Journal of affective disorders最新文献

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.

General anesthetics can exert significant adverse effects on the central nervous system. This study aimed to investigate whether repeated exposure to sevoflurane induces depression-like behaviors in postpartum rats. Pregnant rats were exposed to 3% sevoflurane for 2 h on gestational days 13-15. Emotional behaviors were assessed on postpartum days 1, 7, 14, and 21. Hippocampal protein levels associated with the AMPK/SIRT1/NLRP3 signaling pathway were analyzed by Western blotting. Microglial activation and inflammasome expression were analyzed by immunofluorescence, and cytokine levels (IL-1β, IL-18, TNF-α) by ELISA. To explore the role of the AMPK/SIRT1/NLRP3 pathway and neuroinflammation in postpartum maternal depression, rats were treated with AICAR (an AMPK agonist), MCC950 (an NLRP3 antagonist), and minocycline (a microglial activation inhibitor). Additionally, ketamine, with or without dorsomorphin (an AMPK antagonist), was administered to assess whether ketamine's antidepressant effects are mediated through this pathway. Sevoflurane-exposed rats exhibited behavioral impairments on postpartum day 1, including increased immobility in the forced swim test, prolonged feeding latency, reduced food consumption in the novelty-suppressed feeding test, and decreased movement in the open field test. These behaviors were accompanied by decreased AMPK/SIRT1 expression, NLRP3 inflammasome activation, and microglial activation in the hippocampus, resulting in significant inflammatory cytokine release. Treatment with AICAR, MCC950, minocycline, or ketamine alleviated these effects, while dorsomorphin reversed the antidepressant effects of ketamine. Our findings indicate that repeated sevoflurane exposure during mid-gestation induces depression-like behaviors in postpartum rats, and that ketamine alleviates these behaviors by reducing microglial neuroinflammation and NLRP3 inflammasome activation via the AMPK/SIRT1 signaling pathway.

Background: This study aimed to determine the changes in polysubstance use patterns among adolescents and their dynamic association with other health risk behaviors from 2007 to 2019.

Method: The Youth Risk Behavior Survey data (2007-2019, N = 100,920) were collected biennially through national cross-sectional surveys of US school attending adolescents. Latent class analysis was used to identify polysubstance use patterns. Joinpoint regression was used to estimate biennial percentage changes (BPCs) of 11 substance use behaviors and 19 health risk behaviors over time. Survey-weighted logistic regression analysis with year-by-group interactions assessed dynamics association between polysubstance use patterns and health risk behaviors over time.

Results: Three stable polysubstance use patterns-Low, Moderate, and High Polysubstance Groups-were identified from 2007 to 2019. There was an increasing trend in the Low Polysubstance Group (BPC = 1.60%[95%CI:0.35%,2.87%]), a decreasing trend in the Moderate Polysubstance Group (BPC = -3.21%[95%CI: -5.85%, -0.51%]) and a steady trend in the High Polysubstance Group from 2007 to 2019. There was a significant increase in suicide-related behaviors and self-reported depression specifically among the Low and Moderate Polysubstance Groups, and the disparities in suicide-related behaviors between Moderate/High Polysubstance Groups and Low Polysubstance Groups were smaller over time. The disparities in sexual-risk behaviors and violence-related behaviors between Moderate and Low Polysubstance Groups were widened over time.

Limitations: Limitations include the cross-sectional design, self-reported data, limited applicability to out-of-school adolescents, and lack of substance use severity consideration.

Conclusion: As polysubstance use patterns and their link to other health risk behaviors evolve, policies and services must adapt with multifaceted strategies to address adolescent health risk behaviors.

Background: Subthreshold depressive symptoms significantly hinder functional recovery in bipolar disorder (BD). While most studies use a global score to assess the impact of these symptoms on functioning, this study examines which specific subthreshold depressive symptoms mostly impede functional recovery in patients with BD in remission.

Method: The sample comprised a total of 413 patients with BD. Subthreshold depressive symptoms were assessed using the 17-item Hamilton Depression Rating Scale (HAM-D), and psychosocial functioning was measured with the Functioning Assessment Short Test (FAST). Bivariate analyses were performed to identify items from the HAM-D as well as other clinical and demographic variables associated with functional impairment. Multivariate linear regression analyses were conducted including the variables that demonstrated significant associations in the bivariate analyses.

Results: The linear regression model for the FAST total score demonstrated that "psychomotor retardation" (item 8) had the strongest association on psychosocial functioning (β = 6,9; p < 0,001), followed by "feelings of guilt" (item 2) (β = 5,75; p < 0,001) "work and activities" (item 7) (β = 5,38; p < 0,001) and "somatic anxiety" (item 11) (β = 3,45; p < 0,001). Other significant clinical variables included antipsychotic use, older age, fewer years of education and male sex. This model explained 39,6% of the variance in the FAST total score (R² = 0,396; Adjusted R² = 0,375; F_(399,13) = 20,04; p < 0,001).

Conclusions: Specific subthreshold symptoms, including psychomotor retardation, apathy, guilt and somatic anxiety significantly influence psychosocial functioning. These findings highlight the importance of specifically targeting these symptoms to achieve functional recovery, even when patients are clinically stable.

Background: Parental absence is a significant risk factor for adolescent suicidal ideation, yet the relational mechanisms and sex-specific vulnerabilities within clinical populations remain under-explored. This study investigated how different forms of parental absence relate to suicidal ideation through father-child and mother-child relationships, and whether these associations are moderated by adolescent sex.

Methods: A nationwide multi-center cross-sectional study was conducted from December 2020 to December 2023. We recruited 2467 clinically diagnosed depressed adolescents from 14 hospitals in China. A moderated mediation model was tested using Firth's penalized logistic regression to address outcome imbalance. The model explicitly disaggregated single-parent and dual-parent absence while testing sex as a moderator of direct pathways.

Results: A significant interaction between sex and single-parent absence emerged, indicating single-parent absence was associated with higher suicidal ideation specifically among female adolescents (B = 1.144, p = 0.011). Mediation analyses demonstrated that the father-child relationship served as a consistent mediator for both single-parent (indirect effect = 0.058, 95% CI [0.003, 0.129]) and dual-parent absence (indirect effect = 0.066, 95% CI [0.004, 0.151]). Conversely, the mother-child relationship showed no significant mediating effect after adjustment.

Limitations: The cross-sectional design limits causal inferences, and certain variables were assessed using self-report single-item measures.

Conclusions: Parental absence influences suicidal ideation through distinct structural and relational pathways. The father-child relationship emerged as a more robust mediator than the mother-child relationship, while sex moderated the direct impact of family disruption. These results highlight the necessity of sex-sensitive and father-inclusive clinical interventions in preventing suicide among depressed adolescents.

Background: This research examined whether area-level social fragmentation was associated with adolescent depressive and anxiety symptoms, and whether heterogeneity by gender was present.

Methods: Cross-sectional adolescent data (n = 66, 434) from wave 6 (2017-18) of the COMPASS study were used. Demographic information, depression, and anxiety were reported via questionnaire. Census division social fragmentation was derived from four census variables (proportions of renters, movers in last year, single tenant households, and unmarried couples). Multilevel linear regression analyses were performed to account for students nested within schools (n = 122), who were nested within census divisions (n = 40) while accounting for province, student, and census division characteristics. Interaction terms were added to adjusted models to examine heterogeneity by gender.

Results: In adjusted models, a one standard deviation increase in social fragmentation was associated with higher depressive symptoms (β = 0.39, 95% CI: 0.04, 0.75) and anxiety symptoms (β = 0.39, 95% CI: 0.03, 0.75). Findings became non-significant in models with province as fixed effect. The slopes were lower for females (depression: β = -0.18, 95% CI: -0.28, -0.09; anxiety: β = -0.26, 95% CI: -0.36, -0.16) than for males.

Conclusion: Social fragmentation may be a contextual risk factor for adolescent depression and anxiety; however, more research is needed investigating social fragmentation at multiple scales and over time. Understanding potential mechanisms for differences between males and females is also needed.

Although misophonia is characterized by intense negative emotional responses, the temporal dynamics of these experiences in naturalistic settings are poorly understood. This study utilized ecological momentary assessment (EMA) to characterize the real-time emotional experiences of adults with misophonia outside of laboratory settings. Forty adults with misophonia completed EMA surveys for 10 days. Results indicated that trigger sounds elicited significant elevations in negative emotions, particularly irritability and anger, compared to non-trigger periods. Although most emotional responses subsided substantially within 1 h, recovery patterns and the intensity of reactivity (e.g., hostility, disgust) varied considerably across individuals. Greater emotional reactivity was associated with higher baseline negative affect, greater misophonia severity, and co-occurring psychopathology. To our knowledge, this is the first EMA study to detail real-time emotional patterns in misophonia. Findings provide novel insights into the moment-to-moment experience of the disorder and highlight key individual differences that may inform personalized interventions targeting emotional reactivity.

The burden of depressive and bipolar disorders at the individual and societal level are extraordinary and increasing. For decades, evidence-based treatments for these conditions have been established but outcomes amongst individuals with lived experience remains suboptimal. Notwithstanding calls to close gaps between current practice and best practice, there is an absence of evidence that overall health outcomes are significantly improving. Artificial Intelligence (AI) is the cornerstone of the digital revolution. Currently, AI sources (e.g., Open Source) are widely accessed by healthcare providers and persons with lived experience for search queries and decision support. The aspiration for AI-informed medical practice is to improve health outcomes by assisting in timely diagnostic detection, illness monitoring, informing treatment selection, integrating multimodality care, decreasing barriers to access and facilitating scalability to psychosocial interventions. Against this background, rigorous evidence is still needed to empirically demonstrate transformative improvement in each of the aforementioned areas. In addition, multiple ethical, technical, scientific and economic questions are not adequately answered including aspects of confidentiality and patient engagement. This short commentary endeavors to succinctly summarize the evidentiary base as it relates to the capabilities that AI offers currently, in the near and more intermediate term. The overarching aim is to provide readers with an up-to-date understanding of what aspects of AI are currently applicable versus those that are aspirational.