Pub Date : 2026-03-11DOI: 10.1001/jamapsychiatry.2026.0032
Loran Knol,Andre F Marquand,Nita Farahany,Alex Leow
{"title":"AI in Mental Health Care-Opportunities and Risks Beyond Large Language Models.","authors":"Loran Knol,Andre F Marquand,Nita Farahany,Alex Leow","doi":"10.1001/jamapsychiatry.2026.0032","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.0032","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"6 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147383236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-11DOI: 10.1001/jamapsychiatry.2026.0086
Xuan Li,Chang Lu,Zhaolin Zhai,Robert C Smith,Suzhen Zhang,Huiling Wang,Chuanyue Wang,Zhijian Yao,Zhiyu Chen,Xiufeng Xu,Shoufu Xie,Tienan Feng,Tianhao Gao,Yuke Dong,Kaiming Zhuo,Qiong Xiang,Hua Jin,John M Davis,Kaida Jiang,Yifeng Xu,Stefan Leucht,Dengtang Liu
ImportanceThere is an urgent need for algorithm trials that address treatment steps in schizophrenia sequentially. Moreover, there is a debate about whether clozapine should be used after 1 failed antipsychotic drug trial.ObjectiveTo investigate whether switching to clozapine is effective in patients with first-episode psychosis (FEP) who have not responded to 1 previous antipsychotic drug.Design, Setting, and ParticipantsThis was a sequential, assessor-blind trial with 2 randomizations conducted across 7 centers in China from February 2019 to October 2022. Included were individuals aged 16 to 45 years and with FEP (schizophrenia, schizophreniform disorder, or schizoaffective disorder). In phase 1, patients with FEP were randomized to receive oral olanzapine, risperidone, amisulpride, aripiprazole, or perphenazine for 8 weeks. In phase 2, nonresponders were rerandomized to receive olanzapine, amisulpride, or clozapine for another 8 weeks. Responders entered a 1-year naturalistic follow-up. Study data were analyzed from February to August 2025.InterventionsSpecific antipsychotic drugs.Main Outcomes and MeasuresThe primary outcomes were as follows (1) symptomatic response, defined as the proportion of patients achieving a greater than or equal to 40% reduction in Positive and Negative Syndrome Scale (PANSS) total score and (2) time to all-cause discontinuation, defined as discontinuation of antipsychotic drugs for any reason.ResultsA total of 762 participants were randomized, and 654 (mean [SD] age, 26.9 [7.5] years; 328 male [50.2%]) were eligible for the study. Of the eligible participants, 556 (85.4%) completed phase 1, and 359 (55.1%) responded to treatment. Response rates were 60.5% (78 of 129) for olanzapine, 63.4% (83 of 131) for risperidone, 61.8% (81 of 131) for amisulpride, 44.3% (58 of 131) for aripiprazole, and 45.7% (59 of 129) for perphenazine (χ2 = 18.3; P = .001). In phase 2, 111 nonresponders were rerandomized (41 taking olanzapine, 38 taking amisulpride, and 32 taking clozapine). A total of 92 patients (82.9%) completed phase 2, and the following achieved a response: 13 (31.7%) taking olanzapine vs 17 (44.7%) taking amisulpride and 20 (62.5%) taking clozapine (χ2 = 6.9; P = .03).Conclusions and RelevanceThe majority of patients with FEP responded to an initial antipsychotic drug trial, with risperidone and amisulpride being superior to aripiprazole and perphenazine. In those who initially did not respond to antipsychotic treatment, clozapine was more efficacious than olanzapine and amisulpride based on the PANSS ratings criteria outcome. This study provides some evidence for clinicians to consider regarding use of clozapine as the next sequential treatment after patients have failed an adequate trial with 1 of the more traditional antipsychotics.Trial RegistrationClinicalTrials.gov Identifier: NCT03510325.
{"title":"Clozapine After 1 Failed Antipsychotic Drug Trial in First-Episode Psychosis: A Randomized Clinical Trial.","authors":"Xuan Li,Chang Lu,Zhaolin Zhai,Robert C Smith,Suzhen Zhang,Huiling Wang,Chuanyue Wang,Zhijian Yao,Zhiyu Chen,Xiufeng Xu,Shoufu Xie,Tienan Feng,Tianhao Gao,Yuke Dong,Kaiming Zhuo,Qiong Xiang,Hua Jin,John M Davis,Kaida Jiang,Yifeng Xu,Stefan Leucht,Dengtang Liu","doi":"10.1001/jamapsychiatry.2026.0086","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.0086","url":null,"abstract":"ImportanceThere is an urgent need for algorithm trials that address treatment steps in schizophrenia sequentially. Moreover, there is a debate about whether clozapine should be used after 1 failed antipsychotic drug trial.ObjectiveTo investigate whether switching to clozapine is effective in patients with first-episode psychosis (FEP) who have not responded to 1 previous antipsychotic drug.Design, Setting, and ParticipantsThis was a sequential, assessor-blind trial with 2 randomizations conducted across 7 centers in China from February 2019 to October 2022. Included were individuals aged 16 to 45 years and with FEP (schizophrenia, schizophreniform disorder, or schizoaffective disorder). In phase 1, patients with FEP were randomized to receive oral olanzapine, risperidone, amisulpride, aripiprazole, or perphenazine for 8 weeks. In phase 2, nonresponders were rerandomized to receive olanzapine, amisulpride, or clozapine for another 8 weeks. Responders entered a 1-year naturalistic follow-up. Study data were analyzed from February to August 2025.InterventionsSpecific antipsychotic drugs.Main Outcomes and MeasuresThe primary outcomes were as follows (1) symptomatic response, defined as the proportion of patients achieving a greater than or equal to 40% reduction in Positive and Negative Syndrome Scale (PANSS) total score and (2) time to all-cause discontinuation, defined as discontinuation of antipsychotic drugs for any reason.ResultsA total of 762 participants were randomized, and 654 (mean [SD] age, 26.9 [7.5] years; 328 male [50.2%]) were eligible for the study. Of the eligible participants, 556 (85.4%) completed phase 1, and 359 (55.1%) responded to treatment. Response rates were 60.5% (78 of 129) for olanzapine, 63.4% (83 of 131) for risperidone, 61.8% (81 of 131) for amisulpride, 44.3% (58 of 131) for aripiprazole, and 45.7% (59 of 129) for perphenazine (χ2 = 18.3; P = .001). In phase 2, 111 nonresponders were rerandomized (41 taking olanzapine, 38 taking amisulpride, and 32 taking clozapine). A total of 92 patients (82.9%) completed phase 2, and the following achieved a response: 13 (31.7%) taking olanzapine vs 17 (44.7%) taking amisulpride and 20 (62.5%) taking clozapine (χ2 = 6.9; P = .03).Conclusions and RelevanceThe majority of patients with FEP responded to an initial antipsychotic drug trial, with risperidone and amisulpride being superior to aripiprazole and perphenazine. In those who initially did not respond to antipsychotic treatment, clozapine was more efficacious than olanzapine and amisulpride based on the PANSS ratings criteria outcome. This study provides some evidence for clinicians to consider regarding use of clozapine as the next sequential treatment after patients have failed an adequate trial with 1 of the more traditional antipsychotics.Trial RegistrationClinicalTrials.gov Identifier: NCT03510325.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"127 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147383234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-11DOI: 10.1001/jamapsychiatry.2026.0083
Geert Dom,Cecile Hanon,Andrea Fiorillo,Andrew Brittlebank,Marisa Casanova Dias
{"title":"Results of the First European Board Examination in Psychiatry.","authors":"Geert Dom,Cecile Hanon,Andrea Fiorillo,Andrew Brittlebank,Marisa Casanova Dias","doi":"10.1001/jamapsychiatry.2026.0083","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.0083","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"299 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147383233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-11DOI: 10.1001/jamapsychiatry.2026.0044
Ruben Juarez,Binh Le,Christopher Knightsbridge,Marsha Lowery,Alika K Maunakea
ImportanceClimate-related disasters are escalating in frequency and severity, yet their population-level mental health impacts-especially in racially and ethnically diverse and geographically isolated settings-remain poorly characterized. The 2023 Maui wildfires, one of the deadliest US wildfires in more than a century, offer a critical opportunity to quantify these effects.ObjectiveTo examine associations between wildfire exposure and symptoms of depression, anxiety, and suicidal ideation and to assess indirect pathways of these associations through housing displacement and income disruption.Design, Setting, and ParticipantsThis multiarm, propensity-weighted cross-sectional study compared adults residing within burn zones and outside burn zones on Maui and unexposed residents from other Hawai'i counties. The analytic sample included wildfire-exposed and unexposed adults enrolled between January 2024 and February 2025 through the Maui Wildfire Exposure Study and the UHERO Rapid Health Survey. Residential addresses at the time of the fires were geocoded and linked to official burn zone perimeters to determine exposure status. Data were analyzed from May to September 2025.Main Outcomes and MeasuresThe primary outcomes were self-reported depression (Center for Epidemiologic Studies Depression Scale), anxiety (7-item Generalized Anxiety Disorder scale), and suicidal ideation within the past 30 days, assessed using validated screening instruments.ResultsThe analytic sample included 2453 adults (1535 wildfire exposed and 918 unexposed), among whom mean (SD) age was 50.8 (16.3) years and 1502 participants (61.2%) were women. Wildfire exposure was associated with higher risk of depression (risk ratio [RR], 1.53; 95% CI, 1.20-1.94) and anxiety (RR, 1.67; 95% CI, 1.14-2.45) compared with unexposed individuals. Although suicidal ideation was more frequent among burn zone residents (RR, 2.15; 95% CI, 0.72-6.44), this association was not statistically significant. Residents outside burn zones showed significantly higher risk of suicidal ideation (RR, 2.65; 95% CI, 1.21-5.77). Mediation analyses indicated that housing displacement and income loss jointly accounted for more than half of the associations with depression and anxiety.Conclusions and RelevanceIn this cross-sectional study, wildfire exposure and its socioeconomic consequences were associated with graded increases in psychological distress extending beyond the burn zone. These findings highlight the importance of integrating mental health care, housing stability, and economic recovery as central pillars of disaster response and climate resilience strategies.
{"title":"Housing Displacement, Employment Disruption, and Mental Health After the 2023 Maui Wildfires.","authors":"Ruben Juarez,Binh Le,Christopher Knightsbridge,Marsha Lowery,Alika K Maunakea","doi":"10.1001/jamapsychiatry.2026.0044","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.0044","url":null,"abstract":"ImportanceClimate-related disasters are escalating in frequency and severity, yet their population-level mental health impacts-especially in racially and ethnically diverse and geographically isolated settings-remain poorly characterized. The 2023 Maui wildfires, one of the deadliest US wildfires in more than a century, offer a critical opportunity to quantify these effects.ObjectiveTo examine associations between wildfire exposure and symptoms of depression, anxiety, and suicidal ideation and to assess indirect pathways of these associations through housing displacement and income disruption.Design, Setting, and ParticipantsThis multiarm, propensity-weighted cross-sectional study compared adults residing within burn zones and outside burn zones on Maui and unexposed residents from other Hawai'i counties. The analytic sample included wildfire-exposed and unexposed adults enrolled between January 2024 and February 2025 through the Maui Wildfire Exposure Study and the UHERO Rapid Health Survey. Residential addresses at the time of the fires were geocoded and linked to official burn zone perimeters to determine exposure status. Data were analyzed from May to September 2025.Main Outcomes and MeasuresThe primary outcomes were self-reported depression (Center for Epidemiologic Studies Depression Scale), anxiety (7-item Generalized Anxiety Disorder scale), and suicidal ideation within the past 30 days, assessed using validated screening instruments.ResultsThe analytic sample included 2453 adults (1535 wildfire exposed and 918 unexposed), among whom mean (SD) age was 50.8 (16.3) years and 1502 participants (61.2%) were women. Wildfire exposure was associated with higher risk of depression (risk ratio [RR], 1.53; 95% CI, 1.20-1.94) and anxiety (RR, 1.67; 95% CI, 1.14-2.45) compared with unexposed individuals. Although suicidal ideation was more frequent among burn zone residents (RR, 2.15; 95% CI, 0.72-6.44), this association was not statistically significant. Residents outside burn zones showed significantly higher risk of suicidal ideation (RR, 2.65; 95% CI, 1.21-5.77). Mediation analyses indicated that housing displacement and income loss jointly accounted for more than half of the associations with depression and anxiety.Conclusions and RelevanceIn this cross-sectional study, wildfire exposure and its socioeconomic consequences were associated with graded increases in psychological distress extending beyond the burn zone. These findings highlight the importance of integrating mental health care, housing stability, and economic recovery as central pillars of disaster response and climate resilience strategies.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"24 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147383235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ImportanceAdults with severe mental illness (SMI) face a 10- to 20-year reduction in life expectancy, largely due to heightened cardiometabolic diseases. Low levels of physical activity (PA) and prolonged sedentary behavior (SB) are modifiable risk factors that contribute to this mortality gap. Although strong evidence demonstrates that PA is safe and effective in improving psychiatric and physical outcomes, systematic integration into clinical practice remains limited.ObservationsIndividuals with SMI are among the most physically inactive groups in society, often spending more than 10 hours per day sedentary and rarely meeting recommended PA recommendations. Low PA and high SB exacerbate neuroinflammatory, neuroendocrine, and cardiometabolic pathways implicated in psychiatric morbidity. Recent meta-analyses show that structured PA, that is, exercise, produces moderate to large reductions in depressive and psychotic symptoms, as well as benefits for cognition, quality of life, and cardiometabolic health. Evidence also suggests that mentally passive SB, such as prolonged television viewing, are associated with poorer mental health outcomes. Physical activity should be individualized to each person's capabilities and preferences, emphasizing forms they find enjoyable. Two sessions of strength training weekly are advised, and greater mental health benefits typically arise from leisure or active travel PA. To guide translation into care, the 5A framework (Ask, Assess, Advise, Assist, Arrange) provides a structured, pragmatic approach: clinicians can screen for PA and SB, assess readiness and safety, provide tailored advice, support motivation and goal setting, and arrange follow-up, referral, and community support.Conclusions and RelevancePA should be considered a core component of psychiatric care. By systematically promoting PA and reducing prolonged SB through structured clinical frameworks, psychiatrists and other mental health professionals can improve symptoms, enhance physical and cognitive health, and help narrow the life expectancy gap experienced by people with SMI.
{"title":"Integrating Physical Activity Into Routine Psychiatric Care: A Review.","authors":"Brendon Stubbs,Ruimin Ma,Megan Teychenne,Florence Kinnafick,Nilufar Mossaheb,Nicole Korman,Mike Trott,Simon Rosenbaum,Felipe Schuch,Joseph Firth,Davy Vancampfort","doi":"10.1001/jamapsychiatry.2026.0026","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.0026","url":null,"abstract":"ImportanceAdults with severe mental illness (SMI) face a 10- to 20-year reduction in life expectancy, largely due to heightened cardiometabolic diseases. Low levels of physical activity (PA) and prolonged sedentary behavior (SB) are modifiable risk factors that contribute to this mortality gap. Although strong evidence demonstrates that PA is safe and effective in improving psychiatric and physical outcomes, systematic integration into clinical practice remains limited.ObservationsIndividuals with SMI are among the most physically inactive groups in society, often spending more than 10 hours per day sedentary and rarely meeting recommended PA recommendations. Low PA and high SB exacerbate neuroinflammatory, neuroendocrine, and cardiometabolic pathways implicated in psychiatric morbidity. Recent meta-analyses show that structured PA, that is, exercise, produces moderate to large reductions in depressive and psychotic symptoms, as well as benefits for cognition, quality of life, and cardiometabolic health. Evidence also suggests that mentally passive SB, such as prolonged television viewing, are associated with poorer mental health outcomes. Physical activity should be individualized to each person's capabilities and preferences, emphasizing forms they find enjoyable. Two sessions of strength training weekly are advised, and greater mental health benefits typically arise from leisure or active travel PA. To guide translation into care, the 5A framework (Ask, Assess, Advise, Assist, Arrange) provides a structured, pragmatic approach: clinicians can screen for PA and SB, assess readiness and safety, provide tailored advice, support motivation and goal setting, and arrange follow-up, referral, and community support.Conclusions and RelevancePA should be considered a core component of psychiatric care. By systematically promoting PA and reducing prolonged SB through structured clinical frameworks, psychiatrists and other mental health professionals can improve symptoms, enhance physical and cognitive health, and help narrow the life expectancy gap experienced by people with SMI.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"43 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-04DOI: 10.1001/jamapsychiatry.2026.0021
Anh P Nguyen,Ingrid A Binswanger,Komal J Narwaney,Glenn Goodrich,Paul J Christine,Cynthia I Campbell,Stanley Xu,Amy M Loree,Jason M Glanz
ImportanceHealth plan disenrollment may interrupt treatment for opioid use disorder (OUD) and overall care, increasing risk for serious outcomes, including overdose and death. There is limited evidence on the association of disenrollment with all-cause and overdose mortality after initiating medications for OUD (MOUD) treatment.ObjectiveTo assess the association of health plan disenrollment with all-cause and overdose mortality in patients treated with MOUD.Design, Setting, and ParticipantsThis cohort study included privately and publicly insured patients aged 16 years or older who initiated buprenorphine or naltrexone for OUD treatment between January 1, 2012, and December 31, 2021, at 3 integrated health insurance and care delivery systems in 2 US states. Patients were followed up to 2 years until December 31, 2022. Data were analyzed July 2024 to November 2025.ExposureHealth plan disenrollment following MOUD initiation.Main Outcomes and MeasuresAll-cause mortality and drug-related and alcohol-related overdose mortality within 2 years of MOUD initiation ascertained from the National Death Index. Survival analyses were adjusted for patient sociodemographic and clinical characteristics.ResultsAmong 20 011 patients (mean [SD] age 38.7 [15.1] years; 12 299 males [61.5%]) who were treated for OUD, 6948 (34.7%) experienced disenrollment and 586 (2.9%) died during follow-up. The crude rate was 15.3 (95% CI, 14.1-16.6) per 1000 person-years for all-cause mortality and 6.2 (95% CI, 5.4-7.0) per 1000 person-years for overdose mortality. Ever experiencing disenrollment showed elevated all-cause mortality (17.6 [95% CI, 14.9-20.8] vs 14.7 [95% CI, 13.4-16.1] per 1000 person-years) and overdose mortality (8.9 [95% CI, 7.1-11.3] vs 5.4 [95% CI, 4.7-6.3] per 1000 person-years) relative to remaining enrolled. In adjusted analyses, ever experiencing disenrollment was associated with increased hazards of all-cause (hazard ratio [HR], 1.51; 95% CI, 1.23-1.84) and overdose mortality (HR, 1.56; 95% CI, 1.17-2.09). Compared with remaining enrolled and receiving MOUD treatment, being disenrolled (HR, 4.34; 95% CI, 3.19-5.89) and being enrolled and not receiving MOUD treatment (HR, 4.19; 95% CI, 3.24-5.43) were associated with overall mortality.Conclusions and RelevanceIn this cohort study of patients who initiated MOUD, experiencing health plan disenrollment was associated with increased mortality risk compared with remaining enrolled. Strategies are needed to improve continuity of health coverage and mitigate the elevated mortality risk during insurance transitions for patients receiving medications for OUD.
{"title":"Health Plan Disenrollment and Mortality After Initiation of Medications for Opioid Use Disorder.","authors":"Anh P Nguyen,Ingrid A Binswanger,Komal J Narwaney,Glenn Goodrich,Paul J Christine,Cynthia I Campbell,Stanley Xu,Amy M Loree,Jason M Glanz","doi":"10.1001/jamapsychiatry.2026.0021","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.0021","url":null,"abstract":"ImportanceHealth plan disenrollment may interrupt treatment for opioid use disorder (OUD) and overall care, increasing risk for serious outcomes, including overdose and death. There is limited evidence on the association of disenrollment with all-cause and overdose mortality after initiating medications for OUD (MOUD) treatment.ObjectiveTo assess the association of health plan disenrollment with all-cause and overdose mortality in patients treated with MOUD.Design, Setting, and ParticipantsThis cohort study included privately and publicly insured patients aged 16 years or older who initiated buprenorphine or naltrexone for OUD treatment between January 1, 2012, and December 31, 2021, at 3 integrated health insurance and care delivery systems in 2 US states. Patients were followed up to 2 years until December 31, 2022. Data were analyzed July 2024 to November 2025.ExposureHealth plan disenrollment following MOUD initiation.Main Outcomes and MeasuresAll-cause mortality and drug-related and alcohol-related overdose mortality within 2 years of MOUD initiation ascertained from the National Death Index. Survival analyses were adjusted for patient sociodemographic and clinical characteristics.ResultsAmong 20 011 patients (mean [SD] age 38.7 [15.1] years; 12 299 males [61.5%]) who were treated for OUD, 6948 (34.7%) experienced disenrollment and 586 (2.9%) died during follow-up. The crude rate was 15.3 (95% CI, 14.1-16.6) per 1000 person-years for all-cause mortality and 6.2 (95% CI, 5.4-7.0) per 1000 person-years for overdose mortality. Ever experiencing disenrollment showed elevated all-cause mortality (17.6 [95% CI, 14.9-20.8] vs 14.7 [95% CI, 13.4-16.1] per 1000 person-years) and overdose mortality (8.9 [95% CI, 7.1-11.3] vs 5.4 [95% CI, 4.7-6.3] per 1000 person-years) relative to remaining enrolled. In adjusted analyses, ever experiencing disenrollment was associated with increased hazards of all-cause (hazard ratio [HR], 1.51; 95% CI, 1.23-1.84) and overdose mortality (HR, 1.56; 95% CI, 1.17-2.09). Compared with remaining enrolled and receiving MOUD treatment, being disenrolled (HR, 4.34; 95% CI, 3.19-5.89) and being enrolled and not receiving MOUD treatment (HR, 4.19; 95% CI, 3.24-5.43) were associated with overall mortality.Conclusions and RelevanceIn this cohort study of patients who initiated MOUD, experiencing health plan disenrollment was associated with increased mortality risk compared with remaining enrolled. Strategies are needed to improve continuity of health coverage and mitigate the elevated mortality risk during insurance transitions for patients receiving medications for OUD.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"25 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-04DOI: 10.1001/jamapsychiatry.2026.0037
Lasse Brandt,Michele De Prisco,Daniela Nocera,Marie C Rehm,Sem Cohen,Doga Nur Kosker,Sofia von Luxburg,Dorottya Ori,Justo Pinzón-Espinosa,Pauline Scheuber,Natalie Sonntag,Joaquim Radua,Alkomiet Hasan,Jurjen J Luykx, ,Mazda Adli,Kristina Adorjan,John Jamir Benzon R Aruta,Jura Augustinavicius,Malek Bajbouj,Till Bärnighausen,Marta Bosia,Hilgo Bruining,Joao Mauricio Castaldelli-Maia,Kirsten Catthoor,Eka Chkonia,Geert Dom,Erik Van der Eycken,Andrea Fiorillo,Eva Friedel,Paolo Fusar-Poli,Tomasz M Gondek,Renzo R Guinto,Andreas Heinz,Elke Hertig,Xanthe Hunt,Simone Kühn,Martina Rojnic Kuzman,Emma L Lawrance,Stefan Leucht,Shuyan Liu,Alessandro Massazza,Andreas Meyer-Lindenberg,David Ndetei,René Ernst Nielsen,Tarek Okasha,Lisa Page,Vikram Harshad Patel,Elizabeth Ryznar,Gunter Schumann,Sheikh Shoib,Judit Simon,Heiner Stuke,Tin Tin Su,Paul Summergrad,Jessica Newberry Le Vay,Eduard Vieta,Elias Wagner,Henrik Walter,Siqi Xue
ImportanceClimate change is associated with increasing mental health morbidity and mortality. However, an umbrella review to classify and quantify the global evidence on climate-related and nature-based mental health interventions is lacking.ObjectiveTo assess associations of climate-related and nature-based mental health interventions with mental health outcomes.Data SourcesPubMed, PsycINFO, Web of Science, and Cochrane databases were searched from inception to November 17, 2024.Study SelectionSystematic reviews with meta-analyses (SRMAs) with controlled climate-related or nature-based mental health interventions and mental health outcomes were included.Data Extraction and SynthesisStandardized mean differences (SMDs; intervention vs control) and 95% CIs were synthesized, evidence was stratified according to the level of credibility, and associations were assessed using meta-regression.Main Outcomes and MeasuresOutcomes were mental disorders, psychiatric symptoms, and positive mental health.ResultsTwenty-eight SRMAs were included that examined 344 studies and 91 associations between psychosocial or nature-based interventions and outcomes. Of the 91 associations, 10 (11%) had a moderate credibility of evidence and 81 (89%) had low or very low credibility. Psychosocial interventions addressing climatic impact drivers were associated with very low credibility, based on limited data. Nature-based interventions were associated with reductions in tension (SMD, -0.87; 95% CI, -1.31 to -0.43), fatigue (SMD, -0.80; 95% CI, -1.16 to -0.44), confusion (SMD, -0.65; 95% CI, -1.12 to -0.19), and negative affect (SMD, -0.51; 95% CI, -0.85 to -0.16), as well as increases in positive affect (SMD, 0.98; 95% CI, 0.65 to 1.30), vigor (SMD, 0.83; 95% CI, 0.37 to 1.28), and well-being (SMD, 0.40; 95% CI, 0.07 to 0.73), with moderate credibility of evidence and not addressing climatic impact drivers. Older participants and study locations with lower tree cover, better health care access and quality, and lower systemic vulnerability to climate change were associated with stronger improvements in negative affect following nature-based interventions.Conclusions and RelevanceThere is limited evidence for mental health interventions to reduce adverse mental health impacts of climatic impact drivers, but there is promising potential for future research in this field based on evidence from contexts other than climate change. Currently, strategies for mental health interventions in the context of climate change, such as those for implementing and scaling interventions, need to rely largely on global evidence from contexts other than climate change.
{"title":"Climate-Related and Nature-Based Interventions for Mental Health: An Umbrella Review and Meta-Analysis.","authors":"Lasse Brandt,Michele De Prisco,Daniela Nocera,Marie C Rehm,Sem Cohen,Doga Nur Kosker,Sofia von Luxburg,Dorottya Ori,Justo Pinzón-Espinosa,Pauline Scheuber,Natalie Sonntag,Joaquim Radua,Alkomiet Hasan,Jurjen J Luykx, ,Mazda Adli,Kristina Adorjan,John Jamir Benzon R Aruta,Jura Augustinavicius,Malek Bajbouj,Till Bärnighausen,Marta Bosia,Hilgo Bruining,Joao Mauricio Castaldelli-Maia,Kirsten Catthoor,Eka Chkonia,Geert Dom,Erik Van der Eycken,Andrea Fiorillo,Eva Friedel,Paolo Fusar-Poli,Tomasz M Gondek,Renzo R Guinto,Andreas Heinz,Elke Hertig,Xanthe Hunt,Simone Kühn,Martina Rojnic Kuzman,Emma L Lawrance,Stefan Leucht,Shuyan Liu,Alessandro Massazza,Andreas Meyer-Lindenberg,David Ndetei,René Ernst Nielsen,Tarek Okasha,Lisa Page,Vikram Harshad Patel,Elizabeth Ryznar,Gunter Schumann,Sheikh Shoib,Judit Simon,Heiner Stuke,Tin Tin Su,Paul Summergrad,Jessica Newberry Le Vay,Eduard Vieta,Elias Wagner,Henrik Walter,Siqi Xue","doi":"10.1001/jamapsychiatry.2026.0037","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.0037","url":null,"abstract":"ImportanceClimate change is associated with increasing mental health morbidity and mortality. However, an umbrella review to classify and quantify the global evidence on climate-related and nature-based mental health interventions is lacking.ObjectiveTo assess associations of climate-related and nature-based mental health interventions with mental health outcomes.Data SourcesPubMed, PsycINFO, Web of Science, and Cochrane databases were searched from inception to November 17, 2024.Study SelectionSystematic reviews with meta-analyses (SRMAs) with controlled climate-related or nature-based mental health interventions and mental health outcomes were included.Data Extraction and SynthesisStandardized mean differences (SMDs; intervention vs control) and 95% CIs were synthesized, evidence was stratified according to the level of credibility, and associations were assessed using meta-regression.Main Outcomes and MeasuresOutcomes were mental disorders, psychiatric symptoms, and positive mental health.ResultsTwenty-eight SRMAs were included that examined 344 studies and 91 associations between psychosocial or nature-based interventions and outcomes. Of the 91 associations, 10 (11%) had a moderate credibility of evidence and 81 (89%) had low or very low credibility. Psychosocial interventions addressing climatic impact drivers were associated with very low credibility, based on limited data. Nature-based interventions were associated with reductions in tension (SMD, -0.87; 95% CI, -1.31 to -0.43), fatigue (SMD, -0.80; 95% CI, -1.16 to -0.44), confusion (SMD, -0.65; 95% CI, -1.12 to -0.19), and negative affect (SMD, -0.51; 95% CI, -0.85 to -0.16), as well as increases in positive affect (SMD, 0.98; 95% CI, 0.65 to 1.30), vigor (SMD, 0.83; 95% CI, 0.37 to 1.28), and well-being (SMD, 0.40; 95% CI, 0.07 to 0.73), with moderate credibility of evidence and not addressing climatic impact drivers. Older participants and study locations with lower tree cover, better health care access and quality, and lower systemic vulnerability to climate change were associated with stronger improvements in negative affect following nature-based interventions.Conclusions and RelevanceThere is limited evidence for mental health interventions to reduce adverse mental health impacts of climatic impact drivers, but there is promising potential for future research in this field based on evidence from contexts other than climate change. Currently, strategies for mental health interventions in the context of climate change, such as those for implementing and scaling interventions, need to rely largely on global evidence from contexts other than climate change.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"27 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-04DOI: 10.1001/jamapsychiatry.2026.0322
{"title":"Error in Conflict of Interest Disclosures and Funding/Support.","authors":"","doi":"10.1001/jamapsychiatry.2026.0322","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.0322","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"31 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01DOI: 10.1001/jamapsychiatry.2025.4303
Victor M Castro, Thomas H McCoy, Pilar Verhaak, Anudeepa Ramachandiran, Roy H Perlis
Importance: Despite increasingly widespread use of artificial intelligence (AI)-driven ambient scribes in medicine, the extent to which they are associated with clinician practice is not well studied.
Objective: To characterize differences in documentation and treatment of psychiatric symptoms in primary care outpatient notes generated using ambient scribes compared with human or no scribes.
Design, setting, and participants: This cohort study used a matched retrospective case-control design to evaluate primary care annual visit notes from the Massachusetts General and Brigham and Women's Hospital systems between February 2023 and February 2025. A random sample of notes from 4 types of visits, matched 1:1 using sociodemographic and clinical features, was used: those using an ambient scribe, those using a human scribe, those occurring during the same period without a scribe (contemporaneous), and those occurring prior to scribe deployment. Data analysis was performed from April 25 to May 1, 2025.
Exposure: Use of an AI ambient scribe.
Main outcomes and measures: Neuropsychiatric symptom documentation, in terms of estimated Research Domain Criteria (RDoC), using a Health Insurance Portability and Accountability Act-compliant large language model (GPT-4o version gpt-4o-11-20; OpenAI); antidepressant prescriptions and diagnostic codes; and referral for mental health follow-up.
Results: Among 20 302 notes, the mean (SD) age of the patients was 48 (14) years and 11 960 (59%) were for visits by female patients; 1026 (5%) met criteria for moderate or greater depressive symptoms by Patient Health Questionnaire-9 score. Estimated levels of RDoC symptoms in all 6 domains were significantly greater in the AI-scribed notes compared with other groups. In a multiple logistic regression model, likelihood of a psychiatric intervention (referral, new diagnosis, or antidepressant prescription) was significantly lower among AI-scribed visits compared with contemporaneous unscribed visits (adjusted odds ratio, 0.83; 95% CI, 0.72-0.95), but not for human-scribed visits compared with contemporaneous unscribed visits (adjusted odds ratio, 0.97; 95% CI, 0.85-1.11).
Conclusions and relevance: In this retrospective cohort study using a matched case-control design examining outpatient primary care notes, incorporation of AI ambient scribes in primary care was associated with greater levels of neuropsychiatric symptom documentation but lesser likelihood of documented management of psychiatric symptoms. Further study will be required to determine whether these changes are associated with differential outcomes.
{"title":"Psychiatric Documentation and Management in Primary Care With Artificial Intelligence Scribe Use.","authors":"Victor M Castro, Thomas H McCoy, Pilar Verhaak, Anudeepa Ramachandiran, Roy H Perlis","doi":"10.1001/jamapsychiatry.2025.4303","DOIUrl":"10.1001/jamapsychiatry.2025.4303","url":null,"abstract":"<p><strong>Importance: </strong>Despite increasingly widespread use of artificial intelligence (AI)-driven ambient scribes in medicine, the extent to which they are associated with clinician practice is not well studied.</p><p><strong>Objective: </strong>To characterize differences in documentation and treatment of psychiatric symptoms in primary care outpatient notes generated using ambient scribes compared with human or no scribes.</p><p><strong>Design, setting, and participants: </strong>This cohort study used a matched retrospective case-control design to evaluate primary care annual visit notes from the Massachusetts General and Brigham and Women's Hospital systems between February 2023 and February 2025. A random sample of notes from 4 types of visits, matched 1:1 using sociodemographic and clinical features, was used: those using an ambient scribe, those using a human scribe, those occurring during the same period without a scribe (contemporaneous), and those occurring prior to scribe deployment. Data analysis was performed from April 25 to May 1, 2025.</p><p><strong>Exposure: </strong>Use of an AI ambient scribe.</p><p><strong>Main outcomes and measures: </strong>Neuropsychiatric symptom documentation, in terms of estimated Research Domain Criteria (RDoC), using a Health Insurance Portability and Accountability Act-compliant large language model (GPT-4o version gpt-4o-11-20; OpenAI); antidepressant prescriptions and diagnostic codes; and referral for mental health follow-up.</p><p><strong>Results: </strong>Among 20 302 notes, the mean (SD) age of the patients was 48 (14) years and 11 960 (59%) were for visits by female patients; 1026 (5%) met criteria for moderate or greater depressive symptoms by Patient Health Questionnaire-9 score. Estimated levels of RDoC symptoms in all 6 domains were significantly greater in the AI-scribed notes compared with other groups. In a multiple logistic regression model, likelihood of a psychiatric intervention (referral, new diagnosis, or antidepressant prescription) was significantly lower among AI-scribed visits compared with contemporaneous unscribed visits (adjusted odds ratio, 0.83; 95% CI, 0.72-0.95), but not for human-scribed visits compared with contemporaneous unscribed visits (adjusted odds ratio, 0.97; 95% CI, 0.85-1.11).</p><p><strong>Conclusions and relevance: </strong>In this retrospective cohort study using a matched case-control design examining outpatient primary care notes, incorporation of AI ambient scribes in primary care was associated with greater levels of neuropsychiatric symptom documentation but lesser likelihood of documented management of psychiatric symptoms. Further study will be required to determine whether these changes are associated with differential outcomes.</p>","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"281-286"},"PeriodicalIF":17.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12824846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：