Journal of affective disorders最新文献

Systemic Sclerosis (SSc) is a rare and complex autoimmune disease characterized by skin and internal organ fibrosis, vascular abnormalities, and immune dysfunction. In addition to physical symptoms, many patients experience psychological distress, particularly depression, which can negatively impact treatment adherence and quality of life. The SCL-Dep6 is a subscale of the SCL-90-R questionnaire, consisting of six items that assess core aspects of depression, including low mood, anhedonia, guilt, fatigue, and suicidal thoughts. The aim of this study was to evaluate the structural validity of the SCL-Dep6 in patients with SSc using Rasch analysis. Criterion related validity was assessed using WHO-5. The sample included 219 outpatients with SSc recruited at the Careggi University Hospital in Florence, Italy. Rasch analysis was performed on 188 participants and showed that the data fit the model (χ² = 20.59, p = 0.056), confirming the unidimensional structure of the scale. The Person Separation Index (PSI = 0.651) indicated borderline reliability in this sample. Two items showed disordered thresholds. Differential Item Functioning (DIF) related to sex and education was observed for two items. Criterion related validity was supported by ROC analysis, with an area under the curve (AUC) of 0.7891. In brief, the SCL-Dep6 showed to be valid for identification of depression in patients with SSc. Its brevity makes it suitable for clinical use, although further research is needed to improve sensitivity to mild symptoms and ensure fairness across subgroups.

Objective: Suicide is a major cause of mortality in bipolar disorder (BD), yet its neural underpinnings remain insufficiently understood. Suicide risk is thought to involve impaired cognitive-emotional flexibility arising from fundamental disturbances in brain dynamics. This study aimed to test this hypothesis by characterizing the energetic and dynamical constraints underlying suicide vulnerability in BD.

Methods: We applied energy landscape modeling to resting-state fMRI data from 123 individuals with BD (61 suicide attempters, 62 non-attempters) and 68 healthy controls. Brain activity was modeled as transitions between functional states, enabling quantification of neural rigidity. Group-level comparisons and correlation analyses were conducted to identify attractor stability, transition patterns, and their associations with clinical and cognitive measures.

Results: Four dominant attractor basins were identified. Basins A and D showed progressively reduced appearance frequency and stability from healthy controls to non-attempters and suicide attempters. Increasing suicide risk was associated with greater neural rigidity, reflected in a more constrained transition architecture with shorter and more repetitive transition paths in suicide attempters. Lower stability of basin A was associated with higher suicide risk, with cognitive impairment statistically accounting for part of this association in mediation analyses.

Conclusion: Suicide vulnerability in BD is associated with entrenched functional brain states, reduced transition diversity, and elevated energetic constraints that may limit adaptive brain-state reconfiguration. These findings provide a mechanistic account of neural rigidity and suggest that altered brain-state dynamics may serve as a potential biomarker of suicide risk in BD.

Background: There remains a lack of multi-wave longitudinal studies capable of examining the dynamic bidirectional relationship between depression symptoms and ADL, and the understanding of how this association evolves over time remains incomplete.

Methods: Our study utilizes three-wave data from the China Health and Retirement Longitudinal Study (CHARLS) collected in 2015 (T0), 2018 (T1), and 2020 (T2). Correlation analyses were used to explore the association between depression symptoms and ADL disability. Cross-lagged model (CLPM) adjusted by inverse probability weighting (IPW) was employed to validate the dynamic relationship between the two over time.

Results: Changes in depression symptoms and ADL disability scores vary significantly over different time periods by sample characteristics. Correlation analyses revealed significant positive correlations between depression symptoms and ADL disability at all three waves. CLPM results revealed that depression symptoms and ADL disability mutually predict each other in the early phase (T0 Depression symptoms→T1 ADL disability: β = 0.048, P < 0.001; T0 ADL disability→T1 Depression symptoms: β = 0.043, P = 0.003) and negatively in the later phase (T1 Depression symptoms→T2 ADL disability: β = -0.057, P = 0.006; T1 ADL disability→T2 Depression symptoms: β = -0.069, P < 0.001).

Limitations: Depression symptoms and ADL disability are assessed through self-reporting.

Conclusion: Depression symptoms and ADL disability in elderly people exhibit a phased bidirectional predictive relationship over time, with depression symptoms having a stronger driving effect. A phased, integrated intervention strategy is required to break this cycle.

Background: Resilience is increasingly conceptualized as a dynamic process rather than a static trait. The Mount Sinai Resilience Scale (MSRS) captures this process by assessing the frequency and subjective efficacy of malleable resources employed to manage stress. This study aimed to validate the Chinese MSRS (C-MSRS) and investigate the psychometric and network features of resilience in healthy and clinical populations.

Methods: The MSRS was translated and administered to 600 healthy adults and 95 patients. We utilized Exploratory and Confirmatory Factor Analyses, reliability and validity assessments, network analysis, and quadrant analysis to evaluate the psychometric properties and characterize clinical resilience profiles.

Results: The C-MSRS demonstrated satisfactory psychometric properties, yielding a 21-item, five-factor model. Network analysis identified the "Meaning and Purpose" dimension (specifically hope and growth mindset) as the central hub, functioning as a "motivational engine" that integrates other resilience resources. Clinical profiling revealed distinct phenotypes: depression was characterized by global deficits consistent with amotivation and helplessness (low frequency/low efficacy), whereas anxiety patients exhibited preserved motivational drive in social connections. Furthermore, "Meaning and Purpose" emerged as a core transdiagnostic factor negatively correlated with symptom severity.

Conclusions: The C-MSRS is a robust, process-oriented instrument for the Chinese context. Our findings highlight resilience as an active, cognition-motivated process organized around hope and growth mindset. By capturing distinct resilience deficits in depression versus anxiety, the C-MSRS offers a precise tool for dissecting resilience mechanisms and guiding targeted interventions.

Introduction: Depression in old age often has a poor clinical course, although there is substantial variability in depressive symptom trajectories. We aimed to characterize old-age depressive symptom trajectories, assess their multifactorial correlates, and their impact on mortality.

Methods: We used cohort data from 2118 dementia-free community-dwelling adults aged ≥60 years participating in the Swedish National study on Aging and Care in Kungsholmen (SNAC-K). Depressive symptoms were evaluated using the Montgomery-Åsberg Depression Rating Scale at baseline and 1-3 follow-ups over 9 years. Sociodemographic (age, sex, marital status, socioeconomic status), psychosocial (social connections and support), clinical (multimorbidity), and functional (gait speed; cognitive impairment) factors at baseline were considered as trajectory correlates. Generalized growth mixture models and multinomial logit models estimated depression trajectories and their correlates. Cox proportional hazard models estimated all-cause mortality risk.

Results: Three trajectory classes emerged: low, increasing, and U-shaped trajectories of depressive symptoms. Compared to the low trajectory, socioeconomic status involving high financial strain and poor social support was more common in the increasing and U-shaped trajectories. Slow gait speed was linked to higher odds of increasing depressive symptoms, while greater multimorbidity was associated with the U-shaped trajectory. The increasing and U-shaped trajectories were associated with higher mortality risk, and the association for increasing was robust to the adjustment of covariates.

Conclusions: Depressive symptom trajectories in late life are heterogeneous and linked to diverse socio-economic, clinical, and functional factors, some of which are trajectory-specific. Given its association with mortality, older people should be carefully monitored for depressive symptomatology.

Objective: Declining mental health among college students is a global concern. This study aimed to compare the effects of a Confucianism-based Internet-delivered Acceptance and Commitment Therapy (C-ACT) with a standard mindfulness-based I-ACT (M-ACT) and to examine the longitudinal relationship between psychological flexibility (PF) and meaning-centered coping (MCC).

Method: In this randomized controlled trial, 300 Chinese college students were assigned to either the C-ACT intervention or the M-ACT active comparison group. Both 8-week online interventions were followed over a 20-week period with assessments at five time points. A parallel process latent growth curve model was used to analyze the change trajectories of PF and MCC.

Results: Both groups demonstrated significant increases in PF and MCC over time. At baseline, higher PF was significantly associated with higher MCC. Furthermore, the rate of change in PF was positively correlated with the rate of change in MCC across both groups. Crucially, the C-ACT group showed a significantly greater rate of increase in MCC compared to the M-ACT group. No significant group difference was found for the rate of change in PF.

Conclusions: While the findings support the general efficacy of I-ACT for improving psychological well-being in college students, the superior effect of the culturally adapted C-ACT on meaning-centered coping specifically highlights the potential benefits of integrating indigenous cultural values, such as Confucian ethics, into evidence-based psychological interventions to enhance specific therapeutic outcomes.

Clinical trial registration number: ChiCTR2400090851.

Background: Assessed the efficacy of a transdiagnostic internet-delivered psychological intervention for depression, anxiety and disability in adults with multiple sclerosis (MS).

Methods: Randomised controlled trial of 142 participants with a confirmed diagnosis of MS were allocated to either an immediate treatment group (n = 73) or treatment-as-usual waitlist control (n = 69). The intervention, the Wellbeing Neuro Course, was based on Cognitive Behavioural Therapy and included six online lessons delivered over 10 weeks with the option of support from a psychologist via email and telephone. Primary outcomes were symptoms of depression (PHQ-9), anxiety (GAD-7), and disability (WHODAS 2.0).

Results: One hundred and thirty-three participants commenced the trial (treatment n = 72; control n = 61) and were included in intention-to-treat analyses. Significant between-group differences were observed in depression (PHQ-9; g = 0.54; 23% average [avg.] symptom reduction), anxiety (GAD-7; g = 0.37; 30% avg. reduction) and disability (WHODAS 2.0; g = 0.28; 14% avg. reduction) at post-treatment favouring treatment (all ps < 0.05). Treatment-related effects were maintained at 3 and 12-month follow-up. No adverse treatment events were reported.

Conclusions: Internet-delivered transdiagnostic psychological interventions appear to be an acceptable and efficacious option for providing accessible psychological care for adults with MS.

Background: Non-suicidal self-injury (NSSI) in adults after a suicide attempt may follow distinct courses with different clinical profiles and reattempt risk.

Aims: Examine NSSI patterns, correlates, and associations with suicide reattempts over 12 months.

Method: Adults (n = 685; 72.4% female; mean age 42 [SD 15.45]) were assessed ≤15 days post-index attempt and followed 12 months. NSSI was assessed using Columbia-Suicide Severity Rating Scale (C-SSRS). Baseline assessments captured psychiatric diagnoses, global psychological distress, impulsivity, fearlessness about death, and childhood trauma (assessed with the MINI, BSI, BIS-11, ACSS-FAD, and CTQ-SF, respectively), and suicide-related variables; reattempts were tracked throughout follow-up.

Results: Four a priori patterns: NN (No NSSI→No NSSI; 53.4%), Onset (No→Yes; 5.7%), Remission (Yes→No; 23.9%), and Persistence (Yes→Yes; 16.9%). Persistence was associated with younger age and higher baseline impulsivity, higher baseline global psychological severity, and greater childhood trauma severity along with substance use before the attempt and higher acquired capability. PTSD predicted reattempt within Persistence. Onset was linked to earlier reattempts, narrowing the intervention window, whereas Persistence showed a modest descriptive delay, consistent with short-term regulation (without implying protection). During follow-up, 22.2% reattempted; median time-to-reattempt 138 days (IQR 55-222; mean 149). In multivariable Cox regression, older age showed lower hazard (HR 0.98, 95% CI 0.96-0.99), and a greater number of prior suicide attempts (HR 1.02, 1.01-1.04). Relative to NN, Remission (HR 0.56, 0.32-0.96) and Persistence (HR 0.58, 0.35-0.96) were associated with reduced 12-month hazard.

Conclusions: While NSSI may briefly down-regulate severe affect, Persistence signals elevated clinical risk and acquired capability; Onset appears linked to earlier reattempts.

Objective: Although suicidal ideation (SI) is commonly regarded as a symptom of major depressive episodes (MDE), emerging evidence suggests it may carry prognostic significance for the depressive illness. This study examined whether SI during a MDE independently predicts risk of recurrence or chronicity over a three-years period.

Methods: Data were drawn from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative survey of U.S. adults. We included 2853 participants with past-year DSM-IV MDE at Wave 1 who completed Wave 2 assessments and had complete clinical and sociodemographic data. Multivariate logistic regression was used to identify predictors of chronic (i.e., persistent MDE) or recurrent MDE (i.e., new episode after remission) at Wave 2, adjusting for depression severity, comorbid psychiatric disorders, sociodemographic factors, and history of suicide attempts.

Results: Suicidal ideation during a MDE was associated with a significantly increased risk of MDE recurrence or chronicity at follow-up (adjusted OR = 1.47; 95%CI: 1.16-1.85; p = 0.0010), independent of depression severity and other covariates. In contrast, a history of suicide attempt was not a significant predictor when SI was included in the model. Additional predictors included depression severity, generalized anxiety disorder, post-traumatic stress disorder, and borderline personality disorder.

Conclusions: Suicidal ideation during a MDE is independently associated with the risks of chronic or recurrent depression, underscoring its clinical relevance beyond suicide risk alone. Routine assessment and targeted interventions for suicidal ideation should be prioritized in both psychiatric and primary care settings to mitigate these risks.

The best predictor of a suicide attempt is a previous attempt, apart from psychiatric diagnoses also associated. Some studies found other indicators of great risk for suicide reattempts. Machine Learning algorithms offer the potential for systematic detection of features that carry greater risk for an event. This study sought to develop a classification algorithm distinguishing between Single Suicide Attempters (SSA) and Multiple Suicide Attempters (MSA) in a Spanish multicentre national cohort to explore prediction of subsequent attempts in suicidal patients. Two models including the same sociodemographic and clinical variables grouped in more specific (Model I) or broad (Model II) categories were developed to explore risk factors for suicide reattempts. A Least Absolute Shrinkage and Regression Operator logistic regression with a 10-fold cross-validation was adopted. 1443 adult patients from the SURVIVE cohort were included (582 SSA and 861 MSA). Both Model I (AUC = 0.696; BAC = 0.644) and Model II (AUC = 0.678; BAC = 0.621) outperformed naïve majority-class classification for SSA and MSA. Bipolar disorder type II, binge-eating disorder, and schizophrenia variables weighted heavier on Model I for suicide reattempt-related; while eating disorder diagnosis, Africa as birthplace, affective disorder diagnosis, being employed, schizophrenia-spectrum disorder and substance use disorder diagnoses were the most important suicide reattempt-related of Model II. Affective disorders, eating disorders and schizophrenia-spectrum disorders emerged as the most important variables in predicting reattempts. Both models showed similar sensitivity and specificity when discriminating between SSA and MSA. Identifying specific risk factors for reattempts could have a significant impact on tailoring prevention strategies and interventions.