<div><h3>Background</h3><div>HIV-associated neurocognitive disorders (HAND) remain a significant public health concern among people living with HIV (PWH) in Africa, despite the widespread implementation of highly active antiretroviral therapy (HAART). While HAART has been effective in reducing the incidence of severe neurocognitive disorder, milder forms of neurocognitive impairment continue to be observed even among individuals receiving active antiretroviral therapy. These subtle deficits, particularly prevalent in low-resource and low-literacy contexts, are associated with adverse outcomes such as diminished functional capacity, poor adherence to antiretroviral therapy, and reduced quality of life. This systematic review and meta-analysis aims to synthesize the current evidence on the effectiveness of HAART on neurocognitive outcomes among HIV-positive individuals in Africa.</div></div><div><h3>Methods</h3><div>A comprehensive systematic search was conducted across multiple electronic databases—including PubMed/MEDLINE, Scopus, African Journals Online, PsycINFO, EMBASE, CINAHL, and the Cochrane Library—to identify primary research studies that examined the prevalence and clinical impact of HIV-associated neurocognitive disorders (HAND) among HIV-infected populations in Africa. Study selection and data extraction were performed independently by two reviewers using predefined standardized protocols to ensure methodological rigor and minimize the risk of bias. The review protocol was prospectively registered with PROSPERO (CRD420251017353).</div></div><div><h3>Results</h3><div>This meta-analysis, which included 62 primary studies with a combined sample of 19,831 individuals living with HIV, estimated a pooled prevalence of HIV-associated neurocognitive disorders was 47.18% (95% CI: 39.94%–54.42%). In contrast, among 2,176 HIV-negative individuals in the control group, the prevalence of neurocognitive disorder was 13.48% (95% CI: 10.9%–15.32%). Sub-regional stratification revealed the highest HAND prevalence in Eastern Africa (50.85%), followed by Southern Africa (48.12%) and Western Africa (43.67%), while Central Africa reported the lowest prevalence at 34.68%. Among individuals receiving antiretroviral therapy (ART), the prevalence of HAND was 46.96%, compared to 50.22% in ART-naïve participants, indicating only a modest reduction in neurocognitive impairment associated with ART exposure. Meta-regression analyses identified several independent predictors significantly associated with increased odds of HAND, including advanced HIV disease stage (odds ratio [OR] 3.59; 95% CI: 2.81–4.59), lower educational attainment (3.13, 2.19–4.48), older age (2.05, 1.51–2.78), being female (2.18, 1.79-2.64), history of substance use (2.70, 2.65–2.75), reduced CD4+ T-cell counts (2.49, 1.42–4.36) and comorbid medical illness (2.05, 1.57-2.67).</div></div><div><h3>Conclusion</h3><div>HIV-associated neurocognitive disorders affect nearly half of people living with
{"title":"The role of HAART in mitigating neurocognitive decline among HIV-positive Africans: Systematic review and meta-analysis","authors":"Mulualem Kelebie , Getasew Kibralew , Gebresilassie Tadesse , Girum Nakie , Mulu Muche , Dawed Ali , Birtukan Fasil , Gidey Rtbey , Biruk Fanta , Nega Gedefaw Agmase , Girmaw Medfu Takelle , Melese Gobezie , Mequanente Dagnaw , Setegn Fentahun","doi":"10.1016/j.comppsych.2025.152639","DOIUrl":"10.1016/j.comppsych.2025.152639","url":null,"abstract":"<div><h3>Background</h3><div>HIV-associated neurocognitive disorders (HAND) remain a significant public health concern among people living with HIV (PWH) in Africa, despite the widespread implementation of highly active antiretroviral therapy (HAART). While HAART has been effective in reducing the incidence of severe neurocognitive disorder, milder forms of neurocognitive impairment continue to be observed even among individuals receiving active antiretroviral therapy. These subtle deficits, particularly prevalent in low-resource and low-literacy contexts, are associated with adverse outcomes such as diminished functional capacity, poor adherence to antiretroviral therapy, and reduced quality of life. This systematic review and meta-analysis aims to synthesize the current evidence on the effectiveness of HAART on neurocognitive outcomes among HIV-positive individuals in Africa.</div></div><div><h3>Methods</h3><div>A comprehensive systematic search was conducted across multiple electronic databases—including PubMed/MEDLINE, Scopus, African Journals Online, PsycINFO, EMBASE, CINAHL, and the Cochrane Library—to identify primary research studies that examined the prevalence and clinical impact of HIV-associated neurocognitive disorders (HAND) among HIV-infected populations in Africa. Study selection and data extraction were performed independently by two reviewers using predefined standardized protocols to ensure methodological rigor and minimize the risk of bias. The review protocol was prospectively registered with PROSPERO (CRD420251017353).</div></div><div><h3>Results</h3><div>This meta-analysis, which included 62 primary studies with a combined sample of 19,831 individuals living with HIV, estimated a pooled prevalence of HIV-associated neurocognitive disorders was 47.18% (95% CI: 39.94%–54.42%). In contrast, among 2,176 HIV-negative individuals in the control group, the prevalence of neurocognitive disorder was 13.48% (95% CI: 10.9%–15.32%). Sub-regional stratification revealed the highest HAND prevalence in Eastern Africa (50.85%), followed by Southern Africa (48.12%) and Western Africa (43.67%), while Central Africa reported the lowest prevalence at 34.68%. Among individuals receiving antiretroviral therapy (ART), the prevalence of HAND was 46.96%, compared to 50.22% in ART-naïve participants, indicating only a modest reduction in neurocognitive impairment associated with ART exposure. Meta-regression analyses identified several independent predictors significantly associated with increased odds of HAND, including advanced HIV disease stage (odds ratio [OR] 3.59; 95% CI: 2.81–4.59), lower educational attainment (3.13, 2.19–4.48), older age (2.05, 1.51–2.78), being female (2.18, 1.79-2.64), history of substance use (2.70, 2.65–2.75), reduced CD4+ T-cell counts (2.49, 1.42–4.36) and comorbid medical illness (2.05, 1.57-2.67).</div></div><div><h3>Conclusion</h3><div>HIV-associated neurocognitive disorders affect nearly half of people living with","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"143 ","pages":"Article 152639"},"PeriodicalIF":4.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145262340","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 : 2025-11-01Epub Date: 2025-09-10DOI: 10.1016/j.comppsych.2025.152633
Anna Magi , Zsolt Horváth , Cristina Villalba-García , Borbála Paksi , Andrea Eisinger , Katalin Felvinczi , Sherry H Stewart , Beáta Bőthe , Gyöngyi Kökönyei , Zsolt Demetrovics , Andrea Czakó
Background
Motives underlying addictions have been widely studied, using validated tools such as the Gambling Motives Questionnaire (GMQ) (Stewart and Zack, 2008). Nevertheless, subsequent studies have suggested the need to extend this model. The present paper aimed to identify potential additional factors, such as escapism, omnipotence, pleasure and financial motives, in addition to the social, enhancement and coping aspects already included.
Methods
A total of 40 motivational items (adding 25 additional items to the original GMQ items) were analysed within two datasets. Sample 1 was a player panel from a gambling service provider (N = 1829; mean age: 42.4 [SD = 13.3]; Females: 30 % [n = 548]), while Sample 2 consisted of a nationally representative sample of the Hungarian population (N = 437; mean age: 42.9 [SD = 13.55]; Females: 49.2 % [N = 215]).
Results
Exploratory Factor Analysis on Sample 1 identified four factors (including a total of 27 items): coping/escapism, social motives, enhancement/pleasure, and financial motives. The four-factor structure was confirmed on Sample 2 with confirmatory factor analysis showing adequate model fit (CFI = 0.987; TLI = 0.986; RMSEA[CI] = 0.047 [0.041–0.052]); however, high inter-factor correlations were evident in the general population sample. A shorter, 14-item version of the scale was also suggested.
Conclusions
Although the newly identified motives overlap with the original ones, the content of the factors enables the inclusion of certain aspects, like escapism within the coping factor, that proved to be the most important in relation to other potentially addictive behaviours. This suggests that examining the role of motives in gambling may be crucial in differentiating between problem gambling and recreational gambling.
{"title":"An extended model of gambling motives: The first results with the long and short versions of the gambling motives questionnaire-revised","authors":"Anna Magi , Zsolt Horváth , Cristina Villalba-García , Borbála Paksi , Andrea Eisinger , Katalin Felvinczi , Sherry H Stewart , Beáta Bőthe , Gyöngyi Kökönyei , Zsolt Demetrovics , Andrea Czakó","doi":"10.1016/j.comppsych.2025.152633","DOIUrl":"10.1016/j.comppsych.2025.152633","url":null,"abstract":"<div><h3>Background</h3><div>Motives underlying addictions have been widely studied, using validated tools such as the Gambling Motives Questionnaire (GMQ) (Stewart and Zack, 2008). Nevertheless, subsequent studies have suggested the need to extend this model. The present paper aimed to identify potential additional factors, such as escapism, omnipotence, pleasure and financial motives, in addition to the social, enhancement and coping aspects already included.</div></div><div><h3>Methods</h3><div>A total of 40 motivational items (adding 25 additional items to the original GMQ items) were analysed within two datasets. Sample 1 was a player panel from a gambling service provider (<em>N</em> = 1829; mean age: 42.4 [SD = 13.3]; Females: 30 % [<em>n</em> = 548]), while Sample 2 consisted of a nationally representative sample of the Hungarian population (<em>N</em> = 437; mean age: 42.9 [SD = 13.55]; Females: 49.2 % [<em>N</em> = 215]).</div></div><div><h3>Results</h3><div>Exploratory Factor Analysis on Sample 1 identified four factors (including a total of 27 items): coping/escapism, social motives, enhancement/pleasure, and financial motives. The four-factor structure was confirmed on Sample 2 with confirmatory factor analysis showing adequate model fit (CFI = 0.987; TLI = 0.986; RMSEA[CI] = 0.047 [0.041–0.052]); however, high inter-factor correlations were evident in the general population sample. A shorter, 14-item version of the scale was also suggested.</div></div><div><h3>Conclusions</h3><div>Although the newly identified motives overlap with the original ones, the content of the factors enables the inclusion of certain aspects, like escapism within the coping factor, that proved to be the most important in relation to other potentially addictive behaviours. This suggests that examining the role of motives in gambling may be crucial in differentiating between problem gambling and recreational gambling.</div></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"143 ","pages":"Article 152633"},"PeriodicalIF":4.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148063","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 : 2025-11-01Epub Date: 2025-09-19DOI: 10.1016/j.comppsych.2025.152635
Amir Pakpour , Marit Eriksson , Daniel Kwasi Ahorsu , Gunilla Björling , Anders Broström , Staffan Bengtsson , Malin Jakobsson , Karina Huus
Objectives
This study examined the 1) psychometric properties of an independently translated Swedish version of the gaming disorder test (GDT) among Swedish adolescents based on two psychometric theories, 2) measurement invariance across age (i.e., 15 vs 16–17), gender (i.e., males vs females), and gaming time (i.e., < 2 h vs ≥ 2 h), and 3) factors that predict gaming disorder. The findings will help researchers understand and ascertain the use of the GDT among Swedish adolescents.
Methods
A total of 5320 Swedish adolescents were recruited and responded to measures including gaming disorder, gaming duration, sleep duration, physical activity, mental well-being, and self-esteem. Statistical analyses were conducted using confirmatory factor analysis, regression analysis, latent class analysis, classical test theory, and Rasch analysis.
Results
Satisfactory and unidimensional psychometric properties for the independently translated Swedish version of the GDT were found. Specifically, the factor structure, internal consistencies, separation reliability and separation index were supported, but not the person separation reliability and index. Also, the GDT was invariant across ages but only partially so across gender and gaming time. The GDT can classify adolescents as having a high or low risk of gaming disorder. Lastly, factors that predicted gaming disorder were poorer mental well-being and longer gaming time among males and low physical activity and longer gaming time among females.
Conclusion
Due to its conciseness, researchers may use the independently translated Swedish version of the GDT for screening people for gaming issues even in busy settings like schools. Moreover, attention must be paid to males, those with poorer mental well-being, those who are physically inactive, and those with a longer gaming time to help curb gaming disorder. Future research may focus on examining the test-retest reliability and clinical validity of the GDT among adolescents.
{"title":"Gaming disorder among Swedish adolescents: Measurement, risk factors, and classification","authors":"Amir Pakpour , Marit Eriksson , Daniel Kwasi Ahorsu , Gunilla Björling , Anders Broström , Staffan Bengtsson , Malin Jakobsson , Karina Huus","doi":"10.1016/j.comppsych.2025.152635","DOIUrl":"10.1016/j.comppsych.2025.152635","url":null,"abstract":"<div><h3>Objectives</h3><div>This study examined the 1) psychometric properties of an independently translated Swedish version of the gaming disorder test (GDT) among Swedish adolescents based on two psychometric theories, 2) measurement invariance across age (i.e., 15 vs 16–17), gender (i.e., males vs females), and gaming time (i.e., < 2 h vs ≥ 2 h), and 3) factors that predict gaming disorder. The findings will help researchers understand and ascertain the use of the GDT among Swedish adolescents.</div></div><div><h3>Methods</h3><div>A total of 5320 Swedish adolescents were recruited and responded to measures including gaming disorder, gaming duration, sleep duration, physical activity, mental well-being, and self-esteem. Statistical analyses were conducted using confirmatory factor analysis, regression analysis, latent class analysis, classical test theory, and Rasch analysis.</div></div><div><h3>Results</h3><div>Satisfactory and unidimensional psychometric properties for the independently translated Swedish version of the GDT were found. Specifically, the factor structure, internal consistencies, separation reliability and separation index were supported, but not the person separation reliability and index. Also, the GDT was invariant across ages but only partially so across gender and gaming time. The GDT can classify adolescents as having a high or low risk of gaming disorder. Lastly, factors that predicted gaming disorder were poorer mental well-being and longer gaming time among males and low physical activity and longer gaming time among females.</div></div><div><h3>Conclusion</h3><div>Due to its conciseness, researchers may use the independently translated Swedish version of the GDT for screening people for gaming issues even in busy settings like schools. Moreover, attention must be paid to males, those with poorer mental well-being, those who are physically inactive, and those with a longer gaming time to help curb gaming disorder. Future research may focus on examining the test-retest reliability and clinical validity of the GDT among adolescents.</div></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"143 ","pages":"Article 152635"},"PeriodicalIF":4.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154212","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 : 2025-11-01Epub Date: 2025-10-06DOI: 10.1016/j.comppsych.2025.152641
Youna McGowan , Bilikis Banire , Hailey Burns , Dawson Sutherland , Sherry H. Stewart , Raymond M. Klein , Sandra Meier
Social media's highly visual and interactive nature fosters social comparisons and can thereby exacerbate feelings of inadequacy, especially among youth with anxiety. Compared to their non-anxious peers, anxious youth are more likely to use social media and may be more susceptible to engaging in social comparison, as suggested by prior literature. Anxious youth are also more attentive to indicators of social status and threats. Thus, this study explored the attention bias mechanisms underlying anxiety in response to social media status cues (e.g., follower counts, likes). We predicted that with increasing anxiety symptoms, youth would avoid allocating their attention to these cues. We recruited 69 shy or anxious young females with anxiety symptoms to view Instagram profiles [Mage = 20.44 years, SDage = 1.84 years]. We recorded participants' eye movements with a high degree of spatial and temporal resolution while participants freely engaged with these profiles. Results showed that with increasing anxiety symptoms, youths' first fixation latency was significantly longer and their fixation duration shorter for social media status cues compared to the overall profile, representing an attentional avoidance pattern. This pattern was observed for both popular and less-popular profiles. These findings add to evidence that anxiety symptoms are linked to differences in visual attention to social media status cues. Further research is needed to examine these effects across genders, platforms, and in relation to other psychological constructs.
{"title":"Attention to Instagram features in female youth with anxiety symptoms","authors":"Youna McGowan , Bilikis Banire , Hailey Burns , Dawson Sutherland , Sherry H. Stewart , Raymond M. Klein , Sandra Meier","doi":"10.1016/j.comppsych.2025.152641","DOIUrl":"10.1016/j.comppsych.2025.152641","url":null,"abstract":"<div><div>Social media's highly visual and interactive nature fosters social comparisons and can thereby exacerbate feelings of inadequacy, especially among youth with anxiety. Compared to their non-anxious peers, anxious youth are more likely to use social media and may be more susceptible to engaging in social comparison, as suggested by prior literature. Anxious youth are also more attentive to indicators of social status and threats. Thus, this study explored the attention bias mechanisms underlying anxiety in response to social media status cues (e.g., follower counts, likes). We predicted that with increasing anxiety symptoms, youth would avoid allocating their attention to these cues. We recruited 69 shy or anxious young females with anxiety symptoms to view Instagram profiles [<em>M</em><sub>age</sub> = 20.44 years, <em>SD</em><sub>age</sub> = 1.84 years]. We recorded participants' eye movements with a high degree of spatial and temporal resolution while participants freely engaged with these profiles. Results showed that with increasing anxiety symptoms, youths' first fixation latency was significantly longer and their fixation duration shorter for social media status cues compared to the overall profile, representing an attentional avoidance pattern. This pattern was observed for both popular and less-popular profiles. These findings add to evidence that anxiety symptoms are linked to differences in visual attention to social media status cues. Further research is needed to examine these effects across genders, platforms, and in relation to other psychological constructs.</div></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"143 ","pages":"Article 152641"},"PeriodicalIF":4.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145262341","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 : 2025-11-01Epub Date: 2025-10-02DOI: 10.1016/j.comppsych.2025.152638
Yingzhe He , Siu-Man Ng , Mao-Sheng Ran , Cong Wang , Yi-Yue Yang , Lie Zhou , Jia Cai
Background
Expressed Emotion (EE) is a well-established predictor of schizophrenia relapse, but concerns remain regarding the content validity of its traditional components—criticism, hostility, and emotional overinvolvement (EOI). Recent research suggests a covert EE dimension (disassociation, apathy) unmeasured by current scales. This study developed and validated a self-report EE scale, the Comprehensive Expressed Emotion Scale (CEES), to reconceptualize EE.
Methods
319 adults with schizophrenia in Mainland China completed CEES, relevant Family Environment Scale—Chinese Version (FES-CV) subscales, and SF-12. Ten patient–family dyads also underwent the Camberwell Family Interview (CFI). Exploratory and confirmatory factor analyses determined factor structure; reliability and validity were evaluated using established indices and correlations.
Results
EFA supported a three-factor model—overt (criticism, hostility), covert (disassociation, apathy), and EOI—explaining 64 % of variance. CFA confirmed strong loadings for overt and covert items (0.70–0.91 and 0.72–0.90; all p < 0.001), but weaker, mostly non-significant loadings for EOI items. The three-factor model showed good fit (χ2(402) = 657.17, CFI = 0.971, TLI = 0.968, RMSEA = 0.061, SRMR = 0.079). The total scale and overt and covert subscales showed high internal consistency and strong construct and concurrent validity; EOI subscale reliability was moderate.
Conclusions
CEES operationalizes covert EE in Chinese families, broadening EE assessment to include implicit conflict. It demonstrates strong psychometric properties and potential for targeted interventions, though EOI subscale reliability and generalizability remain limitations.
{"title":"Beyond criticism, hostility, and emotional overinvolvement: Development and psychometric validation of the Comprehensive Expressed Emotion Scale (CEES) in schizophrenia","authors":"Yingzhe He , Siu-Man Ng , Mao-Sheng Ran , Cong Wang , Yi-Yue Yang , Lie Zhou , Jia Cai","doi":"10.1016/j.comppsych.2025.152638","DOIUrl":"10.1016/j.comppsych.2025.152638","url":null,"abstract":"<div><h3>Background</h3><div>Expressed Emotion (EE) is a well-established predictor of schizophrenia relapse, but concerns remain regarding the content validity of its traditional components—criticism, hostility, and emotional overinvolvement (EOI). Recent research suggests a covert EE dimension (disassociation, apathy) unmeasured by current scales. This study developed and validated a self-report EE scale, the Comprehensive Expressed Emotion Scale (CEES), to reconceptualize EE.</div></div><div><h3>Methods</h3><div>319 adults with schizophrenia in Mainland China completed CEES, relevant Family Environment Scale—Chinese Version (FES-CV) subscales, and SF-12. Ten patient–family dyads also underwent the Camberwell Family Interview (CFI). Exploratory and confirmatory factor analyses determined factor structure; reliability and validity were evaluated using established indices and correlations.</div></div><div><h3>Results</h3><div>EFA supported a three-factor model—overt (criticism, hostility), covert (disassociation, apathy), and EOI—explaining 64 % of variance. CFA confirmed strong loadings for overt and covert items (0.70–0.91 and 0.72–0.90; all <em>p</em> < 0.001), but weaker, mostly non-significant loadings for EOI items. The three-factor model showed good fit (χ<sup>2</sup>(402) = 657.17, CFI = 0.971, TLI = 0.968, RMSEA = 0.061, SRMR = 0.079). The total scale and overt and covert subscales showed high internal consistency and strong construct and concurrent validity; EOI subscale reliability was moderate.</div></div><div><h3>Conclusions</h3><div>CEES operationalizes covert EE in Chinese families, broadening EE assessment to include implicit conflict. It demonstrates strong psychometric properties and potential for targeted interventions, though EOI subscale reliability and generalizability remain limitations.</div></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"143 ","pages":"Article 152638"},"PeriodicalIF":4.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257684","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 : 2025-11-01Epub Date: 2025-09-08DOI: 10.1016/j.comppsych.2025.152634
Shanna van Trigt , Mariana Mendoza-Alvarez , Tanja van der Zweerde , Livia De Picker , Annemieke van Straten , Arnoud Arntz , Hein J.F. van Marle
This study evaluated the psychometric properties of a new version of the Borderline Personality Disorder Severity Index-5 that assesses BPD symptom severity over the course of 4 weeks instead of the standard 3 months: the BPDSI-5-4wk. Reliability and validity were evaluated in a mixed sample of patients with BPD (n = 92), patients with avoidant personality disorder (APD) as clinical control group (n = 16), and a non-patient control group (n = 20). The study demonstrated very high interrater agreement and test-retest reliability and acceptable to excellent internal consistencies of the BPDSI-5-4wk. Confirmatory factor analysis supported its assumed nine-factor structure. The BPDSI-5-4wk also showed very good construct (i.e. known-group) validity, as well as criterion-related (i.e. concurrent) validity when correlating the BPDSI-5-4wk with the BPDSI-5 (3-month version), the structured clinical interview for DSM personality disorders (SCID-5-P), and several other BPD- and other mental health-related self-report questionnaires. We additionally derived cut-off scores with high sensitivity and specificity for distinguishing BPD from clinical controls (21.02, 85 % sensitivity, 94 % specificity), from non-patient controls (10.50, 98 % sensitivity, 100 % specificity), and from both control groups combined (17.26, 93 % sensitivity, 92 % specificity). A reliable change criterion of 5.88 was established. Preliminary trial data additionally showed the BPDSI-5-4wk's sensitivity to change. The strong reliability and validity of the BPDSI-5-4wk support its value for detailed, dimensional assessment of BPD symptom severity over shorter time frames. This will facilitate frequent treatment response evaluations, rapid indication of follow-up treatment, and better alignment with shorter intervention and follow-up periods in clinical trials.
{"title":"Psychometric properties of the 4-week version of the Borderline Personality Disorder Severity Index-5","authors":"Shanna van Trigt , Mariana Mendoza-Alvarez , Tanja van der Zweerde , Livia De Picker , Annemieke van Straten , Arnoud Arntz , Hein J.F. van Marle","doi":"10.1016/j.comppsych.2025.152634","DOIUrl":"10.1016/j.comppsych.2025.152634","url":null,"abstract":"<div><div>This study evaluated the psychometric properties of a new version of the Borderline Personality Disorder Severity Index-5 that assesses BPD symptom severity over the course of 4 weeks instead of the standard 3 months: the BPDSI-5-4wk. Reliability and validity were evaluated in a mixed sample of patients with BPD (<em>n</em> = 92), patients with avoidant personality disorder (APD) as clinical control group (<em>n</em> = 16), and a non-patient control group (<em>n</em> = 20). The study demonstrated very high interrater agreement and test-retest reliability and acceptable to excellent internal consistencies of the BPDSI-5-4wk. Confirmatory factor analysis supported its assumed nine-factor structure. The BPDSI-5-4wk also showed very good construct (i.e. known-group) validity, as well as criterion-related (i.e. concurrent) validity when correlating the BPDSI-5-4wk with the BPDSI-5 (3-month version), the structured clinical interview for DSM personality disorders (SCID-5-P), and several other BPD- and other mental health-related self-report questionnaires. We additionally derived cut-off scores with high sensitivity and specificity for distinguishing BPD from clinical controls (21.02, 85 % sensitivity, 94 % specificity), from non-patient controls (10.50, 98 % sensitivity, 100 % specificity), and from both control groups combined (17.26, 93 % sensitivity, 92 % specificity). A reliable change criterion of 5.88 was established. Preliminary trial data additionally showed the BPDSI-5-4wk's sensitivity to change. The strong reliability and validity of the BPDSI-5-4wk support its value for detailed, dimensional assessment of BPD symptom severity over shorter time frames. This will facilitate frequent treatment response evaluations, rapid indication of follow-up treatment, and better alignment with shorter intervention and follow-up periods in clinical trials.</div></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"143 ","pages":"Article 152634"},"PeriodicalIF":4.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145045662","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 : 2025-10-01Epub Date: 2025-06-06DOI: 10.1016/j.comppsych.2025.152612
Alexandra Pham-Scottez , Isabelle Sabbah-Lim , Jean Chambry , Valérie Dao , Raphael Gourevitch , David Barruel Ing , Valérie Dauriac-Le Masson
Although psychiatrists working with adolescents know that sometimes they need to be hospitalised in emergency, few studies have described the hospitalisation of adolescents in adult psychiatric wards. We aimed to estimate the prevalence of adolescents hospitalised in adult psychiatric wards (characteristics, gender comparison, subtypes).
We conducted a monocentric retrospective study in the largest psychiatric hospital in France. All patients aged 15 to <18 years hospitalised in adult psychiatric wards were included, with different variables: socio-demographic and family information, history of inpatient / outpatient treatment, clinical data (like ICD-10 diagnoses, care pathway before / after hospitalisation…).
We included 332 hospitalisations (70 % girls), representing 2.8 % of all psychiatric hospitalisations. For 37 hospitalisations (11.1 %), this was the first psychiatric contact; for 54.2 %, patients had no previous psychiatric hospitalisation, for 87.3 %, patients had previous outpatient treatment. Mood disorders was the diagnosis for 47 % of the admissions, suicide attempts and suicidal ideation accounted for 69 % of the clinical situations leading to hospitalisation. Boys and girls differed significantly on many variables. Cluster analyses revealed two subgroups: cluster 1 patients (62 %) more frequently were girls, had previous hospitalisations in child psychiatry, came from home, had suicide attempts / suicidal ideation, had personality disorders, whereas cluster 2 patients (38 %) more frequently had substance use disorders, psychotic episodes, clastic crisis / hetero-aggression, longer hospital stays. Emergency admission of an adolescent with psychiatric issues to an adult psychiatric ward is not uncommon, especially in the context of a suicidal crisis or psychotic episode. Our results suggest the need for establishing unscheduled hospital beds for such adolescents.
{"title":"Characteristics of adolescents hospitalised in adult psychiatric units. Retrospective study in the largest psychiatric hospital in France","authors":"Alexandra Pham-Scottez , Isabelle Sabbah-Lim , Jean Chambry , Valérie Dao , Raphael Gourevitch , David Barruel Ing , Valérie Dauriac-Le Masson","doi":"10.1016/j.comppsych.2025.152612","DOIUrl":"10.1016/j.comppsych.2025.152612","url":null,"abstract":"<div><div>Although psychiatrists working with adolescents know that sometimes they need to be hospitalised in emergency, few studies have described the hospitalisation of adolescents in adult psychiatric wards. We aimed to estimate the prevalence of adolescents hospitalised in adult psychiatric wards (characteristics, gender comparison, subtypes).</div><div>We conducted a monocentric retrospective study in the largest psychiatric hospital in France. All patients aged 15 to <18 years hospitalised in adult psychiatric wards were included, with different variables: socio-demographic and family information, history of inpatient / outpatient treatment, clinical data (like ICD-10 diagnoses, care pathway before / after hospitalisation…).</div><div>We included 332 hospitalisations (70 % girls), representing 2.8 % of all psychiatric hospitalisations. For 37 hospitalisations (11.1 %), this was the first psychiatric contact; for 54.2 %, patients had no previous psychiatric hospitalisation, for 87.3 %, patients had previous outpatient treatment. Mood disorders was the diagnosis for 47 % of the admissions, suicide attempts and suicidal ideation accounted for 69 % of the clinical situations leading to hospitalisation. Boys and girls differed significantly on many variables. Cluster analyses revealed two subgroups: cluster 1 patients (62 %) more frequently were girls, had previous hospitalisations in child psychiatry, came from home, had suicide attempts / suicidal ideation, had personality disorders, whereas cluster 2 patients (38 %) more frequently had substance use disorders, psychotic episodes, clastic crisis / hetero-aggression, longer hospital stays. Emergency admission of an adolescent with psychiatric issues to an adult psychiatric ward is not uncommon, especially in the context of a suicidal crisis or psychotic episode. Our results suggest the need for establishing unscheduled hospital beds for such adolescents.</div></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"142 ","pages":"Article 152612"},"PeriodicalIF":4.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144298091","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 : 2025-10-01Epub Date: 2025-06-23DOI: 10.1016/j.comppsych.2025.152618
Raphaela J. Gaertner , Elea S.C. Klink , Annika B.E. Benz , Bernadette F. Denk , Maria Meier , Stella Wienhold , Nina Volkmer , Katharina E. Kossmann , Jens C. Pruessner
Introduction
Borderline Personality Disorder (BPD) is associated with psychological as well as physiological dysregulation in patients, including reduced parasympathetic activity at baseline and difficulties returning to baseline after a stressor. Whether this impacts the relaxation response independent of a stressor has so far not been investigated.
Methods
In a within-subject design, we compared two relaxation interventions, a virtual reality nature video, and a paced breathing intervention. We assessed a female-only sample, with 20 BPD patients (meanage = 23.75 ± 4.39) during their inpatient treatment and 22 matched healthy controls (HC; meanage = 22.68 ± 2.68). Psychological relaxation was assessed with the Relaxation State Questionnaire (RSQ) and physiological relaxation with vagally mediated heart rate variability (HRV).
Results
We employed multilevel models to test whether BPD significantly influenced the psychophysiological relaxation response. For psychological relaxation, we found an increase in RSQ scores in both groups in response to both interventions. The HC showed overall higher RSQ scores. For physiological relaxation, we found overall higher HRV values in the HC group but no differences in the relaxation response.
Conclusion
BPD patients exhibit lower psychophysiological relaxation levels at baseline and throughout the experiment, while there was no significant difference in response to relaxation interventions when compared to HC. Future studies should focus on interventions targeting baseline psychophysiological relaxation in BPD patients.
{"title":"Patients with borderline personality disorder show initially reduced psychophysiological relaxation levels but intact relaxation response","authors":"Raphaela J. Gaertner , Elea S.C. Klink , Annika B.E. Benz , Bernadette F. Denk , Maria Meier , Stella Wienhold , Nina Volkmer , Katharina E. Kossmann , Jens C. Pruessner","doi":"10.1016/j.comppsych.2025.152618","DOIUrl":"10.1016/j.comppsych.2025.152618","url":null,"abstract":"<div><h3>Introduction</h3><div>Borderline Personality Disorder (BPD) is associated with psychological as well as physiological dysregulation in patients, including reduced parasympathetic activity at baseline and difficulties returning to baseline after a stressor. Whether this impacts the relaxation response independent of a stressor has so far not been investigated.</div></div><div><h3>Methods</h3><div>In a within-subject design, we compared two relaxation interventions, a virtual reality nature video, and a paced breathing intervention. We assessed a female-only sample, with 20 BPD patients (mean<sub>age</sub> = 23.75 ± 4.39) during their inpatient treatment and 22 matched healthy controls (HC; mean<sub>age</sub> = 22.68 ± 2.68). Psychological relaxation was assessed with the Relaxation State Questionnaire (RSQ) and physiological relaxation with vagally mediated heart rate variability (HRV).</div></div><div><h3>Results</h3><div>We employed multilevel models to test whether BPD significantly influenced the psychophysiological relaxation response. For psychological relaxation, we found an increase in RSQ scores in both groups in response to both interventions. The HC showed overall higher RSQ scores. For physiological relaxation, we found overall higher HRV values in the HC group but no differences in the relaxation response.</div></div><div><h3>Conclusion</h3><div>BPD patients exhibit lower psychophysiological relaxation levels at baseline and throughout the experiment, while there was no significant difference in response to relaxation interventions when compared to HC. Future studies should focus on interventions targeting baseline psychophysiological relaxation in BPD patients.</div></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"142 ","pages":"Article 152618"},"PeriodicalIF":4.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144492173","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 : 2025-10-01Epub Date: 2025-07-07DOI: 10.1016/j.comppsych.2025.152621
Lara Marie Aschenbrenner , Adriana Frei , Thomas Forkmann , Dajana Schreiber , Heide Glaesmer , Juliane Brüdern , Maria Stein , Marie-Anna Sedlinská , Kristina Adorjan , Sebastian Walther , Anja Gysin-Maillart
Objective
This study examined two Death-Implicit Association Test versions targeting associations between the self-concept (standard identity D-IAT; iD-IAT) and internal versus external control (adapted control D-IAT; cD-IAT) and death among suicide attempters. Additionally, correlations with explicit psychological variables and psychometrics were explored.
Method
116 psychiatric inpatients (58.1 % female; age M = 33.6, SD = 12.4) were classified as single versus multiple and recent versus lifetime suicide attempters. Implicit associations were measured using the iD-IAT and cD-IAT. Self-report measures included constructs relevant to suicidal behaviour.
Results
Recent attempters showed weaker self-life (t(114) = 2.18, p = .016) and internal control-life (t(114) = 2.26, p = .013) associations than lifetime attempters. Multiple attempters exhibited weaker internal control-life associations than single attempters (t(114) = 2.25, p = .007). The iD-IAT correlated with suicidal ideation (rs(114) = 0.20, p = .032), depression (rs(114) = 0.20, p = .033) and external control (rs(114) = 0.21, p = .021), the cD-IAT with suicidal ideation (rs(114) = 0.25, p = .006) and depression (rs(114) = 0.26, p = .006). The cD-IAT predicted multiple attempts (χ2(1116) = 3.88, p = .049), showed higher internal consistency (rsb =. 31, p = .001) and predictive validity in detecting multiple (AUC = 0.64; p = .013) and recent (AUC = 0.62; p = .028) attempters than the iD-IAT.
Conclusions
The cD-IAT shows preliminary potential to differentiate suicidal behaviour based on recency and frequency, offering a tentative step toward understanding cognitive vulnerabilities of at-risk subgroups, warranting further refinement, validation and prospective analyses.
目的探讨两种死亡-内隐联想测验版本在自我概念(标准同一性D-IAT；iD-IAT)和内部与外部对照(适应对照D-IAT；cD-IAT)和自杀未遂者的死亡率。此外，还探讨了显式心理变量和心理测量的相关性。方法116例精神科住院患者(女性58.1%；年龄M = 33.6, SD = 12.4)分为单次与多次、近期与终生自杀企图者。使用iD-IAT和cD-IAT测量内隐关联。自我报告测量包括与自杀行为相关的构念。结果近期尝试者的自我寿命（t(114) = 2.18, p = 0.016）和内部控制寿命（t(114) = 2.26, p = 0.013）的相关性较终身尝试者弱。多重尝试者比单一尝试者表现出较弱的内部控制寿命相关性（t(114) = 2.25, p = .007）。iD-IAT与自杀意念（rs(114) = 0.20, p = 0.032）、抑郁（rs(114) = 0.20, p = 0.033）、外部控制（rs(114) = 0.21, p = 0.021）、cD-IAT与自杀意念（rs(114) = 0.25, p = 0.006）、抑郁（rs(114) = 0.26, p = 0.006）相关。cD-IAT预测多次尝试（χ2(1116) = 3.88, p = 0.049），具有较高的内部一致性(rsb =。31, p = .001)和检测多个的预测效度(AUC = 0.64；p = 0.013)和近期(AUC = 0.62；p = .028)。结论cD-IAT显示了基于近期和频率区分自杀行为的初步潜力，为理解高危亚组的认知脆弱性提供了试试性的一步，需要进一步的改进、验证和前瞻性分析。
{"title":"Exploring suicidal behaviour through implicit identity and control biases: Findings from the Death-Implicit Association Test and its novel control-adaptation","authors":"Lara Marie Aschenbrenner , Adriana Frei , Thomas Forkmann , Dajana Schreiber , Heide Glaesmer , Juliane Brüdern , Maria Stein , Marie-Anna Sedlinská , Kristina Adorjan , Sebastian Walther , Anja Gysin-Maillart","doi":"10.1016/j.comppsych.2025.152621","DOIUrl":"10.1016/j.comppsych.2025.152621","url":null,"abstract":"<div><h3>Objective</h3><div>This study examined two <em>Death-Implicit Association Test</em> versions targeting associations between the self-concept (standard identity D-IAT; iD-IAT) and internal versus external control (adapted control D-IAT; cD-IAT) and death among suicide attempters. Additionally, correlations with explicit psychological variables and psychometrics were explored.</div></div><div><h3>Method</h3><div>116 psychiatric inpatients (58.1 % female; age <em>M</em> = 33.6, <em>SD</em> = 12.4) were classified as single versus multiple and recent versus lifetime suicide attempters. Implicit associations were measured using the iD-IAT and cD-IAT. Self-report measures included constructs relevant to suicidal behaviour.</div></div><div><h3>Results</h3><div>Recent attempters showed weaker self-life (<em>t</em>(114) = 2.18, <em>p</em> = .016) and internal control-life (<em>t</em>(114) = 2.26, <em>p</em> = .013) associations than lifetime attempters. Multiple attempters exhibited weaker internal control-life associations than single attempters (<em>t</em>(114) = 2.25, <em>p</em> = .007). The iD-IAT correlated with suicidal ideation (<em>r</em><sub>s</sub>(114) = 0.20, <em>p</em> = .032), depression (<em>r</em><sub>s</sub>(114) = 0.20, <em>p</em> = .033) and external control (<em>r</em><sub>s</sub>(114) = 0.21, <em>p</em> = .021), the cD-IAT with suicidal ideation (<em>r</em><sub>s</sub>(114) = 0.25, <em>p</em> = .006) and depression (<em>r</em><sub>s</sub>(114) = 0.26, <em>p</em> = .006). The cD-IAT predicted multiple attempts (χ<sup>2</sup>(1116) = 3.88, <em>p</em> = .049), showed higher internal consistency (<em>r</em><sub>sb</sub> =. 31, <em>p</em> = .001) and predictive validity in detecting multiple (AUC = 0.64; <em>p</em> = .013) and recent (AUC = 0.62; <em>p</em> = .028) attempters than the iD-IAT.</div></div><div><h3>Conclusions</h3><div>The cD-IAT shows preliminary potential to differentiate suicidal behaviour based on recency and frequency, offering a tentative step toward understanding cognitive vulnerabilities of at-risk subgroups, warranting further refinement, validation and prospective analyses.</div></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"142 ","pages":"Article 152621"},"PeriodicalIF":4.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144587731","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 : 2025-10-01Epub Date: 2025-07-17DOI: 10.1016/j.comppsych.2025.152626
Yuna Jang , EKyong Yoon , Arum Hong , Hye Youn Park
Objectives
Somatic symptom disorder (SSD) is characterized by persistent physical symptoms and excessive emotional responses, but the influence of emotional factors such as anger and alexithymia on symptom severity and course remains unclear. This study examined whether baseline levels and six-month changes in emotional factors are associated with somatic symptom severity and course in SSD, considering sex.
Methods
Eighty-three SSD patients and 80 age- and sex-matched healthy controls completed self-report measures of emotional and somatic symptoms at baseline and six-month follow-up. Changes in symptom levels were compared between patients and controls. Emotional factors associated with symptom severity and change were also examined. Linear mixed models, multiple regression, and Bayesian mediation analyses were employed.
Results
Compared to controls, the SSD group showed significant improvement in somatic symptoms over six months. Trait anger was significantly associated with somatic symptom severity in females, and an interaction between anxiety and trait anger predicted symptom severity. Within the SSD group, reductions in anxiety and alexithymia were significantly associated with symptom improvement. Mediation analyses supported indirect pathways between affective change and symptom reduction.
Conclusions
This prospective study highlights the contribution of emotional dysregulation to both the severity and course of somatic symptoms in SSD. The findings emphasize the relevance of sex differences and emotion-focused mechanisms in symptom maintenance and improvement, supporting the need for tailored interventions in SSD treatment.
{"title":"Affective dysregulation and sex differences in somatic symptom disorder: A 6-month longitudinal and mediation analysis","authors":"Yuna Jang , EKyong Yoon , Arum Hong , Hye Youn Park","doi":"10.1016/j.comppsych.2025.152626","DOIUrl":"10.1016/j.comppsych.2025.152626","url":null,"abstract":"<div><h3>Objectives</h3><div>Somatic symptom disorder (SSD) is characterized by persistent physical symptoms and excessive emotional responses, but the influence of emotional factors such as anger and alexithymia on symptom severity and course remains unclear. This study examined whether baseline levels and six-month changes in emotional factors are associated with somatic symptom severity and course in SSD, considering sex.</div></div><div><h3>Methods</h3><div>Eighty-three SSD patients and 80 age- and sex-matched healthy controls completed self-report measures of emotional and somatic symptoms at baseline and six-month follow-up. Changes in symptom levels were compared between patients and controls. Emotional factors associated with symptom severity and change were also examined. Linear mixed models, multiple regression, and Bayesian mediation analyses were employed.</div></div><div><h3>Results</h3><div>Compared to controls, the SSD group showed significant improvement in somatic symptoms over six months. Trait anger was significantly associated with somatic symptom severity in females, and an interaction between anxiety and trait anger predicted symptom severity. Within the SSD group, reductions in anxiety and alexithymia were significantly associated with symptom improvement. Mediation analyses supported indirect pathways between affective change and symptom reduction.</div></div><div><h3>Conclusions</h3><div>This prospective study highlights the contribution of emotional dysregulation to both the severity and course of somatic symptoms in SSD. The findings emphasize the relevance of sex differences and emotion-focused mechanisms in symptom maintenance and improvement, supporting the need for tailored interventions in SSD treatment.</div></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"142 ","pages":"Article 152626"},"PeriodicalIF":4.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672565","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}
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