General hospital psychiatry最新文献

Demoralization in clinical settings: A scoping review of measurement tools and psychometric properties. 临床环境中的士气低落：测量工具和心理测量特性的范围审查。

IF 3.7 2区医学 Q1 PSYCHIATRY

General hospital psychiatry

Pub Date : 2026-02-02 DOI: 10.1016/j.genhosppsych.2026.01.018

Rongyu Hua, Jinfeng Zhu

Background: Demoralization is a multifaceted clinical construct, and several measurements have been developed to assess demoralization, while no study has systematically mapped these measurement approaches.

Objectives: To map existing measurements for assessing demoralization in clinical settings.

Methods: A scoping review was conducted following the Joanna Briggs Institute (JBI) methodology. Electronic databases, including PubMed, The Cochrane Library, PsycINFO, Embase, and Web of Science, were searched January 2026. The characteristics of included studies, measurement, and psychometric properties were summarized.

Results: A comprehensive analysis identified fourteen measures that were used to assess demoralization across the included studies. These measures are systematically categorized into Three key domains: dimensional self-report scales, multi-symptom screening, diagnostic measure. The demoralization scale (DS) was the most widely used measurement and existed in multiple versions that varied by length and language. Eight core dimensions were consistently associated with demoralization: loss of meaning and purpose, dysphoria, disheartenment, sense of failure, distress, helplessness, subjective incompetence, and coping ability. Full scales generally demonstrated stronger internal reliability and showed evidence of content, construct, criterion, convergent, and discriminant validity. Common limitations included unclear criteria for score interpretation.

Conclusion: This review outlines the strengths and limitations of existing demoralization measurements in clinical settings, providing guidance for clinicians and researchers in selecting appropriate tools. It also highlights the need for standardized cutoff points to improve score interpretation.

Implications: The findings may serve as a valuable resource for clinicians and researchers, supporting informed selection of the most appropriate tools for patient care and research.

Summary: What is known about the subject? What the paper adds to existing knowledge? What are the implications for practice?

背景：士气低落是一个多方面的临床结构，已经开发了几种测量方法来评估士气低落，但没有研究系统地绘制了这些测量方法。目的：绘制评估临床环境中士气低落的现有测量方法。方法：根据乔安娜布里格斯研究所（JBI）的方法进行范围审查。电子数据库，包括PubMed， Cochrane Library, PsycINFO， Embase和Web of Science，检索于2026年1月。总结了纳入研究的特点、测量方法和心理测量特性。结果：综合分析确定了14项用于评估纳入研究的士气低落的措施。这些措施被系统地分为三个关键领域：维度自我报告量表，多症状筛查，诊断措施。士气低落量表（DS）是使用最广泛的测量方法，存在多种版本，其长度和语言各不相同。八个核心维度始终与士气低落相关：失去意义和目标、烦躁不安、沮丧、失败感、痛苦、无助、主观无能和应对能力。完整量表总体上具有较强的内部信度，具有内容效度、结构效度、标准效度、收敛效度和判别效度。常见的限制包括不明确的分数解释标准。结论：本综述概述了临床环境中现有士气低落测量的优势和局限性，为临床医生和研究人员选择合适的工具提供指导。它还强调了标准化分界点以提高分数解释的必要性。意义：研究结果可作为临床医生和研究人员的宝贵资源，支持为患者护理和研究选择最合适的工具。关于这个主题我们知道些什么？这篇论文为现有知识增加了什么？这对实践有什么影响？

{"title":"Demoralization in clinical settings: A scoping review of measurement tools and psychometric properties.","authors":"Rongyu Hua, Jinfeng Zhu","doi":"10.1016/j.genhosppsych.2026.01.018","DOIUrl":"https://doi.org/10.1016/j.genhosppsych.2026.01.018","url":null,"abstract":"<p><strong>Background: </strong>Demoralization is a multifaceted clinical construct, and several measurements have been developed to assess demoralization, while no study has systematically mapped these measurement approaches.</p><p><strong>Objectives: </strong>To map existing measurements for assessing demoralization in clinical settings.</p><p><strong>Methods: </strong>A scoping review was conducted following the Joanna Briggs Institute (JBI) methodology. Electronic databases, including PubMed, The Cochrane Library, PsycINFO, Embase, and Web of Science, were searched January 2026. The characteristics of included studies, measurement, and psychometric properties were summarized.</p><p><strong>Results: </strong>A comprehensive analysis identified fourteen measures that were used to assess demoralization across the included studies. These measures are systematically categorized into Three key domains: dimensional self-report scales, multi-symptom screening, diagnostic measure. The demoralization scale (DS) was the most widely used measurement and existed in multiple versions that varied by length and language. Eight core dimensions were consistently associated with demoralization: loss of meaning and purpose, dysphoria, disheartenment, sense of failure, distress, helplessness, subjective incompetence, and coping ability. Full scales generally demonstrated stronger internal reliability and showed evidence of content, construct, criterion, convergent, and discriminant validity. Common limitations included unclear criteria for score interpretation.</p><p><strong>Conclusion: </strong>This review outlines the strengths and limitations of existing demoralization measurements in clinical settings, providing guidance for clinicians and researchers in selecting appropriate tools. It also highlights the need for standardized cutoff points to improve score interpretation.</p><p><strong>Implications: </strong>The findings may serve as a valuable resource for clinicians and researchers, supporting informed selection of the most appropriate tools for patient care and research.</p><p><strong>Summary: </strong>What is known about the subject? What the paper adds to existing knowledge? What are the implications for practice?</p>","PeriodicalId":12517,"journal":{"name":"General hospital psychiatry","volume":"99 ","pages":"159-170"},"PeriodicalIF":3.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124553","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}

引用次数: 0

Effects of non-pharmacological interventions on anxiety or depressive symptoms in patients with heart failure: A systematic review and network meta-analysis 非药物干预对心衰患者焦虑或抑郁症状的影响：系统回顾和网络荟萃分析

IF 3.7 2区医学 Q1 PSYCHIATRY

General hospital psychiatry

Pub Date : 2026-01-27 DOI: 10.1016/j.genhosppsych.2026.01.013

Ziyue Wang , Yunhao Yi , Guangheng Zhang , Chuanhao Mi , Weijie Zhao , Hao Yang , Jianlin Wu

Objective

Anxiety and depression are common psychological symptoms following heart failure (HF) and are associated with adverse patient outcomes. However, pharmacological treatments often have suboptimal efficacy. Recently, non-pharmacological interventions have attracted increasing attention for improving psychological symptoms in HF patients, yet the most effective approach remains unclear. Therefore, this study performed a network meta-analysis (NMA) to compare the effectiveness of different non-pharmacological interventions in alleviating anxiety or depression among HF patients.

Methods

We comprehensively searched PubMed, Embase, the Cochrane Library, and PsycINFO from inception to March 2025 to identify randomized controlled trials (RCTs) evaluating non-pharmacological interventions for anxiety or depression in HF patients. The RoB 2.0 tool was employed to assess methodological quality and risk of bias. An NMA was conducted under a frequentist framework using R and Stata software. Intervention efficacy was ranked using P-scores, and sensitivity analyses were performed to evaluate the stability of the results and explore potential sources of heterogeneity.

Results

A total of 35 RCTs and one quasi-RCT involving 3829 participants were included. NMA results indicated that Tai Chi (P-score = 0.73; standardized mean difference (95% CI):-0.69(−1.59 to 0.21)) was the most efficacious intervention for improving anxiety symptoms in HF patients, while progressive muscle relaxation training (P-score = 0.78;-1.24(−2.74 to 0.26)) ranked highest for improving depressive symptoms. However, only aerobic exercise demonstrated statistically significant improvements in both anxiety (P-score = 0.63; −0.47(−0.86 to −0.07)) and depression (P-score = 0.74; −0.93(−1.44 to −0.41)).

Conclusion

Aerobic exercise appears effective for both anxiety and depression following HF. However, the evidence is of low to very low certainty.

焦虑和抑郁是心力衰竭（HF）后常见的心理症状，并与患者的不良预后相关。然而，药物治疗往往效果不佳。近年来，非药物干预已引起越来越多的关注，以改善心衰患者的心理症状，但最有效的方法尚不清楚。因此，本研究通过网络荟萃分析（NMA）来比较不同非药物干预措施在缓解心衰患者焦虑或抑郁方面的有效性。方法：我们综合检索PubMed、Embase、Cochrane Library和PsycINFO数据库，检索时间从成立到2025年3月，以确定评估心衰患者焦虑或抑郁的非药物干预措施的随机对照试验（RCTs）。采用RoB 2.0工具评估方法学质量和偏倚风险。使用R和Stata软件在频率分析框架下进行了NMA。采用p评分对干预效果进行排序，并进行敏感性分析以评估结果的稳定性并探索潜在的异质性来源。结果共纳入35项随机对照试验和1项准随机对照试验，共3829名受试者。NMA结果显示，太极（p值= 0.73；标准化平均差（95% CI）：-0.69(- 1.59至0.21)）是改善HF患者焦虑症状最有效的干预措施，而渐进式肌肉放松训练（p值= 0.78;-1.24(- 2.74至0.26)）在改善抑郁症状方面排名最高。然而，只有有氧运动在焦虑（p值= 0.63;- 0.47(- 0.86至- 0.07)）和抑郁（p值= 0.74;- 0.93(- 1.44至- 0.41)）方面有统计学意义的改善。结论有氧运动对心衰后焦虑和抑郁均有较好的治疗效果。然而，证据的确定性很低甚至很低。

{"title":"Effects of non-pharmacological interventions on anxiety or depressive symptoms in patients with heart failure: A systematic review and network meta-analysis","authors":"Ziyue Wang , Yunhao Yi , Guangheng Zhang , Chuanhao Mi , Weijie Zhao , Hao Yang , Jianlin Wu","doi":"10.1016/j.genhosppsych.2026.01.013","DOIUrl":"10.1016/j.genhosppsych.2026.01.013","url":null,"abstract":"<div><h3>Objective</h3><div>Anxiety and depression are common psychological symptoms following heart failure (HF) and are associated with adverse patient outcomes. However, pharmacological treatments often have suboptimal efficacy. Recently, non-pharmacological interventions have attracted increasing attention for improving psychological symptoms in HF patients, yet the most effective approach remains unclear. Therefore, this study performed a network meta-analysis (NMA) to compare the effectiveness of different non-pharmacological interventions in alleviating anxiety or depression among HF patients.</div></div><div><h3>Methods</h3><div>We comprehensively searched PubMed, Embase, the Cochrane Library, and PsycINFO from inception to March 2025 to identify randomized controlled trials (RCTs) evaluating non-pharmacological interventions for anxiety or depression in HF patients. The RoB 2.0 tool was employed to assess methodological quality and risk of bias. An NMA was conducted under a frequentist framework using R and Stata software. Intervention efficacy was ranked using P-scores, and sensitivity analyses were performed to evaluate the stability of the results and explore potential sources of heterogeneity.</div></div><div><h3>Results</h3><div>A total of 35 RCTs and one quasi-RCT involving 3829 participants were included. NMA results indicated that Tai Chi (P-score = 0.73; standardized mean difference (95% CI):-0.69(−1.59 to 0.21)) was the most efficacious intervention for improving anxiety symptoms in HF patients, while progressive muscle relaxation training (P-score = 0.78;-1.24(−2.74 to 0.26)) ranked highest for improving depressive symptoms. However, only aerobic exercise demonstrated statistically significant improvements in both anxiety (P-score = 0.63; −0.47(−0.86 to −0.07)) and depression (P-score = 0.74; −0.93(−1.44 to −0.41)).</div></div><div><h3>Conclusion</h3><div>Aerobic exercise appears effective for both anxiety and depression following HF. However, the evidence is of low to very low certainty.</div></div>","PeriodicalId":12517,"journal":{"name":"General hospital psychiatry","volume":"99 ","pages":"Pages 151-158"},"PeriodicalIF":3.7,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146073786","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}

引用次数: 0

Adverse childhood experiences and cardiovascular disease risk in early-stage CKM: The mediating role of depressive symptoms 童年不良经历与早期CKM心血管疾病风险：抑郁症状的中介作用

IF 3.7 2区医学 Q1 PSYCHIATRY

General hospital psychiatry

Pub Date : 2026-01-25 DOI: 10.1016/j.genhosppsych.2026.01.010

Zengyu Chen , Wei Zhao , Zeping Chen , Kaixin Tian , Yalu Qin , Ya Yu , Rui Xie

Objective

Individuals in the early stages (Stages 0–3) of Cardiovascular-Kidney-Metabolic (CKM) syndrome represent a critical window for cardiovascular disease (CVD) prevention. Adverse Childhood Experiences (ACEs), significant psychosocial risk factors, may accelerate CVD progression in this population through underlying biological pathways, but these mediating mechanisms remain unvalidated in large longitudinal cohorts. The research aimed to determine the independent impact of ACEs on CVD incidence in early-stage CKM individuals and systematically study the core mediating role of depressive symptoms, including its variation across population subgroups.

Methods

Utilizing data from the nationwide China Health and Retirement Longitudinal Study (CHARLS) cohort, we enrolled 4793 participants classified in CKM stages 0–3 and free of baseline CVD. Multivariable Cox proportional hazards models quantified the prospective connection between cumulative ACE exposure (assessed via standardized questionnaire) and CVD incidence. Effect heterogeneity was examined through subgroup analyses. A bootstrap-based mediation model (1000 resamples) systematically assessed the mediating effect of depressive symptoms (CES-D scale).

Results

Over a median follow-up of 108 months, 1199 incident CVD cases occurred. Each unit increase in cumulative ACE score was related with a significant 8% higher CVD risk (HR = 1.08, 95% CI: 1.04–1.12, P < 0.001); individuals experiencing ≥4 ACEs had a 35% higher risk (HR = 1.35, 95% CI: 1.10–1.67). Depressive symptoms mediated 23% (95% CI: 12%–53%, P < 0.001) of the ACEs-CVD association. Subgroup analyses showed no statistically significant effect (all P for interaction >0.05). Sensitivity analyses confirmed robust findings.

Conclusion

This study provides the first evidence in an early-stage CKM population that ACEs are an independent risk factor for CVD incidence, with depressive symptoms serving as a key mediating pathway (contributing 23%). It identifies women, rural residents, and Stage 1 CKM patients as high-risk subgroups. These findings offer direct support for ACEs contributing to CVD via psychobiological mechanisms and underscore the need to prioritize integrated childhood trauma screening and depression interventions for high-risk groups within primary CVD prevention strategies.

目的：早期（0-3期）心血管-肾-代谢（CKM）综合征的个体是心血管疾病（CVD）预防的关键窗口期。不良童年经历（ace）是重要的社会心理风险因素，可能通过潜在的生物学途径加速这一人群的心血管疾病进展，但这些介导机制在大型纵向队列中仍未得到证实。本研究旨在确定ace对早期CKM个体CVD发病率的独立影响，并系统研究抑郁症状的核心介导作用，包括其在人群亚组中的差异。方法利用中国健康与退休纵向研究（CHARLS）队列的数据，我们招募了4793名CKM 0-3期和无基线CVD的参与者。多变量Cox比例风险模型量化了累积ACE暴露（通过标准化问卷评估）与CVD发病率之间的潜在联系。通过亚组分析检验效果异质性。基于自举的中介模型（1000个样本）系统地评估了抑郁症状的中介作用（CES-D量表）。结果随访108个月，共发生1199例心血管疾病。累积ACE评分每增加一个单位，心血管疾病风险显著增加8% (HR = 1.08, 95% CI: 1.04-1.12, P < 0.001)；经历≥4次ace的个体风险增加35% （HR = 1.35, 95% CI: 1.10-1.67）。抑郁症状介导23% （95% CI: 12%-53%, P < 0.001）的ace - cvd相关性。亚组分析显示无统计学意义（P均为相互作用>；0.05）。敏感性分析证实了强有力的发现。结论本研究首次在早期CKM人群中证明ace是CVD发病的独立危险因素，其中抑郁症状是关键的介导途径（占23%）。它确定妇女、农村居民和1期CKM患者为高危亚群。这些发现为ace通过心理生物学机制促进CVD提供了直接支持，并强调了在初级CVD预防策略中优先考虑高危人群的综合儿童创伤筛查和抑郁干预的必要性。

{"title":"Adverse childhood experiences and cardiovascular disease risk in early-stage CKM: The mediating role of depressive symptoms","authors":"Zengyu Chen , Wei Zhao , Zeping Chen , Kaixin Tian , Yalu Qin , Ya Yu , Rui Xie","doi":"10.1016/j.genhosppsych.2026.01.010","DOIUrl":"10.1016/j.genhosppsych.2026.01.010","url":null,"abstract":"<div><h3>Objective</h3><div>Individuals in the early stages (Stages 0–3) of Cardiovascular-Kidney-Metabolic (CKM) syndrome represent a critical window for cardiovascular disease (CVD) prevention. Adverse Childhood Experiences (ACEs), significant psychosocial risk factors, may accelerate CVD progression in this population through underlying biological pathways, but these mediating mechanisms remain unvalidated in large longitudinal cohorts. The research aimed to determine the independent impact of ACEs on CVD incidence in early-stage CKM individuals and systematically study the core mediating role of depressive symptoms, including its variation across population subgroups.</div></div><div><h3>Methods</h3><div>Utilizing data from the nationwide China Health and Retirement Longitudinal Study (CHARLS) cohort, we enrolled 4793 participants classified in CKM stages 0–3 and free of baseline CVD. Multivariable Cox proportional hazards models quantified the prospective connection between cumulative ACE exposure (assessed via standardized questionnaire) and CVD incidence. Effect heterogeneity was examined through subgroup analyses. A bootstrap-based mediation model (1000 resamples) systematically assessed the mediating effect of depressive symptoms (CES-D scale).</div></div><div><h3>Results</h3><div>Over a median follow-up of 108 months, 1199 incident CVD cases occurred. Each unit increase in cumulative ACE score was related with a significant 8% higher CVD risk (HR = 1.08, 95% CI: 1.04–1.12, <em>P</em> < 0.001); individuals experiencing ≥4 ACEs had a 35% higher risk (HR = 1.35, 95% CI: 1.10–1.67). Depressive symptoms mediated 23% (95% CI: 12%–53%, <em>P</em> < 0.001) of the ACEs-CVD association. Subgroup analyses showed no statistically significant effect (all P for interaction >0.05). Sensitivity analyses confirmed robust findings.</div></div><div><h3>Conclusion</h3><div>This study provides the first evidence in an early-stage CKM population that ACEs are an independent risk factor for CVD incidence, with depressive symptoms serving as a key mediating pathway (contributing 23%). It identifies women, rural residents, and Stage 1 CKM patients as high-risk subgroups. These findings offer direct support for ACEs contributing to CVD via psychobiological mechanisms and underscore the need to prioritize integrated childhood trauma screening and depression interventions for high-risk groups within primary CVD prevention strategies.</div></div>","PeriodicalId":12517,"journal":{"name":"General hospital psychiatry","volume":"99 ","pages":"Pages 143-150"},"PeriodicalIF":3.7,"publicationDate":"2026-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146073892","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}

引用次数: 0

Efficacy of internet-based cognitive behavioral therapy on somatic symptom disorder and common related functional disorders: A meta-analysis of randomized controlled trials 基于网络的认知行为治疗躯体症状障碍和常见相关功能障碍的疗效：随机对照试验的荟萃分析

IF 3.7 2区医学 Q1 PSYCHIATRY

General hospital psychiatry

Pub Date : 2026-01-23 DOI: 10.1016/j.genhosppsych.2026.01.017

Shengyi Liu , Yinghong Li , Zihua He , Xiutian Sima , Jinmei Li

Introduction

Cognitive behavioral therapy (CBT) is recommended for somatic symptom disorder (SSD) and functional somatic syndromes. Face-to-face CBT is limited by accessibility barriers. Internet-based CBT (iCBT) addresses the aforementioned limitations. This study aimed to evaluate the efficacy of iCBT in SSD and common functional somatic syndromes.

Methods

A meta-analysis was conducted, following the PRISMA statement for study screening. Databases including PubMed, Embase, and CENTRAL. The primary outcomes included somatic symptoms and health anxiety. Secondary outcomes included mood-related outcomes, functioning, and sleep.

Results

A total of 23 studies were included (1746 iCBT-group vs 1553 control-group patients). Post-treatment, iCBT showed no significant effect difference vs. other psychotherapies (Hedges'g [95% CI]: general symptoms = 0.09 [−0.11; 0.28]; health anxiety: = 0.18 [−0.17; 0.52]), but outperformed waitlisting across most symptoms (Hedges'g [95% CI]: general symptoms = 0.30 [0.12; 0.48]; gastrointestinal = 0.62 [0.35; 0.88]; fatigue = 0.47 [0.25; 0.68]; health anxiety = 0.71 [0.26; 1.16]). The effect of iCBT was not significantly different or slightly higher than treatment as usual after treatment (Hedges'g [95% CI]: gastrointestinal = 0.41 [0.23; 0.58]; fatigue = 0.65 [−0.51; 1.82]; fibromyalgia = 0.27 [0.00; 0.55]). The pooled adverse event rate in the iCBT group was 27%, with no serious adverse events reported.

Discussion

The iCBT is an effective intervention for SSD and common functional somatic syndromes. However, heterogeneity still exists among subtypes, and personalized plans need to be formulated.

认知行为疗法（CBT）被推荐用于躯体症状障碍（SSD）和功能性躯体综合征。面对面认知行为疗法受到可及性障碍的限制。基于internet的CBT （iCBT）解决了上述限制。本研究旨在评价iCBT在SSD和常见功能性躯体综合征中的疗效。方法：根据PRISMA声明进行荟萃分析，进行研究筛选。数据库包括PubMed， Embase和CENTRAL。主要结局包括躯体症状和健康焦虑。次要结果包括情绪相关结果、功能和睡眠。结果：共纳入23项研究（icbt组1746例，对照组1553例）。治疗后，iCBT与其他心理疗法相比无显著效果差异（Hedges'g [95% CI]：一般症状= 0.09[-0.11;0.28]；健康焦虑：= 0.18[-0.17;0.52]），但在大多数症状上优于等候疗法（Hedges'g [95% CI]：一般症状= 0.30[0.12;0.48]；胃肠道= 0.62[0.35;0.88]；疲劳= 0.47[0.25;0.68]；健康焦虑= 0.71[0.26;1.16]）。治疗后iCBT的效果与常规治疗无显著差异或略高于常规治疗（Hedges'g [95% CI]：胃肠道= 0.41[0.23;0.58]；疲劳= 0.65[-0.51;1.82]；纤维肌痛= 0.27[0.00;0.55]）。iCBT组的总不良事件发生率为27%，无严重不良事件报告。讨论：iCBT是SSD和常见功能性躯体综合征的有效干预手段。但亚型间仍存在异质性，需要制定个性化方案。

{"title":"Efficacy of internet-based cognitive behavioral therapy on somatic symptom disorder and common related functional disorders: A meta-analysis of randomized controlled trials","authors":"Shengyi Liu , Yinghong Li , Zihua He , Xiutian Sima , Jinmei Li","doi":"10.1016/j.genhosppsych.2026.01.017","DOIUrl":"10.1016/j.genhosppsych.2026.01.017","url":null,"abstract":"<div><h3>Introduction</h3><div>Cognitive behavioral therapy (CBT) is recommended for somatic symptom disorder (SSD) and functional somatic syndromes. Face-to-face CBT is limited by accessibility barriers. Internet-based CBT (iCBT) addresses the aforementioned limitations. This study aimed to evaluate the efficacy of iCBT in SSD and common functional somatic syndromes.</div></div><div><h3>Methods</h3><div>A meta-analysis was conducted, following the PRISMA statement for study screening. Databases including PubMed, Embase, and CENTRAL. The primary outcomes included somatic symptoms and health anxiety. Secondary outcomes included mood-related outcomes, functioning, and sleep.</div></div><div><h3>Results</h3><div>A total of 23 studies were included (1746 iCBT-group vs 1553 control-group patients). Post-treatment, iCBT showed no significant effect difference vs. other psychotherapies (Hedges'g [95% CI]: general symptoms = 0.09 [−0.11; 0.28]; health anxiety: = 0.18 [−0.17; 0.52]), but outperformed waitlisting across most symptoms (Hedges'g [95% CI]: general symptoms = 0.30 [0.12; 0.48]; gastrointestinal = 0.62 [0.35; 0.88]; fatigue = 0.47 [0.25; 0.68]; health anxiety = 0.71 [0.26; 1.16]). The effect of iCBT was not significantly different or slightly higher than treatment as usual after treatment (Hedges'g [95% CI]: gastrointestinal = 0.41 [0.23; 0.58]; fatigue = 0.65 [−0.51; 1.82]; fibromyalgia = 0.27 [0.00; 0.55]). The pooled adverse event rate in the iCBT group was 27%, with no serious adverse events reported.</div></div><div><h3>Discussion</h3><div>The iCBT is an effective intervention for SSD and common functional somatic syndromes. However, heterogeneity still exists among subtypes, and personalized plans need to be formulated.</div></div>","PeriodicalId":12517,"journal":{"name":"General hospital psychiatry","volume":"99 ","pages":"Pages 92-101"},"PeriodicalIF":3.7,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146061682","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}

引用次数: 0

Hospital-presenting self-harm and suicide among justice-involved adolescents on community-based orders: A population-based cohort study 以社区为基础的秩序中涉及司法的青少年在医院自残和自杀：一项基于人群的队列研究。

IF 3.7 2区医学 Q1 PSYCHIATRY

General hospital psychiatry

Pub Date : 2026-01-23 DOI: 10.1016/j.genhosppsych.2026.01.012

Emaediong I. Akpanekpo , George Karystianis , Jocelyn Jones , Tony Butler

Objective

To estimate the incidence and identify risk factors for hospital-presenting self-harm and suicide among justice-involved adolescents serving community-based orders in New South Wales, Australia.

Method

We conducted a population-based retrospective cohort study of 44,887 adolescents aged 10–17 years at first proven offence who received community-based orders between 1994 and 2020. Hospital and emergency department records were linked with mortality, child protection, and justice data. Cox regression estimated hazard ratios (HRs) for self-harm, and Fine-Gray models estimated subdistribution HRs for suicide, accounting for competing risks.

Results

Over 163,676 person-years, 1901 adolescents had a first self-harm episode (11.6 per 1000 person-years), with higher rates in females than males. Rates were higher among those with psychiatric disorders and with ≥3 types of childhood adversity. Over 168,425 person-years, 61 adolescents died by suicide (0.4 per 1000 person-years). Prior self-harm was associated with suicide (adjusted sHR 11.95, 95% CI 5.58–25.58), however, most suicides (75.4%) occurred without prior hospital-presenting self-harm.

Conclusions

Findings highlight the need for proactive, developmentally informed mental health screening and intervention within youth justice settings, with referral pathways that do not solely rely on prior hospital or emergency presentations for self-harm.

目的：估计在澳大利亚新南威尔士州社区服务的司法参与青少年中出现医院自残和自杀的发生率并确定危险因素。方法：我们进行了一项基于人群的回顾性队列研究，研究对象为44,887名年龄在10-17岁之间首次被证实犯罪的青少年，他们在1994年至2020年间接受了社区命令。医院和急诊科的记录与死亡率、儿童保护和司法数据相关联。Cox回归估计了自残的风险比（hr）， Fine-Gray模型估计了自杀的亚分布hr，考虑了竞争风险。结果：在163,676人/年的研究中，1901名青少年有首次自残发作（11.6 / 1000人/年），女性的发生率高于男性。在有精神障碍和童年逆境≥3种的人群中，患病率更高。超过168,425人年，61名青少年死于自杀（每1000人年0.4人）。先前的自残与自杀相关（调整后的sHR为11.95,95% CI为5.58-25.58），然而，大多数自杀（75.4%）发生时没有先前的医院自残。结论：研究结果强调需要在青少年司法环境中进行主动的、发展知情的心理健康筛查和干预，转诊途径不能仅仅依赖先前的医院或紧急自残陈述。

{"title":"Hospital-presenting self-harm and suicide among justice-involved adolescents on community-based orders: A population-based cohort study","authors":"Emaediong I. Akpanekpo , George Karystianis , Jocelyn Jones , Tony Butler","doi":"10.1016/j.genhosppsych.2026.01.012","DOIUrl":"10.1016/j.genhosppsych.2026.01.012","url":null,"abstract":"<div><h3>Objective</h3><div>To estimate the incidence and identify risk factors for hospital-presenting self-harm and suicide among justice-involved adolescents serving community-based orders in New South Wales, Australia.</div></div><div><h3>Method</h3><div>We conducted a population-based retrospective cohort study of 44,887 adolescents aged 10–17 years at first proven offence who received community-based orders between 1994 and 2020. Hospital and emergency department records were linked with mortality, child protection, and justice data. Cox regression estimated hazard ratios (HRs) for self-harm, and Fine-Gray models estimated subdistribution HRs for suicide, accounting for competing risks.</div></div><div><h3>Results</h3><div>Over 163,676 person-years, 1901 adolescents had a first self-harm episode (11.6 per 1000 person-years), with higher rates in females than males. Rates were higher among those with psychiatric disorders and with ≥3 types of childhood adversity. Over 168,425 person-years, 61 adolescents died by suicide (0.4 per 1000 person-years). Prior self-harm was associated with suicide (adjusted sHR 11.95, 95% CI 5.58–25.58), however, most suicides (75.4%) occurred without prior hospital-presenting self-harm.</div></div><div><h3>Conclusions</h3><div>Findings highlight the need for proactive, developmentally informed mental health screening and intervention within youth justice settings, with referral pathways that do not solely rely on prior hospital or emergency presentations for self-harm.</div></div>","PeriodicalId":12517,"journal":{"name":"General hospital psychiatry","volume":"99 ","pages":"Pages 112-118"},"PeriodicalIF":3.7,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146061809","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}

引用次数: 0

On that day: Warnings of acute risk in narratives (WARN) of suicide attempts in adults 当天：成人自杀企图的急性风险警告（WARN）

IF 3.7 2区医学 Q1 PSYCHIATRY

General hospital psychiatry

Pub Date : 2026-01-23 DOI: 10.1016/j.genhosppsych.2026.01.014

Kenneth R. Conner , Jaclyn C. Kearns , Anthony R. Pisani , Paul N. Pfeiffer , Valeria A. Cuellar Leal , Lauren M. Denneson , Courtney L. Bagge

Objectives

To identify acute risk factors or ‘warning signs’ (WSs) for suicide attempts in adults using a new framework, warnings of acute risk in narratives (WARN), which posits that a broad range of acute symptoms and experiences labeled ‘drivers’ precipitate a narrower range of highly potent ‘WS with direct suicide content’ that confer marked near-term risk.

Methods

We asked adult patients [N = 45; ages 18-plus; 49% women] admitted following a suicide attempt to two U.S. academic medical centers to tell the story of the attempt, focusing on the day it occurred. We coded the transcripts with a 43-item manual developed using directive qualitative content analysis. We assessed frequencies of WSs based on WARN and existing formulations including acute suicidal affective disturbance (ASAD), suicide crisis syndrome (SCS), and an influential list from an expert panel.

Results

Patient narratives frequently contained WSs with direct suicide content (n = 36, 80%), most commonly resolving to attempt suicide in the near future (n = 25, 56%) and making preparations to attempt suicide (n = 19, 42%). When WSs with direct suicide content were present, they were nearly always accompanied by emotional drivers such as dramatic change in mood. Cognitive drivers (e.g., hopelessness) and social drivers (e.g., loneliness) were also frequent. Several WSs in the ASAD, SCS, and expert panel's list were commonly identified, underscoring they contain important ideas.

Conclusions

Consistent with WARN, diverse drivers were accompanied by a narrower set of WSs with direct suicide content which provide specific targets for prioritization in risk assessments in acute care settings.

目的：使用一个新的框架来识别成人自杀企图的急性危险因素或“警告信号”（WSs），即急性风险警告（WARN），它假设被标记为“驱动因素”的广泛急性症状和经历沉淀了一个更窄范围的具有直接自杀内容的强效“WS”，赋予显着的近期风险。方法选取成人患者[N = 45；年龄18 +;（49%的女性）在自杀未遂后，向两家美国学术医疗中心讲述了自杀未遂的故事，重点是发生的那天。我们使用指导定性内容分析开发的43项手册对转录本进行编码。我们基于WARN和现有的公式评估WSs的频率，包括急性自杀情感障碍（ASAD），自杀危机综合征（SCS），以及来自专家小组的有影响力的列表。结果患者口述中经常包含直接自杀内容的WSs (n = 36, 80%)，最常见的是近期企图自杀（n = 25, 56%）和准备自杀（n = 19, 42%）。当有直接自杀内容的WSs出现时，它们几乎总是伴随着情绪驱动因素，如情绪的急剧变化。认知驱动因素（如绝望）和社会驱动因素（如孤独）也很常见。ASAD、SCS和专家小组列表中的几个WSs通常被确定，强调它们包含重要的思想。结论与WARN一致，不同的驱动因素伴随着一组更窄的具有直接自杀内容的WSs，这为急性护理环境中风险评估的优先级提供了具体目标。

{"title":"On that day: Warnings of acute risk in narratives (WARN) of suicide attempts in adults","authors":"Kenneth R. Conner , Jaclyn C. Kearns , Anthony R. Pisani , Paul N. Pfeiffer , Valeria A. Cuellar Leal , Lauren M. Denneson , Courtney L. Bagge","doi":"10.1016/j.genhosppsych.2026.01.014","DOIUrl":"10.1016/j.genhosppsych.2026.01.014","url":null,"abstract":"<div><h3>Objectives</h3><div>To identify acute risk factors or ‘warning signs’ (WSs) for suicide attempts in adults using a new framework, warnings of acute risk in narratives (WARN), which posits that a broad range of acute symptoms and experiences labeled ‘drivers’ precipitate a narrower range of highly potent ‘WS with direct suicide content’ that confer marked near-term risk.</div></div><div><h3>Methods</h3><div>We asked adult patients [<em>N</em> = 45; ages 18-plus; 49% women] admitted following a suicide attempt to two U.S. academic medical centers to tell the story of the attempt, focusing on the day it occurred. We coded the transcripts with a 43-item manual developed using directive qualitative content analysis. We assessed frequencies of WSs based on WARN and existing formulations including acute suicidal affective disturbance (ASAD), suicide crisis syndrome (SCS), and an influential list from an expert panel.</div></div><div><h3>Results</h3><div>Patient narratives frequently contained WSs with direct suicide content (<em>n</em> = 36, 80%), most commonly resolving to attempt suicide in the near future (<em>n</em> = 25, 56%) and making preparations to attempt suicide (<em>n</em> = 19, 42%). When WSs with direct suicide content were present, they were nearly always accompanied by emotional drivers such as dramatic change in mood. Cognitive drivers (e.g., hopelessness) and social drivers (e.g., loneliness) were also frequent. Several WSs in the ASAD, SCS, and expert panel's list were commonly identified, underscoring they contain important ideas.</div></div><div><h3>Conclusions</h3><div>Consistent with WARN, diverse drivers were accompanied by a narrower set of WSs with direct suicide content which provide specific targets for prioritization in risk assessments in acute care settings.</div></div>","PeriodicalId":12517,"journal":{"name":"General hospital psychiatry","volume":"99 ","pages":"Pages 135-142"},"PeriodicalIF":3.7,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146073784","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}

引用次数: 0

Higher risk for elevated PTSD symptoms in patients with stroke mimics versus confirmed stroke or TIA 卒中模拟患者与确诊卒中或TIA患者相比，PTSD症状升高的风险更高。

IF 3.7 2区医学 Q1 PSYCHIATRY

General hospital psychiatry

Pub Date : 2026-01-22 DOI: 10.1016/j.genhosppsych.2026.01.011

Jeffrey L. Birk , Melinda J. Chang , Joshua Willey , Joseph E. Schwartz , Imama A. Naqvi , Bernard P. Chang , Nayrobi Rivera , Donald Edmondson , Ari Shechter , Ammie Jurado , Ian M. Kronish

Background

Stroke mimics, which resemble true strokes or transient ischemic attacks (TIAs), are common in emergency departments (EDs) and carry lower physical health risks, but their mental health impact is unknown. This study compared the risk for elevated post-traumatic stress disorder (PTSD) symptoms in patients with stroke mimics versus those with confirmed stroke or TIA.

Methods

We enrolled 1000 ED patients with suspected stroke/TIA into a prospective cohort and categorized them as stroke mimics or stroke/TIA. At 1-month follow-up, PTSD symptoms were assessed using the PTSD Checklist for DSM-5 (PCL-5). Adjusted odds of elevated 1-month PTSD symptoms (PCL-5 ≥ 33) by diagnostic category (mimic, stroke or TIA) were estimated with logistic regression.

Results

Of 949 analyzed patients (excluding those with equivocal diagnosis), 8.4% screened positive for elevated 1-month PTSD symptoms. The rate was higher in patients with mimic (13.5%) than in those with confirmed stroke or TIA (6.4%). Adjusting for demographics, stroke severity, functional status at discharge, and baseline PTSD symptoms due to prior traumatic events, risk of elevated 1-month PTSD symptoms attributed to suspected stroke/TIA was higher after mimic events versus stroke/TIA (OR = 2.61, 95% CI [1.35, 5.05], p < .01).

Discussion

Elevated PTSD symptoms were surprisingly more common after stroke mimics than confirmed stroke/TIA, despite the distress of stroke/TIA. Because patients with severe stroke were not enrolled, PTSD risk in the stroke/TIA group may have been underestimated. Research on the behavioral and clinical consequences of mimic-related distress is warranted, and PTSD screening and treatment should be considered.

背景：卒中模拟，类似于真正的卒中或短暂性脑缺血发作（tia），在急诊科（ed）很常见，具有较低的身体健康风险，但其对心理健康的影响尚不清楚。这项研究比较了卒中模拟患者与确诊卒中或TIA患者创伤后应激障碍（PTSD）症状升高的风险。方法：我们将1000例疑似卒中/TIA的ED患者纳入前瞻性队列，并将其分为卒中模拟组和卒中/TIA组。在1个月的随访中，使用DSM-5 PTSD检查表（PCL-5）评估PTSD症状。按诊断类别（模拟、卒中或TIA）估计1个月PTSD症状（PCL-5≥33）升高的调整几率。结果：在分析的949例患者中（不包括诊断不明确的患者），8.4%的患者1个月PTSD症状升高。模拟卒中患者的发生率（13.5%）高于确诊卒中或TIA患者（6.4%）。调整人口统计学、中风严重程度、出院时的功能状态和由于先前创伤事件导致的基线PTSD症状，模拟事件后疑似卒中/TIA导致的1个月PTSD症状升高的风险高于卒中/TIA （OR = 2.61, 95% CI [1.35, 5.05], p）讨论：尽管卒中/TIA令人痛苦，但卒中模拟后PTSD症状升高比确诊卒中/TIA更常见。由于没有纳入严重中风患者，卒中/TIA组的PTSD风险可能被低估了。对模仿相关痛苦的行为和临床后果的研究是必要的，PTSD的筛查和治疗应该被考虑。

{"title":"Higher risk for elevated PTSD symptoms in patients with stroke mimics versus confirmed stroke or TIA","authors":"Jeffrey L. Birk , Melinda J. Chang , Joshua Willey , Joseph E. Schwartz , Imama A. Naqvi , Bernard P. Chang , Nayrobi Rivera , Donald Edmondson , Ari Shechter , Ammie Jurado , Ian M. Kronish","doi":"10.1016/j.genhosppsych.2026.01.011","DOIUrl":"10.1016/j.genhosppsych.2026.01.011","url":null,"abstract":"<div><h3>Background</h3><div>Stroke mimics, which resemble true strokes or transient ischemic attacks (TIAs), are common in emergency departments (EDs) and carry lower physical health risks, but their mental health impact is unknown. This study compared the risk for elevated post-traumatic stress disorder (PTSD) symptoms in patients with stroke mimics versus those with confirmed stroke or TIA.</div></div><div><h3>Methods</h3><div>We enrolled 1000 ED patients with suspected stroke/TIA into a prospective cohort and categorized them as stroke mimics or stroke/TIA. At 1-month follow-up, PTSD symptoms were assessed using the PTSD Checklist for DSM-5 (PCL-5). Adjusted odds of elevated 1-month PTSD symptoms (PCL-5 ≥ 33) by diagnostic category (mimic, stroke or TIA) were estimated with logistic regression.</div></div><div><h3>Results</h3><div>Of 949 analyzed patients (excluding those with equivocal diagnosis), 8.4% screened positive for elevated 1-month PTSD symptoms. The rate was higher in patients with mimic (13.5%) than in those with confirmed stroke or TIA (6.4%). Adjusting for demographics, stroke severity, functional status at discharge, and baseline PTSD symptoms due to prior traumatic events, risk of elevated 1-month PTSD symptoms attributed to suspected stroke/TIA was higher after mimic events versus stroke/TIA (OR = 2.61, 95% CI [1.35, 5.05], <em>p</em> < .01).</div></div><div><h3>Discussion</h3><div>Elevated PTSD symptoms were surprisingly more common after stroke mimics than confirmed stroke/TIA, despite the distress of stroke/TIA. Because patients with severe stroke were not enrolled, PTSD risk in the stroke/TIA group may have been underestimated. Research on the behavioral and clinical consequences of mimic-related distress is warranted, and PTSD screening and treatment should be considered.</div></div>","PeriodicalId":12517,"journal":{"name":"General hospital psychiatry","volume":"99 ","pages":"Pages 87-91"},"PeriodicalIF":3.7,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146061782","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}

引用次数: 0

Independent and joint associations of physical activity and sleep with ADHD in a population-based sample of children: A cross-sectional study 在以人群为基础的儿童样本中，体育活动和睡眠与ADHD的独立和联合关联：一项横断面研究

IF 3.7 2区医学 Q1 PSYCHIATRY

General hospital psychiatry

Pub Date : 2026-01-21 DOI: 10.1016/j.genhosppsych.2026.01.016

Beibei Shi , Hong Mou , Zhiduo Chen , Changshuang He , Meng Zhang , Zimeng Zhang , Huakun Zheng , Jing Wang , Minghui Quan

Background

This study examines the independent and joint associations of physical activity (PA) and sleep with ADHD prevalence and severity.

Methods

Data from the 2016–2023 National Survey of Children's Health were used in this population-based, cross-sectional study. All measures were parent-reported. PA was categorized by weekly guideline-meeting days (≥60 min/day). Sleep duration, regularity, and ADHD severity were classified as short/optimal/long (age-specific), four-level, and three-level, respectively. Weighted multivariable logistic and ordinal regression models were used to examine the associations of PA and sleep with ADHD prevalence and severity.

Results

This study analyzed 98,182 adolescents aged 13–17, including 13,258 with ADHD. PA, sleep duration, and sleep regularity were independently associated with ADHD (all P < 0.05). Significant interactions between PA and sleep duration/regularity were observed for ADHD prevalence (P < 0.05), but not for ADHD severity. Compared to children with long sleep and 0 weekly PA days, those with optimal sleep and ≥ 1 weekly PA days had lower ADHD odds, with the lowest in the “optimal sleep and daily PA” group (OR = 0.32, 95% CI:0.21–0.51). Better sleep regularity plus more PA-meeting weekly days was linked to lower ADHD odds, with the lowest in the “always regular sleep and daily PA” group (OR = 0.25, 95% CI:0.18–0.36).

Conclusion

Even occasional engagement in regular PA was associated with lower odds of ADHD in children. Improving sleep regularity is as important as ensuring optimal sleep duration. Combining sufficient PA with healthy sleep habits showed the strongest association, underscoring the value of an integrated lifestyle approach to understanding childhood health risks.

本研究探讨了体力活动（PA）和睡眠与ADHD患病率和严重程度的独立和联合关联。方法采用2016-2023年全国儿童健康调查的数据进行基于人群的横断面研究。所有的测量都是由家长报告的。PA按每周指南会议天数（≥60分钟/天）进行分类。睡眠时间、规律性和ADHD严重程度分别分为短/最佳/长（特定年龄）、四级和三级。采用加权多变量logistic和有序回归模型来检验PA和睡眠与ADHD患病率和严重程度的关系。结果本研究分析了98,182名13-17岁的青少年，其中13,258名患有ADHD。PA、睡眠时间、睡眠规律与ADHD独立相关（均P <； 0.05）。在ADHD患病率方面，PA和睡眠持续时间/规律性之间存在显著的相互作用（P < 0.05），但在ADHD严重程度方面没有显著的相互作用。与睡眠时间长、每周PA天数0天的儿童相比，最佳睡眠和每周PA天数≥1天的儿童ADHD的发生率较低，以“最佳睡眠和每日PA”组最低（OR = 0.32, 95% CI: 0.21-0.51）。更好的睡眠规律加上每周更多的PA会议与较低的ADHD发病率有关，“经常规律睡眠和每天PA”组的发病率最低（OR = 0.25, 95% CI: 0.18-0.36）。结论：即使偶尔参加常规的PA也与儿童ADHD发生率降低有关。改善睡眠规律与保证最佳睡眠时间同样重要。将足够的PA与健康的睡眠习惯相结合显示出最强的关联，强调了综合生活方式方法对了解儿童健康风险的价值。

{"title":"Independent and joint associations of physical activity and sleep with ADHD in a population-based sample of children: A cross-sectional study","authors":"Beibei Shi , Hong Mou , Zhiduo Chen , Changshuang He , Meng Zhang , Zimeng Zhang , Huakun Zheng , Jing Wang , Minghui Quan","doi":"10.1016/j.genhosppsych.2026.01.016","DOIUrl":"10.1016/j.genhosppsych.2026.01.016","url":null,"abstract":"<div><h3>Background</h3><div>This study examines the independent and joint associations of physical activity (PA) and sleep with ADHD prevalence and severity.</div></div><div><h3>Methods</h3><div>Data from the 2016–2023 National Survey of Children's Health were used in this population-based, cross-sectional study. All measures were parent-reported. PA was categorized by weekly guideline-meeting days (≥60 min/day). Sleep duration, regularity, and ADHD severity were classified as short/optimal/long (age-specific), four-level, and three-level, respectively. Weighted multivariable logistic and ordinal regression models were used to examine the associations of PA and sleep with ADHD prevalence and severity.</div></div><div><h3>Results</h3><div>This study analyzed 98,182 adolescents aged 13–17, including 13,258 with ADHD. PA, sleep duration, and sleep regularity were independently associated with ADHD (all <em>P</em> < 0.05). Significant interactions between PA and sleep duration/regularity were observed for ADHD prevalence (<em>P</em> < 0.05), but not for ADHD severity. Compared to children with long sleep and 0 weekly PA days, those with optimal sleep and ≥ 1 weekly PA days had lower ADHD odds, with the lowest in the “optimal sleep and daily PA” group (OR = 0.32, 95% CI:0.21–0.51). Better sleep regularity plus more PA-meeting weekly days was linked to lower ADHD odds, with the lowest in the “always regular sleep and daily PA” group (OR = 0.25, 95% CI:0.18–0.36).</div></div><div><h3>Conclusion</h3><div>Even occasional engagement in regular PA was associated with lower odds of ADHD in children. Improving sleep regularity is as important as ensuring optimal sleep duration. Combining sufficient PA with healthy sleep habits showed the strongest association, underscoring the value of an integrated lifestyle approach to understanding childhood health risks.</div></div>","PeriodicalId":12517,"journal":{"name":"General hospital psychiatry","volume":"99 ","pages":"Pages 119-128"},"PeriodicalIF":3.7,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146073787","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}

引用次数: 0

Exercise and nutritional intervention on improving mental health in older adults: A systematic review and meta-analysis 运动和营养干预对改善老年人心理健康的影响：一项系统综述和荟萃分析。

IF 3.7 2区医学 Q1 PSYCHIATRY

General hospital psychiatry

Pub Date : 2026-01-21 DOI: 10.1016/j.genhosppsych.2026.01.015

Shi Yan , Longqi Zhou , Jie Zhang , Xinjun Dong

<div><h3>Background</h3><div>Depression and anxiety are prevalent and burdensome in older adults. Both exercise and nutrition have been individually proven to be beneficial. However, the incremental effects of combined interventions remain underexplored.</div></div><div><h3>Objective</h3><div>This research sought to estimate the efficacy of combined exercise + nutrition intervention on depression and anxiety in older individuals, and explicitly compare this intervention with conventional care, exercise alone, or nutrition alone.</div></div><div><h3>Methods</h3><div>A search was implemented through PubMed, EMBASE, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) based upon the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (from their inception to January 6, 2025). The primary outcomes were changes in depression and anxiety scales (pooled effect size as standard mean difference [SMD] with 95% confidence interval [CI]). Heterogeneity was estimated utilizing I<sup>2</sup> and Q tests. Funnel plots and Egger's regression were implemented when the number of studies was ≥10. Sensitivity analysis utilizing the leave-one-out method and subgroup analysis by follow-up time points were implemented. Methodological quality was estimated utilizing National Institutes of Health Quality Assessment Tool (NIH-QAT). Registration number was PROSPERO.</div></div><div><h3>Results</h3><div>Fourteen RCTs (conducted between 2014 and 2024 in 10 countries) were included. Regarding depression outcomes, combined interventions exhibited marked improvement relative to conventional care at 3 months (SMD = −0.44, 95% CI −0.72 to −0. 16; I<sup>2</sup> = 53.8%, Qpavle = 0.090) and 6 months (SMD = −0.68, 95% CI −1.06 to −0.30; I<sup>2</sup> = 0.0%, Qpavle = 0.589). No significant differences were detected relative to nutrition alone (SMD = −0.22, 95% CI −0.57 to 0. 12; I<sup>2</sup> = 81%, Qpavle = 0.022) or exercise alone (SMD = −0.06, 95% CI −0.20 to 0.07; I<sup>2</sup> = 10.9%, Qpavle = 0.344). Regarding anxiety outcomes (<em>n</em> = 5), combined interventions did not significantly diminish anxiety scores relative to conventional care (SMD = −0.34, 95% CI −0.86 to 0. 18; I<sup>2</sup> = 60.9%, Qpavle = 0. 11), nutrition alone (SMD = 0.05, 95% CI −0.39 to 0.49; I<sup>2</sup> = 0%, Qpavle = 0.88), or exercise alone (SMD = −0.23, 95% CI −0.64 to 0. 17; I<sup>2</sup> = 0%, Qpavle = 0.347). The NIH-QAT rated 7 studies as good and 7 as fair. Predominant limitations included inadequate allocation concealment, blinding, and reporting.</div></div><div><h3>Conclusion</h3><div>Relative to conventional care, exercise + nutrition can improve depression in older individuals in the short term, but show no significant additional benefits for anxiety compared to controls. Nevertheless, no consistent additional strengths were observed over exercise or nutrition alone, suggesting limited or undetected synergistic effect with

背景：抑郁和焦虑在老年人中普遍存在且令人难以承受。运动和营养都被单独证明是有益的。然而，联合干预措施的增量效应仍未得到充分探索。目的：本研究旨在评估运动+营养联合干预对老年人抑郁和焦虑的疗效，并明确将这种干预与传统护理、单独运动或单独营养进行比较。方法：通过PubMed、EMBASE、Web of Science和Cochrane Library检索基于系统评价和荟萃分析首选报告项目（PRISMA）指南（从最初到2025年1月6日）的随机对照试验（rct）。主要结局是抑郁和焦虑量表的变化（合并效应大小为标准平均差[SMD]， 95%可信区间[CI]）。利用I2和Q检验估计异质性。当研究数≥10时，采用漏斗图和Egger回归。采用留一法进行敏感性分析，并按随访时间点进行亚组分析。采用美国国立卫生研究院质量评估工具（NIH-QAT）评估方法学质量。注册号为普洛斯彼罗。结果：纳入14项随机对照试验（2014年至2024年在10个国家进行）。在抑郁结局方面，与常规护理相比，联合干预在3个月时表现出显著改善（SMD = -0.44, 95% CI -0.72至-0）。16;I2 = 53.8%, Qpavle = 0.090)和6个月(SMD = -0.68, 95%可信区间-1.06到-0.30;I2 = 0.0%, Qpavle = 0.589)。相对于单独营养，未发现显著差异（SMD = -0.22, 95% CI -0.57 ~ 0）。12;I2 = 81%, Qpavle = 0.022)或独自锻炼(SMD = -0.06, 95%可信区间-0.20到0.07;I2 = 10.9%, Qpavle = 0.344)。关于焦虑结局（n = 5），与传统护理相比，联合干预没有显著降低焦虑评分（SMD = -0.34, 95% CI -0.86 -0）。18;I2 = 60.9%, Qpavle = 0。11)，单独营养（SMD = 0.05, 95% CI -0.39 ~ 0.49; I2 = 0%, Qpavle = 0.88），或单独运动（SMD = -0.23, 95% CI -0.64 ~ 0）。17;I2 = 0%, Qpavle = 0.347)。NIH-QAT将7项研究评为优秀，7项评为公平。主要的限制包括分配不足、隐瞒、盲目和报告。结论：与传统护理相比，运动+营养可以在短期内改善老年人的抑郁，但与对照组相比，对焦虑没有明显的额外益处。然而，仅通过运动或营养没有观察到一致的额外强度，这表明目前的证据表明有限或未被发现的协同效应。普洛斯彼罗注册号：CRD420250649541。

{"title":"Exercise and nutritional intervention on improving mental health in older adults: A systematic review and meta-analysis","authors":"Shi Yan , Longqi Zhou , Jie Zhang , Xinjun Dong","doi":"10.1016/j.genhosppsych.2026.01.015","DOIUrl":"10.1016/j.genhosppsych.2026.01.015","url":null,"abstract":"<div><h3>Background</h3><div>Depression and anxiety are prevalent and burdensome in older adults. Both exercise and nutrition have been individually proven to be beneficial. However, the incremental effects of combined interventions remain underexplored.</div></div><div><h3>Objective</h3><div>This research sought to estimate the efficacy of combined exercise + nutrition intervention on depression and anxiety in older individuals, and explicitly compare this intervention with conventional care, exercise alone, or nutrition alone.</div></div><div><h3>Methods</h3><div>A search was implemented through PubMed, EMBASE, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) based upon the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (from their inception to January 6, 2025). The primary outcomes were changes in depression and anxiety scales (pooled effect size as standard mean difference [SMD] with 95% confidence interval [CI]). Heterogeneity was estimated utilizing I<sup>2</sup> and Q tests. Funnel plots and Egger's regression were implemented when the number of studies was ≥10. Sensitivity analysis utilizing the leave-one-out method and subgroup analysis by follow-up time points were implemented. Methodological quality was estimated utilizing National Institutes of Health Quality Assessment Tool (NIH-QAT). Registration number was PROSPERO.</div></div><div><h3>Results</h3><div>Fourteen RCTs (conducted between 2014 and 2024 in 10 countries) were included. Regarding depression outcomes, combined interventions exhibited marked improvement relative to conventional care at 3 months (SMD = −0.44, 95% CI −0.72 to −0. 16; I<sup>2</sup> = 53.8%, Qpavle = 0.090) and 6 months (SMD = −0.68, 95% CI −1.06 to −0.30; I<sup>2</sup> = 0.0%, Qpavle = 0.589). No significant differences were detected relative to nutrition alone (SMD = −0.22, 95% CI −0.57 to 0. 12; I<sup>2</sup> = 81%, Qpavle = 0.022) or exercise alone (SMD = −0.06, 95% CI −0.20 to 0.07; I<sup>2</sup> = 10.9%, Qpavle = 0.344). Regarding anxiety outcomes (<em>n</em> = 5), combined interventions did not significantly diminish anxiety scores relative to conventional care (SMD = −0.34, 95% CI −0.86 to 0. 18; I<sup>2</sup> = 60.9%, Qpavle = 0. 11), nutrition alone (SMD = 0.05, 95% CI −0.39 to 0.49; I<sup>2</sup> = 0%, Qpavle = 0.88), or exercise alone (SMD = −0.23, 95% CI −0.64 to 0. 17; I<sup>2</sup> = 0%, Qpavle = 0.347). The NIH-QAT rated 7 studies as good and 7 as fair. Predominant limitations included inadequate allocation concealment, blinding, and reporting.</div></div><div><h3>Conclusion</h3><div>Relative to conventional care, exercise + nutrition can improve depression in older individuals in the short term, but show no significant additional benefits for anxiety compared to controls. Nevertheless, no consistent additional strengths were observed over exercise or nutrition alone, suggesting limited or undetected synergistic effect with ","PeriodicalId":12517,"journal":{"name":"General hospital psychiatry","volume":"99 ","pages":"Pages 102-111"},"PeriodicalIF":3.7,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146061657","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}

引用次数: 0

Early response to psilocybin in adults with treatment-resistant depression as a predictor for antidepressant efficacy 成人难治性抑郁症患者对裸盖菇素的早期反应作为抗抑郁药物疗效的预测因子

IF 3.7 2区医学 Q1 PSYCHIATRY

General hospital psychiatry

Pub Date : 2026-01-19 DOI: 10.1016/j.genhosppsych.2026.01.001

Zoe Doyle , Noah Chisamore , Erica S. Kaczmarek , Danica E. Johnson , Ryan M. Brudner , Geneva Weiglein , Marc G. Blainey , Jordan Bawks , Jeremy Riva-Cambrin , Rickinder Sethi , Roger S. McIntyre , Joshua D. Rosenblat

引用次数: 0