Journal of affective disorders最新文献_第2页

Management of insomnia symptoms in depressed patients treated with agomelatine, mirtazapine and trazodone: A systematic review and meta-analysis 阿戈美拉汀、米氮平和曲唑酮治疗抑郁症患者失眠症状的管理：一项系统回顾和荟萃分析

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Journal of affective disorders

Pub Date : 2026-06-01 Epub Date: 2026-02-10 DOI: 10.1016/j.jad.2026.121378

Xusheng Zhang , Yang Chen , Renhao Deng , Shiwan Tao , Min Zou , Qiang Wang

Background and purpose

Insomnia is a common symptom in depressive disorder, affecting up to 80% of those patients. Evidences suggest that sleep symptom improvements could alleviating depressive symptoms and reducing relapse. This article evaluated the efficacy of three antidepressants—agomelatine, mirtazapine, and trazodone—in treating insomnia symptoms in depressed patients, with a focus on polysomnographic (PSG) data, subjective sleep experience, improvement in depressive symptoms, and adverse drug reactions.

Methods

A systematic search of PubMed, Cochrane Library, MEDLINE, Embase, and Web of Science was conducted for studies published from 1974 to August 2025; 30 studies (16 randomized controlled trials and 14 non-randomized controlled trials) were included. The primary outcomes were PSG measures; secondary outcomes included PSQI and HAMD scores, as well as adverse medication reactions.

Results

The PSG results showed that agomelatine may not significantly change percentage N1 of sleep period time (N1%) and Latency of REM sleep (L-REM). Mirtazapine significantly increased total sleep time (TST), slow-wave sleep of sleep period time (SWS%), and sleep efficiency (SE%), while reducing percentage wake after sleep onset of sleep period time (WASO%). Trazodone notably improved TST, and SE%. For adverse effects, agomelatine was well-tolerated; mirtazapine commonly caused weight gain and sedation; and trazodone frequently led to dizziness, sedation, headache, nausea, and somnolence.

Conclusion

All three medications significantly enhance subjective sleep perception and alleviate depressive symptoms. However, agomelatine may lack a definitive effect on improving objective sleep parameters in depressed patients. Future studies should involve larger, high-quality trials with unified methodologies to strengthen the reliability of conclusions.

背景与目的：失眠是抑郁症的常见症状，影响到80%的抑郁症患者。有证据表明，改善睡眠症状可以减轻抑郁症状，减少复发。本文评估了三种抗抑郁药——阿戈美拉汀、米氮平和曲唑酮治疗抑郁症患者失眠症状的疗效，重点关注了多导睡眠图（PSG）数据、主观睡眠体验、抑郁症状的改善和药物不良反应。方法：系统检索PubMed、Cochrane Library、MEDLINE、Embase和Web of Science，检索1974年至2025年8月间发表的研究；纳入30项研究（16项随机对照试验和14项非随机对照试验）。主要结局为PSG测量；次要结局包括PSQI和HAMD评分，以及药物不良反应。结果：PSG结果显示阿戈美拉汀对睡眠时间N1百分比（N1%）和快速眼动睡眠潜伏期（L-REM）无显著影响。米氮平显著增加了总睡眠时间（TST）、慢波睡眠时间（SWS%）和睡眠效率（SE%），同时降低了睡眠后醒觉率（WASO%）。曲唑酮显著改善TST和SE%。对于不良反应，阿戈美拉汀耐受性良好；米氮平通常会导致体重增加和镇静；曲唑酮常导致头晕、镇静、头痛、恶心和嗜睡。结论：三种药物均能显著增强主观睡眠知觉，减轻抑郁症状。然而，阿戈美拉汀在改善抑郁症患者客观睡眠参数方面可能缺乏明确的效果。未来的研究应采用统一的方法进行更大规模、高质量的试验，以加强结论的可靠性。

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引用次数: 0

Maternal antenatal depression and offspring DNA methylation 母亲产前抑郁与后代DNA甲基化。

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Journal of affective disorders

Pub Date : 2026-06-01 Epub Date: 2026-02-07 DOI: 10.1016/j.jad.2026.121335

Diane L. Putnick , Akhgar Ghassabian , Weihua Guan , Pauline Mendola , Rajeshwari Sundaram , Edwina Yeung

Objective

Research on the link between antenatal depression and alterations in offspring DNA methylation is sparse and inconsistent. This study aimed to provide a robust and rigorous test of the association between maternal antenatal depression and offspring DNA methylation in neonatal and middle childhood (8–10 years) periods.

Methods

Moderate to severe maternal antenatal depression was identified via a combination of diagnosis codes from outpatient and inpatient encounters during pregnancy and self-reported symptom severity on birth certificates. Offspring DNA methylation was quantified from dried blood spot and venous blood samples in the neonatal and middle childhood periods, respectively.

Results

Of 733 mothers with available data in the neonatal period, 53 (7%) experienced moderate to severe antenatal depression. In middle childhood, 15 (9%) of the 161 mothers with available data experienced moderate to severe antenatal depression. In the neonatal period, no probes passed false discovery rate (FDR) correction. In middle childhood, antenatal depression was associated with hypomethylation at two probes after adjustment and FDR correction: cg06112204 (in MAD1L1; β = −1.68, SE = 0.29) and cg17830140 (in POLRMT, β = −1.94, SE = 0.36). Both probes had a similar direction and magnitude when controlling for postnatal depression (β = −1.71, SE = 0.34 and β = −1.78, SE = 0.42, respectively). cg06112204 was also hypomethylated in the neonatal sample (β = −0.49, SE = 0.21), but cg17830140 was not (β = 0.07, SE = 0.22).

Conclusions

Methylation of other probes in the MAD1L1 gene have previously been associated with depression phenotypes in adolescents and adults, lending credibility to the finding that antenatal depression is associated with hypomethylation of cg06112204 in offspring.

目的：关于产前抑郁与后代DNA甲基化改变之间关系的研究很少且不一致。本研究旨在为新生儿和儿童中期（8-10 年）期间母亲产前抑郁与后代DNA甲基化之间的关系提供一个强大而严格的测试。方法：通过结合怀孕期间门诊和住院患者的诊断代码以及出生证明上自我报告的症状严重程度来确定中度至重度产妇产前抑郁。分别从新生儿和儿童中期的干血斑和静脉血样本中定量测定子代DNA甲基化。结果：在新生儿期733名母亲中，53名（7%）经历了中度至重度产前抑郁。在儿童中期，有数据的161名母亲中有15名（9%）经历过中度至重度产前抑郁。在新生儿期，没有探针通过错误发现率（FDR）校正。在儿童中期，经调整和FDR校正后，产前抑郁与两个探针的低甲基化相关：cg06112204（在MAD1L1中，β = -1.68,SE = 0.29）和cg17830140（在POLRMT中，β = -1.94,SE = 0.36）。在控制产后抑郁时，两种探针的方向和幅度相似（β = -1.71,SE = 0.34,β = -1.78,SE = 0.42）。cg06112204在新生儿样本中也存在低甲基化（β = -0.49,SE = 0.21），而cg17830140不存在低甲基化（β = 0.07,SE = 0.22）。结论：MAD1L1基因中其他探针的甲基化先前与青少年和成人的抑郁表型相关，这为产前抑郁与后代cg06112204的低甲基化相关的发现提供了可信度。

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引用次数: 0

Disentangling PTSD and MDD: Examining temporal changes in symptoms during trauma-focused treatment 分离创伤后应激障碍和重度抑郁症：在创伤集中治疗期间检查症状的时间变化

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Journal of affective disorders

Pub Date : 2026-06-01 Epub Date: 2026-02-05 DOI: 10.1016/j.jad.2026.121355

Alexander C. Kline , Juan Diego Vera , Laura D. Crocker , Allison L. Baier , Nicholas P. Otis , Hayley C. Myers , Lisa H. Glassman , W. Michael Hunt , Kristen H. Walter

Major depressive disorder (MDD) frequently co-occurs with posttraumatic stress disorder (PTSD), yet little is known about the sequence of symptom changes in trauma-focused treatment for individuals with this comorbidity. This study used disaggregated cross-lagged multilevel models to examine the temporal relationships between PTSD and depression symptom change in a randomized clinical trial comparing cognitive processing therapy (CPT) and CPT enhanced with behavioral activation (BA+CPT). The sample included 78 U.S. active duty service members with comorbid PTSD and MDD. Symptoms were assessed weekly at each session. To reduce collinearity between PTSD and depression, models examined core PTSD symptoms (e.g., several intrusion and avoidance symptoms previously identified) and cognitive-affective and somatic depression symptom clusters. Core PTSD and depression symptom clusters demonstrated strong, bidirectional between-person effects (ds = 1.21 to 1.46), indicating that lower core PTSD scores relative to other participants were associated with subsequent lower scores in depression scores, and vice versa. For within-person effects, lagged effects of core PTSD symptoms significantly predicted subsequent reductions in cognitive-affective (d = 0.51) and somatic (d = 0.32) depression scores, indicating that when a participant's core PTSD symptoms decreased relative to their average score, both clusters of depression symptoms also decreased at the next session. However, the inverse relationships were not significant (ds = −0.03 to 0.10). Treatment condition did not moderate lagged relationships across all models. Among service members with comorbid PTSD and MDD, addressing PTSD symptoms may be more important for achieving downstream reductions in depression than vice versa.

重度抑郁障碍（MDD）经常与创伤后应激障碍（PTSD）共同发生，然而，对于患有这种共病的个体，以创伤为重点的治疗中症状变化的顺序知之甚少。本研究通过比较认知加工疗法（CPT）和行为激活强化CPT （BA+CPT）的随机临床试验，采用分解交叉滞后多水平模型研究PTSD与抑郁症状变化之间的时间关系。样本包括78名患有PTSD和重度抑郁症的美国现役军人。在每次治疗中，每周对症状进行评估。为了减少创伤后应激障碍和抑郁之间的共线性，模型检查了核心创伤后应激障碍症状（例如，先前确定的几种入侵和回避症状）和认知-情感和躯体抑郁症状群。核心PTSD和抑郁症状集群表现出强烈的双向人际效应（ds = 1.21至1.46），表明相对于其他参与者较低的核心PTSD得分与随后较低的抑郁得分相关，反之亦然。对于人体内的影响，核心PTSD症状的滞后效应显著地预测了随后认知-情感（d = 0.51）和躯体（d = 0.32）抑郁得分的降低，这表明当参与者的核心PTSD症状相对于他们的平均得分下降时，两组抑郁症状在下一个疗程中也会下降。然而，负相关关系不显著（ds = - 0.03 ~ 0.10）。在所有模型中，治疗条件都没有适度的滞后关系。在同时患有PTSD和MDD的服役人员中，解决PTSD症状对于实现抑郁的下游减少可能比反之更重要。

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引用次数: 0

Hippocampal volume trajectory and its relation to clinical course during and following ECT-treatment in patients with depression: A systematic review and meta-analysis 抑郁症患者ect治疗期间和之后海马体积轨迹及其与临床病程的关系：一项系统回顾和荟萃分析。

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Journal of affective disorders

Pub Date : 2026-06-01 Epub Date: 2026-02-05 DOI: 10.1016/j.jad.2026.121344

Tobias Bracht , Lara Köhler , Mario Pfammatter , Niklaus Denier , Leila M. Soravia , Kristina Adorjan , Daniela Hubl , Bogdan Draganski , Sebastian Olbrich , Annette Brühl , Gianluca A. Florineth

Background

Neuroimaging studies in humans and translational animal models consistently demonstrate ECT-induced hippocampal volume increases. However, evidence linking hippocampal volume changes to clinical improvement in depression has been inconsistent. This systematic review with meta-analysis extends previous work to investigate whether hippocampal volume changes following the completion of an ECT-index series are associated with the clinical course of depression.

Methods

We conducted a systematic review and meta-analysis following PRISMA guidelines. Studies were eligible if they assessed hippocampal volume and included at least three imaging timepoints, with two performed after completion of the ECT-index series (t1 = pre-ECT, t2 = post-ECT, t3 = follow-up). Standardized mean change (SMC) was calculated for hippocampal volume and depressive symptom severity across timepoints. Pooled estimates were derived using random-effects models with restricted maximum likelihood (REML) estimation to account for between-study heterogeneity. Meta-regression analyses were performed to evaluate associations between volumetric changes and trajectories of depressive symptoms post-ECT.

Results

Fifteen studies (N = 447 patients) were included in the systematic review, with six studies (N = 151 patients) contributing complete volumetric data for meta-analysis. Hippocampal volumes increased significantly from t1 to t2 and largely returned to baseline at t3. Depression severity decreased substantially from t1 to t2 and remained stable at follow-up. Meta-regression analyses indicated no significant associations between changes of hippocampal volume and depressive symptoms from post-ECT to follow-up. Sensitivity analyses confirmed robustness of the findings.

Conclusions

Hippocampal volume increases following ECT are transient and not associated with the clinical course of depression.

背景：人类和转化动物模型的神经影像学研究一致表明ect诱导海马体积增加。然而，将海马体积变化与抑郁症临床改善联系起来的证据并不一致。本系统综述与荟萃分析扩展了之前的工作，以调查完成ect指数系列后海马体积变化是否与抑郁症的临床病程相关。方法：我们按照PRISMA指南进行了系统回顾和荟萃分析。如果评估海马体积并包括至少三个成像时间点，其中两个在ect指数系列完成后进行（t1 = ect前，t2 = ect后，t3 = 随访），则研究符合条件。计算各时间点海马体积和抑郁症状严重程度的标准化平均变化（SMC）。合并估计是使用随机效应模型和限制最大似然（REML）估计得出的，以解释研究间的异质性。进行meta回归分析以评估ect后体积变化与抑郁症状轨迹之间的关系。结果：系统评价纳入了15项研究（N = 447例患者），其中6项研究（N = 151例患者）为meta分析提供了完整的容量数据。海马体积从t1到t2显著增加，并在t3时基本恢复到基线。抑郁症严重程度从t1到t2显著下降，并在随访时保持稳定。meta回归分析显示，从ect后到随访，海马体积变化与抑郁症状之间无显著关联。敏感性分析证实了研究结果的稳健性。结论：ECT后海马体积增加是短暂的，与抑郁症的临床病程无关。

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引用次数: 0

Transdiagnostic emotional profiles in at-risk Spanish adolescents: A latent profile analysis 高危西班牙青少年的跨诊断情绪概况：一项潜在概况分析。

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Journal of affective disorders

Pub Date : 2026-06-01 Epub Date: 2026-02-05 DOI: 10.1016/j.jad.2026.121315

Alfonso Pérez-Esteban , Adriana Díez-Gómez , Beatriz Lucas Molina , Alicia Pérez-Albéniz , Eduardo Fonseca-Pedrero

The transdiagnostic approach to psychopathology offers an alternative to traditional nosology by focusing on shared dimensions across emotional disorders. The Multidimensional Emotional Disorders Inventory (MEDI) operationalizes a prominent transdiagnostic model, yet evidence in adolescent community samples remains limited. This study aimed to identify latent transdiagnostic profiles of emotional symptomatology in at-risk adolescents using MEDI and to test their external validity with indicators of mental health and psychosocial functioning. A total of 582 adolescents (73.4% female; M = 13.8 years, SD = 1.4, range 11–18) were selected from a community screening of 8746 students. Latent profile analysis (LPA) was conducted on the nine MEDI dimensions, and the Bolck–Croon–Hagenaars (BCH) method compared profiles on depressive and anxiety symptoms, emotional/behavioral difficulties, suicidal behavior, self-esteem, social support, and quality of life. Two complementary solutions emerged: a three-profile solution (Low Risk, Mild Risk, High Risk) reflecting severity gradients, and a five-profile solution (Low Risk, Mild Risk, Anxious–Traumatic, Socially Inhibited–Depressed, High Comorbid Risk) capturing more differentiated phenotypic configurations. Both solutions showed significant between-profile differences on all external indicators. In the three-profile model, High and Mild Risk groups reported lower self-esteem and quality of life than Low Risk. In the five-profile model, High Comorbid Risk and Socially Inhibited–Depressed showed the highest distress and suicidality, whereas Anxious–Traumatic preserved positive affect and relatively better functioning. Findings support the utility of MEDI for deriving clinically meaningful transdiagnostic profiles in adolescents, with implications for early detection, risk stratification, and the development of modular transdiagnostic interventions tailored to subgroup needs.

精神病理学的跨诊断方法通过关注情感障碍的共同维度，为传统的分类学提供了一种选择。多维情绪障碍量表（MEDI）运作了一个突出的跨诊断模型，但在青少年社区样本中的证据仍然有限。本研究旨在利用MEDI识别高危青少年情绪症状的潜在跨诊断特征，并通过心理健康和社会心理功能指标测试其外部有效性。在社区筛查8746名学生中，共选择582名青少年（73.4%为女性；M = 13.8 岁，SD = 1.4，范围11-18）。对9个MEDI维度进行潜在特征分析（LPA），并采用Bolck-Croon-Hagenaars （BCH）方法比较抑郁和焦虑症状、情绪/行为困难、自杀行为、自尊、社会支持和生活质量的特征。出现了两种互补的解决方案：反映严重程度梯度的三种解决方案（低风险、轻度风险、高风险），以及捕获更多分化表型配置的五种解决方案（低风险、轻度风险、焦虑-创伤、社交抑制-抑郁、高共病风险）。两种解决方案在所有外部指标上都显示出显著差异。在三轮廓模型中，高风险组和轻度风险组报告的自尊和生活质量低于低风险组。在五轮廓模型中，高合并症患者和社会抑制抑郁患者表现出最高的痛苦和自杀倾向，而焦虑创伤患者则保留了积极情绪和相对较好的功能。研究结果支持MEDI在获得青少年临床有意义的跨诊断概况方面的效用，这对早期发现、风险分层和针对亚组需求量身定制的模块化跨诊断干预措施的发展具有重要意义。

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引用次数: 0

Association between selective serotonin reuptake inhibitors and 28-day in-hospital mortality in critically ill patients with depression: A cohort study stratified by exposure timing 选择性5 -羟色胺再摄取抑制剂与抑郁症危重患者住院28天死亡率之间的关系：一项按暴露时间分层的队列研究

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Journal of affective disorders

Pub Date : 2026-06-01 Epub Date: 2026-02-05 DOI: 10.1016/j.jad.2026.121332

Jian-Dong Niu , Juan Yang , Zhong-Yi He , Tao Wang

Background

Selective serotonin reuptake inhibitors (SSRIs) have reported immunomodulatory effects. Whether SSRI exposure is associated with short-term survival among critically ill patients with comorbid depression, and whether associations differ by exposure timing, remains uncertain.

Methods

We performed a retrospective cohort study using MIMIC-IV. SSRI exposure was modeled as a time-varying covariate in time-dependent Cox models with landmark analyses. Patients were categorized as pre-ICU maintenance users versus post-ICU initiators. Propensity-score methods were used to improve baseline comparability. As a sensitivity analysis among SSRI-naïve patients, we applied a sequential-trials stabilized IPTW marginal structural model incorporating lagged severity measures.

Results

Among 8033 patients, overall SSRI exposure showed no clear association with 28-day mortality. Associations differed by exposure pattern: post-ICU initiation was associated with a lower mortality signal (adjusted HR = 0.39, 95% CI 0.25–0.62; p < 0.0001), whereas maintenance use showed no survival advantage versus non-use. Post-ICU initiators also had lower mortality than maintenance users (adjusted HR = 0.35, 95% CI 0.21–0.57; p < 0.0001). Agent-specific findings were exploratory; fluoxetine showed the strongest association (HR = 0.28, 95% CI 0.12–0.67; p < 0.0001). In sequential-trials IPTW–MSM analyses, initiation was associated with lower standardized 28-day risk (8.25% vs 5.45%; RD = −2.80%).

Conclusion

In ICU patients with comorbid depression, overall SSRI exposure was not clearly associated with 28-day mortality after time-aligned analyses. A lower mortality signal was observed for post-ICU initiation, whereas pre-ICU maintenance use showed no survival advantage. These findings are hypothesis-generating and warrant prospective confirmation.

背景：选择性血清素再摄取抑制剂（SSRIs）有免疫调节作用的报道。SSRI暴露是否与合并抑郁症的危重患者的短期生存相关，以及暴露时间是否存在差异，目前仍不确定。方法：我们使用MIMIC-IV进行回顾性队列研究。SSRI暴露在具有里程碑分析的时变Cox模型中被建模为时变协变量。患者分为icu前维持使用者和icu后启动者。倾向评分法用于提高基线可比性。作为SSRI-naïve患者的敏感性分析，我们应用了一个序列试验稳定的IPTW边际结构模型，该模型包含滞后的严重程度测量。结果：8033例患者中，总体SSRI暴露与28天死亡率无明显关联。暴露模式不同，相关关系也不同：ICU后开始与较低的死亡率信号相关（调整后危险度 = 0.39,95% CI 0.25-0.62; p ）结论：在合并抑郁症的ICU患者中，经时间序列分析，SSRI暴露总体与28天死亡率无明显关联。icu后开始使用的死亡率较低，而icu前维持使用没有生存优势。这些发现是假设产生和保证预期的确认。

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引用次数: 0

Preference for solitude modulates anterior insula responses to social exclusion 独处偏好调节前脑岛对社会排斥的反应。

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Journal of affective disorders

Pub Date : 2026-06-01 Epub Date: 2026-01-26 DOI: 10.1016/j.jad.2026.121287

Ryota Sakurai , Rui Watanabe , Hironobu Kuruma

Background

Social exclusion is a distressing human experience; however, individual differences in the preference for solitude (PS) may shape how social pain is processed. This study examined neural responses to social exclusion among solitude-preferring individuals, focusing on the anterior cingulate cortex (ACC) and anterior insula (aINS), regions consistently implicated in social pain.

Methods

Forty healthy participants completed functional MRI scanning during the Cyberball task in which they experienced exclusion. Subsequently, participants reported their task-related distress. They were also assessed for mental health and PS, and stratified into low and high PS groups.

Results

Compared to individuals with low PS, those with high PS reported significantly higher depressive symptoms and loneliness scores. Neuroimaging revealed significant deactivation of the left aINS among participants with high PS during exclusion. Functional connectivity analyses further showed enhanced coupling between the left aINS and the bilateral secondary somatosensory cortices. Notably, among participants with high PS, ACC activity was positively associated with perceived distress during exclusion.

Conclusions

Our findings suggest that solitude-preferring individuals suppress the emotional appraisal of exclusion, as reflected by attenuated insular responses, while maintaining heightened internal sensitivity through the ACC. Strengthened coupling between the insula and somatosensory cortices suggests a shift toward sensory–discriminative processing, representing an adaptive yet costly regulation strategy that reduces overt affective responses but preserves the internal experience of social pain. This neural pattern may not reflect resilience but rather a reduced emotional valuation of social stimuli, possibly linked to elevated anxiety and depressive tendencies commonly associated with solitude preference.

背景：社会排斥是一种痛苦的人类经历；然而，对独处的偏好（PS）的个体差异可能会影响社会痛苦的处理方式。本研究考察了偏好孤独的个体对社会排斥的神经反应，重点关注了前扣带皮层（ACC）和前岛叶（aINS），这两个区域一直与社交疼痛有关。方法：40名健康参与者在赛博球任务期间完成了功能MRI扫描，他们经历了排斥。随后，参与者报告了他们与任务相关的痛苦。他们还被评估了心理健康和PS，并被分为低和高PS组。结果：与低PS个体相比，高PS个体报告的抑郁症状和孤独得分显著高于低PS个体。神经影像学显示，在排除过程中，高PS参与者的左侧ais明显失活。功能连通性分析进一步表明，左侧ais和双侧第二体感觉皮质之间的耦合增强。值得注意的是，在高PS的参与者中，ACC活动与被排斥期间的感知痛苦呈正相关。结论：我们的研究结果表明，偏爱孤独的个体抑制了对排斥的情绪评价，这反映在减弱的岛岛反应上，同时通过前扣带皮层保持了较高的内部敏感性。脑岛和体感觉皮层之间的加强耦合表明了一种向感觉辨别加工的转变，这是一种适应性但代价高昂的调节策略，它减少了明显的情感反应，但保留了社会痛苦的内在体验。这种神经模式可能并不反映适应力，而是反映了对社会刺激的情感评价降低，可能与通常与孤独偏好相关的焦虑和抑郁倾向升高有关。

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引用次数: 0

Depressive symptoms as a risk factor for postoperative delirium in older adults: A systematic review and meta-analysis 抑郁症状是老年人术后谵妄的危险因素：一项系统回顾和荟萃分析

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Journal of affective disorders

Pub Date : 2026-06-01 Epub Date: 2026-02-11 DOI: 10.1016/j.jad.2026.121371

Dimitrios Adamis , Jan Willem van Dalen , Piet Eikelenboom

Background

Post-operative delirium (POD) in older adults may be linked to preoperative depression via shared biological pathways. This review synthesizes current findings, highlights methodological gaps and suggests possible pathophysiological mechanisms.

Methods

Searches across major databases identified eligible studies using validated tools. Standardized mean differences (SMD) and log odds ratios were pooled using random-effects models. Heterogeneity, moderators, and publication bias were assessed using meta-regression and sensitivity analyses in R (metafor package).

Results

This meta-analysis synthesized findings from 42 studies examining the association between preoperative depression and postoperative delirium (POD), analysing categorical (k = 16) and continuous (k = 26) reported depression data from 9701 patients. Preoperative depression was significantly associated with increased POD risk (OR = 2.50, 95% CI: 1.90–3.28; SMD = 0.49, 95% CI: 0.26–0.73 after outlier removal). Surgical cohort type and depression assessment tools significantly moderated this association. Cognition evaluated by the MMSE did not significantly influence outcomes. Geriatric depression scale (GDS-15) emerged as a consistent predictor, prompting further investigation into optimal cutoff scores for POD risk stratification. Publication bias and heterogeneity were low to moderate.

Discussion

This meta-analysis confirms preoperative depression, including subclinical symptoms, as a significant predictor of POD. Findings highlight the roles of surgical type and depressive symptoms, suggesting tailored screening and further research into symptom-specific risk pathways.

Conclusion

Preoperative depression predicts POD. Notably, even GDS-15 scores below the conventional cutoff for depression were associated with increased delirium risk. This finding requires further investigation, including exploration of potential underlying mechanisms such as vascular or other symptom-specific pathways.

背景：老年人术后谵妄（POD）可能通过共同的生物学途径与术前抑郁有关。这篇综述综合了目前的发现，突出了方法学上的差距，并提出了可能的病理生理机制。方法在主要数据库中搜索，使用经过验证的工具确定符合条件的研究。标准化平均差异（SMD）和对数比值比采用随机效应模型合并。异质性、调节因子和发表偏倚采用R （meta-regression package）中的meta-regression和敏感性分析进行评估。本荟萃分析综合了42项研究的结果，研究了术前抑郁和术后谵妄（POD）之间的关系，分析了9701例患者的分类（k = 16）和连续（k = 26）报告的抑郁数据。术前抑郁与POD风险增加显著相关（OR = 2.50, 95% CI: 1.90-3.28; SMD = 0.49, 95% CI: 0.26-0.73）。手术队列类型和抑郁评估工具显著调节了这种关联。MMSE评估的认知对结果没有显著影响。老年抑郁量表（GDS-15）作为一致的预测因子出现，促使进一步研究POD风险分层的最佳临界值。发表偏倚和异质性为低至中等。本荟萃分析证实术前抑郁，包括亚临床症状，是POD的重要预测因子。研究结果强调了手术类型和抑郁症状的作用，建议对特定症状的风险途径进行针对性筛查和进一步研究。结论术前抑郁可预测POD。值得注意的是，即使GDS-15得分低于抑郁症的常规临界值，谵妄风险也会增加。这一发现需要进一步调查，包括探索潜在的潜在机制，如血管或其他症状特异性途径。

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引用次数: 0

Mental health risk factors for psychological disorders after COVID-19 infection: A systematic review and meta-analysis COVID-19感染后心理障碍的心理健康危险因素：系统综述和荟萃分析

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Journal of affective disorders

Pub Date : 2026-06-01 Epub Date: 2026-02-11 DOI: 10.1016/j.jad.2026.121377

Tiffany Milligan, Reshmi Nair, Kiriana Cowansage, Courtney Boyd, Maria A. Morgan, Daniel Kotzab, Dawn M. Bellanti, Lisa M. Shank, Dan E. Berman, Sharmila Chari, Daniel P. Evatt, Marija S. Kelber

The coronavirus disease 2019 (COVID-19) global pandemic was a time of uncertainty and rapid change that has had demonstrable effects on the mental health of those who experienced it. For individuals who contracted the illness, some types of risk factors for adverse mental health post-COVID have been examined (e.g., demographics), but how pre-COVID psychiatric risk factors may have contributed to worsened outcomes has not been systematically evaluated. This systematic review and meta-analysis examines mental health risk factors (e.g., general psychiatric history, trauma history) for depression, anxiety, posttraumatic stress disorder (PTSD), and adjustment disorder in individuals after resolution of acute COVID-19 infection. We searched three databases (PubMed, PsycInfo, Scopus) and included 27 studies (15 cohort, 12 cross-sectional). Studies were dually extracted and assessed for quality. We conducted meta-analyses by study design and outcome for the risk factor of a general psychiatric history. Medium-to-large effect sizes were found for psychiatric history on post-COVID infection depression, anxiety, and PTSD. No studies examined adjustment disorder as an outcome. Studies of mental health risk factors that could not be incorporated into the meta-analyses (e.g., history of trauma) showed small-to-large effect sizes on post-COVID mental health. These results consistently show that mental health factors predict worse psychological health after acute COVID-19 infection. More robust study designs would improve this body of research.

2019年冠状病毒病（COVID-19）全球大流行是一个充满不确定性和快速变化的时期，对患者的心理健康产生了明显影响。对于感染该疾病的个体，已经检查了covid后不良心理健康的某些类型的风险因素（例如人口统计学），但尚未系统评估covid前的精神风险因素如何导致恶化的结果。本系统综述和荟萃分析探讨了急性COVID-19感染消退后个体的抑郁、焦虑、创伤后应激障碍（PTSD）和适应障碍的心理健康风险因素（如一般精神病史、创伤史）。我们检索了三个数据库（PubMed, PsycInfo, Scopus），纳入了27项研究（15项队列研究，12项横断面研究）。对研究进行了双重提取和质量评估。我们通过研究设计和结果对一般精神病史的危险因素进行了荟萃分析。精神病史对covid感染后抑郁、焦虑和创伤后应激障碍的影响为中大型效应。没有研究将适应障碍作为结果。对无法纳入荟萃分析的心理健康风险因素（例如创伤史）的研究显示，对covid后心理健康的影响大小不等。这些结果一致表明，心理健康因素预测急性COVID-19感染后心理健康状况恶化。更可靠的研究设计将改善这一研究体系。

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引用次数: 0

Neurochemical and neurophysiological glutamatergic correlates in adolescents with depression: An exploratory ultra-high field magnetic resonance spectroscopy and transcranial magnetic stimulation study 青少年抑郁症的神经化学和神经生理谷氨酸能相关性：一项探索性超高场磁共振波谱和经颅磁刺激研究。

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Journal of affective disorders

Pub Date : 2026-06-01 Epub Date: 2026-02-06 DOI: 10.1016/j.jad.2026.121309

Cicek N. Bakir , Guglielmo Genovese , Paul Nakonezny , Irem Azamet , Julia Shekunov , Jennifer L. Vande Voort , Małgorzata Marjańska , Paul E. Croarkin

引用次数: 0