Frontiers in Psychiatry最新文献

Introduction: This study investigates the long-term impact of perceived caregiver anxiety and stress during childhood on late-life depression. Adverse childhood experiences related to caregiver mental health may significantly influence emotional well-being, and this study utilizes data from the China Health and Retirement Longitudinal Study (CHARLS) to explore these associations.

Methods: CHARLS data were analyzed for individuals who reported perceived caregiver anxiety and stress. Depression was measured using the CES-10 depression scale. Multivariate logistic regression models examined the relationship between caregiver anxiety and stress frequency and late-life depression, adjusting for confounders like socioeconomic status, health behaviors, and demographics.

Results: Childhood exposure to caregiver anxiety and stress significantly increased the risk of depression in later life (p < 0.05), with stronger effects observed among individuals with female caregivers. The risk escalated with the frequency of caregiver anxiety episodes. After adjusting for covariates, the association for male caregivers weakened, highlighting the potential role of other mediators.

Discussion: The results highlight the critical importance of parental mental health, especially maternal anxiety, in mitigating intergenerational mental health risks. Targeted interventions for caregiver mental health, particularly for female caregivers, are crucial. Longitudinal studies are needed to better establish causality and further investigate these mechanisms.

Background: Digital mental health interventions, such as artificial intelligence (AI) conversational agents, hold promise for improving access to care by innovating therapy and supporting delivery. However, little research exists on patient perspectives regarding AI conversational agents, which is crucial for their successful implementation. This study aimed to fill the gap by exploring patients' perceptions and acceptability of AI conversational agents in mental healthcare.

Methods: Adults with self-reported mild to moderate anxiety were recruited from the UMass Memorial Health system. Participants engaged in semi-structured interviews to discuss their experiences, perceptions, and acceptability of AI conversational agents in mental healthcare. Anxiety levels were assessed using the Generalized Anxiety Disorder scale. Data were collected from December 2022 to February 2023, and three researchers conducted rapid qualitative analysis to identify and synthesize themes.

Results: The sample included 29 adults (ages 19-66), predominantly under age 35, non-Hispanic, White, and female. Participants reported a range of positive and negative experiences with AI conversational agents. Most held positive attitudes towards AI conversational agents, appreciating their utility and potential to increase access to care, yet some also expressed cautious optimism. About half endorsed negative opinions, citing AI's lack of empathy, technical limitations in addressing complex mental health situations, and data privacy concerns. Most participants desired some human involvement in AI-driven therapy and expressed concern about the risk of AI conversational agents being seen as replacements for therapy. A subgroup preferred AI conversational agents for administrative tasks rather than care provision.

Conclusions: AI conversational agents were perceived as useful and beneficial for increasing access to care, but concerns about AI's empathy, capabilities, safety, and human involvement in mental healthcare were prevalent. Future implementation and integration of AI conversational agents should consider patient perspectives to enhance their acceptability and effectiveness.

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is a lifelong neurodevelopmental condition with a global prevalence of 2.5% to 6.7% among adults. Non-pharmacological interventions have demonstrated effectiveness both as standalone treatments and adjuncts to pharmacotherapy in managing adult ADHD. Nevertheless, the comparative efficacy of these interventions, particularly with respect to diverse ADHD-related outcomes and their long-term impacts, remains insufficiently investigated.

Objective: This study aims to evaluate and compare the short-term and long-term effects of various non-pharmacological therapies on core ADHD symptoms (inattention, hyperactivity, and impulsivity) and emotional disorders (depression and anxiety) in adults with ADHD and to rank these therapies accordingly.

Methods: A systematic search was conducted for relevant randomized controlled trials (RCTs) in the Web of Science, PubMed, Cochrane Library, and EMBASE databases from inception to Sep 2024. Researchers independently screened and extracted data, and the analysis was performed using R version 4.3.2. Cochrane Risk of Bias tool version 2 (ROB2) and Confidence in Network Meta-Analysis (CINeMA) were used to assess the risk of bias and the certainty of the evidence. Standardized mean differences were estimated using network meta-analyses with random effects.

Results: A total of 37 RCTs involving 2,289 participants and 10 non-pharmacological therapies were included. The risk of bias was classified as low in 24.3%, unclear in 27%, and high in 48.6%, while the CINeMA assessment indicated that confidence in the evidence was "very low" or "low" for most of the remaining treatments. Cognitive behavioral therapy (CBT) showed significantly greater effectiveness than the control group/condition in both the short-term (SMD: -4.43, 95%CI: -5.50 to -3.37) and long-term (SMD: -3.61, 95%CI: -4.66 to -2.56) core symptoms. Additionally, CBT shows both short-term and long-term efficacy for depression (SMD: -4.16, 95%CI: -5.51 to -2.81; SMD: -3.89, 95%CI: -5.95 to -1.83) and anxiety (SMD: -2.12, 95%CI: -3.18 to -1.07; SMD: -7.25, 95%CI: -10.57 to -3.94).

Conclusion: CBT may be the most effective intervention for adults with ADHD and associated emotional disorders, while Mindfulness-based Cognitive Therapy (MC) is recommended as a preferable option for those without comorbidities. Caution is needed in interpreting our results, and high-quality RCTs are urgently required for more reliable insights.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?, identifier CRD42024432912.

Aims: To investigate the effects of an online health education lecture on the positive screening rate of attention-deficit/hyperactivity disorder (ADHD) and parenting stress among parents of children diagnosed with or screened positive for ADHD.

Methods: Using stratified proportional random cluster sampling, 14 primary schools in Chongqing were selected to conduct an online lecture about ADHD for parents and teachers. A total of 2,611 questionnaires were collected (1,508 intervention group, 1,103 control group).

Results: The lecture did not significantly affect the positive screening rate of ADHD (parents: β=-0.37, p=0.208; teachers: β=0.53, p=0.338); however, the positive screening rate increased post-intervention. Inattention scores were higher in the intervention group (β=0.42, p=0.040). Parents as primary caregivers were associated with lower ADHD symptom scores (β=-0.61, p=0.022). Lower parental education levels were associated with higher ADHD screening rates (β=0.49, p=0.039) and symptom scores (β=0.60, p=0.022). Teachers with 10-19 years of experience had higher positive screening rates (β=1.26, p=0.005) and symptom scores (β=2.60, p<0.001). The intervention did not affect parenting stress (Z=-1.413, p=0.158).

Conclusions: The lecture's effects were relatively weak, using questionnaires may have facilitated health communication. Individual characteristics of parents and teachers should be considered in assessments (ClinicalTrial.gov ID: NCT05231902).

Introduction: Populations with serious mental illness are less likely to receive evidence-based care for cardiovascular disease (CVD) risk factors. We sought to characterize the implementation of an adapted team-based quality improvement strategy to improve mental health providers' delivery of evidence-based CVD risk factor care.

Methods: In a 12-month, single arm pre/post pilot study in four behavioral health homes embedded within psychiatric rehabilitation programs, sites implemented an adapted Comprehensive Unit Safety Program (CUSP). Primary measures examined changes in organizational quality improvement culture and provider self-efficacy for CVD risk factor care. Secondary measures examined changes in acceptability, appropriateness, and feasibility of CUSP and receipt of guideline-concordant care for hypertension, dyslipidemia, and diabetes.

Results: Provider self-efficacy to coordinate care for hypertension and diabetes improved, but organizational quality improvement culture did not change. Acceptability, appropriateness, and feasibility were rated highly but did not change pre/post CUSP. The percentage who reached goals per national guidelines improved for those with dyslipidemia but not for those with hypertension or diabetes. CUSP teams implemented processes to build staff capacity, standardize communication, elicit feedback, and deliver education on coordination for CVD risk factors.

Conclusion: This pilot study showed no effects of CUSP on organizational quality improvement culture or provider self-efficacy, the mechanisms by which CUSP is expected to improve care processes. Long term investments are needed to support organizational quality improvement work and providers' efficacy to delivery - evidence-based CVD risk factor care delivery.

Clinical trial registration: http://www.ClinicalTrials.gov, identifier NCT04696653.

Introduction: This study aimed to compare the clinical oral health status of individuals with Methamphetamine (MA), Cannabis (THC), and Polysubstance (PS) use disorders to healthy controls, and assess the impact of substance type, usage duration, quantity, and oral health behaviors on dental health outcomes through comprehensive oral examinations.

Methods: This cross-sectional clinical study was conducted at İzmir Democracy University Buca Seyfi Demirsoy Education and Research Hospital between April 2024 and August 2024. A total of 190 individuals with substance use disorders (MA, THC, and PS users) and 91 healthy controls participated. Sociodemographic data, substance use history, and oral health behaviors were collected using a researcher-developed questionnaire and the Turkish version of the Hiroshima University Dental Behavior Inventory (HU-DBI). Oral health status was assessed through clinical oral examinations using the Decayed, Missing, and Filled Teeth (DMFT) index. Statistical analyses were performed using SPSS 26.0, applying t-tests, ANOVA, Chi-square tests, and Pearson correlation to evaluate group differences and relationships between variables. A p-value of < 0.05 was considered statistically significant.

Results: The study revealed significant differences in oral health among substance users compared to the control group. MA users had the highest DMFT scores (11.04 ± 5.56), followed by THC users (9.49 ± 5.87), and PS users (8.40 ± 4.52), with the control group showing the lowest scores (6.08 ± 4.18) (p<0.001). The study also found a moderate positive correlation between MA use and DMFT scores, indicating that longer and higher usage leads to poorer oral health, while no significant association was observed between THC use and DMFT scores. Additionally, significant disparities in education levels were observed, with substance users having lower education compared to controls (p=0.001). HU-DBI scores indicated poorer oral health behaviors in substance users, though the difference was not statistically significant (p=0.053).

Discussion: The study reveals that all substance use groups, including MA, THC, and PS users, exhibit significantly poorer oral health outcomes, with higher DMFT scores and worse oral health behaviors compared to the control group, highlighting the critical need for comprehensive dental care interventions for individuals with substance use disorders.

Clinical trial registration: https://clinicaltrials.gov/study/NCT06640712, identifier NCT06640712.

In today's world, the internet is seamlessly woven into every facet of our existence. This constant engagement with digital media has generated concerns about the negative effects of digital media use, especially among adolescents. These concerns have led to the development and testing of numerous digital wellbeing interventions that focus on adolescents' digital media use. However, these interventions are lacking in the Middle East and North Africa, and specifically in Saudi Arabia, where digital media use is highly prevalent and frequent. Our research team is conducting a series of studies - literature reviews, stakeholder engagement work, and a nationwide survey of adolescent digital media use - to inform, develop, and ultimately test school-based digital wellbeing intervention for high school students in Saudi Arabia. The goal of this manuscript is to explain our process of informing and creating an intervention that builds on previously established, evidence-based approaches, and is also tailored to a particular context (e.g., Saudi Arabia). Moreover, we distill the lessons learned from each study and provide recommendations to assist others in developing tailored digital wellbeing interventions for contexts that have not been the focus of previous intervention development.

Background: This study aimed to determine the most significant indicators of positive well-being and understand differences in sources of well-being across different life situations, age groups, genders, and income levels, utilizing a novel measure of positive well-being, the Well-being Balance and Lived Experiences (WBAL) Assessment, which evaluates the frequency of various positive experiences and feelings across a range of activation and arousal levels that have previously been demonstrated to affect subjective well-being and human flourishing.

Methods: A sample of 496 evaluable subjects aged 20-69 and census-balanced for gender were recruited from a U.S. population panel. Differences in well-being and sources of well-being were analyzed across subgroups via MANOVA analysis followed by post-hoc ANOVA and Tukey's HSD analyses using Cohen's d to determine size and direction of effects between categorical subgroups.

Results: Life situations, including relationship, parenting and employment status, were shown to have a more significant effect on overall well-being than the demographic variables of age, gender and household income. Reported well-being improved significantly with life situations, including companionate relationships (d=0.38, p<0.001) and parenting (d=0.35, p<0.001), that provide greater opportunities for more frequent social connection (d's=0.25, p<0.01 to 0.62, p<0.001) and purposeful contribution to others' well-being (d's=0.34 to 0.71, p<0.001), associated with increased feelings of significance (d's=0.40 to 0.45, p<0.001) and efficacy (d's=0.37 to 0.44, p<0.001). An age-related positivity effect was observed, with older adults reporting more frequent positive feelings than younger age groups (d=0.31, p<0.01). Measures of mindset positivity, variety of positive experiences and feelings, and frequency and range of positive feelings across arousal levels each corresponded closely with overall well-being.

Conclusion: Life situations, including relationship, parenting and employment status, had a more broad and significant effect on wellbeing than age, gender or income. Across life situations, purposeful contribution and social connection, with associated feelings of efficacy and significance were key drivers of differences in well-being. Mindset positivity and variety of positive experiences and feelings correspond closely with overall well-being. Findings from this study can help guide the design and implementation of intervention programs to improve well-being for individuals and targeted subgroups, demonstrating the utility of the WBAL Assessment to evaluate discrete modifiable sources of positive well-being.

Objective: This study aims to investigate the depression levels among Workers with Agricultural Hukou (WAH) in China, considering their varied living environments, types of work, and social discrimination experiences. It specifically addresses the research question: Is there a significant discrepancy in depression levels among different subgroups within WAH?

Methods: The study utilizes data from the China Family Panel Studies (CFPS) for the years 2018 and 2020. To estimate the depression levels and their variances across different WAH subgroups, we employed three analytical methods: Ordinary Least Squares, Propensity Score Matching, and Two-Stage Least Squares.

Results: Our findings indicate that all WAH subgroups experience higher levels of depression compared to Workers with Non-Agricultural Hukou (WNAH). Among the WAH subgroups, the depression levels, in ascending order, are observed in Rural-to-Urban Migrant Workers (RUMW), Rural Non-Agricultural Workers (RNAW), Subsistence Farmers, and Agricultural Laborers. Notably, these differences in depression levels may be influenced by the mechanism of cognitive openness.

Conclusion: The study concludes that there are significant disparities in depression levels among WAH subgroups. Understanding these differences is crucial for targeted mental health interventions and for addressing the broader implications of social discrimination and work-related stress among agricultural workers in China.