Pub Date : 2026-02-10DOI: 10.1016/j.jad.2026.121259
Soonho Ha, Hee-Ju Kang, Taeyeong Lee, KyungMin Kang, Jae-Min Kim, Hwamin Lee
Major depressive disorder (MDD) is a leading global health burden, yet only one-third of patients achieve remission with initial antidepressant therapy. Inflammatory biomarkers and epigenetic signatures such as DNA methylation have been implicated in treatment response, but their temporal predictive utility remains unclear. We analyzed 821 Korean patients with MDD from the MAKE BETTER study, integrating clinical variables, serum inflammatory biomarkers, and DNA methylation profiles into machine-learning models. Twelve-month remission was modeled as prospective prediction using baseline and week-12 treatment data, whereas early improvement (2 weeks) and 12-week remission were assessed as exploratory classification tasks using all 12-week data (look-ahead bias). For 12-month remission, XGBoost achieved AUROC 0.728 and AUPRC 0.840. For 12-week remission, logistic regression achieved AUROC 0.742 and AUPRC 0.595. Predictive drivers shifted over time, from baseline clinical severity (early response) and antidepressant dosage (12-week remission) to inflammatory/epigenetic markers (hs-CRP and epigenetic inflammation score, EIS) for 12-month remission. Differential methylation results showed increasing numbers of significant CpGs over time, with inflammation-linked CpGs providing stable contributions. A two-CpG signature (cg10636246 in AIM2; cg02650017 near ABCG1/PHOSPHO1) achieved AUROC 0.757 and AUPRC 0.854, supporting compact epigenetic signatures for long-term risk stratification. Clinical and treatment features were most informative for short-term outcomes, whereas inflammatory and epigenetic markers became increasingly important for long-term remission. These findings support precision psychiatry approaches integrating dynamic multimodal features, emphasizing treatment exposure for acute management and inflammation-related markers for long-term planning.
{"title":"Multimodal machine learning models for predicting remission in major depressive disorder using clinical data, blood biomarkers, and DNA methylation.","authors":"Soonho Ha, Hee-Ju Kang, Taeyeong Lee, KyungMin Kang, Jae-Min Kim, Hwamin Lee","doi":"10.1016/j.jad.2026.121259","DOIUrl":"10.1016/j.jad.2026.121259","url":null,"abstract":"<p><p>Major depressive disorder (MDD) is a leading global health burden, yet only one-third of patients achieve remission with initial antidepressant therapy. Inflammatory biomarkers and epigenetic signatures such as DNA methylation have been implicated in treatment response, but their temporal predictive utility remains unclear. We analyzed 821 Korean patients with MDD from the MAKE BETTER study, integrating clinical variables, serum inflammatory biomarkers, and DNA methylation profiles into machine-learning models. Twelve-month remission was modeled as prospective prediction using baseline and week-12 treatment data, whereas early improvement (2 weeks) and 12-week remission were assessed as exploratory classification tasks using all 12-week data (look-ahead bias). For 12-month remission, XGBoost achieved AUROC 0.728 and AUPRC 0.840. For 12-week remission, logistic regression achieved AUROC 0.742 and AUPRC 0.595. Predictive drivers shifted over time, from baseline clinical severity (early response) and antidepressant dosage (12-week remission) to inflammatory/epigenetic markers (hs-CRP and epigenetic inflammation score, EIS) for 12-month remission. Differential methylation results showed increasing numbers of significant CpGs over time, with inflammation-linked CpGs providing stable contributions. A two-CpG signature (cg10636246 in AIM2; cg02650017 near ABCG1/PHOSPHO1) achieved AUROC 0.757 and AUPRC 0.854, supporting compact epigenetic signatures for long-term risk stratification. Clinical and treatment features were most informative for short-term outcomes, whereas inflammatory and epigenetic markers became increasingly important for long-term remission. These findings support precision psychiatry approaches integrating dynamic multimodal features, emphasizing treatment exposure for acute management and inflammation-related markers for long-term planning.</p>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":" ","pages":"121259"},"PeriodicalIF":4.9,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146179942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-09DOI: 10.1016/j.jad.2026.121370
Ahsan Aziz Sarkar , Md Faruq Alam , Helal Uddin Ahmed , Mohammad Tariqul Alam , Niaz Mohammad Khan
Background
Depressive disorders are among the leading causes of disability worldwide. Cultural variations in symptom presentation and the wide treatment gap in low- and middle-income countries underscore the need for country-specific data.
Methods
A nationally representative household survey was conducted among Bangladeshi adults. Participants were first screened with the Self-Reporting Questionnaire (SRQ), and those screening positive underwent face-to-face clinical interviews with trained psychiatrists. Diagnoses were made using the DSM-5 criteria.
Results
A total of 7270 adults completed all study procedures. The weighted current prevalence of depressive disorders was 5.2% (95% CI: 4.5–6.0), comprising 3.9% with major depressive disorder and 1.3% with persistent depressive disorder, based on DSM-5 criteria assessed through psychiatric interviews. Higher prevalence was observed among older adults aged ≥60 years (aOR = 1.55), females (aOR = 1.53), individuals with lower education (aOR = 1.68), divorced, separated, or widowed (aOR = 2.09), unemployed (aOR = 2.87), and those with a family history of mental illness (aOR = 3.58) or suicidal behavior (aOR = 2.17). Among affected individuals, somatic symptoms were more commonly reported than affective or cognitive symptoms of depression. Despite this considerable burden, the treatment gap remained high, with only 4.1% seeking professional help.
Conclusion
Depression imposes a substantial burden in Bangladesh. The findings highlight the need for enhanced awareness and mental health literacy programs to address the treatment gap. Findings indicate that certain physical complaints may reflect underlying depression and therefore warrant routine depression screening; this highlights the importance of culturally sensitive screening instruments.
{"title":"Prevalence, symptom profile, associated factors, and treatment gap of depressive disorders among adults: Findings from a nationwide household survey in Bangladesh","authors":"Ahsan Aziz Sarkar , Md Faruq Alam , Helal Uddin Ahmed , Mohammad Tariqul Alam , Niaz Mohammad Khan","doi":"10.1016/j.jad.2026.121370","DOIUrl":"10.1016/j.jad.2026.121370","url":null,"abstract":"<div><h3>Background</h3><div>Depressive disorders are among the leading causes of disability worldwide. Cultural variations in symptom presentation and the wide treatment gap in low- and middle-income countries underscore the need for country-specific data.</div></div><div><h3>Methods</h3><div>A nationally representative household survey was conducted among Bangladeshi adults. Participants were first screened with the Self-Reporting Questionnaire (SRQ), and those screening positive underwent face-to-face clinical interviews with trained psychiatrists. Diagnoses were made using the DSM-5 criteria.</div></div><div><h3>Results</h3><div>A total of 7270 adults completed all study procedures. The weighted current prevalence of depressive disorders was 5.2% (95% CI: 4.5–6.0), comprising 3.9% with major depressive disorder and 1.3% with persistent depressive disorder, based on DSM-5 criteria assessed through psychiatric interviews. Higher prevalence was observed among older adults aged ≥60 years (aOR = 1.55), females (aOR = 1.53), individuals with lower education (aOR = 1.68), divorced, separated, or widowed (aOR = 2.09), unemployed (aOR = 2.87), and those with a family history of mental illness (aOR = 3.58) or suicidal behavior (aOR = 2.17). Among affected individuals, somatic symptoms were more commonly reported than affective or cognitive symptoms of depression. Despite this considerable burden, the treatment gap remained high, with only 4.1% seeking professional help.</div></div><div><h3>Conclusion</h3><div>Depression imposes a substantial burden in Bangladesh. The findings highlight the need for enhanced awareness and mental health literacy programs to address the treatment gap. Findings indicate that certain physical complaints may reflect underlying depression and therefore warrant routine depression screening; this highlights the importance of culturally sensitive screening instruments.</div></div>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":"402 ","pages":"Article 121370"},"PeriodicalIF":4.9,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-09DOI: 10.1016/j.jad.2026.121327
Ling Zhu , Qiao Mao , Zhixiong Luo , Bin Chen , Yong Zhang , Xiaowei Lu , Ping Liu , Jiawu Ji , Xiaoping Wang , Kesheng Wang , Xinghua Pan , Yuping Cao , Na Liu , Jianming Zheng , Fan Wang , Kebing Yang , Fude Yang , Zongyang Yu , Jia Hu , Jennifer Luo , Xiaoyun Guo
Objectives
P2RX7 has been implicated in bipolar disorder, major depressive disorder, schizophrenia, anxiety disorders, Alzheimer's disease, and Parkinson's disease. However, the specificity and comparability of these associations remain unclear. This study aimed to systematically evaluate multiple neuropsychiatric disorders to identify those most robustly associated with P2RX7.
Methods
We analyzed 1861 imputed SNPs spanning the P2RX7 gene in 1,087,925 individuals from 72 independent cohorts across 18 neuropsychiatric disorders. SNP-disease associations were assessed within each cohort, followed by meta-analysis and false discovery rate (FDR) correction to identify significant disease-risk variants. P2RX7 mRNA and protein expression across tissues or cells was characterized. Functional analyses evaluated the regulatory effects of disease-associated SNPs on P2RX7 mRNA expression, subcortical gray matter volumes (GMVs), cortical surface area (SA), and cortical thickness (TH).
Results
Bipolar disorder showed the strongest association with P2RX7 variants in European Americans (EAs) (4.0 × 10−8 ≤ p ≤ 0.004; 3.8 × 10−5 ≤ q ≤ 0.05), followed by schizophrenia in EAs (8.9 × 10−6 ≤ p ≤ 2.6 × 10−4; 9.4 × 10−3 ≤ q ≤ 0.043) and Chinese populations (2.1 × 10−5 ≤ p ≤ 1.7 × 10−3; 6.8 × 10−3 ≤ q ≤ 0.049), and major depression in both EAs (p = 4.1 × 10−5; q = 0.030) and Chinese (4.3 × 10−5 ≤ p ≤ 0.009; 6.1 × 10−3 ≤ q ≤ 0.046). The significance of most associations and their relative ranking across disorders was maintained in the trans-ancestry meta-analysis. Expression analysis revealed that P2RX7 mRNA and protein expression were abundant in the brain, glial cells and macrophages. Approximately half of the disease-associated SNPs significantly influenced P2RX7 mRNA expression in nine brain regions (1.0 × 10−7 ≤ p ≤ 0.047) and altered GMV, SA, and TH of seven brain regions (1.9 × 10−4 ≤ p ≤ 3.4 × 10−3).
Conclusion
P2RX7 is most consistently and specifically associated with bipolar disorder, schizophrenia, and major depression, supported by both statistical and biological evidence.
{"title":"Phenome-wide association study of P2RX7 identifies schizophrenia and mood disorders as primary associated phenotypes","authors":"Ling Zhu , Qiao Mao , Zhixiong Luo , Bin Chen , Yong Zhang , Xiaowei Lu , Ping Liu , Jiawu Ji , Xiaoping Wang , Kesheng Wang , Xinghua Pan , Yuping Cao , Na Liu , Jianming Zheng , Fan Wang , Kebing Yang , Fude Yang , Zongyang Yu , Jia Hu , Jennifer Luo , Xiaoyun Guo","doi":"10.1016/j.jad.2026.121327","DOIUrl":"10.1016/j.jad.2026.121327","url":null,"abstract":"<div><h3>Objectives</h3><div><em>P2RX7</em> has been implicated in bipolar disorder, major depressive disorder, schizophrenia, anxiety disorders, Alzheimer's disease, and Parkinson's disease. However, the specificity and comparability of these associations remain unclear. This study aimed to systematically evaluate multiple neuropsychiatric disorders to identify those most robustly associated with <em>P2RX7</em>.</div></div><div><h3>Methods</h3><div>We analyzed 1861 imputed SNPs spanning the <em>P2RX7</em> gene in 1,087,925 individuals from 72 independent cohorts across 18 neuropsychiatric disorders. SNP-disease associations were assessed within each cohort, followed by meta-analysis and false discovery rate (FDR) correction to identify significant disease-risk variants. <em>P2RX7</em> mRNA and protein expression across tissues or cells was characterized. Functional analyses evaluated the regulatory effects of disease-associated SNPs on <em>P2RX7</em> mRNA expression, subcortical gray matter volumes (GMVs), cortical surface area (SA), and cortical thickness (TH).</div></div><div><h3>Results</h3><div>Bipolar disorder showed the strongest association with <em>P2RX7</em> variants in European Americans (EAs) (4.0 × 10<sup>−8</sup> ≤ <em>p</em> ≤ 0.004; 3.8 × 10<sup>−5</sup> ≤ q ≤ 0.05), followed by schizophrenia in EAs (8.9 × 10<sup>−6</sup> ≤ <em>p</em> ≤ 2.6 × 10<sup>−4</sup>; 9.4 × 10<sup>−3</sup> ≤ q ≤ 0.043) and Chinese populations (2.1 × 10<sup>−5</sup> ≤ <em>p</em> ≤ 1.7 × 10<sup>−3</sup>; 6.8 × 10<sup>−3</sup> ≤ q ≤ 0.049), and major depression in both EAs (<em>p</em> = 4.1 × 10<sup>−5</sup>; q = 0.030) and Chinese (4.3 × 10<sup>−5</sup> ≤ <em>p</em> ≤ 0.009; 6.1 × 10<sup>−3</sup> ≤ q ≤ 0.046). The significance of most associations and their relative ranking across disorders was maintained in the trans-ancestry meta-analysis. Expression analysis revealed that <em>P2RX7</em> mRNA and protein expression were abundant in the brain, glial cells and macrophages. Approximately half of the disease-associated SNPs significantly influenced <em>P2RX7</em> mRNA expression in nine brain regions (1.0 × 10<sup>−7</sup> ≤ <em>p</em> ≤ 0.047) and altered GMV, SA, and TH of seven brain regions (1.9 × 10<sup>−4</sup> ≤ <em>p</em> ≤ 3.4 × 10<sup>−3</sup>).</div></div><div><h3>Conclusion</h3><div><em>P2RX7</em> is most consistently and specifically associated with bipolar disorder, schizophrenia, and major depression, supported by both statistical and biological evidence.</div></div>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":"402 ","pages":"Article 121327"},"PeriodicalIF":4.9,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-09DOI: 10.1016/j.jad.2026.121367
Pauline Rivart , Saied Ibrahim , Lana Bojanić , Pauline Turnbull , Cathryn Rodway , Louis Appleby , Nav Kapur , Isabelle M. Hunt
Background
Previous research has highlighted the importance of surveillance of suicide methods to identify emerging patterns and to support prevention strategies. However, research on methods in clinical populations is limited. We aimed to investigate trends in suicide methods by people who had been in contact with mental health services in the 12 months before death.
Method
Data were collected as part of the National Confidential Inquiry into Suicide and Safety in Mental Health. We examined method-specific trends among psychiatric patients in the UK who died by suicide between 2000 and 2022 using an exploratory joinpoint regression analysis.
Findings
Hanging/strangulation increased by 43.0% over the study period, or 1.9% per year, while cutting/stabbing increased by 88.9%, or 4.2% per year. Deaths by self-poisoning, drowning and gas inhalation decreased by 1.7%, 2.3% and 4.6% every year respectively. No significant trends were identified for deaths by jumping/multiple injuries. No changes overall were identified in the last three years of the study, including during the COVID-19 pandemic.
Discussion
The increase in patient suicide deaths by hanging/strangulation is of concern. Attention should be paid to the steady increase in deaths by cutting/stabbing. Our findings support the need for surveillance, including real-time surveillance, of emerging methods and continued efforts towards means restriction.
{"title":"Trends in methods of suicide among mental health patients between 2000 and 2022 in the UK: A joinpoint regression analysis","authors":"Pauline Rivart , Saied Ibrahim , Lana Bojanić , Pauline Turnbull , Cathryn Rodway , Louis Appleby , Nav Kapur , Isabelle M. Hunt","doi":"10.1016/j.jad.2026.121367","DOIUrl":"10.1016/j.jad.2026.121367","url":null,"abstract":"<div><h3>Background</h3><div>Previous research has highlighted the importance of surveillance of suicide methods to identify emerging patterns and to support prevention strategies. However, research on methods in clinical populations is limited. We aimed to investigate trends in suicide methods by people who had been in contact with mental health services in the 12 months before death.</div></div><div><h3>Method</h3><div>Data were collected as part of the National Confidential Inquiry into Suicide and Safety in Mental Health. We examined method-specific trends among psychiatric patients in the UK who died by suicide between 2000 and 2022 using an exploratory joinpoint regression analysis.</div></div><div><h3>Findings</h3><div>Hanging/strangulation increased by 43.0% over the study period, or 1.9% per year, while cutting/stabbing increased by 88.9%, or 4.2% per year. Deaths by self-poisoning, drowning and gas inhalation decreased by 1.7%, 2.3% and 4.6% every year respectively. No significant trends were identified for deaths by jumping/multiple injuries. No changes overall were identified in the last three years of the study, including during the COVID-19 pandemic.</div></div><div><h3>Discussion</h3><div>The increase in patient suicide deaths by hanging/strangulation is of concern. Attention should be paid to the steady increase in deaths by cutting/stabbing. Our findings support the need for surveillance, including real-time surveillance, of emerging methods and continued efforts towards means restriction.</div></div>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":"402 ","pages":"Article 121367"},"PeriodicalIF":4.9,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-09DOI: 10.1016/j.jad.2026.121366
Benjamin M Rosenberg, Nora M Barnes-Horowitz, Doan Ngo, Jung Woon Park, Ossanna H Amran, Aleeza West, Jiani Li, Chiana Yang, Kelly Y Cai, Thomas E Valles, Cole Matthews, Isabelle Lanser, Jill M Newby, Michael Millard, Andrew F Leuchter, Michelle G Craske
Major Depressive Disorder (MDD) is common and burdensome. Repetitive Transcranial Magnetic Stimulation (rTMS) is recommended for individuals who do not respond to first-line treatments. Coach-supported digital mental health programs are scalable strategies for delivering therapeutic content. This randomized controlled trial tested whether digital mental health programs bolster rTMS for MDD. N = 36 depressed adults completed a six-week course of rTMS. Of this group, n = 18 were randomized to digital cognitive behavioral therapy (iCBT with Coaching), and n = 18 were randomized to digital narrative stories of hope (iNarratives with Coaching). Multilevel models tested group differences in treatment outcomes over time. Principal outcomes focused on the Hamilton Rating Scale for Depression. Exploratory analyses compared outcomes versus a Benchmarking Sample of N = 29 patients who received rTMS without coaching. There was a main effect of time (p < .001), indicating an overall reduction in depression symptoms during the trial. Contrary to hypotheses, there was no Group x Time interaction (p = .662), and groups did not differ on clinical response rates (p = .654). Secondary analyses found that the iNarratives group showed greater improvement in positive emotion and functional impairment, whereas the iCBT group showed less dropout from the coaching intervention. Exploratory analyses found a Group x Time interaction (p = .039), potentially suggesting that participants in iCBT or iNarratives showed steeper symptom reduction versus the Benchmarking Sample. The coach-supported iCBT and iNarratives approaches are comparable as adjuncts to rTMS for depression and may yield lower depression scores versus rTMS alone. iNarratives effects appeared specific to increases in positive emotions and decreases in functional impairment.
重度抑郁症（MDD）是一种常见且令人负担沉重的疾病。重复经颅磁刺激（rTMS）是推荐的个人谁不响应一线治疗。教练支持的数字心理健康项目是提供治疗内容的可扩展策略。这个随机对照试验测试了数字心理健康项目是否支持重度抑郁症的rTMS治疗。N = 36名抑郁症成年人完成了为期六周的rTMS疗程。在这一组中，n = 18人被随机分配到数字认知行为疗法（iCBT + Coaching）， n = 18人被随机分配到数字希望叙事故事（innarratives with Coaching）。多水平模型测试各组治疗结果随时间的差异。主要结果集中在汉密尔顿抑郁量表上。探索性分析比较了结果与基准样本N = 29例未接受指导的rTMS患者的结果。时间是主要的影响因素
{"title":"Does mental health coaching improve efficacy of transcranial magnetic stimulation for major depression? A pilot randomized controlled trial and benchmarking study.","authors":"Benjamin M Rosenberg, Nora M Barnes-Horowitz, Doan Ngo, Jung Woon Park, Ossanna H Amran, Aleeza West, Jiani Li, Chiana Yang, Kelly Y Cai, Thomas E Valles, Cole Matthews, Isabelle Lanser, Jill M Newby, Michael Millard, Andrew F Leuchter, Michelle G Craske","doi":"10.1016/j.jad.2026.121366","DOIUrl":"10.1016/j.jad.2026.121366","url":null,"abstract":"<p><p>Major Depressive Disorder (MDD) is common and burdensome. Repetitive Transcranial Magnetic Stimulation (rTMS) is recommended for individuals who do not respond to first-line treatments. Coach-supported digital mental health programs are scalable strategies for delivering therapeutic content. This randomized controlled trial tested whether digital mental health programs bolster rTMS for MDD. N = 36 depressed adults completed a six-week course of rTMS. Of this group, n = 18 were randomized to digital cognitive behavioral therapy (iCBT with Coaching), and n = 18 were randomized to digital narrative stories of hope (iNarratives with Coaching). Multilevel models tested group differences in treatment outcomes over time. Principal outcomes focused on the Hamilton Rating Scale for Depression. Exploratory analyses compared outcomes versus a Benchmarking Sample of N = 29 patients who received rTMS without coaching. There was a main effect of time (p < .001), indicating an overall reduction in depression symptoms during the trial. Contrary to hypotheses, there was no Group x Time interaction (p = .662), and groups did not differ on clinical response rates (p = .654). Secondary analyses found that the iNarratives group showed greater improvement in positive emotion and functional impairment, whereas the iCBT group showed less dropout from the coaching intervention. Exploratory analyses found a Group x Time interaction (p = .039), potentially suggesting that participants in iCBT or iNarratives showed steeper symptom reduction versus the Benchmarking Sample. The coach-supported iCBT and iNarratives approaches are comparable as adjuncts to rTMS for depression and may yield lower depression scores versus rTMS alone. iNarratives effects appeared specific to increases in positive emotions and decreases in functional impairment.</p>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":" ","pages":"121366"},"PeriodicalIF":4.9,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-09DOI: 10.1016/j.jad.2026.121372
Arleise Nunes Cavalcanti de Albuquerque, Carla Alexandra da Silva Moita Minervino, Robert Sérgio de Almeida Costa, Paloma Victória de Sales Alves, Joecaz Vitor Alves Araújo
Electroconvulsive therapy (ECT) proves to be an effective intervention in severe cases of major depressive disorder (MDD), especially when there is resistance to pharmacological treatment. The neurotrophic hypothesis proposes that an increase in brain-derived neurotrophic factor (BDNF) is one of the mechanisms responsible for the therapeutic response. The aim of this study is to investigate the effects of ECT on peripheral levels of BDNF, measured in serum and plasma, and analyze clinical outcomes associated with this intervention, as well as identify methodological variables that may influence findings. A systematic review and meta-analysis of studies published between 1995 and 2025 on the PubMed, Scopus and Web of Science databases were conducted, following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies of BDNF in serum (14) and plasma (6) were performed separately. Clinical effectiveness was evaluated according to average standardized differences in depression scores. Meta-regressions in the R software identified the impact of four moderators: type of ECT, number of sessions, type of anesthetic and the time blood sample was taken. ECT was associated with an increase in BDNF levels in both biological matrices, especially in studies with plasma (I2 = 0%). Significant reductions in depression symptoms were also observed. These meta-regressions indicate that the kind of anesthetic used and the time the blood sample was taken greatly influence BDNF levels. The biological matrix used, as well as specific methodological variables, affects the measurement of BDNF, reinforcing the need to standardize future studies.
电痉挛疗法（ECT）被证明是一种有效的干预重度抑郁症（MDD）的病例，特别是当有抗药性的药物治疗。神经营养假说提出脑源性神经营养因子（BDNF）的增加是导致治疗反应的机制之一。本研究的目的是研究ECT对血清和血浆外周BDNF水平的影响，并分析与此干预相关的临床结果，以及确定可能影响结果的方学变量。对1995年至2025年间发表在PubMed、Scopus和Web of Science数据库上的研究进行了系统回顾和荟萃分析，遵循系统回顾和荟萃分析的首选报告项目（PRISMA）指南。分别对血清（14）和血浆(6)中的BDNF进行研究。根据抑郁评分的平均标准化差异评估临床疗效。R软件中的元回归确定了四种调节因素的影响：电痉挛疗法类型、治疗次数、麻醉类型和采血时间。ECT与两种生物基质中BDNF水平的增加有关，特别是在血浆研究中（I2 = 0%）。抑郁症症状也明显减轻。这些元回归表明，使用的麻醉剂种类和采集血液样本的时间对BDNF水平有很大影响。所使用的生物基质以及具体的方法变量会影响BDNF的测量，因此需要对未来的研究进行标准化。
{"title":"Electroconvulsive therapy, BDNF and major depressive disorder: A meta-analysis with biological subgroups and clinical assessment of outcomes.","authors":"Arleise Nunes Cavalcanti de Albuquerque, Carla Alexandra da Silva Moita Minervino, Robert Sérgio de Almeida Costa, Paloma Victória de Sales Alves, Joecaz Vitor Alves Araújo","doi":"10.1016/j.jad.2026.121372","DOIUrl":"https://doi.org/10.1016/j.jad.2026.121372","url":null,"abstract":"<p><p>Electroconvulsive therapy (ECT) proves to be an effective intervention in severe cases of major depressive disorder (MDD), especially when there is resistance to pharmacological treatment. The neurotrophic hypothesis proposes that an increase in brain-derived neurotrophic factor (BDNF) is one of the mechanisms responsible for the therapeutic response. The aim of this study is to investigate the effects of ECT on peripheral levels of BDNF, measured in serum and plasma, and analyze clinical outcomes associated with this intervention, as well as identify methodological variables that may influence findings. A systematic review and meta-analysis of studies published between 1995 and 2025 on the PubMed, Scopus and Web of Science databases were conducted, following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies of BDNF in serum (14) and plasma (6) were performed separately. Clinical effectiveness was evaluated according to average standardized differences in depression scores. Meta-regressions in the R software identified the impact of four moderators: type of ECT, number of sessions, type of anesthetic and the time blood sample was taken. ECT was associated with an increase in BDNF levels in both biological matrices, especially in studies with plasma (I<sup>2</sup> = 0%). Significant reductions in depression symptoms were also observed. These meta-regressions indicate that the kind of anesthetic used and the time the blood sample was taken greatly influence BDNF levels. The biological matrix used, as well as specific methodological variables, affects the measurement of BDNF, reinforcing the need to standardize future studies.</p>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":" ","pages":"121372"},"PeriodicalIF":4.9,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Individuals who self-harm show an increased risk of self-harm repetition. We aimed to compare factors associated with fatal and non-fatal self-harm repetition among adults who presented to hospitals with self-harm.
Methods: We conducted a cohort study using data from Taiwan's National Suicide Surveillance System (NSSS) from 2012 to 2017, linking data to national mortality records to identify fatal repetitions (i.e., suicide). We calculated incidence rates for repeated self-harm and suicide, examined risk factors using Cox proportional hazards models, and calculated population attributable fraction (PAF) for each factor.
Results: The overall incidence rate of non-fatal and fatal self-harm repetition was 67.6 (95% confidence interval [CI] 66.5-68.6) and 10.4 (95% CI 10.0-10.8) per 1000 person-years, respectively. Risk factors for non-fatal self-harm repetition included female sex, younger age, being divorced/separated, lower education, overdose as the index self-harm method, a history of psychiatric disorders, and psychiatric and non-psychiatric hospitalizations in the past year. Risk factors for fatal self-harm repetition included male sex, older age, being single/divorced/separated, using higher lethality methods at the index episode, and a history of psychiatric disorders. Depressive disorders showed the highest PAF (19.28%) for non-fatal self-harm repetition, while male sex showed the highest PAF (20.56%) for fatal repetition among all risk factors.
Conclusions: Non-fatal and fatal self-harm repetition shared some risk factors but also had distinct ones. A better understanding of the shared and distinct mechanisms underlying the risk of non-fatal and fatal self-harm repetition can improve intervention strategies.
背景：自我伤害的个体表现出更高的自我伤害重复的风险。我们的目的是比较因自残而到医院就诊的成年人中与致命和非致命自残重复相关的因素。我们计算了重复自残和自杀的发生率，使用Cox比例风险模型检查了危险因素，并计算了每个因素的人口归因分数（PAF）。结果：非致死性和致死性自我伤害重复的总发生率分别为67.6（95%可信区间[CI] 66.5-68.6）和10.4 (95% CI 10.0-10.8) / 1000人年。非致命性自残重复发生的危险因素包括女性、年龄较小、离婚/分居、受教育程度较低、自残方法指标为用药过量、有精神疾病史、过去一年的精神和非精神住院情况。致命自残重复的危险因素包括男性、年龄较大、单身/离婚/分居、在指数发作时使用高致死率方法以及有精神疾病史。在所有危险因素中，抑郁障碍的非致命性自残重复行为PAF最高（19.28%），而男性的致命性自残重复行为PAF最高（20.56%）。结论：非致死性和致死性自残重复有共同的危险因素，但也有不同的危险因素。更好地了解非致命性和致命性自我伤害重复风险的共同和独特机制可以改进干预策略。
{"title":"Comparison of risk factors in fatal and non-fatal repetition of self-harm: A population-based cohort study of 84,430 Taiwanese adults who presented to hospital with self-harm.","authors":"Cho-Yin Huang, Chien-Yu Lin, Yi-Han Chang, Chia-Yueh Hsu, David Gunnell, Ying-Yeh Chen, Shu-Sen Chang","doi":"10.1016/j.jad.2026.121369","DOIUrl":"https://doi.org/10.1016/j.jad.2026.121369","url":null,"abstract":"<p><strong>Background: </strong>Individuals who self-harm show an increased risk of self-harm repetition. We aimed to compare factors associated with fatal and non-fatal self-harm repetition among adults who presented to hospitals with self-harm.</p><p><strong>Methods: </strong>We conducted a cohort study using data from Taiwan's National Suicide Surveillance System (NSSS) from 2012 to 2017, linking data to national mortality records to identify fatal repetitions (i.e., suicide). We calculated incidence rates for repeated self-harm and suicide, examined risk factors using Cox proportional hazards models, and calculated population attributable fraction (PAF) for each factor.</p><p><strong>Results: </strong>The overall incidence rate of non-fatal and fatal self-harm repetition was 67.6 (95% confidence interval [CI] 66.5-68.6) and 10.4 (95% CI 10.0-10.8) per 1000 person-years, respectively. Risk factors for non-fatal self-harm repetition included female sex, younger age, being divorced/separated, lower education, overdose as the index self-harm method, a history of psychiatric disorders, and psychiatric and non-psychiatric hospitalizations in the past year. Risk factors for fatal self-harm repetition included male sex, older age, being single/divorced/separated, using higher lethality methods at the index episode, and a history of psychiatric disorders. Depressive disorders showed the highest PAF (19.28%) for non-fatal self-harm repetition, while male sex showed the highest PAF (20.56%) for fatal repetition among all risk factors.</p><p><strong>Conclusions: </strong>Non-fatal and fatal self-harm repetition shared some risk factors but also had distinct ones. A better understanding of the shared and distinct mechanisms underlying the risk of non-fatal and fatal self-harm repetition can improve intervention strategies.</p>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":" ","pages":"121369"},"PeriodicalIF":4.9,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Maternal antenatal depression and offspring DNA methylation","authors":"Diane L. Putnick , Akhgar Ghassabian , Weihua Guan , Pauline Mendola , Rajeshwari Sundaram , Edwina Yeung","doi":"10.1016/j.jad.2026.121335","DOIUrl":"10.1016/j.jad.2026.121335","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 <em>MAD1L1;</em> β = −1.68, SE = 0.29) and cg17830140 (in <em>POLRMT</em>, 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).</div></div><div><h3>Conclusions</h3><div>Methylation of other probes in the <em>MAD1L1</em> 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.</div></div>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":"402 ","pages":"Article 121335"},"PeriodicalIF":4.9,"publicationDate":"2026-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-07DOI: 10.1016/j.jad.2026.121336
Shouying Li , Jiaxin Feng , Shilin Zhang
Objective
To describe and compare the reporting patterns and signal strengths of male sexual dysfunction associated with six commonly prescribed SSRIs in the FDA Adverse Event Reporting System.
Methods
Adverse event data for six representative SSRIs, fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram, and escitalopram, were retrieved from the FAERS database, spanning from the first quarter of 2004 to the first quarter of 2025. Disproportionality analysis was conducted using both the reporting odds ratio (ROR) and proportional reporting ratio (PRR) to identify potential signals of adverse drug events associated with these medications.
Results
We analyzed 6,631,746 adverse drug event reports associated with SSRIs and detected significant disproportionality signals indicative of male sexual dysfunction in patients with depression. Across all SSRIs, erectile dysfunction was the most commonly reported adverse event [fluoxetine (ROR: 4.97, 95%CI: 4.25–5.82), paroxetine (ROR: 3.99, 95%CI: 3.53–4.5), sertraline (ROR: 6.11, 95%CI: 5.53–6.75), fluvoxamine (ROR: 1.08, 95%CI: 0.35–3.36), citalopram (ROR: 7.7, 95%CI: 6.81–8.69), and escitalopram (ROR: 7.93, 95%CI: 6.99–8.99)], followed by sexual dysfunction [fluoxetine (ROR: 11.94, 95%CI: 10.01–14.23), paroxetine (ROR: 11.39, 95%CI: 10.05–12.91), sertraline (ROR: 13.34, 95%CI: 11.86–15.01), fluvoxamine (ROR: 9.64, 95%CI: 5.01–18.56), citalopram (ROR: 15.09, 95%CI: 12.98–17.54), and escitalopram (ROR: 16.42, 95%CI: 14.11–19.12)].
Conclusion
This FAERS analysis detected significant disproportionality signals for male sexual dysfunction across SSRIs. Signal variation reflects reporting differences, not comparative risk, due to database limitations. These findings highlight the need for clinical vigilance and further investigation.
{"title":"Male sexual dysfunction associated with selective serotonin reuptake inhibitors (SSRIs): A pharmacovigilance disproportionality analysis of FAERS data","authors":"Shouying Li , Jiaxin Feng , Shilin Zhang","doi":"10.1016/j.jad.2026.121336","DOIUrl":"10.1016/j.jad.2026.121336","url":null,"abstract":"<div><h3>Objective</h3><div>To describe and compare the reporting patterns and signal strengths of male sexual dysfunction associated with six commonly prescribed SSRIs in the FDA Adverse Event Reporting System.</div></div><div><h3>Methods</h3><div>Adverse event data for six representative SSRIs, fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram, and escitalopram, were retrieved from the FAERS database, spanning from the first quarter of 2004 to the first quarter of 2025. Disproportionality analysis was conducted using both the reporting odds ratio (ROR) and proportional reporting ratio (PRR) to identify potential signals of adverse drug events associated with these medications.</div></div><div><h3>Results</h3><div>We analyzed 6,631,746 adverse drug event reports associated with SSRIs and detected significant disproportionality signals indicative of male sexual dysfunction in patients with depression. Across all SSRIs, erectile dysfunction was the most commonly reported adverse event [fluoxetine (ROR: 4.97, 95%CI: 4.25–5.82), paroxetine (ROR: 3.99, 95%CI: 3.53–4.5), sertraline (ROR: 6.11, 95%CI: 5.53–6.75), fluvoxamine (ROR: 1.08, 95%CI: 0.35–3.36), citalopram (ROR: 7.7, 95%CI: 6.81–8.69), and escitalopram (ROR: 7.93, 95%CI: 6.99–8.99)], followed by sexual dysfunction [fluoxetine (ROR: 11.94, 95%CI: 10.01–14.23), paroxetine (ROR: 11.39, 95%CI: 10.05–12.91), sertraline (ROR: 13.34, 95%CI: 11.86–15.01), fluvoxamine (ROR: 9.64, 95%CI: 5.01–18.56), citalopram (ROR: 15.09, 95%CI: 12.98–17.54), and escitalopram (ROR: 16.42, 95%CI: 14.11–19.12)].</div></div><div><h3>Conclusion</h3><div>This FAERS analysis detected significant disproportionality signals for male sexual dysfunction across SSRIs. Signal variation reflects reporting differences, not comparative risk, due to database limitations. These findings highlight the need for clinical vigilance and further investigation.</div></div>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":"402 ","pages":"Article 121336"},"PeriodicalIF":4.9,"publicationDate":"2026-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-07DOI: 10.1016/j.jad.2026.121352
Olivia M. Losiewicz , Alainna Wen , Zachary D. Cohen , Samir Akre , Alex A.T. Bui , Michelle G. Craske
Emotional flexibility, thought to reflect the ability to adapt to internal and external environmental stimuli, is associated with psychological well-being. Emotional inertia and network density, defined as stability and interconnectedness, respectively, of emotions, are aspects of emotion dynamics that represent low emotional flexibility. Studies examining biological substrates of emotional persistence are largely limited to emotional inertia and non-depressed samples. Heart-rate variability (HRV) is a transdiagnostic biomarker for psychopathology thought to be associated with emotional flexibility. This study examined whether emotional inertia and network density were associated with HRV in adults with moderate-to-severe depression (N = 315). Participants completed three 8-day epochs of ecological momentary assessment (EMA) five times daily. Smartwatches measured HRV throughout the study. Emotional inertia and idiographic networks were calculated separately for EMA-rated negative and positive affect. Bayesian dynamic structural equation models with noninformative prior distributions examined the association between emotional inertia and HRV; hierarchical linear modeling examined associations between network density and HRV. Both daytime and bedrest HRV were inversely associated with contemporaneous network density of negative emotions. HRV was not associated with inertia, positive network density, or average EMA-reported affect, though it was associated with age, antidepressant medication, and physical exercise. This was the first study to examine HRV in relation to these emotion dynamics in a depressed sample. The results suggest that experiencing a variety of negative emotions within a short period of time may be associated with underlying biological inflexibility. Future studies should examine the directionality and mechanisms behind this effect and explore potential clinical interventions.
{"title":"Negative emotional inflexibility underlies biological inflexibility: An ecological momentary assessment and passive digital sensing study","authors":"Olivia M. Losiewicz , Alainna Wen , Zachary D. Cohen , Samir Akre , Alex A.T. Bui , Michelle G. Craske","doi":"10.1016/j.jad.2026.121352","DOIUrl":"10.1016/j.jad.2026.121352","url":null,"abstract":"<div><div>Emotional flexibility, thought to reflect the ability to adapt to internal and external environmental stimuli, is associated with psychological well-being. Emotional inertia and network density, defined as stability and interconnectedness, respectively, of emotions, are aspects of emotion dynamics that represent low emotional flexibility. Studies examining biological substrates of emotional persistence are largely limited to emotional inertia and non-depressed samples. Heart-rate variability (HRV) is a transdiagnostic biomarker for psychopathology thought to be associated with emotional flexibility. This study examined whether emotional inertia and network density were associated with HRV in adults with moderate-to-severe depression (<em>N</em> = 315). Participants completed three 8-day epochs of ecological momentary assessment (EMA) five times daily. Smartwatches measured HRV throughout the study. Emotional inertia and idiographic networks were calculated separately for EMA-rated negative and positive affect. Bayesian dynamic structural equation models with noninformative prior distributions examined the association between emotional inertia and HRV; hierarchical linear modeling examined associations between network density and HRV. Both daytime and bedrest HRV were inversely associated with contemporaneous network density of negative emotions. HRV was not associated with inertia, positive network density, or average EMA-reported affect, though it was associated with age, antidepressant medication, and physical exercise. This was the first study to examine HRV in relation to these emotion dynamics in a depressed sample. The results suggest that experiencing a variety of negative emotions within a short period of time may be associated with underlying biological inflexibility. Future studies should examine the directionality and mechanisms behind this effect and explore potential clinical interventions.</div></div>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":"402 ","pages":"Article 121352"},"PeriodicalIF":4.9,"publicationDate":"2026-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146141968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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