Epidemiology and Psychiatric Sciences最新文献

Aims: Having a child with a psychiatric diagnosis is associated with parents' greater risk of subsequent mental disorders but no immediate change in their annual labour market metrics. This discrepancy could be explained by shorter absences from work. We examined first-time psychiatric sickness absences in parents whose children have psychiatric diagnoses.

Methods: Using several linked nationwide Finnish registers, in this cohort study we examined time to first psychiatric sickness absence in parents whose children were born in 2001-2012 (early-childhood-onset diagnoses) or 2005-2016 (late-childhood-onset diagnoses). Exposure was having a child with a psychiatric diagnosis. Follow-up started when the parent's eldest turned 1 (early-childhood-onset diagnoses) or 5 (late-childhood-onset diagnoses) and ended at psychiatric sickness absence, emigration, 68th birthday, death, or 31 December 2020, whichever occurred first.

Results: The 2001-2012 and 2005-2016 cohorts included 357 135 and 397 874 parents followed for 3.31 and 3.70 million person-years. Having a diagnosed child was associated with greater risk of psychiatric sickness absence in all except men whose children had substance use or psychotic disorder diagnoses. Time-varying analyses showed the greatest associations for women (HR: 4.92; 95% CI: 3.97-6.10) and men (HR: 2.48; 95% CI: 1.61-3.80) within 6 months of a child's eating disorder diagnosis.

Conclusions: Parents of children with psychiatric diagnoses may be at a greater risk of a psychiatric sickness absence. Associations differed by child's diagnosis, parent's gender and time since diagnosis.

Aims: Although extensive research has been conducted on the impact of the COVID-19 pandemic on global mental health, a systematic synthesis of the cross-time dynamics of suicidal ideation (SI) remains lacking. This study aims to systematically synthesise the global aggregated prevalence of SI before and after the pandemic, investigate the potential association between pandemic exposure and the SI risk through meta-regression analysis of longitudinal studies, and explore key moderating factors.

Methods: A systematic search was conducted in Web of Science, PubMed, PsycINFO and ProQuest databases up to August 2025. Observational studies were included if they employed cross-sectional or longitudinal designs and reported the prevalence of SI before and after the pandemic across global regions.

Results: The analysis included 354 cross-sectional studies (N = 8,247,875) and 27 longitudinal studies. In cross-sectional studies, the pooled prevalence of SI was 13.20% [95% CI 12.06%-14.42%]. Pre-pandemic prevalence was 12.52% [95% CI 8.46%-18.14%], and post-pandemic prevalence was 13.24% [95% CI 12.07%-14.50%], with no significant difference. Meta-regression analysis identified three moderators. Specifically, larger sample sizes (n) were associated with lower prevalence (β = -0.232, P < 0.0001); higher study quality predicted lower prevalence (β = -0.278, P < 0.001); and studies on adults reported significantly lower prevalence than adolescents (β = -0.366, P < 0.05). Conversely, time progression during the pandemic, development level, geographical area, gender and measurement method did not show significant independent effects. Interaction analyses also found no significant moderating effect of economic development level or geographical area on the temporal trend of SI prevalence. Longitudinal analysis found no significant increase in prevalence from the pre-pandemic to the post-pandemic period (P = 0.101). However, a small but significant increase occurred between early and late stages within the pandemic (β = 0.265, P = 0.021). Subgroup analyses showed no significant moderation of these temporal changes.

Conclusions: The COVID-19 pandemic's impact on SI was dynamic. While no significant prevalence change was found between pre- and post-pandemic periods, a significant increase occurred as the crisis progressed. This deteriorating trend was more pronounced in adolescents, identifying them as a key vulnerable group. Methodologically, findings were moderated by the measurement instrument, study quality and sample size, with evidence suggesting potential small-study effects. These findings underscore the need for robust mental health surveillance and targeted interventions for at-risk populations during prolonged public health crises.The protocol was registered on PROSPERO (CRD42024603151).

Aims: Efforts to reduce restrictive practices (RPs) in mental health care are growing internationally. Yet, inconsistent definitions and perspectives often challenge the consistent implementation and evaluation of reduction strategies. This study explored which scenarios different mental health stakeholders classify as RPs, examined the contextual factors influencing these classifications and compared classification patterns across clinicians, researchers, service users and family caregivers.

Methods: An international cross-sectional survey was conducted using a multilingual online questionnaire hosted on the Qualtrics platform. A total of 851 stakeholders participated, including clinicians (n = 517), service users (n = 80), family caregivers (n = 89) and researchers (n = 165). Participants were presented with 44 potential RP case scenarios and asked to rate whether each scenario should be classified as an RP using a four-point Likert scale (Definitely yes, Probably yes, Probably no, Definitely no). The scenarios were organized into 22 paired comparisons, each sharing the same core context but differing in specific details. Paired comparisons were analyzed one pair at a time, allowing us to identify classification patterns between the scenarios and isolate the effects of particular contextual factors using ordered logistic regression. Interaction analyses were then conducted to assess how classification patterns varied across stakeholder groups.

Results: Substantial discrepancies exist both within and between stakeholder groups regarding whether a given action should be considered an RP or not. Physically visible actions were often identified as RPs across all groups, while less visible forms often went unrecognized. Contextual differences, such as the healthcare professional's intention, duration of the action, methods used, presence or absence of consent, door-locking status, and the severity of anticipated harm to be prevented influenced whether a given action was classified as an RP. Service users classified more scenarios as RPs than other groups; however, their decisions were more context-sensitive, shifting notably even with minor changes in scenario details. Among the 22 paired scenarios compared, 13 (59.09%) showed significant differences (p < 0.01) within at least one stakeholder group and eight demonstrated differences between groups.

Conclusions: Mental health stakeholders' interpretations of RPs were often shaped not only by the inherent coercive nature of actions but also by the context in which they occurred and the professional role of the assessors. This underscores the need for harmonized definitions and classification frameworks for RPs, co-designed with diverse stakeholders. Addressing less visible forms of RPs in policy and clinical practice is also essential.

Aims: In England, psychological therapies provided in primary care are recommended as first-line treatment for people living with mild-to-moderate dementia experiencing depression or anxiety. It is known that people living with dementia experience more barriers to accessing therapy than people without dementia, but such inequalities in terms of rates of access to primary care services are yet to be characterised.

Methods: In this retrospective, observational study of linked electronic healthcare records, the national database of the National Health Service (NHS) Talking Therapies for anxiety and depression programme was used to compare pathways to accessing therapy between 6623 people living with dementia and 4 825 489 without dementia between 2012 and 2019. Outcomes included access to an assessment, to therapy and reasons for discharge. Primary analyses used a propensity-score matched cohort to compare outcomes. Exact matching was used for the NHS service entity.

Results: The prevalence of dementia in the study cohort was lower than the prevalence of dementia in a representative population, based on an estimation of prevalence in people with mild-to-moderate age over 35 (0.23% in our study vs 3.82% in previous research). Compared to people without dementia, people living with dementia were less likely to access an assessment (odds ratio [OR] = 0.60; 95% confidence interval [CI]: 0.55-0.65), to subsequently receive therapy (OR = 0.67; 95% CI: 0.61-0.73) and more likely to be discharged because services were deemed not suitable before having an assessment (relative rate ratio [RRR] = 4.90; 95% CI: 4.20-5.72) and starting therapy (RRR = 2.74; 95% CI: 2.24-3.35). Female gender, social deprivation, Asian ethnicity and less common dementia subtypes (such as frontotemporal dementia) were also associated with poorer access rates and a higher likelihood of services being deemed not suitable. Involvement of care partners in the referral process was associated with better access rates.

Conclusions: Pathways to accessing primary care psychological therapy services must be made more accessible for people living with dementia. Better access could be achieved by increasing referrer awareness and training for staff within services to promote access for people living with dementia (especially for groups under-represented in services), better understanding how to involve care partners in the process, as well as when specialist support might be more suited in secondary care. More granularity in the medical coding of rarer dementia diagnoses in electronic health records would also allow for better statistically powered research for these groups.

Aims: While depressive symptoms are common during menopausal transition, the relationship between the two remains unclear. Therefore, this study aimed to examine the longitudinal changes in depressive symptoms among middle-aged Korean women and identify those with elevated and worsening symptoms during this period.

Methods: A total of 1,178 participants who underwent comprehensive health examinations at Kangbuk Samsung Hospital in Korea were followed for a median of 10.8 years (IQR, 9.2-11.6; maximum, 12.7), including all women who reached natural menopause during follow-up, with only data prior to HRT initiation included. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D), and menopausal stages were classified according to the STRAW + 10 criteria and final menstrual period (FMP). Linear mixed-effects models and group-based trajectory modelling (GBTM) were applied to evaluate longitudinal changes in depressive symptoms and to identify distinct trajectories in the severity and stability of depressive symptoms.

Results: The age-adjusted prevalence of CES-D ≥ 16 was 11.0%, 11.5%, 11.2% and 12.4%, with corresponding mean scores of 6.7, 6.6, 6.9 and 7.1 across stages. After adjusting for time-varying age and covariates, menopausal stage transitions were not significantly associated with higher levels of depressive symptoms, whether analysed as continuous or binary variables. For binary CES-D (≥16), the estimated coefficients (95% CI) were 0.10 (-0.20 to 0.41) for early transition, 0.09 (-0.21 to 0.39) for late transition and 0.26 (-0.09 to 0.61) for post-menopause. Similarly, time relative to the FMP (-11 to +9 years) showed no significant association with depressive symptoms. GBTM identified three distinct trajectories: most participants (75.5%) maintained consistently low depressive symptoms throughout the transition, whereas 5.8% showed worsening symptoms. Poor sleep quality (OR 5.83, 95% CI 3.25 to 10.45) and moderate-to-severe vasomotor symptoms (OR 2.95, 95% CI 1.30 to 6.70) were significantly associated with the worsening trajectory. Suicidal ideation was higher in this group (45.4% at baseline, increasing to 70.5% at follow-up).

Conclusions: Most women maintained low depressive symptoms during the menopausal transition; however, a subset experienced worsening symptoms linked to menopause-related physical symptoms. Medical visits for menopause-related symptoms may provide opportunities for screening depressive symptoms in higher-risk women, though the screening effectiveness requires further evaluation.

Aims: To investigate the association of midlife and late-life undiagnosed mood symptoms, especially their comorbidity, with long-term dementia risk among multi-regional and ethnic adults.

Methods: The prospective study used data from the UK Biobank (N = 142,670; mean follow-up 11.0 years) and three Asian studies (N = 1,610; mean follow-up 4.4 years). Undiagnosed mood symptoms (manic symptoms, depressive symptoms and comorbidity of depressive and manic symptoms) and diagnosed mood disorders (depression, mania and bipolar disorders) were classified. Plasma levels of 168 metabolites were measured. The association between undiagnosed mood symptoms and 12-year dementia (including subtypes) risk and domain-specific cognitive function was examined. The contribution of metabolites in explaining the association between symptom comorbidity and dementia risk was estimated.

Results: Undiagnosed mood symptoms were prevalent (11.4% in the UK cohort and 31.2% in Asian cohorts) among 1,462 (1.0%) and 74 (19.4%) participants who developed dementia. Comorbidity of undiagnosed mood symptoms was associated with higher dementia risk (sub-distribution hazard ratios = 9.46; 95% confidence interval = 4.07-21.97), especially Alzheimer's disease, and with worse reasoning ability, poorer numeric memory and metabolic dysfunction. Glucose and total Esterified Cholesterol explained 9.1% of the association between symptom comorbidity and dementia, with most of the contribution being from glucose (6.8%).

Conclusions: Comorbidity of undiagnosed mood symptoms was associated with a higher cumulative risk of dementia in the long term. Glucose metabolism could be implicated in the development of mood disorders and dementia. The distinctive pathophysiological mechanism between psychiatric and neurodegenerative disorders warrants further exploration.

Aims: Depression among middle-aged and older adults is a critical public health priority. Clarifying the dynamic evolution of depression is essential for establishing prevention and intervention strategies; however, relevant research is limited. The aim of this study was to elucidate the transition patterns underlying different depressive symptoms (DS) states.

Methods: Data from the China Health and Retirement Longitudinal Study were utilised in this study, which included participants aged ≥45 years with multiple DS assessments via the Center for Epidemiological Studies Depression Scale. Multi-state Markov models were employed to estimate transition probabilities and intensities between DS states, the total length of stay and mean sojourn time in each state and the hazard ratios (HRs) of factors.

Results: Among 19,991 participants (average follow-up: 7.3 years), the 10-year cumulative probabilities of transition from non-DS to depressive states increased by 19.4% in males and 31.8% in females. Mild DS was the most unstable state, with the highest transition intensities (males: 1.029; females: 0.970) and shortest sojourn time (males: 0.959 years; females: 1.022 years). Sex and age strongly influenced depressive state transitions. Compared to participants without chronic disease, those with ≥3 chronic diseases had a higher risk of developing mild DS (HR = 1.685, 95% Confidence Interval [CI]: 1.530-1.856) and transitioning to death from both the non-DS (HR = 2.905, 95% CI: 2.293-3.681) and severe-DS (HR = 3.429, 95% CI: 1.290-9.112) states, but a lower likelihood of recovery from mild DS (HR = 0.821, 95% CI: 0.749-0.900) and severe DS (HR = 0.730, 95% CI: 0.630-0.847). Compared to no participation in social activities, frequent participation was associated with a lower risk of progression to the mild-DS state (HR = 0.851, 95% CI: 0.785-0.920) and a greater likelihood of recovery from severe DS (HR = 1.169, 95% CI: 1.034-1.322). Being underweight was associated with an increased risk of mild-DS onset (HR = 1.338, 95% CI: 1.129-1.587) and transitioning to death from both the non-DS and mild-DS states, compared with individuals of normal weight.

Conclusions: Our study revealed a continuous population shift towards depressive states and identified the mild-DS state as a critical intervention state owing to its instability. In addition to sex and age, modifiable factors, including chronic disease conditions, social activity participation and weight status, significantly influenced DS-state transitions, offering actionable insights for precision prevention strategies.

Aims: Fine particulate matter (PM_2.5) exposure and unfavourable lifestyle are both significant risk factors for mental health disorders, yet their combined effects on adolescent depression and anxiety remain poorly understood. This study aims to determine whether PM_2.5 exposure and lifestyle are independently associated with adolescent depression and anxiety, and whether there are joint effects between these factors on mental health outcomes.

Methods: In this cross-sectional study, 19852 participants were analysed. PM_2.5 concentrations were obtained from the ChinaHighAirPollutants (CHAP) dataset. Lifestyle factors were assessed through self-reported questionnaires, and a healthy lifestyle score was developed based on eight lifestyle risk factors. Depression and anxiety were assessed using the PHQ-9 and GAD-7 scales. Restricted cubic spline analysed dose-response relationships between PM_2.5 exposure and mental health outcomes. The independent and joint effects were assessed using logistic regression models. Both multiplicative and additive interactions (relative excess risk due to interaction, RERI) were examined. Multiple classification approaches were incorporated to ensure robust results.

Results: The study included 19852 participants with a mean age of 15.16 years (SD 1.60), comprising 9886 (49.8%) males and 9966 (50.2%) females. Depression and anxiety were identified in 3845 (19.37%) and 3230 (16.27%) participants, respectively. PM_2.5 exposure showed a linear dose-response relationship with depression and anxiety. Joint effects analysis at the 75th percentile of PM_2.5 with a lifestyle risk score of 4 revealed the strongest associations, with adjusted odds ratios of 4.49 (95% CI: 3.79-5.33) for depression, 4.01 (95% CI: 3.36-4.78) for anxiety and 4.24 (95% CI: 3.52-5.10) for their comorbidity. Simultaneously, significant additive interactions (RERI > 0) between high levels of PM_2.5 exposure and unfavourable lifestyle factors were detected, suggesting synergistic effects on mental health outcomes. Subgroup and sensitivity analyses confirmed the robustness of these findings.

Conclusions: High PM_2.5 exposure and unfavourable lifestyle factors demonstrated significant independent and joint effects on depression and anxiety among adolescents. These findings highlight that implementing stringent air pollution control measures, combined with promoting healthy lifestyle practices, may be crucial for protecting adolescent mental health.

Background: Promoting mental health, preventing mental disorders and providing effective treatments are public health priorities. Randomized controlled trials (RCTs) frequently evaluate mental health and psychosocial support interventions to achieve one or more of these objectives. Distinguishing between RCTs focused on mental health promotion, prevention or treatment remains conceptually and methodologically challenging. No standardized tool exists to position RCTs along a promotion-to-treatment continuum in mental health. We aimed to develop and validate the VErona-LUgano Tool (VELUT) for distinguishing RCTs along the promotion-to-treatment continuum.

Methods: An interdisciplinary tool development group (TDG) was established. The Population, Intervention, Comparison and Outcome framework was used to define key constructs. Items in the tool were devised, categorized and reduced through qualitative and quantitative methods. Finally, we performed a preliminary validation of the VELUT applying item response theory (IRT) using data from 180 RCTs.

Results: The TDG generated 33 items for the initial version of the VELUT, reduced to 16 through review, cognitive interviews and psychometric analysis. Analyses of 180 RCTs using the 16-item tool showed high internal consistency (α = 0.94) and unidimensionality. Following item reduction and IRT, a final 8-item version was retained, and IRT models confirmed strong item discrimination for the 8 items and high scale reliability (marginal reliability >0.90 across most of the range of the scale), good response distribution, item performance and alignment with the Institute of Medicine (IOM) promotion-to-treatment continuum.

Conclusions: The VELUT addresses methodological gaps in global mental health research by helping to position RCTs of MHPSS interventions along the IOM promotion-to-treatment continuum.

Aims: This study employs a longitudinal network approach to investigate the dynamic relationships between COVID-19-related stressors and depressive symptoms among Canadian adults and to explore any sex and age differences in these associations.

Methods: The study utilised data from the Canadian Longitudinal Study on Ageing (CLSA), a large, national, long-term study of Canadian adults aged 45 years and older. Depressive symptoms were measured using the Centre for Epidemiologic Studies Depression Scale (CES-D), and COVID-19-related stressors were evaluated using a standardised stress inventory adapted for the pandemic context. The cross-lagged panel network analysis (CLPN) was employed to examine the temporal relationships and dynamic interactions between depressive symptoms and COVID-19-related stressors.

Results: Significant variations in network structures and strengths were identified across demographic groups. Individuals aged between 45 and 65 years and females exhibited stronger connections between COVID-19-related stressors and depressive symptoms. Central symptoms such as "feeling unhappy" were consistent across groups, while "feeling depressed" was more central among males and "increased verbal or physical conflict" among females. Additionally, health-related stressors and family separation emerged as critical bridge symptoms for males and individuals under 65 years, respectively.

Conclusions: Both cross-sectional and longitudinal relationships, and directionality between COVID-19-related stressors and depressive symptoms across sex and age groups were identified. The findings of the study highlight that dedicated mental health intervention and prevention efforts are warranted to ameliorate the negative impact of stressors on depressive symptoms.