Pub Date : 2024-04-15DOI: 10.1016/j.comppsych.2024.152486
Daniel Minkin Levy , Oded Ben Arush , Lior Carmi , Alzbeta Juven Wetzler , Joseph Zohar
Objective
To examine the long-term safety and tolerability of off-label high-dose serotonin reuptake inhibitors (OLHD-SRIs) in the treatment of obsessive-compulsive disorder (OCD).
Methods
A retrospective longitudinal study was performed on 105 randomly selected outpatients diagnosed with OCD and were treated with OLHD-SRIs for at least 6 months. Patients received sertraline >200 mg/day, escitalopram >20 mg/day, fluvoxamine >300 mg/day, and fluoxetine >60 mg/day, combined with exposure and response prevention therapy. Patients were divided into three dosing groups: sertraline equivalent dose (SED) ≤ 200 mg/day (n = 26, 24.7%), 201–400 mg/day (n = 51, 48.5%) and 401–650 mg/day (n = 28, 26.6%). Safety and tolerability were assessed with an electrocardiogram, blood biochemistry, complete blood count, and side-effects monitoring.
Results
SED ranged from 100 to 650 mg/day and the mean duration of OLHD-SRI treatment was 20.8 months. The most common side-effects reported were sexual dysfunction (n = 36, 34%), weight gain (n = 28, 27%), sedation (n = 27, 26%), hyperhidrosis (n = 20, 19%), and tremor (n = 11, 10%). Abnormal ECG was documented in one patient, and another patient experienced a first-time seizure, whereas elevated liver enzymes were seen in 4.8% of the sample (n = 5). None of the patients had serotonin syndrome or drug-induced liver injury. Side-effects did not differ among the three dosing groups.
Conclusion
OLHD-SRIs appear to be safe and well tolerated in OCD patients in SED ≤ 650 mg/day doses and the side-effects did not differ between the three dosing groups.
{"title":"Off-label higher doses of serotonin reuptake inhibitors in the treatment of obsessive-compulsive disorder: Safety and tolerability","authors":"Daniel Minkin Levy , Oded Ben Arush , Lior Carmi , Alzbeta Juven Wetzler , Joseph Zohar","doi":"10.1016/j.comppsych.2024.152486","DOIUrl":"10.1016/j.comppsych.2024.152486","url":null,"abstract":"<div><h3>Objective</h3><p>To examine the long-term safety and tolerability of off-label high-dose serotonin reuptake inhibitors (OLHD-SRIs) in the treatment of obsessive-compulsive disorder (OCD).</p></div><div><h3>Methods</h3><p>A retrospective longitudinal study was performed on 105 randomly selected outpatients diagnosed with OCD and were treated with OLHD-SRIs for at least 6 months. Patients received sertraline >200 mg/day, escitalopram >20 mg/day, fluvoxamine >300 mg/day, and fluoxetine >60 mg/day, combined with exposure and response prevention therapy. Patients were divided into three dosing groups: sertraline equivalent dose (SED) ≤ 200 mg/day (<em>n</em> = 26, 24.7%), 201–400 mg/day (<em>n</em> = 51, 48.5%) and 401–650 mg/day (<em>n</em> = 28, 26.6%). Safety and tolerability were assessed with an electrocardiogram, blood biochemistry, complete blood count, and side-effects monitoring.</p></div><div><h3>Results</h3><p>SED ranged from 100 to 650 mg/day and the mean duration of OLHD-SRI treatment was 20.8 months. The most common side-effects reported were sexual dysfunction (<em>n</em> = 36, 34%), weight gain (<em>n</em> = 28, 27%), sedation (<em>n</em> = 27, 26%), hyperhidrosis (<em>n</em> = 20, 19%), and tremor (<em>n</em> = 11, 10%). Abnormal ECG was documented in one patient, and another patient experienced a first-time seizure, whereas elevated liver enzymes were seen in 4.8% of the sample (<em>n</em> = 5). None of the patients had serotonin syndrome or drug-induced liver injury. Side-effects did not differ among the three dosing groups.</p></div><div><h3>Conclusion</h3><p>OLHD-SRIs appear to be safe and well tolerated in OCD patients in SED ≤ 650 mg/day doses and the side-effects did not differ between the three dosing groups.</p></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"133 ","pages":"Article 152486"},"PeriodicalIF":7.3,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0010440X24000373/pdfft?md5=a86a67b93e201a4aba0b19f96f874e72&pid=1-s2.0-S0010440X24000373-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140789919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-10DOI: 10.1016/j.comppsych.2024.152484
Sedera Mioramalala , Lara Mroueh , Pierre-Emile Bruand , Mbolatiana Michèle Raharinivo , Roger Marie Rafanomezantsoa , Daniel Gérard , Arsène Ratsimbasoa , Pierre-Marie Preux , Farid Boumédiène
Background
Despite the high prevalence of mental disorders and epilepsy in low- and middle-income countries, nearly 80% of patients are not treated. In Madagascar, initiatives to improve access to epilepsy and mental health care, including public awareness and training of general practitioners (GPs), were carried out between 2013 and 2018. Our study's main objective was to assess the effectiveness of these initiatives, two to five years post-intervention.
Methods
This quasi-experimental study (intervention vs. control areas) included five surveys assessing: general population's Knowledge Attitudes and Practices (KAP), GPs' KAP , number of epilepsy and mental health consultations at different levels of the healthcare system, diagnostic accuracy, and treatments' availability.
Outcomes
In the general population, KAP scores were higher in intervention areas for epilepsy (11.4/20 vs. 10.3/20; p = 0.003). For mental disorders, regardless of the area, KAP scores were low, especially for schizophrenia (1.1/20 and 0.1/20). Among GPs, KAP scores were higher in intervention areas for schizophrenia (6.0/10 vs. 4.5/10; p = 0.008) and epilepsy (6.9/10 vs. 6.2/10; p = 0.044). Overall, there was a greater proportion of mental health and epilepsy consultations in intervention areas (4.5% vs 2.3%). Although low, concordance between GPs' and psychiatrists' diagnoses was higher in intervention areas. There was a greater variety of anti-epileptic and psychotropic medications available in intervention areas.
Interpretation
This research has helped to better understand the effectiveness of initiatives implemented in Madagascar to improve epilepsy and mental health care and to identify barriers which will need to be addressed.
Funding
Sanofi Global Health, as part of the Fight Against STigma Program.
背景尽管精神障碍和癫痫在中低收入国家的发病率很高，但仍有近 80% 的患者得不到治疗。在马达加斯加，2013 年至 2018 年期间开展了旨在改善癫痫和精神健康护理的举措，包括提高公众意识和培训全科医生（GPs）。我们研究的主要目的是评估这些措施在干预后两到五年内的有效性。方法这项准实验研究（干预地区与对照地区）包括五项调查，分别评估：普通人群的知识态度与实践（KAP）、全科医生的知识态度与实践（KAP）、医疗系统不同层面的癫痫和精神健康咨询次数、诊断准确性以及治疗方法的可用性。结果在普通人群中，干预地区的癫痫患者 KAP 分数更高（11.4/20 vs. 10.3/20；P = 0.003）。在精神障碍方面，无论在哪个地区，KAP 评分都很低，尤其是精神分裂症（1.1/20 和 0.1/20）。在全科医生中，精神分裂症（6.0/10 对 4.5/10；p = 0.008）和癫痫（6.9/10 对 6.2/10；p = 0.044）的 KAP 得分在干预地区较高。总体而言，干预地区的心理健康和癫痫咨询比例更高（4.5% 对 2.3%）。在干预地区，全科医生和精神科医生诊断的一致性虽然较低，但却较高。这项研究有助于更好地了解马达加斯加为改善癫痫和精神健康护理而实施的措施的有效性，并找出需要解决的障碍。
{"title":"Effects of an intervention program to improve mental health and epilepsy care in Madagascar","authors":"Sedera Mioramalala , Lara Mroueh , Pierre-Emile Bruand , Mbolatiana Michèle Raharinivo , Roger Marie Rafanomezantsoa , Daniel Gérard , Arsène Ratsimbasoa , Pierre-Marie Preux , Farid Boumédiène","doi":"10.1016/j.comppsych.2024.152484","DOIUrl":"https://doi.org/10.1016/j.comppsych.2024.152484","url":null,"abstract":"<div><h3>Background</h3><p>Despite the high prevalence of mental disorders and epilepsy in low- and middle-income countries, nearly 80% of patients are not treated. In Madagascar, initiatives to improve access to epilepsy and mental health care, including public awareness and training of general practitioners (GPs), were carried out between 2013 and 2018. Our study's main objective was to assess the effectiveness of these initiatives, two to five years post-intervention.</p></div><div><h3>Methods</h3><p>This quasi-experimental study (intervention vs. control areas) included five surveys assessing: general population's Knowledge Attitudes and Practices (KAP), GPs' KAP , number of epilepsy and mental health consultations at different levels of the healthcare system, diagnostic accuracy, and treatments' availability.</p></div><div><h3>Outcomes</h3><p>In the general population, KAP scores were higher in intervention areas for epilepsy (11.4/20 vs. 10.3/20; <em>p</em> = 0.003). For mental disorders, regardless of the area, KAP scores were low, especially for schizophrenia (1.1/20 and 0.1/20). Among GPs, KAP scores were higher in intervention areas for schizophrenia (6.0/10 vs. 4.5/10; <em>p</em> = 0.008) and epilepsy (6.9/10 vs. 6.2/10; <em>p</em> = 0.044). Overall, there was a greater proportion of mental health and epilepsy consultations in intervention areas (4.5% vs 2.3%). Although low, concordance between GPs' and psychiatrists' diagnoses was higher in intervention areas. There was a greater variety of anti-epileptic and psychotropic medications available in intervention areas.</p></div><div><h3>Interpretation</h3><p>This research has helped to better understand the effectiveness of initiatives implemented in Madagascar to improve epilepsy and mental health care and to identify barriers which will need to be addressed.</p></div><div><h3>Funding</h3><p>Sanofi Global Health, as part of the Fight Against STigma Program.</p></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"132 ","pages":"Article 152484"},"PeriodicalIF":7.3,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0010440X2400035X/pdfft?md5=251948c98a2fa6ac9067c28633a02c97&pid=1-s2.0-S0010440X2400035X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140552194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-08DOI: 10.1016/j.comppsych.2024.152482
Tobias A. Thomas , Anna M. Schmid , Annica Kessling , Oliver T. Wolf , Matthias Brand , Sabine Steins-Loeber , Astrid Müller
Introduction
Theoretical frameworks of behavioral addictions mostly acknowledge the role of stress in the development and maintenance of these disorders, models of compulsive buying-shopping disorder (CBSD) however rarely incorporated stress. The association between stress and CBSD has not been reviewed yet.
Methods
A scoping review was conducted to evaluate empirical results on the association between stress and CBSD. A comprehensive search string was employed in three databases.
Results
16 studies were included. Correlative studies suggested significant correlations between general perceived stress and CBSD symptom severity. Studies involving mean comparisons found higher general perceived stress levels in persons with problematic buying-shopping behavior/CBSD compared to control participants (large effects). Mixed results were found in studies involving regression/structural equation models and ecological momentary assessments. One study with a stress/negative mood induction observed more CBSD symptoms in a high stress group compared to a low stress group.
Discussion
The studies are heterogeneous concerning design, samples and measures. Only very few studies surpass the level of cross-sectional correlative data which limits the ability to draw clear conclusions. Future research should study the impact of experimentally induced stress on CBSD symptoms, examine the relationship between stress and CBSD longitudinally and assess objective stress markers.
{"title":"Stress and compulsive buying-shopping disorder: A scoping review","authors":"Tobias A. Thomas , Anna M. Schmid , Annica Kessling , Oliver T. Wolf , Matthias Brand , Sabine Steins-Loeber , Astrid Müller","doi":"10.1016/j.comppsych.2024.152482","DOIUrl":"https://doi.org/10.1016/j.comppsych.2024.152482","url":null,"abstract":"<div><h3>Introduction</h3><p>Theoretical frameworks of behavioral addictions mostly acknowledge the role of stress in the development and maintenance of these disorders, models of compulsive buying-shopping disorder (CBSD) however rarely incorporated stress. The association between stress and CBSD has not been reviewed yet.</p></div><div><h3>Methods</h3><p>A scoping review was conducted to evaluate empirical results on the association between stress and CBSD. A comprehensive search string was employed in three databases.</p></div><div><h3>Results</h3><p>16 studies were included. Correlative studies suggested significant correlations between general perceived stress and CBSD symptom severity. Studies involving mean comparisons found higher general perceived stress levels in persons with problematic buying-shopping behavior/CBSD compared to control participants (large effects). Mixed results were found in studies involving regression/structural equation models and ecological momentary assessments. One study with a stress/negative mood induction observed more CBSD symptoms in a high stress group compared to a low stress group.</p></div><div><h3>Discussion</h3><p>The studies are heterogeneous concerning design, samples and measures. Only very few studies surpass the level of cross-sectional correlative data which limits the ability to draw clear conclusions. Future research should study the impact of experimentally induced stress on CBSD symptoms, examine the relationship between stress and CBSD longitudinally and assess objective stress markers.</p></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"132 ","pages":"Article 152482"},"PeriodicalIF":7.3,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0010440X24000336/pdfft?md5=48bbb428f4213d91228e3b88dc19b6d6&pid=1-s2.0-S0010440X24000336-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140542848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-05DOI: 10.1016/j.comppsych.2024.152483
Tania Bosqui , Anas Mayya , Sally Farah , Zahraa Shaito , Mark J.D. Jordans , Gloria Pedersen , Theresa S. Betancourt , Alan Carr , Michael Donnelly , Felicity L. Brown
Background
Given the protective effect of nurturing caregivers and families for child and adolescent mental health, there is a need to review and synthesize research evidence regarding the effectiveness of parenting and family interventions in low and middle-income countries, including humanitarian settings. To advance practice, further understanding of the active ingredients of such interventions and implementation factors that lead to effectiveness are essential.
Method
This systematic review, an update from a previous review, included studies on any parenting or family intervention for children and adolescents aged 0–24, living in a low- or middle-income country, that quantitatively measured child or adolescent mental health outcomes. We searched Global Health, PubMed, PsychINFO, PILOTS and the Cochrane Library databases on the 9th July 2020, and updated on the 12th August 2022. Risk of bias was assessed using an adapted version of the NIH Quality Assessment Tool. We extracted data on: effectiveness outcomes, practice elements included in effective interventions, and implementation challenges and successes.
Main findings
We found a total of 80 studies (n = 18,193 participants) representing 64 different family or parenting interventions, 43 of which had evidence of effect for a child or adolescent mental health outcome. Only 3 studies found no effect on child, adolescent or caregiver outcomes. The most common practice elements delivered in effective interventions included caregiver psychoeducation, communication skills, and differential reinforcement. Key implementation strategies and lessons learned included non-specialist delivery, the engagement of fathers, and integrated or multi-sector care to holistically address family needs.
Preliminary conclusions
Despite a high level of heterogeneity, preliminary findings from the review are promising and support the use of parenting and family interventions to address the wider social ecology of children in low resource and humanitarian contexts. There are remaining gaps in understanding mechanisms of change and the empirical testing of different implementation models. Our findings have implications for better informing task sharing from specialist to non-specialist delivery, and from individual-focused to wider systemic interventions.
{"title":"Parenting and family interventions in lower and middle-income countries for child and adolescent mental health: A systematic review","authors":"Tania Bosqui , Anas Mayya , Sally Farah , Zahraa Shaito , Mark J.D. Jordans , Gloria Pedersen , Theresa S. Betancourt , Alan Carr , Michael Donnelly , Felicity L. Brown","doi":"10.1016/j.comppsych.2024.152483","DOIUrl":"https://doi.org/10.1016/j.comppsych.2024.152483","url":null,"abstract":"<div><h3>Background</h3><p>Given the protective effect of nurturing caregivers and families for child and adolescent mental health, there is a need to review and synthesize research evidence regarding the effectiveness of parenting and family interventions in low and middle-income countries, including humanitarian settings. To advance practice, further understanding of the active ingredients of such interventions and implementation factors that lead to effectiveness are essential.</p></div><div><h3>Method</h3><p>This systematic review, an update from a previous review, included studies on any parenting or family intervention for children and adolescents aged 0–24, living in a low- or middle-income country, that quantitatively measured child or adolescent mental health outcomes. We searched Global Health, PubMed, PsychINFO, PILOTS and the Cochrane Library databases on the 9th July 2020, and updated on the 12th August 2022. Risk of bias was assessed using an adapted version of the NIH Quality Assessment Tool. We extracted data on: effectiveness outcomes, practice elements included in effective interventions, and implementation challenges and successes.</p></div><div><h3>Main findings</h3><p>We found a total of 80 studies (<em>n</em> = 18,193 participants) representing 64 different family or parenting interventions, 43 of which had evidence of effect for a child or adolescent mental health outcome. Only 3 studies found no effect on child, adolescent or caregiver outcomes. The most common practice elements delivered in effective interventions included caregiver psychoeducation, communication skills, and differential reinforcement. Key implementation strategies and lessons learned included non-specialist delivery, the engagement of fathers, and integrated or multi-sector care to holistically address family needs.</p></div><div><h3>Preliminary conclusions</h3><p>Despite a high level of heterogeneity, preliminary findings from the review are promising and support the use of parenting and family interventions to address the wider social ecology of children in low resource and humanitarian contexts. There are remaining gaps in understanding mechanisms of change and the empirical testing of different implementation models. Our findings have implications for better informing task sharing from specialist to non-specialist delivery, and from individual-focused to wider systemic interventions.</p></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"132 ","pages":"Article 152483"},"PeriodicalIF":7.3,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0010440X24000348/pdfft?md5=eacb376a7c9e30c110c12ef31fe16b44&pid=1-s2.0-S0010440X24000348-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140558230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.1016/j.comppsych.2024.152480
Bianca D. Berndorfler , James M. Warwick , Alex G.G. Doruyter
Background
Neuropsychiatric systemic lupus erythematosus (NPSLE) is a major contributor to morbidity and mortality in systemic lupus erythematosus (SLE) patients. To date no single clinical, laboratory or imaging test has proven accurate for NPSLE diagnosis which is a testament to the intricate and multifactorial pathophysiological mechanisms suspected to exist. Functional imaging with FDG PET-CT has shown promise in NPSLE diagnosis, detecting abnormalities prior to changes evident on anatomical imaging. Research indicates that NPSLE may be more aggressive in people of African descent with higher mortality rates, making rapid and correct diagnosis even more important in the African context.
Methods
In this narrative review, we provide a thorough appraisal of the current literature on the role of FDG PET-CT in NPSLE. Large, well-known databases were searched using appropriate search terms. Manual searches of references of retrieved literature were also included.
Findings
A total of 73 article abstracts were assessed, yielding 26 papers that were directly relevant to the topic of FDG PET-CT in NPSLE. Results suggest that FDG PET-CT is a sensitive imaging test for NPSLE diagnosis and may play a role in assessing treatment response. It is complementary to routine anatomical imaging, particularly in diffuse manifestations of the disease. Newer quantitative analyses are commonly used for interpretation and can detect even subtle abnormalities, missed on visual inspection. Findings of group-wise analyses of FDG PET-CT scans in NPSLE patients are important in furthering our understanding of the complicated pathophysiological mechanisms involved. Limitations of FDG PET-CT include its lack of specificity, high cost and poor access.
Conclusion
FDG PET-CT is a sensitive test for NPSLE diagnosis but is hampered by lack of specificity. It is a valuable tool for clinicians managing SLE patients, particularly when anatomical imaging is negative. Its exact application will depend on the local context and clinical scenario.
{"title":"Role of F-18 FDG PET-CT in neuropsychiatric systemic lupus erythematosus","authors":"Bianca D. Berndorfler , James M. Warwick , Alex G.G. Doruyter","doi":"10.1016/j.comppsych.2024.152480","DOIUrl":"https://doi.org/10.1016/j.comppsych.2024.152480","url":null,"abstract":"<div><h3>Background</h3><p>Neuropsychiatric systemic lupus erythematosus (NPSLE) is a major contributor to morbidity and mortality in systemic lupus erythematosus (SLE) patients. To date no single clinical, laboratory or imaging test has proven accurate for NPSLE diagnosis which is a testament to the intricate and multifactorial pathophysiological mechanisms suspected to exist. Functional imaging with FDG PET-CT has shown promise in NPSLE diagnosis, detecting abnormalities prior to changes evident on anatomical imaging. Research indicates that NPSLE may be more aggressive in people of African descent with higher mortality rates, making rapid and correct diagnosis even more important in the African context.</p></div><div><h3>Methods</h3><p>In this narrative review, we provide a thorough appraisal of the current literature on the role of FDG PET-CT in NPSLE. Large, well-known databases were searched using appropriate search terms. Manual searches of references of retrieved literature were also included.</p></div><div><h3>Findings</h3><p>A total of 73 article abstracts were assessed, yielding 26 papers that were directly relevant to the topic of FDG PET-CT in NPSLE. Results suggest that FDG PET-CT is a sensitive imaging test for NPSLE diagnosis and may play a role in assessing treatment response. It is complementary to routine anatomical imaging, particularly in diffuse manifestations of the disease. Newer quantitative analyses are commonly used for interpretation and can detect even subtle abnormalities, missed on visual inspection. Findings of group-wise analyses of FDG PET-CT scans in NPSLE patients are important in furthering our understanding of the complicated pathophysiological mechanisms involved. Limitations of FDG PET-CT include its lack of specificity, high cost and poor access.</p></div><div><h3>Conclusion</h3><p>FDG PET-CT is a sensitive test for NPSLE diagnosis but is hampered by lack of specificity. It is a valuable tool for clinicians managing SLE patients, particularly when anatomical imaging is negative. Its exact application will depend on the local context and clinical scenario.</p></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"132 ","pages":"Article 152480"},"PeriodicalIF":7.3,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0010440X24000312/pdfft?md5=5095c98641cb29c19f209ac205008b6c&pid=1-s2.0-S0010440X24000312-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140331098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.1016/j.comppsych.2024.152481
S. Tempia Valenta , G. Campanile , U. Albert , F. Marcolini , G. Faedi , D. De Ronchi , A.R. Atti
Introduction
Recent reclassifications have expanded the understanding of Obsessive-Compulsive Disorders (OCDs), now incorporated into a broader category known as Obsessive-Compulsive Disorder and Related Disorders (OCRDs). This study sought to assess obsessive-compulsive symptoms and body uneasiness among outpatients seeking treatment for Eating Disorders (ED). Additionally, we aimed to explore associations and potential mediation effects between obsessive-compulsive symptoms and body uneasiness. This investigation extended beyond concerns related solely to body shape and weight, encompassing fears associated with specific body components (such as facial features, abdominal region, and limbs) or functions (including sweating, blushing, emitting noises, and releasing odors).
Methods
Psychometric assessments included the Obsessive-Compulsive Inventory-Revised (OCI-R) and the Body Uneasiness Test (BUT). Statistical analyses involved bivariate correlations, linear regression, and mediation analysis to explore the associations and potential mediation effects between obsessive-compulsive symptoms and different manifestations of body uneasiness.
Results
The sample (N = 210) demonstrated substantial obsessive-compulsive symptoms and notable body discomfort. OCI-R scores positively correlated with various dimensions of body dissatisfaction, including shape, weight, and specific body components or functions. Linear regression revealed significant associations between OCI-R scores and overall body uneasiness (BUT-A) as well as concerns about body components or functions (BUTB). Mediation analysis indicated that BUT-A mediated the relationship between obsessive-compulsive symptoms and BUTB.
Conclusion
This study offers new insights into the comprehensive landscape of OCRDs. It specifically emphasizes the association between obsessive-compulsive symptoms and body uneasiness, embracing not only concerns about body shape and weight but also extending to body components and functions.
{"title":"Beyond the surface: Understanding obsessive symptoms and body perceptions, from shape concerns to fear of blushing","authors":"S. Tempia Valenta , G. Campanile , U. Albert , F. Marcolini , G. Faedi , D. De Ronchi , A.R. Atti","doi":"10.1016/j.comppsych.2024.152481","DOIUrl":"https://doi.org/10.1016/j.comppsych.2024.152481","url":null,"abstract":"<div><h3>Introduction</h3><p>Recent reclassifications have expanded the understanding of Obsessive-Compulsive Disorders (OCDs), now incorporated into a broader category known as Obsessive-Compulsive Disorder and Related Disorders (OCRDs). This study sought to assess obsessive-compulsive symptoms and body uneasiness among outpatients seeking treatment for Eating Disorders (ED). Additionally, we aimed to explore associations and potential mediation effects between obsessive-compulsive symptoms and body uneasiness. This investigation extended beyond concerns related solely to body shape and weight, encompassing fears associated with specific body components (such as facial features, abdominal region, and limbs) or functions (including sweating, blushing, emitting noises, and releasing odors).</p></div><div><h3>Methods</h3><p>Psychometric assessments included the Obsessive-Compulsive Inventory-Revised (OCI-R) and the Body Uneasiness Test (BUT). Statistical analyses involved bivariate correlations, linear regression, and mediation analysis to explore the associations and potential mediation effects between obsessive-compulsive symptoms and different manifestations of body uneasiness.</p></div><div><h3>Results</h3><p>The sample (<em>N</em> = 210) demonstrated substantial obsessive-compulsive symptoms and notable body discomfort. OCI-R scores positively correlated with various dimensions of body dissatisfaction, including shape, weight, and specific body components or functions. Linear regression revealed significant associations between OCI-R scores and overall body uneasiness (BUT-A) as well as concerns about body components or functions (BUT<img>B). Mediation analysis indicated that BUT-A mediated the relationship between obsessive-compulsive symptoms and BUT<img>B.</p></div><div><h3>Conclusion</h3><p>This study offers new insights into the comprehensive landscape of OCRDs. It specifically emphasizes the association between obsessive-compulsive symptoms and body uneasiness, embracing not only concerns about body shape and weight but also extending to body components and functions.</p></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"132 ","pages":"Article 152481"},"PeriodicalIF":7.3,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0010440X24000324/pdfft?md5=34407f4a0e171253670bcfbe51f65b5d&pid=1-s2.0-S0010440X24000324-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140321461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-24DOI: 10.1016/j.comppsych.2024.152479
Chad Beyer , Christopher B. Currin , Taryn Williams , Dan J. Stein
Background
Benzodiazepines and antidepressants are effective agents for the treatment of generalized anxiety disorder (GAD), with the HAM-A frequently used as a primary outcome measure. The GAD literature is inconsistent regarding which medications are more effective for somatic versus psychic symptoms of GAD, and treatment guidelines do not advocate for prescribing based on subtype. This meta-analysis aimed to determine whether benzodiazepines and antidepressants have a differential impact on the somatic versus psychic subscales of the HAM-A in GAD.
Methods
An electronic search was undertaken for randomized controlled trials of either benzodiazepines or antidepressants for GAD that reported treatment response using the HAM-A subscales. Data were extracted by independent reviewers. A random effects assessment of weighted mean difference with 95% confidence intervals and subgroup difference was applied. All analysis was done on SPSS 26. An assessment of bias, and of quality of evidence was performed.
Results
24 randomized controlled trials met the inclusion criteria: 18 antidepressant trials, 5 benzodiazepine trials and 1 of both. 14 studies were assessed as having between some and high risk of bias, while 10 were assessed as having low risk of bias. Benzodiazepines (WMD of 1.81 [CI 1.03, 2.58]) were significantly more effective than antidepressants (WMD of 0.83 [CI 0.64, 1.02]) for reducing somatic symptoms of GAD (Chi2 = 5.81, p = 0.02), and were also more effective (WMD of 2.46 [CI 1.83, 3.09]) in reducing psychic symptoms than antidepressants (WMD of 1.83 [CI 1.55, 2.10]), although this comparison did not reach statistical significance (Chi2 = 3.31, p = 0.07).
Conclusion
The finding that benzodiazepines were significantly more effective than antidepressants for somatic symptoms needs to be weighed up against potential benefits of antidepressants over benzodiazepines. It may be useful for future treatment guidelines for GAD to explicitly consider symptom subtype.
{"title":"Meta-analysis of the comparative efficacy of benzodiazepines and antidepressants for psychic versus somatic symptoms of generalized anxiety disorder","authors":"Chad Beyer , Christopher B. Currin , Taryn Williams , Dan J. Stein","doi":"10.1016/j.comppsych.2024.152479","DOIUrl":"https://doi.org/10.1016/j.comppsych.2024.152479","url":null,"abstract":"<div><h3>Background</h3><p>Benzodiazepines and antidepressants are effective agents for the treatment of generalized anxiety disorder (GAD), with the HAM-A frequently used as a primary outcome measure. The GAD literature is inconsistent regarding which medications are more effective for somatic versus psychic symptoms of GAD, and treatment guidelines do not advocate for prescribing based on subtype. This meta-analysis aimed to determine whether benzodiazepines and antidepressants have a differential impact on the somatic versus psychic subscales of the HAM-A in GAD.</p></div><div><h3>Methods</h3><p>An electronic search was undertaken for randomized controlled trials of either benzodiazepines or antidepressants for GAD that reported treatment response using the HAM-A subscales. Data were extracted by independent reviewers. A random effects assessment of weighted mean difference with 95% confidence intervals and subgroup difference was applied. All analysis was done on SPSS 26. An assessment of bias, and of quality of evidence was performed.</p></div><div><h3>Results</h3><p>24 randomized controlled trials met the inclusion criteria: 18 antidepressant trials, 5 benzodiazepine trials and 1 of both. 14 studies were assessed as having between some and high risk of bias, while 10 were assessed as having low risk of bias. Benzodiazepines (WMD of 1.81 [CI 1.03, 2.58]) were significantly more effective than antidepressants (WMD of 0.83 [CI 0.64, 1.02]) for reducing somatic symptoms of GAD (Chi<sup>2</sup> = 5.81, <em>p</em> = 0.02), and were also more effective (WMD of 2.46 [CI 1.83, 3.09]) in reducing psychic symptoms than antidepressants (WMD of 1.83 [CI 1.55, 2.10]), although this comparison did not reach statistical significance (Chi<sup>2</sup> = 3.31, <em>p</em> = 0.07).</p></div><div><h3>Conclusion</h3><p>The finding that benzodiazepines were significantly more effective than antidepressants for somatic symptoms needs to be weighed up against potential benefits of antidepressants over benzodiazepines. It may be useful for future treatment guidelines for GAD to explicitly consider symptom subtype.</p></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"132 ","pages":"Article 152479"},"PeriodicalIF":7.3,"publicationDate":"2024-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0010440X24000300/pdfft?md5=cc132f10aaaf4b34147d3bbeb980b53a&pid=1-s2.0-S0010440X24000300-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140332476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-21DOI: 10.1016/j.comppsych.2024.152478
Mie Sedoc Jørgensen , Lise Møller , Sune Bo , Mickey Kongerslev , Lene Halling Hastrup , Andrew Chanen , Ole Jakob Storebø , Stig Poulsen , Emma Beck , Erik Simonsen
Background
Studies of the medium- to long-term clinical and functional course for treatment-seeking adolescents with borderline personality disorder (BPD) are lacking. This study aims to outline the psychopathological and functional status of participants, five years after being diagnosed with BPD during adolescence.
Methods
Participants were originally enrolled in a randomized clinical trial that compared mentalization-based group treatment with treatment as usual for adolescents with BPD. Semi-structured interview assessments at five-year follow-up included the Schedules for Clinical Assessment in Neuropsychiatry and the Structured Clinical Interview for DSM-5 Personality Disorders. Attention deficit hyperactivity disorder (ADHD), alcohol, substance and tobacco use, posttraumatic stress disorder (PTSD), complex PTSD, and general functioning were assessed using self-report instruments.
Results
97 of the original sample of 111 participants (87%) participated. They were aged 19–23 years. The most prevalent disorders were ADHD (59%), any personality disorder (47%) of which half continued to meet criteria for BPD (24%), anxiety disorders (37%), depressive disorders (32%), PTSD or complex PTSD (20%), schizophrenia (16%), and eating disorders (13%). Only 16% did not meet criteria for any mental disorder. Approximately half of the sample were in psychological and/or psychopharmacological treatment at the time of follow-up. Their general functioning remained impaired, with 36% not engaged in education, employment or training (NEET), which is nearly four times the rate of NEET in the same age group in the general population.
Conclusions
Although stability of the categorical BPD diagnosis is modest, adolescents meeting diagnostic criteria for BPD show a broad range of poor outcomes at five-year follow-up. BPD appears to be a marker of general maladjustment during adolescence and a harbinger of severe problems during the transition to young adulthood. Early intervention programs for adolescents diagnosed with BPD should focus upon a broad range of functional and psychopathological outcomes, especially social and vocational support, rather than the narrow BPD diagnosis.
{"title":"The course of borderline personality disorder from adolescence to early adulthood: A 5-year follow-up study","authors":"Mie Sedoc Jørgensen , Lise Møller , Sune Bo , Mickey Kongerslev , Lene Halling Hastrup , Andrew Chanen , Ole Jakob Storebø , Stig Poulsen , Emma Beck , Erik Simonsen","doi":"10.1016/j.comppsych.2024.152478","DOIUrl":"https://doi.org/10.1016/j.comppsych.2024.152478","url":null,"abstract":"<div><h3>Background</h3><p>Studies of the medium- to long-term clinical and functional course for treatment-seeking adolescents with borderline personality disorder (BPD) are lacking. This study aims to outline the psychopathological and functional status of participants, five years after being diagnosed with BPD during adolescence.</p></div><div><h3>Methods</h3><p>Participants were originally enrolled in a randomized clinical trial that compared mentalization-based group treatment with treatment as usual for adolescents with BPD. Semi-structured interview assessments at five-year follow-up included the Schedules for Clinical Assessment in Neuropsychiatry and the Structured Clinical Interview for DSM-5 Personality Disorders. Attention deficit hyperactivity disorder (ADHD), alcohol, substance and tobacco use, posttraumatic stress disorder (PTSD), complex PTSD, and general functioning were assessed using self-report instruments.</p></div><div><h3>Results</h3><p>97 of the original sample of 111 participants (87%) participated. They were aged 19–23 years. The most prevalent disorders were ADHD (59%), any personality disorder (47%) of which half continued to meet criteria for BPD (24%), anxiety disorders (37%), depressive disorders (32%), PTSD or complex PTSD (20%), schizophrenia (16%), and eating disorders (13%). Only 16% did not meet criteria for any mental disorder. Approximately half of the sample were in psychological and/or psychopharmacological treatment at the time of follow-up. Their general functioning remained impaired, with 36% not engaged in education, employment or training (NEET), which is nearly four times the rate of NEET in the same age group in the general population.</p></div><div><h3>Conclusions</h3><p>Although stability of the categorical BPD diagnosis is modest, adolescents meeting diagnostic criteria for BPD show a broad range of poor outcomes at five-year follow-up. BPD appears to be a marker of general maladjustment during adolescence and a harbinger of severe problems during the transition to young adulthood. Early intervention programs for adolescents diagnosed with BPD should focus upon a broad range of functional and psychopathological outcomes, especially social and vocational support, rather than the narrow BPD diagnosis.</p></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"132 ","pages":"Article 152478"},"PeriodicalIF":7.3,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0010440X24000294/pdfft?md5=5035205a3b801ccdc3e809ace5ed18cb&pid=1-s2.0-S0010440X24000294-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140195577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-21DOI: 10.1016/j.comppsych.2024.152474
Xiuxiu Shi , Xuhai Sun , Chong Zhang , Zheng Li
Introduction
The reason why some people with severe mental illness (SMI) maintain positive self-identity, while some are affected by the stigmatized environment is unclear.
Aims
To describe the status of individual stigma and explore the relationship between self-stigma, stigma resistance and related variables in people with SMI.
Methods
A cross-sectional study was conducted from April 2021 to March 2022. The Chinese version of Internalized Stigma of Mental Illness Scale and Stigma Resistance Scale were used to assess individual stigma. Perceived public stigma, psychological capital, stigma stress appraisal and coping orientations were also measured by scales. Data was provided by 422 patients with schizophrenia or bipolar disorder, from one psychiatric hospital and four community healthcare centers in China. A structural equation model was applied for analysis.
Results
The total mean scores of self-stigma and stigma resistance were (2.06 ± 0.65), and (3.95 ± 0.84). Perceived public stigma was the primary condition for constructing individual stigma, which indirectly affected self-stigma (β = 0.268) and stigma resistance (β = −0.145). Stigma stress appraisal mediated the transformation of public stigma into individual, which had direct and indirect effects on self-stigma (β = 0.417, 0.166), and an indirect effect on stigma resistance (β = −0.374). Secrecy positively affected self-stigma (β = 0.117), while positive coping positively affected stigma resistance (β = 0.380). Psychological capital significantly directly impacted individual stigma.
Conclusions
Findings highlighted how public stigma determines the degree to which patients with SMI deal with stigma stress appraisal, and how this influences individuals. Anti-stigma programs and interventions to improve individuals' psychological capital and coping capabilities should be emphasized.
{"title":"Individual stigma in people with severe mental illness: Associations with public stigma, psychological capital, cognitive appraisal and coping orientations","authors":"Xiuxiu Shi , Xuhai Sun , Chong Zhang , Zheng Li","doi":"10.1016/j.comppsych.2024.152474","DOIUrl":"10.1016/j.comppsych.2024.152474","url":null,"abstract":"<div><h3>Introduction</h3><p>The reason why some people with severe mental illness (SMI) maintain positive self-identity, while some are affected by the stigmatized environment is unclear.</p></div><div><h3>Aims</h3><p>To describe the status of individual stigma and explore the relationship between self-stigma, stigma resistance and related variables in people with SMI.</p></div><div><h3>Methods</h3><p>A cross-sectional study was conducted from April 2021 to March 2022. The Chinese version of Internalized Stigma of Mental Illness Scale and Stigma Resistance Scale were used to assess individual stigma. Perceived public stigma, psychological capital, stigma stress appraisal and coping orientations were also measured by scales. Data was provided by 422 patients with schizophrenia or bipolar disorder, from one psychiatric hospital and four community healthcare centers in China. A structural equation model was applied for analysis.</p></div><div><h3>Results</h3><p>The total mean scores of self-stigma and stigma resistance were (2.06 ± 0.65), and (3.95 ± 0.84). Perceived public stigma was the primary condition for constructing individual stigma, which indirectly affected self-stigma (<em>β</em> = 0.268) and stigma resistance (<em>β</em> = −0.145). Stigma stress appraisal mediated the transformation of public stigma into individual, which had direct and indirect effects on self-stigma (<em>β</em> = 0.417, 0.166), and an indirect effect on stigma resistance (<em>β</em> = −0.374). Secrecy positively affected self-stigma (<em>β</em> = 0.117), while positive coping positively affected stigma resistance (<em>β</em> = 0.380). Psychological capital significantly directly impacted individual stigma.</p></div><div><h3>Conclusions</h3><p>Findings highlighted how public stigma determines the degree to which patients with SMI deal with stigma stress appraisal, and how this influences individuals. Anti-stigma programs and interventions to improve individuals' psychological capital and coping capabilities should be emphasized.</p></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"132 ","pages":"Article 152474"},"PeriodicalIF":7.3,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0010440X24000257/pdfft?md5=1c827808363d6e4a1afe13e69d501ea6&pid=1-s2.0-S0010440X24000257-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140277374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-19DOI: 10.1016/j.comppsych.2024.152476
C. Ward-Smith, K. Sorsdahl, C. van der Westhuizen
Introduction
Mental health conditions (MHC) among adolescents in low- and middle-income countries, including South Africa, are estimated to be high. Adaptive emotion regulation (ER) skills can protect against MHC among adolescents. In South Africa, there is limited adolescent mental health prevalence data as well as little understanding of the associations between MHC and ER among adolescents. This study aimed to address these gaps by describing the psychosocial characteristics of older South African adolescents from low-income settings as well as investigating associations between depression and anxiety symptoms and ER.
Methods
We selected 12 schools in collaboration with two NGOs. Learners aged 15–18-years were recruited to complete a tablet-based survey. ER, depression, anxiety, and other psychosocial measures were included. Two multiple linear regression models were used to determine associations between depression symptoms, anxiety symptoms, other psychosocial factors, and ER.
Results
Of the 733 participants from 12 Western Cape schools, 417 (56.90%) screened at risk for clinically significant anxiety symptoms, 423 (57.70%) participants for depression symptoms, 229 (31.40%) participants for PTSD symptoms and 263 (35.90%) for risky alcohol use. Depression and anxiety scores were found to be significantly positively correlated with ER difficulties and adolescents struggled most with identifying and utilizing adaptive ER strategies. The adjusted linear regression model reported that female gender, clinically significant depressive, anxiety, post-traumatic stress symptoms and risky-alcohol use were all significantly associated with poorer ER scores, while self-esteem was significantly associated with better ER scores.
Conclusion
These findings contribute to the South African adolescent mental health literature and to the research gap on the links between depression and anxiety and ER. Future research should consider further exploration of the relationships between psychosocial factors and ER to inform the urgent development and testing of appropriate adolescent interventions in this setting.
{"title":"An investigation into symptoms of depression and anxiety and emotion regulation among older adolescents from low-income settings in South Africa","authors":"C. Ward-Smith, K. Sorsdahl, C. van der Westhuizen","doi":"10.1016/j.comppsych.2024.152476","DOIUrl":"10.1016/j.comppsych.2024.152476","url":null,"abstract":"<div><h3>Introduction</h3><p>Mental health conditions (MHC) among adolescents in low- and middle-income countries, including South Africa, are estimated to be high. Adaptive emotion regulation (ER) skills can protect against MHC among adolescents. In South Africa, there is limited adolescent mental health prevalence data as well as little understanding of the associations between MHC and ER among adolescents. This study aimed to address these gaps by describing the psychosocial characteristics of older South African adolescents from low-income settings as well as investigating associations between depression and anxiety symptoms and ER.</p></div><div><h3>Methods</h3><p>We selected 12 schools in collaboration with two NGOs. Learners aged 15–18-years were recruited to complete a tablet-based survey. ER, depression, anxiety, and other psychosocial measures were included. Two multiple linear regression models were used to determine associations between depression symptoms, anxiety symptoms, other psychosocial factors, and ER.</p></div><div><h3>Results</h3><p>Of the 733 participants from 12 Western Cape schools, 417 (56.90%) screened at risk for clinically significant anxiety symptoms, 423 (57.70%) participants for depression symptoms, 229 (31.40%) participants for PTSD symptoms and 263 (35.90%) for risky alcohol use. Depression and anxiety scores were found to be significantly positively correlated with ER difficulties and adolescents struggled most with identifying and utilizing adaptive ER strategies. The adjusted linear regression model reported that female gender, clinically significant depressive, anxiety, post-traumatic stress symptoms and risky-alcohol use were all significantly associated with poorer ER scores, while self-esteem was significantly associated with better ER scores.</p></div><div><h3>Conclusion</h3><p>These findings contribute to the South African adolescent mental health literature and to the research gap on the links between depression and anxiety and ER. Future research should consider further exploration of the relationships between psychosocial factors and ER to inform the urgent development and testing of appropriate adolescent interventions in this setting.</p></div>","PeriodicalId":10554,"journal":{"name":"Comprehensive psychiatry","volume":"132 ","pages":"Article 152476"},"PeriodicalIF":7.3,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0010440X24000270/pdfft?md5=9b4f698dc9dc4e57823944240add2bbc&pid=1-s2.0-S0010440X24000270-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140199434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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