Pub Date : 2026-01-23DOI: 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.
{"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}
Pub Date : 2026-01-22DOI: 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}
Pub Date : 2026-01-21DOI: 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.
{"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}
Pub Date : 2026-01-21DOI: 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
{"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}
Pub Date : 2026-01-19DOI: 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
{"title":"Early response to psilocybin in adults with treatment-resistant depression as a predictor for antidepressant efficacy","authors":"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","doi":"10.1016/j.genhosppsych.2026.01.001","DOIUrl":"10.1016/j.genhosppsych.2026.01.001","url":null,"abstract":"","PeriodicalId":12517,"journal":{"name":"General hospital psychiatry","volume":"99 ","pages":"Pages 84-86"},"PeriodicalIF":3.7,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023180","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}
Loneliness undergoes changes over time, but its cumulative effect on frailty is unknown. We aimed to investigate the association between cumulative loneliness and frailty.
Methods
3781 participants from English Longitudinal Study of Ageing (ELSA) waves 2 to 9 were involved. Cumulative loneliness was evaluated by Cumulative Loneliness Index-Sum (CLI-Sum); Cumulative Loneliness Index-AUC (CLI-AUC) and Time-Weighted Average Loneliness Index (TWA-LI). Thirty-items frailty index (FI) was used to assess frailty status. Multivariate linear mixed models and cox proportional hazards models were utilized.
Results
Participants in the highest quartile (Quartile 4) of cumulative loneliness exhibited worse frailty compared to Quartile 1: Quartile 4 groups showed faster annual increases in FI, the β (95%CI) were as follows: 0.28 (0.12–0.45) for CLI-Sum, 0.20 (0.04–0.37) for CLI-AUC, and 0.28 (0.12–0.44) for TWA-LI. In addition, Quartile 4 groups associated with higher frailty risk, the hazard ratios (95%CI) were as follows: 1.53 (1.24–1.89) for CLI-Sum; 1.65 (1.34–2.02) for CLI-AUC and 1.61 (1.31–1.99) for TWA-LI and all P trend <0.05.
Discussion
Cumulative loneliness can significantly accelerate the frailty progression. Our study emphasizes the significance of improving duration of loneliness.
{"title":"Cumulative experience of loneliness and frailty progression: A prospective cohort study","authors":"Chengxiang Hu, Beibei Han, Hewanmeng Geng, Yue He, Runhong Li, Tong Xu, Jiaqi Zhang, Lina Jin","doi":"10.1016/j.genhosppsych.2026.01.009","DOIUrl":"10.1016/j.genhosppsych.2026.01.009","url":null,"abstract":"<div><h3>Objective</h3><div>Loneliness undergoes changes over time, but its cumulative effect on frailty is unknown. We aimed to investigate the association between cumulative loneliness and frailty.</div></div><div><h3>Methods</h3><div>3781 participants from English Longitudinal Study of Ageing (ELSA) waves 2 to 9 were involved. Cumulative loneliness was evaluated by Cumulative Loneliness Index-Sum (CLI-Sum); Cumulative Loneliness Index-AUC (CLI-AUC) and Time-Weighted Average Loneliness Index (TWA-LI). Thirty-items frailty index (FI) was used to assess frailty status. Multivariate linear mixed models and cox proportional hazards models were utilized.</div></div><div><h3>Results</h3><div>Participants in the highest quartile (Quartile 4) of cumulative loneliness exhibited worse frailty compared to Quartile 1: Quartile 4 groups showed faster annual increases in FI, the β (95%CI) were as follows: 0.28 (0.12–0.45) for CLI-Sum, 0.20 (0.04–0.37) for CLI-AUC, and 0.28 (0.12–0.44) for TWA-LI. In addition, Quartile 4 groups associated with higher frailty risk, the hazard ratios (95%CI) were as follows: 1.53 (1.24–1.89) for CLI-Sum; 1.65 (1.34–2.02) for CLI-AUC and 1.61 (1.31–1.99) for TWA-LI and all <em>P</em> trend <0.05.</div></div><div><h3>Discussion</h3><div>Cumulative loneliness can significantly accelerate the frailty progression. Our study emphasizes the significance of improving duration of loneliness.</div></div>","PeriodicalId":12517,"journal":{"name":"General hospital psychiatry","volume":"99 ","pages":"Pages 129-134"},"PeriodicalIF":3.7,"publicationDate":"2026-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146073785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-13DOI: 10.1016/j.genhosppsych.2026.01.006
Peitian Gao , Guichao Liu , Zirui Huang , Yutian Wu , Jiaobin Zhao , Sibei Fan , Jiahui Liang , Zhenni Luo
Background
As global aging intensifies, multisite pain and depression are critical health issues in middle-aged and older adults. While their bidirectional relationship is acknowledged, the pathways and effects of specific pain site combinations remain unclear.
Methods
Using three waves (2015–2020) of CHARLS data from 10,077 adults aged 45+, we applied cross-lagged mediation models to analyze the bidirectional relationship between the number of pain sites and depression, with Instrumental Activities of Daily Living (IADL) as a mediator. Restricted cubic splines and association rule mining identified critical pain counts and co-occurrence patterns.
Results
A significant bidirectional relationship existed between pain sites and depression, mediated by IADL. Depression risk rose rapidly from 0 to 3 pain sites, then plateaued. Co-occurrence of pain in the lower back, ankles, knees, and back carried the highest risk. Women were more likely to develop depression via IADL impairment, whereas men were more directly affected by multisite pain.
Conclusion
Multi-site pain and depression interact bidirectionally in middle-aged and older adults, mediated by IADL, with risk influenced by pain profiles and gender. Integrated and personalized pain management addressing both physical and mental health is warranted.
随着全球老龄化的加剧，多部位疼痛和抑郁是中老年人的重要健康问题。虽然它们的双向关系是公认的，但特定疼痛部位组合的途径和效果仍不清楚。方法利用10077名45岁以上成年人的CHARLS数据（2015-2020）三波，以日常生活工具活动（Instrumental Activities of Daily Living， IADL）为中介，应用交叉滞后中介模型分析疼痛部位数量与抑郁之间的双向关系。限制三次样条和关联规则挖掘识别临界疼痛计数和共发生模式。结果疼痛部位与抑郁之间存在显著的双向关系，并由IADL介导。抑郁风险从0到3个疼痛点迅速上升，然后趋于平稳。下背部、脚踝、膝盖和背部同时出现疼痛的风险最高。女性更有可能通过IADL障碍患上抑郁症，而男性则更直接受到多部位疼痛的影响。结论在中老年人群中，多部位疼痛和抑郁以IADL为中介，双向相互作用，疼痛特征和性别影响其风险。综合和个性化的疼痛管理解决身体和心理健康是必要的。
{"title":"Co-occurring pain patterns and depressive symptoms in middle-aged and older adults: A cross-lagged analysis from a national longitudinal study","authors":"Peitian Gao , Guichao Liu , Zirui Huang , Yutian Wu , Jiaobin Zhao , Sibei Fan , Jiahui Liang , Zhenni Luo","doi":"10.1016/j.genhosppsych.2026.01.006","DOIUrl":"10.1016/j.genhosppsych.2026.01.006","url":null,"abstract":"<div><h3>Background</h3><div>As global aging intensifies, multisite pain and depression are critical health issues in middle-aged and older adults. While their bidirectional relationship is acknowledged, the pathways and effects of specific pain site combinations remain unclear.</div></div><div><h3>Methods</h3><div>Using three waves (2015–2020) of CHARLS data from 10,077 adults aged 45+, we applied cross-lagged mediation models to analyze the bidirectional relationship between the number of pain sites and depression, with Instrumental Activities of Daily Living (IADL) as a mediator. Restricted cubic splines and association rule mining identified critical pain counts and co-occurrence patterns.</div></div><div><h3>Results</h3><div>A significant bidirectional relationship existed between pain sites and depression, mediated by IADL. Depression risk rose rapidly from 0 to 3 pain sites, then plateaued. Co-occurrence of pain in the lower back, ankles, knees, and back carried the highest risk. Women were more likely to develop depression via IADL impairment, whereas men were more directly affected by multisite pain.</div></div><div><h3>Conclusion</h3><div>Multi-site pain and depression interact bidirectionally in middle-aged and older adults, mediated by IADL, with risk influenced by pain profiles and gender. Integrated and personalized pain management addressing both physical and mental health is warranted.</div></div>","PeriodicalId":12517,"journal":{"name":"General hospital psychiatry","volume":"99 ","pages":"Pages 66-74"},"PeriodicalIF":3.7,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145974255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-13DOI: 10.1016/j.genhosppsych.2026.01.008
Yang Yu , Kamal Sabran , Guoqing Wang , Ziyue Chen
Background
During the patient's surgery, they tend to experience anxiety a lot which sometimes affect their outcomes in a negative way. Music intervention which is a non-pharmacological intervention is being used increasingly to address perioperative anxiety among patients. However, the existing evidence shows varied quality of studies, intervention timing and patient characteristics. This study aimed to analysis RCT evidence on the effectiveness of music intervention in reducing anxiety among adult surgical patients.
Methods
We searched 5 databases following PRISMA guidelines. The search scope covers the period from database creation to July 2025. Eligible studies included RCTs examining the impact of music as an approach for surgical patients. Risk of bias was assessed using the Cochrane tool. We combined standardized mean differences with a random effects model. The intervention timing, type of anesthesia, gender distribution and average age were studied in subgroup analyses. Sensitivity analyses and publication bias evaluations were done.
Results
A total of 33 RCTs (n = 3793) were included and the data from 8 statistical outliers was removed, leaving 25 studies for the primary meta-analysis. Music intervention significantly reduced perioperative anxiety (SMD = –0.50, 95% CI –0.60 to –0.39, p < 0.001) with moderate heterogeneity (I2 = 33.3%). There were greater outcomes in those receiving multi-phase interventions, local/regional anesthesia, males, and older patients. Although there were no significant subgroup differences. Sensitivity analysis confirmed robustness of findings and no meaningful publication bias was detected.
Conclusion
Music intervention, as a safe, effective, and easy-to-implement intervention strategy, can help reduce perioperative anxiety in patients undergoing various surgeries in different clinical settings. Including music protocols in standard perioperative care may help enhance patient experience and mental well-being.
在病人的手术过程中，他们往往会经历很多焦虑，有时会以消极的方式影响他们的结果。音乐干预是一种非药物干预，越来越多地被用于解决围手术期患者的焦虑。然而，现有证据显示研究质量、干预时机和患者特征各不相同。本研究旨在分析音乐干预在减轻成人外科患者焦虑方面的有效性。方法按照PRISMA指南检索5个数据库。搜索范围从数据库创建到2025年7月。符合条件的研究包括随机对照试验，检查音乐作为手术患者治疗方法的影响。使用Cochrane工具评估偏倚风险。我们将标准化均值差异与随机效应模型相结合。亚组分析干预时间、麻醉方式、性别分布及平均年龄。进行敏感性分析和发表偏倚评价。结果共纳入33项rct (n = 3793)，剔除8项统计异常值，留下25项研究进行初步meta分析。音乐干预显著降低围手术期焦虑（SMD = -0.50, 95% CI -0.60 ~ -0.39, p < 0.001），异质性中等（I2 = 33.3%）。接受多阶段干预、局部/区域麻醉、男性和老年患者的预后更好。虽然没有明显的亚组差异。敏感性分析证实了研究结果的稳健性，未发现有意义的发表偏倚。结论音乐干预是一种安全、有效、易于实施的干预策略，可降低不同临床环境下各种手术患者的围手术期焦虑。在标准的围手术期护理中加入音乐方案可能有助于提高患者的体验和心理健康。
{"title":"Effect of music intervention on anxiety in surgical patients: Systematic review and meta-analysis of randomized controlled trials","authors":"Yang Yu , Kamal Sabran , Guoqing Wang , Ziyue Chen","doi":"10.1016/j.genhosppsych.2026.01.008","DOIUrl":"10.1016/j.genhosppsych.2026.01.008","url":null,"abstract":"<div><h3>Background</h3><div>During the patient's surgery, they tend to experience anxiety a lot which sometimes affect their outcomes in a negative way. Music intervention which is a non-pharmacological intervention is being used increasingly to address perioperative anxiety among patients. However, the existing evidence shows varied quality of studies, intervention timing and patient characteristics. This study aimed to analysis RCT evidence on the effectiveness of music intervention in reducing anxiety among adult surgical patients.</div></div><div><h3>Methods</h3><div>We searched 5 databases following PRISMA guidelines. The search scope covers the period from database creation to July 2025. Eligible studies included RCTs examining the impact of music as an approach for surgical patients. Risk of bias was assessed using the Cochrane tool. We combined standardized mean differences with a random effects model. The intervention timing, type of anesthesia, gender distribution and average age were studied in subgroup analyses. Sensitivity analyses and publication bias evaluations were done.</div></div><div><h3>Results</h3><div>A total of 33 RCTs (<em>n</em> = 3793) were included and the data from 8 statistical outliers was removed, leaving 25 studies for the primary meta-analysis. Music intervention significantly reduced perioperative anxiety (SMD = –0.50, 95% CI –0.60 to –0.39, <em>p</em> < 0.001) with moderate heterogeneity (I<sup>2</sup> = 33.3%). There were greater outcomes in those receiving multi-phase interventions, local/regional anesthesia, males, and older patients. Although there were no significant subgroup differences. Sensitivity analysis confirmed robustness of findings and no meaningful publication bias was detected.</div></div><div><h3>Conclusion</h3><div>Music intervention, as a safe, effective, and easy-to-implement intervention strategy, can help reduce perioperative anxiety in patients undergoing various surgeries in different clinical settings. Including music protocols in standard perioperative care may help enhance patient experience and mental well-being.</div></div>","PeriodicalId":12517,"journal":{"name":"General hospital psychiatry","volume":"99 ","pages":"Pages 50-65"},"PeriodicalIF":3.7,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145974313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-13DOI: 10.1016/j.genhosppsych.2026.01.007
Chengcheng Zhang , Yang Zhang , Zhen Ling , Yi Xiao , Minxue Shen , Shuiyuan Xiao
Background
Cardiometabolic diseases (CMDs) and mental disorders (MDs) exhibit high comorbidity and result in a substantial disease burden. The impact of smoking, a risk factor for both diseases, on the comorbidity trajectory remains unclear.
Methods
We conducted a prospective cohort study involving 355,488 UK Biobank participants, utilizing multi-state models to explore the potential impact of smoking status on all transition stages. Smoking status were classified as never, previous, and current. Incident CMDs (ischaemic heart disease, stroke, and diabetes) and MDs (depression and anxiety) were ascertained via linkage to hospital inpatient records, primary care data, self-reports, and death registries.
Results
Across all pathway, current smokers had higher transition probabilities than previous smokers and never-smokers. Compared to the effects on incident MDs or CMDs from baseline, current smoking was associated with higher risks of transitions from MDs to comorbid CMDs (HR = 1.63; 95% CI: 1.34–1.98), from CMDs to comorbid MDs (HR = 1.45; 95% CI: 1.20–1.76), and from comorbidity to death (HR = 2.43; 95% CI: 1.79–2.29). In contrast, smoking cessation attenuated this risk (HRs range: 0.45–0.93). Moreover, current and previous smoking were associated with average life expectancy reductions of 6.88 years (95% CI: 4.78–8.98) and 0.84 years (95% CI: 0.59–2.27), respectively, among 45-year-old participants with comorbidity. The associations between smoking and the comorbidity trajectory were robust in sensitivity analyses.
Conclusion
Current smoking has stronger impacts on transitions to comorbidity than on the first occurrence of CMDs or MDs. While current smoking increases the risk of death, smoking cessation mitigates the loss of life expectancy.
{"title":"Smoking and the comorbidity trajectory of cardiometabolic and mental disorders: A multi-state model","authors":"Chengcheng Zhang , Yang Zhang , Zhen Ling , Yi Xiao , Minxue Shen , Shuiyuan Xiao","doi":"10.1016/j.genhosppsych.2026.01.007","DOIUrl":"10.1016/j.genhosppsych.2026.01.007","url":null,"abstract":"<div><h3>Background</h3><div>Cardiometabolic diseases (CMDs) and mental disorders (MDs) exhibit high comorbidity and result in a substantial disease burden. The impact of smoking, a risk factor for both diseases, on the comorbidity trajectory remains unclear.</div></div><div><h3>Methods</h3><div>We conducted a prospective cohort study involving 355,488 UK Biobank participants, utilizing multi-state models to explore the potential impact of smoking status on all transition stages. Smoking status were classified as never, previous, and current. Incident CMDs (ischaemic heart disease, stroke, and diabetes) and MDs (depression and anxiety) were ascertained via linkage to hospital inpatient records, primary care data, self-reports, and death registries.</div></div><div><h3>Results</h3><div>Across all pathway, current smokers had higher transition probabilities than previous smokers and never-smokers. Compared to the effects on incident MDs or CMDs from baseline, current smoking was associated with higher risks of transitions from MDs to comorbid CMDs (HR = 1.63; 95% CI: 1.34–1.98), from CMDs to comorbid MDs (HR = 1.45; 95% CI: 1.20–1.76), and from comorbidity to death (HR = 2.43; 95% CI: 1.79–2.29). In contrast, smoking cessation attenuated this risk (HRs range: 0.45–0.93). Moreover, current and previous smoking were associated with average life expectancy reductions of 6.88 years (95% CI: 4.78–8.98) and 0.84 years (95% CI: 0.59–2.27), respectively, among 45-year-old participants with comorbidity. The associations between smoking and the comorbidity trajectory were robust in sensitivity analyses.</div></div><div><h3>Conclusion</h3><div>Current smoking has stronger impacts on transitions to comorbidity than on the first occurrence of CMDs or MDs. While current smoking increases the risk of death, smoking cessation mitigates the loss of life expectancy.</div></div>","PeriodicalId":12517,"journal":{"name":"General hospital psychiatry","volume":"99 ","pages":"Pages 77-83"},"PeriodicalIF":3.7,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-12DOI: 10.1016/j.genhosppsych.2026.01.002
Marina López-Miralles, Antonio Serrano García
{"title":"Assessment of the family system in patients with medically unexplained symptoms","authors":"Marina López-Miralles, Antonio Serrano García","doi":"10.1016/j.genhosppsych.2026.01.002","DOIUrl":"10.1016/j.genhosppsych.2026.01.002","url":null,"abstract":"","PeriodicalId":12517,"journal":{"name":"General hospital psychiatry","volume":"99 ","pages":"Pages 75-76"},"PeriodicalIF":3.7,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145974312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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