 95 % CI [−0.28, −0.04]), rumination (<em>β</em> = −0.09, 95 % CI [−0.18, −0.01]), and sleep quality (<em>β</em> = −0.05, 95 % CI [−0.11, −0.03]), as well as sequential mediations involving perceived stress with rumination or sleep quality. In the extended model, the indirect pathways through perceived stress and reflection (<em>β</em> = −0.04, 95 % CI [−0.08, −0.01]) and through perceived stress, brooding, and sleep quality (<em>β</em> = −0.03, 95 % CI [−0.05, −0.01]) remained significant.</div></div><div><h3>Conclusions</h3><div>These findings highlight the need to incorporate chronotype assessment into post-transplant care. Interventions should emphasize circadian rhythm regulation, stress reduction, disruption of maladaptive rumination, and sleep improvement to prevent depressive symptoms among kidney transplant recipients.</div></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"145 ","pages":"Article 152661"},"PeriodicalIF":4.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145921443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-18DOI: 10.1016/j.comppsych.2025.152651
Quentin Adrian , Renaud F. Cohen , Julien Plasse , Isabelle Chéreau-Boudet , Benjamin Gouache , Emilie Legros-Lafarge , Catherine Massoubre , Nathalie Guillard-Bouhet , Léon Temblay , Nicolas Franck , Guillaume Barbalat
Purpose
Mental well-being is a cornerstone of recovery for people with mental disorders. Unfortunately, despite many studies on the topic, the literature still lacks results from large samples processed using advanced models capable of taking numerous variables into account. This study aims to leverage robust machine learning techniques on data from the REHABase cohort to identify key predictors of mental well-being in patients with severe mental disorders, with a particular focus on schizophrenia.
Methods
In all, 47 clinical, psychological, and sociodemographic variables were selected. Three distinct samples were analyzed: all patients (n = 2206), schizophrenia patients (n = 1136) and non-schizophrenia patients (n = 1070). The performances of 3 machine learning algorithms were compared: regularized linear regression, random forest, and gradient boosting with tenfold cross-validation.
Results
The regularized linear regression model was found to be the best performing in terms of generalizability. Results highlighted the influence of the internalized stigmatization subscales of resistance, resilience, and alienation alongside the resilience dimension of quality of life in predicting mental well-being across all of the disorders. For schizophrenia patients, mental well-being was primarily predicted by social withdrawal.
Conclusion
Using advanced machine learning methodology on a large sample of patients with transdiagnostic exploration, our results showed both the crucial role of resilience and resistance to stigma in overall mental well-being and the critical importance of social contact in schizophrenia. These insights should help improve care trajectories for individuals with severe psychopathologies, particularly by promoting social cognitive remediation in schizophrenia.
{"title":"Machine learning analysis of clinical, psychological and sociodemographic factors predicting mental well-being in patients with severe mental illness: Insights from the French REHABase cohort","authors":"Quentin Adrian , Renaud F. Cohen , Julien Plasse , Isabelle Chéreau-Boudet , Benjamin Gouache , Emilie Legros-Lafarge , Catherine Massoubre , Nathalie Guillard-Bouhet , Léon Temblay , Nicolas Franck , Guillaume Barbalat","doi":"10.1016/j.comppsych.2025.152651","DOIUrl":"10.1016/j.comppsych.2025.152651","url":null,"abstract":"<div><h3>Purpose</h3><div>Mental well-being is a cornerstone of recovery for people with mental disorders. Unfortunately, despite many studies on the topic, the literature still lacks results from large samples processed using advanced models capable of taking numerous variables into account. This study aims to leverage robust machine learning techniques on data from the REHABase cohort to identify key predictors of mental well-being in patients with severe mental disorders, with a particular focus on schizophrenia.</div></div><div><h3>Methods</h3><div>In all, 47 clinical, psychological, and sociodemographic variables were selected. Three distinct samples were analyzed: all patients (<em>n</em> = 2206), schizophrenia patients (<em>n</em> = 1136) and non-schizophrenia patients (<em>n</em> = 1070). The performances of 3 machine learning algorithms were compared: regularized linear regression, random forest, and gradient boosting with tenfold cross-validation.</div></div><div><h3>Results</h3><div>The regularized linear regression model was found to be the best performing in terms of generalizability. Results highlighted the influence of the internalized stigmatization subscales of resistance, resilience, and alienation alongside the resilience dimension of quality of life in predicting mental well-being across all of the disorders. For schizophrenia patients, mental well-being was primarily predicted by social withdrawal.</div></div><div><h3>Conclusion</h3><div>Using advanced machine learning methodology on a large sample of patients with transdiagnostic exploration, our results showed both the crucial role of resilience and resistance to stigma in overall mental well-being and the critical importance of social contact in schizophrenia. These insights should help improve care trajectories for individuals with severe psychopathologies, particularly by promoting social cognitive remediation in schizophrenia.</div></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"145 ","pages":"Article 152651"},"PeriodicalIF":4.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-19DOI: 10.1016/j.comppsych.2025.152653
Naomi A. Fineberg , Annika Brandtner , Nana Löchner , Christopher Kannen , Megan Smith , Simon Foster , Anita Meinke , Kristin Mosler , Shai Fine , Lior Carmi , Talia Friedman , Zsolt Demetrovics , Célia Sales , Julia Jones , Hernâni Oliveira , Samuel R. Chamberlain , Konstantinos Ioannidis , Katalin Felvinczi , Joseph Zohar , Andres Roman-Urrestarazu , Matthias Brand
Background
There is increasing global concern about the harms associated with problematic usage of the internet (PUI) affecting young people. Various risk factors have been proposed, but there is a scarcity of reliable evidence on the extent of the problem, who is most at risk of developing PUI and why, and how best to tackle it.
Objectives
BootStRaP (ISRCTN59576080) is a five-year multinational research programme designed to boost young people's health and resilience by determining, through prospective longitudinal assessment, the risk factors associated with PUI and its health economic impact and designing and testing preventative self-management interventions tailored to individual risk factors.
Methods
This paper describes the first phase of the project (i.e., Cohort 1). A sample of over 2500 schoolchildren aged 12–16 years was recruited across nine European countries. They were prospectively monitored over a 6-month period using a dedicated smartphone application (BootstrApp), through which their internet use habits, health and wellbeing were measured. Young people were involved in the co-design of aspects of the protocol including the recruitment plan and elements of the app design. The components of the assessment battery were chosen to investigate specific individual, clinical, cognitive and environmental risk determinants as defined a priori in an evidence-based logic-model. Participants were assessed using a combination of standardised demographic and clinical questionnaires, ambulatory assessment techniques, cognitive testing and passive digital monitoring. Multimodal data is analysed according to machine learning and structured equation modelling.
Expected outcomes
Our findings will contribute toward A) developing algorithms for predicting individuals at risk for PUI, B) identifying actionable variables for application to subjects as interventions for testing in the second phase of the project, C) validating risk hypotheses stated in the logic model of PUI including the interplay between predisposing risk factors (e.g., impulsivity, compulsivity), affective and cognitive processes (e.g., reward-related attentional biases), and executive functions (e.g., inhibitory control), D) calculating the health economic cost and impact of PUI in young people across Europe.
{"title":"Research protocol for BootStRaP assessment phase: A nine-nation study on boosting societal adaptation and mental health in a rapidly digitalising, post-pandemic Europe","authors":"Naomi A. Fineberg , Annika Brandtner , Nana Löchner , Christopher Kannen , Megan Smith , Simon Foster , Anita Meinke , Kristin Mosler , Shai Fine , Lior Carmi , Talia Friedman , Zsolt Demetrovics , Célia Sales , Julia Jones , Hernâni Oliveira , Samuel R. Chamberlain , Konstantinos Ioannidis , Katalin Felvinczi , Joseph Zohar , Andres Roman-Urrestarazu , Matthias Brand","doi":"10.1016/j.comppsych.2025.152653","DOIUrl":"10.1016/j.comppsych.2025.152653","url":null,"abstract":"<div><h3>Background</h3><div>There is increasing global concern about the harms associated with problematic usage of the internet (PUI) affecting young people. Various risk factors have been proposed, but there is a scarcity of reliable evidence on the extent of the problem, who is most at risk of developing PUI and why, and how best to tackle it.</div></div><div><h3>Objectives</h3><div>BootStRaP (ISRCTN59576080) is a five-year multinational research programme designed to boost young people's health and resilience by determining, through prospective longitudinal assessment, the risk factors associated with PUI and its health economic impact and designing and testing preventative self-management interventions tailored to individual risk factors.</div></div><div><h3>Methods</h3><div>This paper describes the first phase of the project (i.e., Cohort 1). A sample of over 2500 schoolchildren aged 12–16 years was recruited across nine European countries. They were prospectively monitored over a 6-month period using a dedicated smartphone application (<em>BootstrApp</em>), through which their internet use habits, health and wellbeing were measured. Young people were involved in the co-design of aspects of the protocol including the recruitment plan and elements of the app design. The components of the assessment battery were chosen to investigate specific individual, clinical, cognitive and environmental risk determinants as defined a priori in an evidence-based logic-model. Participants were assessed using a combination of standardised demographic and clinical questionnaires, ambulatory assessment techniques, cognitive testing and passive digital monitoring. Multimodal data is analysed according to machine learning and structured equation modelling.</div></div><div><h3>Expected outcomes</h3><div>Our findings will contribute toward A) developing algorithms for predicting individuals at risk for PUI, B) identifying actionable variables for application to subjects as interventions for testing in the second phase of the project, C) validating risk hypotheses stated in the logic model of PUI including the interplay between predisposing risk factors (e.g., impulsivity, compulsivity), affective and cognitive processes (e.g., reward-related attentional biases), and executive functions (e.g., inhibitory control), D) calculating the health economic cost and impact of PUI in young people across Europe.</div></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"145 ","pages":"Article 152653"},"PeriodicalIF":4.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Depressive symptoms are prevalent among young adults, with cognitive theories suggesting that impaired cognitive control contributes to sustained negative mood and depressive symptoms. This study investigated the feasibility and efficacy of a remotely-applied, tablet-based cognitive control video game, Legends of Hoa'manu (LoH), for reducing depressive symptoms in subclinical adults.
A randomized controlled trial (NCT05447091) was conducted with 173 participants (mean age 33 ± 11.6 years; 75.1 % female) exhibiting at least a minimal level of depressive symptoms (PHQ-8 ≥ 5). Participants were randomized into three groups: high-dose experimental game (HD_EG; N = 58), low-dose experimental game (LD_EG; N = 61), and high-dose control game (HD_CG; N = 54), with interventions spanning three weeks.
The intervention demonstrated high feasibility and adherence (69.5–76.5 % of sessions completed) without direct study contact. Overall depressive symptoms (BDI-II total score) improved across all groups, with a significant main effect of time, but no significant group differences. Still, group differences were found for the cognitive-affective BDI-II subscale, where the HD_EG group showed the largest reduction (4.5 points vs. 2.3 and 2.1 in the LD_EG and HD_CG, respectively). These improvements were maintained at 3-week and 3-month follow-ups. Secondary outcomes, including anxiety and rumination, also improved across all groups. Overall cognitive control performance did not differ between groups; however, significant improvements in inhibitory control emerged exclusively in the HD_EG group.
The results highlight the feasibility of this novel, cost-effective, and remotely-applied cognitive control-based intervention. These findings underscore the potential of LoH as a scalable solution for addressing depressive symptoms in subclinical populations.
抑郁症状在年轻人中很普遍，认知理论表明认知控制受损会导致持续的负面情绪和抑郁症状。本研究调查了远程应用、基于平板电脑的认知控制视频游戏《Hoa’manu Legends》（LoH）减轻亚临床成人抑郁症状的可行性和有效性。一项随机对照试验（NCT05447091）对173名参与者（平均年龄33±11.6岁；75.1%为女性）进行了研究，这些参与者至少表现出最低程度的抑郁症状（PHQ-8≥5）。参与者被随机分为三组：高剂量实验游戏（HD_EG, N = 58）、低剂量实验游戏（LD_EG, N = 61）和高剂量控制游戏（HD_CG, N = 54），干预时间为三周。在没有直接研究接触的情况下，干预显示出很高的可行性和依从性（69.5- 76.5%的疗程完成）。总体抑郁症状（BDI-II总分）在所有组间均有改善，主要受时间影响，但组间无显著差异。然而，在认知情感BDI-II子量表上发现了组间差异，其中HD_EG组表现出最大的下降（4.5分，LD_EG和HD_CG分别为2.3和2.1分）。这些改善在3周和3个月的随访中保持不变。包括焦虑和反刍在内的次要结果在所有组中也有所改善。整体认知控制表现在两组之间没有差异；然而，抑制控制的显著改善仅出现在HD_EG组。结果强调了这种新颖、经济、远程应用的基于认知控制的干预措施的可行性。这些发现强调了LoH作为解决亚临床人群抑郁症状的可扩展解决方案的潜力。
{"title":"A remotely-applied, cognitive control-based video game intervention to reduce depressive symptoms in a sub-clinical population: A randomized controlled trial (RCT)","authors":"Noa Givon Schacham , Angela Pasqualotto , Naamah Lerner , Marios Fanourakis , Zeno Menestrina , Daphne Bavelier , Mor Nahum","doi":"10.1016/j.comppsych.2025.152645","DOIUrl":"10.1016/j.comppsych.2025.152645","url":null,"abstract":"<div><div>Depressive symptoms are prevalent among young adults, with cognitive theories suggesting that impaired cognitive control contributes to sustained negative mood and depressive symptoms. This study investigated the feasibility and efficacy of a remotely-applied, tablet-based cognitive control video game, <em>Legends of Hoa'manu</em> (LoH), for reducing depressive symptoms in subclinical adults.</div><div>A randomized controlled trial (<span><span>NCT05447091</span><svg><path></path></svg></span>) was conducted with 173 participants (mean age 33 ± 11.6 years; 75.1 % female) exhibiting at least a minimal level of depressive symptoms (PHQ-8 ≥ 5). Participants were randomized into three groups: high-dose experimental game (HD_EG; <em>N</em> = 58), low-dose experimental game (LD_EG; <em>N</em> = 61), and high-dose control game (HD_CG; <em>N</em> = 54), with interventions spanning three weeks.</div><div>The intervention demonstrated high feasibility and adherence (69.5–76.5 % of sessions completed) without direct study contact. Overall depressive symptoms (BDI-II total score) improved across all groups, with a significant main effect of time, but no significant group differences. Still, group differences were found for the cognitive-affective BDI-II subscale, where the HD_EG group showed the largest reduction (4.5 points vs. 2.3 and 2.1 in the LD_EG and HD_CG, respectively). These improvements were maintained at 3-week and 3-month follow-ups. Secondary outcomes, including anxiety and rumination, also improved across all groups. Overall cognitive control performance did not differ between groups; however, significant improvements in inhibitory control emerged exclusively in the HD_EG group.</div><div>The results highlight the feasibility of this novel, cost-effective, and remotely-applied cognitive control-based intervention. These findings underscore the potential of LoH as a scalable solution for addressing depressive symptoms in subclinical populations.</div></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"144 ","pages":"Article 152645"},"PeriodicalIF":4.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145444367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-11-16DOI: 10.1016/j.comppsych.2025.152646
Marta Błoch, Błażej Misiak
Background
Loneliness is a public health priority due to its high prevalence and impact on various health outcomes. It might be associated with problematic internet use that is highly prevalent in young adults. However, its associations with specific problematic online behaviours (POBs) at their early stages of development remains unknown. The present study explored longitudinal associations between loneliness and various POBs in a general population sample of young adults without a history of psychiatric treatment.
Methods
Altogether, 1441 individuals were assessed at baseline (aged 29.5 ± 6.3 years, 51.4 % women). The follow-up assessment was scheduled after 6 months and was completed by 733 individuals (aged 30.5 ± 6.0 years, 49.1 % women, retention rate of 50.9 %). The data were collected using self-reports and analyzed using a cross-lagged panel network model.
Results
Higher baseline levels of loneliness predicted higher levels of problematic cybersex, depressive symptoms, and anxiety symptoms at the follow-up. In turn, higher levels of loneliness were predicted by higher baseline levels of problematic online gaming, cyberchondria, and depressive symptoms. The highest output centrality was found for problematic online gaming and shopping. Loneliness was ranked among the nodes with the lowest output centrality in the network. However, it showed the highest auto-regressive effect suggesting its high stability over time.
Conclusions
The findings indicate that loneliness is bidirectionally associated with POBs with problematic online gaming, cyberchondria, and cybersex playing the most important roles in these associations. These observations indicate the necessity to consider loneliness among therapeutic targets among individuals with POBs.
{"title":"Loneliness and the emergence of problematic online behaviours in young adults: A cross-lagged panel network analysis","authors":"Marta Błoch, Błażej Misiak","doi":"10.1016/j.comppsych.2025.152646","DOIUrl":"10.1016/j.comppsych.2025.152646","url":null,"abstract":"<div><h3>Background</h3><div>Loneliness is a public health priority due to its high prevalence and impact on various health outcomes. It might be associated with problematic internet use that is highly prevalent in young adults. However, its associations with specific problematic online behaviours (POBs) at their early stages of development remains unknown. The present study explored longitudinal associations between loneliness and various POBs in a general population sample of young adults without a history of psychiatric treatment.</div></div><div><h3>Methods</h3><div>Altogether, 1441 individuals were assessed at baseline (aged 29.5 ± 6.3 years, 51.4 % women). The follow-up assessment was scheduled after 6 months and was completed by 733 individuals (aged 30.5 ± 6.0 years, 49.1 % women, retention rate of 50.9 %). The data were collected using self-reports and analyzed using a cross-lagged panel network model.</div></div><div><h3>Results</h3><div>Higher baseline levels of loneliness predicted higher levels of problematic cybersex, depressive symptoms, and anxiety symptoms at the follow-up. In turn, higher levels of loneliness were predicted by higher baseline levels of problematic online gaming, cyberchondria, and depressive symptoms. The highest output centrality was found for problematic online gaming and shopping. Loneliness was ranked among the nodes with the lowest output centrality in the network. However, it showed the highest auto-regressive effect suggesting its high stability over time.</div></div><div><h3>Conclusions</h3><div>The findings indicate that loneliness is bidirectionally associated with POBs with problematic online gaming, cyberchondria, and cybersex playing the most important roles in these associations. These observations indicate the necessity to consider loneliness among therapeutic targets among individuals with POBs.</div></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"144 ","pages":"Article 152646"},"PeriodicalIF":4.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145573395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-11-16DOI: 10.1016/j.comppsych.2025.152647
Jon E. Grant , Megha Neelapu , Laurie Avila , Sophia Boutouis , Samuel R. Chamberlain
Background
Trichotillomania (hair pulling disorder) and skin picking disorder have typical age of onset around puberty, and appear more common in women than in men, suggesting the possibility that hormonal systems may relate to symptoms. Yet virtually no research has explored relationships between pregnancy (and the post-partum period) and symptom severity in people affected by these conditions.
Methods
People with trichotillomania and/or skin picking disorder were recruited from the general community if they had previously experienced at least one pregnancy during their lifetimes. Data were collected regarding perceived relationships between symptom severity, pregnancy, and the post-partum period.
Results
Whilst some women reported an exacerbation of hair pulling and/or skin picking during pregnancy or in the perinatal period, the majority of women reported no change or even reductions in such symptoms during these times.
Conclusions
These data suggest that relationships between pregnancy and hair pulling plus skin picking symptoms can vary depending on the individual. Future work could examine these relationships at the time of pregnancy and afterwards, rather than using retrospective questionnaires; and could also collect biological measures to help explore any underlying mechanisms that may account for this variation in symptoms.
{"title":"Trichotillomania, skin picking disorder, and pregnancy","authors":"Jon E. Grant , Megha Neelapu , Laurie Avila , Sophia Boutouis , Samuel R. Chamberlain","doi":"10.1016/j.comppsych.2025.152647","DOIUrl":"10.1016/j.comppsych.2025.152647","url":null,"abstract":"<div><h3>Background</h3><div>Trichotillomania (hair pulling disorder) and skin picking disorder have typical age of onset around puberty, and appear more common in women than in men, suggesting the possibility that hormonal systems may relate to symptoms. Yet virtually no research has explored relationships between pregnancy (and the post-partum period) and symptom severity in people affected by these conditions.</div></div><div><h3>Methods</h3><div>People with trichotillomania and/or skin picking disorder were recruited from the general community if they had previously experienced at least one pregnancy during their lifetimes. Data were collected regarding perceived relationships between symptom severity, pregnancy, and the post-partum period.</div></div><div><h3>Results</h3><div>Whilst some women reported an exacerbation of hair pulling and/or skin picking during pregnancy or in the perinatal period, the majority of women reported no change or even reductions in such symptoms during these times.</div></div><div><h3>Conclusions</h3><div>These data suggest that relationships between pregnancy and hair pulling plus skin picking symptoms can vary depending on the individual. Future work could examine these relationships at the time of pregnancy and afterwards, rather than using retrospective questionnaires; and could also collect biological measures to help explore any underlying mechanisms that may account for this variation in symptoms.</div></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"144 ","pages":"Article 152647"},"PeriodicalIF":4.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145548623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-11-16DOI: 10.1016/j.comppsych.2025.152648
Shiau-Shian Huang , Ying-Ting Chao , Yu-Ning Chen , Mei-Hsin Su , Chiao-Erh Chang , Shih-Jen Tsai , Po-Hsiu Kuo
Introduction
Antidepressant-induced mania (AIM) is a significant clinical concern, primarily studied in bipolar disorder patients. Limited research exists on AIM in unipolar depression, with reported incidence rates of 3.0–8.2 %.
Methods
Using data from the Taiwan's National Health Insurance Research Database merged with Taiwan Biobank (2001–2017), we analyzed 772 depression patients who were prescribed antidepressants and had available genotype data. A genome-wide association study (GWAS) was performed to investigate potential genetic factors associated with AIM. Single-marker association analysis and polygenic risk scores were calculated using PLINK.
Results
AIM developed in 145 (19.65 %) of depressive patients within 28 days of medication use or discontinuation. Significant associated clinical characteristics included female gender, postpartum depression, comorbid obsessive-compulsive disorder, severe depression, substance use disorders, and other non-organic psychosis. Eight single nucleotide polymorphisms were identified as potential genetic markers associated with AIM in this GWAS, and higher polygenic risk scores for bipolar disorder were associated with increased AIM risk.
Conclusion
AIM was observed in one-fifth of depressive patients of the Han Chinese origin, with female gender and psychiatric comorbidities as significant clinical characteristics. This GWAS of AIM in depressive patients identified potential genetic markers and suggested that a genetic predisposition to bipolar disorder may increase the likelihood of developing AIM, although this association did not reach statistical significance. Future research should aim to increase sample size and further investigate genotype-AIM associations.
{"title":"Genetic and clinical characteristics associated with antidepressant-induced mania in depression patients","authors":"Shiau-Shian Huang , Ying-Ting Chao , Yu-Ning Chen , Mei-Hsin Su , Chiao-Erh Chang , Shih-Jen Tsai , Po-Hsiu Kuo","doi":"10.1016/j.comppsych.2025.152648","DOIUrl":"10.1016/j.comppsych.2025.152648","url":null,"abstract":"<div><h3>Introduction</h3><div>Antidepressant-induced mania (AIM) is a significant clinical concern, primarily studied in bipolar disorder patients. Limited research exists on AIM in unipolar depression, with reported incidence rates of 3.0–8.2 %.</div></div><div><h3>Methods</h3><div>Using data from the Taiwan's National Health Insurance Research Database merged with Taiwan Biobank (2001–2017), we analyzed 772 depression patients who were prescribed antidepressants and had available genotype data. A genome-wide association study (GWAS) was performed to investigate potential genetic factors associated with AIM. Single-marker association analysis and polygenic risk scores were calculated using PLINK.</div></div><div><h3>Results</h3><div>AIM developed in 145 (19.65 %) of depressive patients within 28 days of medication use or discontinuation. Significant associated clinical characteristics included female gender, postpartum depression, comorbid obsessive-compulsive disorder, severe depression, substance use disorders, and other non-organic psychosis. Eight single nucleotide polymorphisms were identified as potential genetic markers associated with AIM in this GWAS, and higher polygenic risk scores for bipolar disorder were associated with increased AIM risk.</div></div><div><h3>Conclusion</h3><div>AIM was observed in one-fifth of depressive patients of the Han Chinese origin, with female gender and psychiatric comorbidities as significant clinical characteristics. This GWAS of AIM in depressive patients identified potential genetic markers and suggested that a genetic predisposition to bipolar disorder may increase the likelihood of developing AIM, although this association did not reach statistical significance. Future research should aim to increase sample size and further investigate genotype-AIM associations.</div></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"144 ","pages":"Article 152648"},"PeriodicalIF":4.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145577144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号