Psychological Medicine最新文献

Background: Parenthood is consistently identified as a protective factor for suicidal behavior. However, it remains unclear whether this relationship varies as a function of sex, age, time since birth, number of children, and other risk/protective factors.

Methods: We used Cox proportional hazards models to describe the relationship between the birth of up to four children and suicide attempt (SA) risk in Swedish individuals born between 1960 and 1980. Models were stratified by sex and controlled for a range of covariates. We tested whether the relationship between parenthood and SA risk varies based on age at first birth and explored whether SA risk differed based on education, genetic liability, cohabitation with one's co-parent, and geographic proximity to one's mother (the child's grandmother).

Results: The first year following childbirth was associated with reduced SA risk in mothers (hazard ratios [HRs] = 0.34-0.64) and fathers (HRs = 0.60-0.86). However, later time periods following the birth of one's third and fourth children were associated with elevated risk (HRs = 1.02-1.26). Moreover, age at first birth moderated the association between parenthood and SA: individuals who became parents at age 15 exhibited increased risk for SA (HRs = 2.81-5.30), while individuals with an older age at first birth (30+ years) experienced a reduction in risk (HRs = 0.31-0.92). The effect of parenthood also varied based on cohabitation and proximity to one's mother.

Conclusions: These findings underscore the complexity of the relationship between parenthood and SA, indicating that there are some subgroups for whom the transition to parenthood is not protective. Clinical outreach may be warranted as a preventative measure.

Background: Cognitive and behavioral symptoms of major depressive disorder (MDD) are linked to aberrant changes in the controllability of brain networks. However, previous studies examined network controllability using white matter tractography, neglecting the contributions of gray matter. We aimed to examine differences in the controllability of morphometric networks between patients with MDD and demographic-matched healthy controls and identify the associated neurobiological signatures.

Methods: Based on the structural and diffusion MRI data from two independent cohorts, we calculated the controllability of morphometric similarity networks for each participant. A generalized additive model was used to investigate the case-control differences in regional controllability and their cognitive and behavioral associations. We investigated the associations between imaging-derived controllability and neurotransmitters, brain metabolism, and gene transcription profiles using multivariate linear regression and partial least squares regression analyses.

Results: In both cohorts, depression-related abnormalities of morphometric network controllability were primarily located in the prefrontal, cingulate, and visual cortices, contributing to memory, sensation, and perception processes. These abnormalities in network controllability were spatially aligned with the distributions of serotonergic transmission pathways as well as with altered oxygen and glucose metabolism. In addition, these abnormalities spatially overlapped with differentially expressed genes enriched in annotations related to protein catabolism and mitochondria in neuronal cells and were disproportionately located on chromosome 22.

Conclusions: Collectively, neuroimaging evidence revealed aberrant morphometric network controllability underlying MDD-related cognitive and behavioral deficits, and the associated genetic and molecular signatures may help identify the neurobiological mechanisms underlying MDD and provide feasible therapeutic targets.

Background: Auditory verbal hallucinations (AVH) in schizophrenia spectrum disorders (SSDs) may arise from misattributed inner speech. However, it is unclear if inner speech frequency and phenomenology differ in schizophrenia-spectrum voice-hearers compared with healthy individuals, and how different inner speech varieties relate to AVH and affect. Using experience sampling methodology (ESM), this study examined the moment-to-moment dynamics between inner speech varieties, AVH, and affect.

Methods: Participants completed 6 days of ESM on an electronic device, responding to 10 daily prompts on inner speech varieties (i.e. dialogic, evaluative, other people, condensed, and positive), AVH, and affect. Responses from 32 individuals with SSDs with current AVH ('SSD') and 34 healthy controls ('HC') were analyzed using linear mixed modeling.

Results: SSD reported significantly more inner speech moments and higher momentary intensity of evaluative, other people, condensed, and positive inner speech compared with HC, but not for dialogic inner speech. Within SSD, higher momentary intensities of dialogic, evaluative, other people, and condensed inner speech were associated with higher AVH levels. Momentary negative affect (NA) moderated the association between evaluative inner speech and AVH, with a stronger association at higher NA levels.

Conclusions: SSDs with current AVH experience more frequent inner speech and exhibit a distinct phenomenological profile compared with healthy individuals. Several inner speech varieties are associated with AVH severity momentarily, supporting the hypothesis that inner speech contributes to AVH at the phenomenological level. This study highlights the emotional state as an important moderator of the inner speech-AVH relationship and as a potential therapeutic target.

Background: The results of a previous randomized trial showed that mentalization-based treatment for psychotic disorder (MBTp) was associated with greater improvement than treatment as usual (TAU) in social functioning up to 6 months after treatment. The purpose of the present study is to examine the effect after 5 years.

Methods: The researchers tried to find all patients who had participated in the trial (n = 84) and to assess, blind to previous treatment status, their social functioning and mentalizing capacity. Social functioning was measured using the Social Functioning Scale, mentalizing using the Social Cognition and Object Relations Scale and the Hinting Task.

Results: Twenty-three MBTp patients and 23 TAU patients collaborated. There was no evidence of selective drop-out. A complete case, repeated measure analysis of variance on the basis of intention-to-treat showed that, 5 years post-treatment, MBTp patients still scored better on social functioning compared to baseline [η_p² = .25, p = .01], whereas TAU patients did not [η_p² = .01, p = .67], with a significant difference between the conditions [η_p² = .10, p = .03]. A sensitivity analysis with linear mixed models, however, showed weaker evidence for an additive effect of MBTp over TAU on social functioning 5 years post-treatment, F = 3.731, p = .06. MBT patients also showed a greater improvement in one aspect of mentalizing, understanding of social causality [η_p² = 0.17, p = .04], but not other aspects of mentalizing.

Conclusion: The results suggest a durable effect of MBTp.

Childhood trauma is a well-established risk factor for the onset and persistence of psychotic symptoms. Consequently, trauma-focused interventions (TFIs) are increasingly incorporated into psychosis treatment, though their effectiveness in reducing hallucinations and delusions remains unclear. This systematic review and meta-analysis evaluated the effects of TFIs on psychosis-related outcomes in individuals with psychotic disorders or subclinical symptoms. Thirty-six studies (N = 1,384) were included, with 18 (N = 806) contributing to meta-analyses. Study quality and risk of bias were assessed using AXIS, Cochrane RoB2, and GRADE. Pre-post analyses showed small reductions in hallucinations (g = -0.37; adjusted g = -0.28; K = 15) and medium reductions in delusions (g = -0.55; K = 14), with younger participants benefiting more. In controlled trials, TFIs did not significantly reduce hallucinations at the end of treatment or follow-up (g = -0.12 and -0.01; both K = 7), whereas delusions showed significant reductions at both time points (g = -0.44 and g = -0.48; both K = 7). No significant effect on negative symptoms was observed at the end of trial (g = -0.02; K = 6), though a small improvement appeared at follow-up (g = -0.26; K = 6). TFIs produced small but significant reductions in PTSD symptoms at both time points (K = 6). No consistent effects were found for secondary outcomes: depression (K = 7), anxiety (K = 5), or quality of life (K = 3), though functioning improved at follow-up (K = 6). TFIs appear particularly effective in reducing delusions, but show limited benefit for hallucinations and other secondary outcomes. Further work is needed to design and test symptom-specific psychological interventions for distinct psychotic experiences.

Background: Exercise improves stress perception and sleep quality and reduces repetitive negative thinking in patients with various mental disorders. However, it is unclear whether changes in these processes mediate treatment effects on psychopathology in a transdiagnostic sample.

Methods: Physically inactive adult outpatients with depressive disorders, agoraphobia, panic disorder, post-traumatic stress disorder, and/or nonorganic primary insomnia were randomly allocated to ImPuls - a 6-month transdiagnostic group exercise intervention - plus treatment-as-usual (n = 198), or to a treatment-as-usual alone control group (n = 201) at 10 study sites between March 2021 and May 2022. The primary outcome was global symptom severity; perceived stress, repetitive negative thinking, and sleep quality were included as mediators. All variables were assessed at baseline, 6 months, and 12 months using validated rating scales. As a secondary analysis of an RCT, intention-to-treat analyses were performed using structural equation modeling to test whether changes in stress perception, repetitive negative thinking, and sleep quality mediate treatment effects on changes in global symptom severity in two path models (from baseline to 6 and 12 months, respectively).

Results: Treatment effects on global symptom severity were fully mediated by changes in perceived stress (6 months: β = -0.99, p = .024; 12 months: β = -1.28, p = .014) and repetitive negative thinking (6 months: β = -1.34, p = .004; 12 months: β = -0.94, p = .024).

Conclusions: Our results suggest that changes in perceived stress and repetitive negative thinking may be key transdiagnostic mechanisms underlying the treatment effect of exercise on global symptom severity.

Background: Girls with predispositions for disordered eating (DE) may select into weight-conscious peer groups (i.e. peer groups that emphasize body weight/shape). However, factors driving selection into these peer groups remain unknown, as genetic and/or environmental predisposition to DE may lead girls to select weight-conscious peers. To explore what may drive selection, the present study investigated whether genetic or shared environmental influences underlie associations between DE and exposure to weight-conscious peers and whether effects differ by pubertal status.

Methods: Participants included 833 female twins (ages 8-15) from the Michigan State University Twin Registry. Bivariate twin models were conducted to explore etiologic overlap between DE and exposure to weight-conscious peers. Separate models were run for pre-early pubertal girls and mid-late pubertal girls given past research demonstrates differences in genetic and environmental contributions underlying eating pathology by pubertal status.

Results: During pre-early puberty, shared and non-shared environmental correlations accounted for the overlap between DE and weight-conscious peer group exposure. Furthermore, shared environmental and non-shared environmental influences underlying DE contributed to 33.3% and 20.0% of the individual differences in weight-conscious peer group membership, respectively. In mid-late puberty, the genetic and non-shared environmental correlations accounted for the overlap between DE and weight-conscious peer group exposure. Genetic and non-shared environmental influences underlying DE contributed to 37.5% and 19.4% of the variance in weight-conscious peer group membership, respectively.

Conclusions: While selection effects may exist across development, these effects may be driven by variance in DE due to shared environment in pre-early puberty and genes in mid-late puberty.

Background: Cumulative stress exposure is extensively involved in carcinogenesis. However, cancer risk associated with allostatic load (AL), a valid measure of chronic stress, has not been comprehensively evaluated in large cohorts, and the combined effect of AL and personality trait on cancer risk remains unknown.

Methods: This prospective cohort study was conducted based on 245,683 participants from the UK Biobank, with a median follow-up of 13.5 years. The AL score was calculated based on 11 biomarkers. Personality traits were constructed and categorized into two clusters. Multivariable Cox regression model was used to assess the risk of incident cancer according to AL and personality clusters, and multiplicative and additive interactions were evaluated.

Results: High AL was associated with an increased cancer risk compared to low AL (hazard ratio [HR] = 1.06, 95% confidence interval [CI]: 1.04-1.09), particularly for cancers of stomach, liver, kidney, esophageal, lung, colorectal, breast, and leukemia (HR ranged from 1.08 to 1.43). Personality clusters was associated with risk of lung cancer (HR = 1.14, 95% CI: 1.05-1.23), but not overall cancer. Significant synergistic interaction was observed between high AL and 'nervous-dominant' personality for overall cancer risk, with the strongest association observed for liver cancer (HR = 1.58, 95% CI: 1.24-2.02).

Conclusions: High AL was related to higher risks of overall cancer and site-specific cancers, particularly when combined with nervous-dominant personality, highlighting the interplay between chronic physiological stress and psychological factors in cancer development.