Journal of affective disorders最新文献_第3页

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 : 2026-02-06 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

The clinician rated suicide crisis syndrome checklist (SCS-C): Structure, reliability, and concurrent validity among adult psychiatric inpatients 临床医师对成人精神科住院病人自杀危机综合征量表（SCS-C）的结构、信度和并发效度进行评定。

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Journal of affective disorders

Pub Date : 2026-02-06 DOI: 10.1016/j.jad.2026.121341

Sarah Bloch-Elkouby , Rawad El-Hayek , Lisa Cohen , Jimmy Pengyu Chen , Bernard Gorman , Yael Apter , Erin Wheeler , Byounyoung Park , Anna Stefania Prekas , Igor Galynker

Background

The Suicide Crisis Syndrome (SCS) is a suicidal mental state and a proposed DSM diagnostic condition shown to predict short-term suicidal behaviors among clinical and non-clinical populations in the United States and worldwide. The goal of this study was to develop and assess the psychometric properties of a short clinician-rated SCS diagnostic tool, the SCS Checklist (SCS-C), to provide a structured assessment of patients' SCS through clinical interview.

Method

The SCS-C, a clinician-rated measure composed of 15 binary (yes/no) items was developed and administered to 219 patients upon admission into an inpatient psychiatric unit. Factor structure, internal and interrater reliability, concurrent construct validity (i.e., convergent and divergent validity), and concurrent criterion validity (within one week prior to inpatient admission) were respectively assessed using Confirmatory Factor Analysis, Cronbach's Alpha and McDonald's Omega, Cohen's Kappa, and linear and logistic regressions.

Results

The SCS-C demonstrated excellent fit for a one factor solution, high internal consistency (Cronbach's α = 0.87; McDonalds' Ω = 0.89), moderate convergent validity, good divergent validity, as well as good concurrent criterion validity with regards to suicidal behaviors.

Discussion

This study's findings suggest that the SCS-C is a psychometrically valid and reliable diagnostic tool to assess the presence of the SCS through a swift clinical interview, regardless of patients' disclosure of suicidal ideation. Given the persistent difficulty in evaluating suicide risk through patient self-report, this concise diagnostic tool holds substantial clinical promise for improving suicide risk detection and prevention. Future studies will need to investigate the predictive validity of the instrument.

背景：自杀危机综合征（SCS）是一种有自杀倾向的精神状态，在美国和世界范围内的临床和非临床人群中被提出用于预测短期自杀行为的DSM诊断条件。本研究的目的是开发和评估一种简短的临床评价的SCS诊断工具的心理测量特性，即SCS检查表（SCS- c），通过临床访谈对患者的SCS进行结构化评估。方法：采用由15个二元（是/否）项目组成的临床评定量表（SCS-C），对219例住院精神科患者进行评定。采用验证性因子分析、Cronbach’s Alpha和McDonald’s Omega、Cohen’s Kappa、线性和逻辑回归分别评估因子结构、内部信度和量表间信度、并发构式效度（即收敛效度和分散效度）和并发效度（入院前一周内）。结果：量表对自杀行为具有良好的单因素拟合性、较高的内部一致性（Cronbach's α = 0.87;McDonalds' s Ω = 0.89）、中等的收敛效度、较好的发散效度和较好的并发效度。讨论：本研究的结果表明，SCS- c是一种心理测量学上有效和可靠的诊断工具，通过快速临床访谈来评估SCS的存在，无论患者是否披露自杀意念。鉴于通过患者自我报告评估自杀风险的持续困难，这种简洁的诊断工具在改善自杀风险检测和预防方面具有实质性的临床前景。未来的研究将需要调查该工具的预测有效性。

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引用次数: 0

Effectiveness of an integrated prevention programme (“JoyAge”) for depressive symptoms, anxiety, and loneliness in older adults in Hong Kong: A pragmatic quasi-experimental trial 综合预防计划（“欢乐时光”）对香港老年人抑郁症状、焦虑和孤独的有效性：一项实用的准实验试验。

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Journal of affective disorders

Pub Date : 2026-02-06 DOI: 10.1016/j.jad.2026.121333

Tianyin Liu , Dara Kiu Yi Leung , Daniel Wong , Samson Tse , Paul Wong , Siu Man Ng , Wai Chi Chan , Vivian Lou , Jennifer Yee-Man Tang , Reynold Cheng , Shiyu Lu , Frankie Ho Chun Wong , Wen Zhang , Lesley Cai Yin Sze , Wai Wai Kwok , Martin Knapp , Terry Yat Sang Lum , Gloria Wong

Background

With population ageing and insufficient mental health workforce, there are huge treatment gaps for late-life depression. Real-world evidence of scalable preventive services is scarce. This study examines the effectiveness of an integrated selective and indicated prevention programme for late-life depression in a large group of older adults in Hong Kong.

Methods

This was a pragmatic quasi-experimental trial of a new service (“JoyAge”) for older people with risk factors for late-life depression or subsyndromal depressive symptoms. Participants were recruited and allocated, based on their district of residence, to receive JoyAge (N = 2975) or usual care (N = 441). The primary outcome was depressive symptoms (PHQ-9) at 12-month follow-up; secondary outcomes were anxiety symptoms (GAD-7) and loneliness (UCLA-3). Analyses were conducted in an intention-to-treat framework using mixed modelling, with subgroup analyses based on baseline depressive symptoms, and sensitivity analyses in a 1:1 (N = 422 each group) propensity score-matched sample.

Results

The JoyAge participants had a greater reduction in depressive symptoms over the 12-month period compared to those assigned to usual care (adjusted mean difference [AMD] = 1.65, 95% CI = 1.24–2.07, p < .001), similarly in anxiety symptoms (AMD = 1.47, 95% CI = 1.01–1.93, p < .001), and loneliness (AMD = 1.29, 95% CI = 0.98–1.60, p < .001). Results were similar in propensity-score matched analyses. Subgroup analysis showed that JoyAge was particularly effective among people with moderate to moderately severe symptoms and those with risk factors only.

Conclusions

Integrated late-life depression prevention can be effectively implemented at scale in rapidly ageing settings with a limited specialist mental health workforce. Economic analyses are needed to support further implementation.

背景：随着人口老龄化和精神卫生人力资源不足，老年抑郁症的治疗存在巨大缺口。可扩展预防服务的实际证据很少。本研究在香港一大批老年人中检验了一项综合选择性和指示性预防计划对老年抑郁症的有效性。方法：这是一个实用的准实验试验的新服务（“JoyAge”）为老年人的风险因素的晚年抑郁或亚综合征性抑郁症状。参与者被招募并分配，根据他们的居住地区，接受JoyAge （N = 2975）或常规护理（N = 441）。随访12个月时主要终点为抑郁症状（PHQ-9）；次要结局是焦虑症状（GAD-7）和孤独感（UCLA-3）。使用混合模型在意向治疗框架中进行分析，基于基线抑郁症状进行亚组分析，并在1:1 （N = 422每组）倾向评分匹配的样本中进行敏感性分析。结果：与常规护理组相比，JoyAge组的参与者在12个月的时间内抑郁症状有更大的减轻（调整后的平均差[AMD] = 1.65,95% CI = 1.24-2.07,p ）结论：在快速老龄化的环境中，在专业精神卫生人员有限的情况下，综合晚年抑郁预防可以有效地大规模实施。需要进行经济分析以支持进一步的实施。

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引用次数: 0

Bidirectional associations between socioeconomic status, physical activity, and depressive symptoms in middle-aged and older adults: A cross-lagged prospective cohort study. 中老年人社会经济地位、身体活动和抑郁症状之间的双向关联：一项交叉滞后的前瞻性队列研究

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Journal of affective disorders

Pub Date : 2026-02-06 DOI: 10.1016/j.jad.2026.121334

Jiarong Ge, Ming Chen, Xuan Xiong, Yifei Zhai

Objective: This study aims to investigate the bidirectional relationship and cascading effects of socioeconomic status (SES) and depression symptoms in middle-aged and older adults, with physical activity acting as a mediator.

Methods: A total of 23,747 adults (age ≥ 45 years) from the Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA), the Mexican Health and Ageing Study (MHAS), and the Survey of Health, Ageing and Retirement in Europe (SHARE) participated in this six-year longitudinal study. Socioeconomic status was categorized using latent class analysis. Physical activity depends on participants' frequency over the past two years. The Center for Epidemiologic Studies Depression (CESD) Scale and the European Depression (EURO-D) Scale was used to assess depressive symptoms. Cross-lagged models examined bidirectional associations.

Results: After adjusting for potential covariates, there was strong continuity across the three time points for socioeconomic status, physical activity, and depressive symptoms. Socioeconomic status and physical activity positively predicted each other, while depressive symptoms were associated with lower levels of physical activity.

Limitations: The limitations of this study include the exclusion of the indirect selection hypothesis and the reliance on self-reported depressive symptoms.

Conclusion: Physical activity mediates the relationship between depressive symptoms and subsequent socioeconomic status, with depression-related risks potentially having a greater impact on the socioeconomic status of middle-aged and older single women in developed countries, highlighting the need to consider additional factors in reducing depression risk among older adults.

目的：探讨社会经济地位（SES）与中老年人抑郁症状的双向关系和级联效应，其中体力活动为中介。方法：来自健康与退休研究（HRS）、英国老龄化纵向研究（ELSA）、墨西哥健康与老龄化研究（MHAS）和欧洲健康、老龄化和退休调查（SHARE）的23,747名成年人（年龄 ≥ 45 岁）参与了这项为期六年的纵向研究。社会经济地位分类采用潜在类分析。身体活动取决于参与者在过去两年的频率。采用流行病学研究中心抑郁量表（CESD）和欧洲抑郁量表（EURO-D）评估抑郁症状。交叉滞后模型检验了双向关联。结果：在对潜在协变量进行调整后，社会经济地位、身体活动和抑郁症状在三个时间点之间存在很强的连续性。社会经济地位与身体活动呈正相关，而抑郁症状与较低的身体活动水平相关。局限性：本研究的局限性包括排除了间接选择假说和依赖于自我报告的抑郁症状。结论：体育活动介导抑郁症状与随后的社会经济地位之间的关系，抑郁相关风险可能对发达国家中老年单身女性的社会经济地位产生更大的影响，这突出了在降低老年人抑郁风险时考虑其他因素的必要性。

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引用次数: 0

Social network index and its association with cognitive impairment and depressive symptoms in healthy older adults: Age-stratified analysis 健康老年人的社会网络指数及其与认知障碍和抑郁症状的关系：年龄分层分析

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Journal of affective disorders

Pub Date : 2026-02-06 DOI: 10.1016/j.jad.2026.121342

Bomgyeol Kim , JaeWon Hyun , Hun Kang , Seongmi Choi , Jin-kyung Lee , JiYeon Choi

Background

We investigated associations between the Social Network Index (SNI) and cognitive impairment and depressive symptoms among healthy older adults in South Korea, focusing on distinctions among age subgroups within the older population.

Methods

Data were derived from the 2023 National Survey of Older Koreans. From an initial sample of 10,078 adults aged ≥65 years, we excluded proxy respondents, individuals officially registered with disability, classified as frail, and diagnosed with depression, dementia, Parkinson's disease, or two or more other chronic conditions by physician. The final analytic sample comprised 3379 healthy older adults. Multiple logistic regression analyses were conducted to examine associations between SNI and cognitive impairment and depressive symptoms in the full sample, as well as in the subgroups of young-old and middle-old and oldest-old groups.

Results

Participants with low SNI had significantly higher odds of cognitive impairment (adjusted odds ratio [aOR] = 1.72; 95% confidence interval [CI]: 1.35–2.18) and depressive symptoms (aOR = 2.35; 95% CI: 1.54–3.59) compared to those with high SNI. These associations remained significant in both young-old (65–74 years; cognitive impairment aOR = 1.79, 95% CI: 1.34–2.37; depressive symptoms aOR = 2.07, 95% CI: 1.24–3.47) and middle-old and oldest-old groups (≥75 years; cognitive impairment aOR = 1.70, 95% CI: 1.07–2.70; depressive symptoms aOR = 2.85, 95% CI: 1.27–6.42).

Conclusions

Our findings underscore the significant associations between social connectedness and cognitive and mental health in later life and suggest that targeted interventions promoting social engagement may be particularly beneficial for older age groups with limited social networks.

背景：我们调查了韩国健康老年人的社会网络指数（SNI）与认知障碍和抑郁症状之间的关系，重点关注老年人群中年龄亚组之间的差异。方法：数据来源于2023年韩国老年人全国调查。从10078名年龄≥65 岁的成年人的初始样本中，我们排除了代理受访者，即正式登记为残疾、被归类为虚弱、被医生诊断为抑郁症、痴呆、帕金森病或两种或两种以上其他慢性疾病的个体。最终的分析样本包括3379名健康老年人。采用多元逻辑回归分析，检验SNI与全样本、中青年组、中老年组和最高龄组的认知障碍和抑郁症状之间的关系。结果：与SNI值高的受试者相比，SNI值低的受试者出现认知障碍（调整优势比[aOR] = 1.72；95%可信区间[CI]: 1.35-2.18）和抑郁症状（aOR = 2.35;95% CI: 1.54-3.59）的几率明显更高。这些协会仍然是老当益壮的重大(65 - 74年 年;认知障碍aOR = 1.79,95%置信区间CI: 1.34 - -2.37;抑郁症状aOR = 2.07,95%置信区间CI: 1.24 - -3.47)和middle-old和长寿老人组(≥75 年;认知障碍aOR = 1.70,95%置信区间CI: 1.07 - -2.70;抑郁症状aOR = 2.85,95%置信区间CI: 1.27 - -6.42)。结论：我们的研究结果强调了社会联系与晚年认知和心理健康之间的重要联系，并表明促进社会参与的有针对性的干预措施可能对社会网络有限的老年群体特别有益。

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引用次数: 0

Clinical and cognitive profile of nigral iron content in children with ADHD 儿童ADHD患者的临床和认知特征。

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Journal of affective disorders

Pub Date : 2026-02-05 DOI: 10.1016/j.jad.2026.121329

Hugo A.E. Morandini , Sjoerd B. Vos , Ranila Bhoyroo , Angela Jacques , Pradeep Rao

Background

ADHD has been associated with impaired central nervous dopaminergic pathways. Brain iron is an essential cofactor for the synthesis of dopamine and the substantia nigra (SN) is a significant pool of dopaminergic neurons playing a central role in the activity of the nigrostriatal pathway. The present study investigated SN iron content in children with ADHD, its relationship with ADHD symptom severity and cognitive performance.

Methods

Neuroimaging and phenotypical data were extracted from the Healthy Brain Network dataset. After initial screening, 54 medication-naïve children with ADHD and 44 neurotypical (NT) children (8–12 year) were included. ADHD symptom severity was extracted from the Child Behavior Checklist (CBCL) Parent report and working memory (WM) and inhibitory control scores from the National Institute of Health toolbox.

Results

A mixed between-within subjects ANOVA revealed no significant difference in SN iron content between medication-naïve children with ADHD and NT (partial eta squared = 0.001, p = .79). In the ADHD group, Spearman's correlation revealed a significant inverse relationship between left (r = −0.38; p < .01) and right (r = −0.33; p = .01) SN iron content and CBCL Attention Problems T score, while in the NT group left SN iron content significantly correlated with inhibitory control (r = 0.36; p = .02).

Conclusions

Although there was no difference in nigral iron content between both groups, higher SN iron content was associated with lower attention problems in children with ADHD and higher SN iron content was associated with better inhibitory control in NT children.

背景：ADHD与中枢神经多巴胺能通路受损有关。脑铁是多巴胺合成的重要辅助因子，而黑质（SN）是多巴胺能神经元的重要储藏库，在黑质纹状体通路的活动中起着核心作用。本研究探讨ADHD患儿SN铁含量与ADHD症状严重程度及认知表现的关系。方法：从健康脑网络数据集中提取神经影像学和表型数据。初步筛选后，纳入54名medication-naïve ADHD儿童和44名神经正常（NT）儿童（8-12 岁）。ADHD症状严重程度提取自儿童行为检查表（CBCL）家长报告和美国国立卫生研究院工具箱中的工作记忆（WM）和抑制控制评分。结果：混合受试者间方差分析显示medication-naïve ADHD患儿和NT患儿SN铁含量无显著差异（偏平方 = 0.001,p = .79）。在ADHD组中，Spearman相关显示左与右呈显著负相关（r = -0.38;p ）结论：虽然两组间的神经铁含量无差异，但高SN铁含量与ADHD儿童较低的注意力问题相关，高SN铁含量与NT儿童较好的抑制控制相关。

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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 : 2026-02-05 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 : 2026-02-05 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

Family environment and cognitive function as predictors of efficacy for rTMS combined with group therapy in adolescent depression. 家庭环境和认知功能作为rTMS联合团体治疗青少年抑郁症疗效的预测因子。

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Journal of affective disorders

Pub Date : 2026-02-05 DOI: 10.1016/j.jad.2026.121354

Yanju Liu, Bo Xin, Shaowei Liu, Ming Yu, Hong Liu, Limin Meng

Objective: While repetitive transcranial magnetic stimulation (rTMS) combined with group therapy has demonstrated efficacy for adolescent depression, clinical responses vary; this study aimed to identify baseline family environment and cognitive function predictors of symptomatic improvement to support personalized treatment strategies.

Methods: A prospective cohort (August 2023-July 2024) enrolled 163 adolescents with major depressive disorder receiving a 4-week program of high-frequency rTMS (20 sessions) and group cognitive behavioral therapy (8 sessions). All participants were on stable antidepressants. Predictors included Family Environment Scale (cohesion, conflict) and neuropsychological tests (Stroop, Wisconsin Card Sorting Test [WCST]). The primary outcome was HAMD-24 reduction at week 4.

Results: Of the 163 enrolled patients, 148 (90.8%) completed the study and were included in the final analysis. The mean HAMD-24 reduction was 48.6% ± 14.2%. Multivariate regression analysis, validated by bootstrapping, indicated that greater baseline family cohesion (β = 0.29, p = 0.002), lower family conflict (β = -0.25, p = 0.004), and better executive function indexed by fewer WCST perseverative errors (β = -0.24, p = 0.003) were independently associated with larger symptom reductions. The model explained 32.5% of outcome variance (adjusted R² = 0.325). Medication dose was not a significant predictor.

Conclusion: Higher family cohesion, lower conflict, and intact executive function predict favorable response to combined rTMS and group therapy in adolescent MDD. Baseline screening for these factors may inform adjunctive approaches such as family therapy or cognitive remediation to optimize outcomes. These findings represent prognostic associations requiring further interventional validation.

目的：反复经颅磁刺激（rTMS）联合团体治疗已证明对青少年抑郁症有效，但临床反应各不相同；本研究旨在确定症状改善的基线家庭环境和认知功能预测因素，以支持个性化治疗策略。方法：前瞻性队列研究（2023年8月- 2024年7月）纳入163名重度抑郁症青少年，接受为期4周的高频rTMS（20次）和群体认知行为治疗（8次）。所有参与者都在服用稳定的抗抑郁药。预测因子包括家庭环境量表（凝聚力、冲突）和神经心理测试（Stroop， Wisconsin卡片分类测试[WCST]）。主要终点是第4周时HAMD-24降低。结果：163例入组患者中，148例（90.8%）完成研究并纳入最终分析。HAMD-24平均降低48.6% ± 14.2%。多元回归分析,验证通过引导,表明更大的基线家庭凝聚力(β = 0.29,p = 0.002),降低家庭冲突(β = -0.25,p = 0.004),和更好的执行功能被更少的WCST持续的错误(β = -0.24,p = 0.003)是独立与更大的症状减少有关。该模型解释了32.5%的结果方差（调整后R2 = 0.325）。用药剂量不是显著的预测因子。结论：较高的家庭凝聚力、较低的冲突和完整的执行功能预示着rTMS联合团体治疗对青少年MDD的良好反应。对这些因素的基线筛查可以告知辅助方法，如家庭治疗或认知补救，以优化结果。这些发现表明预后相关性需要进一步的介入验证。

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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 : 2026-02-05 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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