Frontiers in Psychiatry最新文献

Background: Violent suicide attempts pose a major challenge to trauma and psychiatric services due to their high lethality and complex clinical profiles. While non-violent suicidal behaviors have been extensively studied, considerably less is known about the recurrence of violent suicide attempts. This study examined demographic and clinical factors associated with repeated violent suicide attempts in Hungary.

Methods: A retrospective chart review was conducted at the Dr. Manninger Jenő National Trauma Center in Budapest among patients admitted between January 2015 and December 2024 following a violent suicide attempt. Electronic health records provided sociodemographic, psychiatric, motivational, and method-related data. Subgroup and logistic regression analyses were used to identify predictors of repetition.

Results: The final sample comprised 327 individuals (222 males, 105 females; mean age = 46.95 years, SD = 19.5). Repeated violent suicide attempts were observed in 18% of females and 10% of males. Overall, 31% of violent suicide attempters had a history of a prior non-violent suicide attempt followed by a transition to violent methods. Males had approximately threefold higher odds of transitioning from non-violent to violent methods. Among suicide deaths, 76% occurred in males, and 96% were fatal at the first attempt. Personality disorders (OR = 4.15, p = 0.028), substance use disorders (OR = 2.86, p = 0.005), and sedative/hypnotic medication dependence (OR = 3.72, p = 0.009) were significantly associated with repeated violent suicide attempts, particularly among males. Polytoxicomania was associated with nearly fourfold higher odds of repetition (OR = 3.97, p = 0.0004). A history of a prior violent suicide attempt was the strongest predictor of repetition (OR ≈ 660, p < 0.000001), independent of age and sex. Acute psychotic symptoms, while not inherently motivational in themselves, emerged as the most frequently reported proxy associated with violent suicide among repeat attempters, followed by relational conflict, existential crisis, and chronic illness.

Conclusion: Repeated violent suicide attempts constitute a distinct and exceptionally high-risk clinical phenotype. Prior violent attempts, male sex in the context of repetition, personality disorders and substance abuse-particularly polytoxicomania-emerged as salient risk markers. These behaviors appear to arise at the intersection of prior violent conduct and acute substance-induced psychopathological states, notably psychotic symptoms with impaired reality testing and heightened impulsivity. Early identification and integrated psychiatric care, initiated during acute trauma management and maintained throughout rehabilitation, are critical to mitigating subsequent suicide risk in this vulnerable population.

Introduction: Veteran death by suicide is a complex issue made up of many factors. Despite the high need for mental health treatment, and treatments that specifically target suicide, evidence-based psychotherapies (EBPs) are difficult to access, even more so in rural areas. In concordance with the 2018 National Strategy for Preventing Veteran Suicide, VA suicide prevention leadership developed Suicide Prevention 2.0 (SP 2.0) to implement a public health model that includes community-based prevention strategies and improves clinical interventions within VA. The Suicide Prevention 2.0 Clinical Telehealth program was implemented in each of VA's 18 regional Clinical Resource Hubs and expanded clinical intervention strategies within VA by implementing four EBPs for Suicide Prevention (EBP-SP) via telehealth: the Safety Planning Intervention, Problem-Solving Therapy for Suicide Prevention, Cognitive Behavioral Therapy for Suicide Prevention, and Dialectical Behavior Therapy.

Methods: A wide variety of implementation strategies were used (e.g., access new funding, training, consultation, create new clinical teams). The primary inclusion criterion for veteran referral to SP 2.0 Clinical Telehealth is a recent history of suicidal self-directed violence. Implementation was guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework and RE-AIM was used as an evaluation framework.

Results: By April 2023, SP 2.0 Clinical Telehealth services were available in all 18 regions and in 139 of 139 (100%) VA health care systems in the U.S. By the end of September 2024, the program had hired 137 therapists and retained 78.10% in their role, and 100% were trained in two or more EBP-SPs. By the end of September 2024, the program received 23,628 referrals nationwide. Increasing referral rates year over year suggests ongoing sustained reach.

Discussion: SP 2.0 Clinical Telehealth represents the first and only enterprise-wide fully virtual evidence-based treatment program for veterans with a recent history of suicidal self-directed violence. The program's implementation was successful in reaching all VISNs and all VA health care systems in the U.S. The SP 2.0 Clinical Telehealth program can be used as a model for other large health care systems looking to improve provision of evidence-based interventions for suicide prevention.

Background: Adolescents requiring acute inpatient psychiatric care for severe behavioral and emotional dysregulation represent one of the most clinically vulnerable populations within child and adolescent mental health services. While international studies have documented high rates of psychiatric morbidity among adolescents presenting with externalizing pathology and crisis-related admissions, region-specific data from Central and Eastern Europe remain limited. This study aimed to characterize the clinical mental health profile of high-risk adolescents admitted to acute inpatient psychiatric care and to examine patterns of hospitalization and readmission within this population.

Methods: A retrospective cohort study was conducted at a national child and adolescent psychiatric inpatient unit in Hungary. Medical records of adolescents aged 10-19 years admitted between 2009 and 2019 under acute, medically indicated inpatient conditions, including cases involving police or judicial contact, were analyzed. Psychiatric diagnoses were established using standardized assessment tools, including the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-Kid), Child Behavior Checklist (CBCL), Strengths and Difficulties Questionnaire (SDQ), and Piéron Attention Test. Statistical analyses examined diagnostic prevalence, demographic characteristics, and readmission patterns, including Kaplan-Meier survival analysis of time to readmission.

Results: The final cohort consisted of 570 high-risk adolescents, predominantly male (72.1%), with a mean age of 15.3 years (SD ± 2.1). Psychiatric morbidity was substantial, with conduct disorder (76.2%) and substance use disorders (78.4%) representing the most prevalent diagnoses. Attention-deficit/hyperactivity disorder (17.6%), oppositional defiant disorder (14.9%), post-traumatic stress disorder (10.1%), and psychotic disorders (3.2%) were also identified. One-quarter of participants experienced multiple hospital admissions. While gender was not significantly associated with readmission intervals, increasing age emerged as a significant predictor of earlier readmission, indicating heightened clinical instability among older adolescents.

Conclusions: High-risk adolescents admitted to acute inpatient psychiatric care exhibit an exceptionally high burden of psychiatric disorders, dominated by severe externalizing and substance-related conditions. The findings suggest that acute hospitalization in this population reflects cumulative developmental and psychosocial vulnerability rather than isolated behavioral crises. These results underscore the need for integrated, trauma-informed, and developmentally sensitive psychiatric care pathways, with particular emphasis on early identification, continuity of care, and relapse prevention in clinically unstable adolescents.

Background: The use of antipsychotic medications, including first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs), during pregnancy has risen substantially. However, concerns remain regarding their potential metabolic effects, especially the risk of gestational diabetes mellitus (GDM).

Methods: We conducted a systematic review and meta-analysis of observational studies published up to 2025 that examined the association between maternal exposure to antipsychotics or antidepressants and the risk of GDM. Data were extracted independently by two reviewers, quality was assessed using the Newcastle-Ottawa Scale, and pooled relative risks (RRs) were calculated using a random-effects model.

Results: We selected seventeen eligible studies, including large registry-based cohorts and prospective investigations across multiple countries. Pooled analysis demonstrated that maternal exposure to SGAs was significantly associated with an increased risk of GDM (RR = 1.59; 95% CI: 1.24-1.94), whereas FGAs showed no significant association (RR = 1.31; 95% CI: 0.29-2.32). The risk appeared greatest among women with continuous or multi-trimester exposure, particularly when exposure extended from first trimester into the third trimester. Funnel plot and Egger test showed no publication bias.

Conclusions: The higher risk of GDM seen with antipsychotic use was mainly linked to SGAs, while FGAs did not show the same effect. These findings emphasize the need to tailor treatment plans, closely monitor blood sugar levels, and involve a team of healthcare professionals when caring for pregnant women who require psychotropic medications.

Background: Caregiving for people with dementia imposes significant psychological and physical burdens on family caregivers, which may affect overall family functioning. This study aimed to examine whether mutuality statistically mediates the relationship between caregiver burden and family resilience among Chinese dementia caregivers.

Methods: This cross-sectional research was conducted from October 2022 to December 2023 across two tertiary hospitals in Henan Province, China. A total of 296 family caregivers of people with dementia participated in the study. Caregivers completed the Chinese versions of the Zarit Burden Interview, the Mutuality Scale, and the Family Resilience Assessment Scale. Pearson correlations were used to examine associations between caregiver burden, mutuality, and family resilience. Structural equation modeling was performed in AMOS 24.0 to assess the mediating role of mutuality.

Results: Caregiver burden was negatively associated with mutuality (p <.01) and family resilience (p <.01). Mutuality (total score) and its four dimensions demonstrated positive correlations with family resilience (p <.01). Furthermore, mutuality significantly mediated the relationship between caregiver burden and family resilience (p <.01), with a mediating effect of 39.0%.

Conclusions: This study suggests that mutuality may be an important relational process associated with both caregiver burden and family resilience in dementia caregiving. Public health interventions may benefit from strengthening the caregiver-care recipient relationship to reduce psychological burden and enhance family resilience. Community-based programs and caregiver support initiatives that foster mutual understanding and positive interactions may be particularly effective in promoting the health and well-being of both caregivers and patients.

Objectives: The purpose of this research was to investigate how emotion regulation, particularly reappraisal and inhibition, mediate the connection between psychological control from parents and psychological distress experienced by university students who are addicted to smartphones.

Methods: A total of 1,276 university students from Henan Province, China, participated in this study. The proposed relationships and mediation pathways were examined through data analysis employing Partial Least Squares Structural Equation Modeling (PLS-SEM).

Results: Both mother psychological control (β = 0.162, p < 0.05) and father psychological control (β = 0.319, p < 0.05) were positively associated with psychological distress. Reappraisal was negatively related to psychological distress (β = -0.074, p < 0.05), whereas inhibition showed a positive correlation (β = 0.299, p < 0.05). Father psychological control was positively associated with both reappraisal (β = 0.130, p < 0.05) and inhibition (β = 0.233, p < 0.05). Mother psychological control was positively linked to inhibition (β = 0.106, p < 0.05) but not to reappraisal (β = -0.036, p > 0.05). Inhibition significantly mediated the effects of father (β = 0.070, p < 0.05) and mother psychological control (β = 0.032, p < 0.05) on psychological distress, while reappraisal did not exhibit a mediation effect.

Conclusion: These findings show that inhibition mediates the psychological effects of parental psychological control on university students with smartphone addiction. These connections were not mediated by reappraisal. Interventions to reduce parental psychological control-related psychological distress should target inhibitory mechanisms, according to the study.

Background: Patient complexity in mental health varies substantially, yet treatment approaches often rely on standardized protocols. Identifying distinct complexity profiles may support stratified care and more personalized intervention planning in depression.

Objective: To identify distinct patient complexity profiles in depression across sociodemographic, clinical, and psychosocial indicators and to evaluate their clinical relevance for personalized treatment planning.

Methods: We analyzed complete-case data from 270 adults with major depression using a Knowledge Discovery in Databases framework. Twelve indicators were analyzed via Principal Component Analysis followed by K-means clustering. Robustness was evaluated using supervised validation with a Random Forest classifier and SHAP-based interpretability analysis. Between-profile comparisons were conducted, and expert clinicians evaluated clinical relevance.

Results: Model selection supported a three-cluster solution (k = 3: Low-, Moderate-, and High-complexity profiles). The solution was validated using a Random Forest classifier with strong performance (accuracy = 0.91). Statistical comparisons showed that the Low-complexity profile (n = 100, 37.0%) was older and more often partnered and employed, with lower depressive symptoms and better personality functioning. The Moderate-complexity profile (n = 87, 32.2%) was younger, predominantly unpartnered, and had the lowest employment rate and medical comorbidity. The High-complexity profile (n = 83, 30.7%) showed the most severe presentation, characterized by higher depressive symptoms, greater childhood maltreatment, and impaired personality functioning. Clinical experts confirmed interpretability and suggested tailored strategies for each profile.

Conclusions: Machine learning identified clinically meaningful patient complexity profiles with significant differences across multiple domains. These profiles provide a framework for stratified care and personalized intervention planning, moving beyond one-size-fits-all approaches.

Background: Interoceptive exposure (IE) to feared bodily sensations is a core component of cognitive-behavioral therapy for panic disorder (PD), but standard office-based IE can be perceived as aversive and tedious, potentially limiting engagement. Vigorous physical exercise may provide a more acceptable and health-promoting way to elicit interoceptive cues. Objective: To examine the feasibility and efficacy of a brief intermittent intense exercise (BIE) program, used as an IE strategy, compared with Jacobson's relaxation training (RT) in treatment-free patients with PD.

Methods: In this prospective, parallel-group, randomized, assessor-blinded clinical trial, 72 sedentary adults with PD (34 men; mean age 33.3 ± 7.7 years), free of pharmacological treatment for ≥12 weeks, were allocated to either a 12-week BIE program (n = 37) or RT (n = 35). BIE consisted of supervised walking interspersed with repeated 30-s high-intensity sprints, while RT followed a standardized progressive muscular relaxation protocol. All participants received identical placebo medication. The primary outcome was Panic Agoraphobia Scale (PAS) score, assessed by a blinded rater at baseline and weeks 6, 12, and 24 (follow-up). Secondary outcomes included frequency and intensity of panic attacks, Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HAM-D) scores.

Results: Both groups improved over time, but a significant group × time interaction favored BIE on PAS scores (F = 56.1, p < 0.001, η² = 0.46). At week 12, PAS scores were lower in the BIE group than in RT (14.9 ± 5.3 vs. 23.1 ± 9.4; t = -4.72, p < 0.001), and this difference was maintained at week 24 (14.2 ± 5.5 vs. 24.7 ± 8.5; t = -6.07, p < 0.001). At follow-up, BIE also yielded fewer panic attacks (0.7 ± 0.6 vs. 1.5 ± 1.0; t = 3.79, p = 0.003) and lower HAM-D scores (13.3 ± 4.7 vs. 16.4 ± 5.6; t = -2.55, p = 0.013).

Conclusion: A 12-week BIE program used as interoceptive exposure was feasible and more effective than relaxation training in reducing panic symptom severity and panic attack frequency, with effects sustained for at least 24 weeks. These findings support the incorporation of structured exercise-based IE into PD treatment programs as a low-cost and engaging option.

Clinial trial registration: https://www.clinicaltrials.gov, identifier NCT06073691.

Introduction: Precision child and youth mental health (PCYMH) offers a promising array of tools and methodologies to address the intensifying burden of mental health challenges in child and youth populations. However, the current state of PCYMH research requires better characterization. To this end, we conducted a scoping review aiming to provide a 'lay of the literature' for this emerging field.

Methods: Following the Joanna Briggs Institute methodology for scoping reviews, we searched PubMed and Embase for PCYMH studies from January 1, 1980 to November 30, 2023, updating the search on November 1, 2024. The final dataset comprised 124 publications, summarized with descriptive quantitative analysis and qualitative content analysis.

Results: Quantitative analyses revealed that 48% (60/124) of studies had been published between 2020 and 2024, with the majority (51% (63/124)) studying populations in the U.S. Most studies were observational in design. Content analysis revealed four categories of PCYMH research focus: (1) Biomarkers (68% (84/124)); (2) Non-Biological Markers (17% (22/124)); (3) Implementation of PCYMH Interventions (14% (17/124)); and (4) Predictive Algorithms (5% (6/124)). PCYMH tools were underutilized and infrequently combined. Studies producing multimodal profiles of participants, e.g., using neuroimaging, genetics, digital health data, and lifestyle data were scarce. No study used reporting guidelines.

Discussion: Our findings indicate that this body of research is still in its infancy. We highlight opportunities to advance the study of PCYMH and provide recommendations to support the maturation of this new field.