Psychological Medicine最新文献

Background: As populations age rapidly, understanding the psychological benefits of sustained employment has become increasingly important. In South Korea, where the suicide rate among older adults is one of the highest among Organisation for Economic Co-operation and Development (OECD) countries, identifying modifiable social determinants, such as employment, may inform effective prevention strategies.

Methods: This retrospective cohort study used data from the Korean Welfare Panel Study (2009-2024), a nationally representative longitudinal survey. Individuals with depressive symptoms or suicidal ideation at baseline were excluded. The main exposure was participation in a government-led senior employment program. We employed discrete-time survival analysis using a generalized linear model with a complementary log-log link function, which appropriately handled the interval-censored structure of the panel data.

Results: Older adults who participated in the employment program had a significantly lower risk of developing depressive symptoms (adjusted hazard ratio [HR] = 0.76, 95% confidence interval [CI]: 0.67-0.86) and suicidal ideation (adjusted HR = 0.60, 95% CI: 0.45-0.81) compared to those who did not participate. Subgroup analyses revealed that the strength of the association was particularly strong among individuals aged ≥80 years, those with chronic illness, poor self-rated health, and those who were previously or never married.

Conclusion: Structured government-supported employment may mitigate the risk of depressive symptoms and suicidal ideation in later life. These findings support the potential of senior employment programs as effective mental health promotion and suicide prevention strategies for aging populations.

Background: Recovery rates for panic disorder in NHS Talking Therapies (NHSTT) services in the United Kingdom do not match those in randomized trials. Previous research has found that training therapists in 'focused cognitive behavioral therapy' (CBT) improves outcomes. The primary aim was to examine whether focused CBT delivered by trained psychological well-being practitioners (PWPs) can improve treatment outcomes for panic disorder. An exploratory aim was to evaluate the potential impact of a novel component of focused CBT, which includes the use of 'approach-supporting behaviors' (ASBs) where safety-seeking behaviors (SSBs) are prominent.

Methods: We conducted a randomized parallel trial. Participants were randomly allocated to focused CBT or the current treatment at 'Step Two' (treatment as usual) in two NHSTT services (ISRCTN:11268881).

Results: We found a significant group-timepoint interaction. Those in focused CBT had significantly greater reductions in the primary measure of panic severity relative to those in treatment as usual (TAU). The level of ASBs did not predict a change in panic severity; however, the level of SSBs at the end of treatment did predict a change in panic severity.

Conclusions: Focused CBT is effective for panic disorder and is superior to TAU, supporting the applicability of this lower-intensity and panic-specific version of CBT for panic disorder.

Schizophrenia features pervasive insight deficits, with many failing to recognize symptoms or the need for treatment, predictors of poorer outcomes. Rather than unitary, insight comprises clinical (awareness of illness and need for care) and cognitive (self-reflectiveness and the ability to question one's beliefs). This review examines whether mental time travel (MTT) - vivid recollection of past events and construction of detailed future scenarios - may underlie insight deficits in schizophrenia. We synthesize evidence up to May 2025 from meta-analyses, experimental studies, and neuroimaging/neuroanatomical reports on MTT (autobiographical memory specificity, future simulation, temporal horizon) and their associations with clinical and cognitive insight. Individuals with schizophrenia show reduced autobiographical specificity, future simulation vividness, alongside a narrowed temporal horizon. These impairments are linked to diminished self-reflection, narrative coherence, and metacognitive abilities, all of which are essential for accurate illness recognition. Neuroimaging indicates that the networks supporting mental time travel, self-reflection, and insight - particularly the default-mode and ventromedial prefrontal circuits - substantially overlap and are disrupted in schizophrenia, with heterogeneity across illness stage and analytic approach. Moderators such as negative symptoms and trauma appear to intensify the MTT-insight links, while depressive mood may paradoxically enhance illness awareness. Although therapies targeting episodic specificity and metacognitive mastery show promise, longitudinal and interventional evidence remains limited. Associations between MTT impairments and insight are robust but largely correlational, so reverse or bidirectional causality cannot be excluded. We outline priorities for longitudinal, interventional, and trauma-stratified studies - attentive to illness stage and default-mode dynamics - to clarify mechanisms and guide targeted interventions.

Background: Individuals with first-episode psychosis (FEP) face markedly increased excess mortality, yet the long-term trends and key contributing factors remain insufficiently characterized. This study aimed to examine long-term mortality patterns, standardized mortality ratios (SMRs), and associated factors in a FEP cohort.

Methods: This population-based cohort study included 1,389 individuals diagnosed with FEP, followed for up to 25 years. Mortality outcomes were obtained from Hong Kong's centralized hospital database (CMS) and coroner's court reports, with SMRs calculated. Baseline sociodemographic and clinical, as well as long-term treatment-related factors of all-cause, natural, and unnatural mortality were analyzed.

Results: Among 1,389 participants, 137 deaths (9.86%) occurred during the follow-up period with the overall SMR of 6.56 (95% CI, 5.50-7.71). The cumulative incidence rate of unnatural mortality increased sharply over the first 10 years and that of the natural cause of death started to increase after the first decade of the illness. Male gender and poorer social functioning were associated with increased all-cause mortality risk, while male gender, lower education, and baseline hospitalization raised unnatural mortality risk. Greater monthly antipsychotic variability during the first 10 years increased all-cause mortality risk in the period after the initial 10 years.

Conclusions: This 25-year follow-up study of FEP highlighted the changes in the long-term mortality pattern of FEP and thus the phase-specific needs of individuals with FEP. Therefore, it is important to integrate physical care into mental health services, as well as stage-specific and individualized care for patients with psychotic disorders to reduce long-term excess mortality.

Background: Depression rates are higher in women, especially during periods of hormonal fluctuation. Reproductive system disorders (RSDs), which often disrupt hormonal balance, may contribute to this mental health burden. Despite their prevalence and significant health implications, the link between RSDs and depression remains underexplored, leaving a gap in understanding these women's mental health risks.

Methods: Using Danish nationwide health registers (2005-2018), we conducted a cohort study of 2,295,824 women aged 15-49, examining depression outcomes in 265,891 women diagnosed with 24 RSDs, including endometriosis, polycystic ovary syndrome, and pain-related diagnoses. For each RSD, age-matched controls were selected. We calculated incidence rates, incidence rate ratios, and prevalence proportions of depression diagnoses or antidepressant use around RSD diagnosis.

Results: Across all RSD subtypes, women demonstrated higher rates of depression both before and after diagnosis, with a peak within the year following diagnosis. Incidence rate ratios within 1 year of RSD diagnosis ranged from 1.15 (95% confidence interval [CI] 1.06-1.25) to 2.09 (95% CI 1.98-2.21), depending on RSD subtype. Elevated depression prevalence was observed 3 years before diagnosis, suggesting mental health impacts may have preceded clinical RSD identification.

Conclusions: This study reveals a striking association between RSDs and depression. Women with RSDs are more likely to suffer from depression, before and after RSD diagnosis, highlighting the need for integrated mental health screening and intervention. With over 10% of women affected by RSDs, addressing this overlooked mental health burden is imperative for improving well-being in a significant portion of the population.

Background: How psychotic symptoms, depressive symptoms, cognitive deficits, and functional impairment may interact with one another in schizophrenia or bipolar disorder is unclear.

Methods: This study explored these interactions in a discovery sample of 339 Chinese, of whom 146 had first-episode schizophrenia and 193 had bipolar disorder. Psychotic symptoms were assessed using the Positive and Negative Symptom Scale; depressive symptoms, using the Hamilton Depression Rating Scale; cognitive deficits, using tests of processing speed, executive function, and logical memory; and functional impairment, using clinical assessments. Network models connecting the four types of variables were developed and compared between men and women and between disorders. Potential causal relationships among the variables were explored through directed acyclic graphing. The results in the discovery sample were compared to those obtained for a validation sample of 235 Chinese, of whom 138 had chronic schizophrenia and 97 had bipolar disorder.

Results: In the discovery and validation cohorts, schizophrenia and bipolar disorder showed similar networks of associations, in which the central hubs included 'disorganized' symptoms, depressive symptoms, and deficits in processing speed during the digital symbol substitution test. Directed acyclic graphing suggested that disorganized symptoms were upstream drivers of cognitive impairment and functional decline, while core depressive symptoms (e.g. low mood) drove somatic and anxiety symptoms.

Conclusions: Our study advocates for transdiagnostic, network-informed strategies prioritizing the mitigation of disorganization and depressive symptoms to disrupt symptom cascades and improve functional outcomes in schizophrenia and bipolar disorder.

Background: Major depressive episodes (MDEs) are highly recurrent in clinical samples. However, the course of MDEs and predictors of their endurance are unclear in the general youth population.

Methods: We investigated prospective factors associated with enduring MDE (the presence of 12-month DSM-IV MDE at baseline and 1 year using the Composite International Diagnostic Interview-Screening Scales) in 1,833 participants of a 1-year epidemiological youth cohort study in Hong Kong. Multivariable logistic regression models were used to examine the influences of a range of personal and environmental factors.

Results: At baseline, 13.7% participants had MDEs, among whom 21.1% presented enduring MDEs. More severe symptoms of post-traumatic stress disorder (adjusted odds ratio [aOR] = 5.54, confidence interval [CI] = 2.14-14.38), depression (aOR = 3.92, CI = 1.79-8.62), and generalized anxiety (aOR = 2.27, CI = 1.21-4.25) at baseline were among the strongest associated factors for enduring MDE, with trends of associations observed for psychotic-like experiences (aOR = 1.98, CI = 0.98-4.02) and eating disorder symptoms (aOR = 1.88, CI = 0.90-3.95). Among various types of stressors, only dependent stressors at follow-up showed a clear association with enduring MDE (aOR = 4.22, CI = 1.81-9.83). Those with enduring MDE showed poorer functioning and mental health-related quality of life at follow-up, with only 35.6% having sought any psychiatric/psychological help during the past year.

Conclusions: Detecting comorbid symptoms in those with prior MDEs and reducing the impact of dependent stressors may help reduce their long-term implications. Enhancing the accessibility and acceptability of youth-targeted mental health services would also be crucial to improve help-seeking.

Background: Sexual minorities have continuously been found to experience poorer mental health compared to the general population, despite promising changes in attitudes and legislation throughout the 21st century in many Western countries. The present study is one of the first to assess group-level changes over time in mental health among sexual minorities compared to their heterosexual counterparts.

Methods: We used four waves of a Finnish population-based survey spanning 16 years (2006-2022) to compare heterosexual and sexual minority adults on depression and anxiety symptoms, alcohol use, and sexual distress.

Results: Sexual minority individuals reported more depression and anxiety symptoms, sexual distress, and alcohol use relative to their heterosexual counterparts at all time points. There were no group differences in the direction or rate of change in group means from 2006 to 2022. Depression and anxiety symptoms showed equally large increases, and alcohol use showed equally large decreases among both heterosexual and sexual minority participants.

Conclusions: Contrary to our expectations based on minority stress theory, differences in mental health between sexual minority and heterosexual individuals persist despite changes in the sociolegal status of sexual minorities during the first two decades of the 21st century. Our findings align with the increasing general trend in anxiety and depression symptoms, which seems to affect the whole population regardless of sexual orientation. We conclude that the effect of legislative societal improvements seems to be small, and the mental health gap between sexual minority and heterosexual adults is likely maintained by factors not included in our study.

Background: Mitochondrial dysfunction has been implicated in the pathogenesis of major depressive disorder (MDD); however, the causal contributions of specific mitochondrial genes across regulatory layers remain unclear.

Methods: We integrated genome-wide association study summary statistics from the Psychiatric Genomics Consortium and FinnGen with quantitative-trait-locus (QTL) datasets for DNA methylation, gene expression (eQTL), and protein abundance. Mitochondrial genes were annotated using the MitoCarta3.0 database. Summary-based Mendelian randomization and Bayesian colocalization were applied to assess causal relationships, with colocalization determined by the posterior probability of a shared causal variant (PPH4), and the false discovery rate used for multiple-testing correction. Brain-specific effects were evaluated using Genotype-Tissue Expression eQTL data. Prioritized genes were ranked based on cross-omics consistency and replication evidence.

Results: Five mitochondrial genes were prioritized. TDRKH showed consistent associations across methylation, transcription, and protein levels, with hypermethylation at cg24503712 linked to reduced expression and a lower risk of MDD (Tier 1). METAP1D (Tier 2) demonstrated protective effects at both the transcript and protein levels. LONP1, FIS1, and SCP2 (Tier 3) exhibited consistent but complex regulatory patterns. Several signals were replicated in brain tissues, including TDRKH in the caudate and METAP1D in the cortex.

Conclusions: This study provides multi-omics evidence for the causal involvement of mitochondrial genes in MDD. TDRKH and METAP1D emerged as key candidates, offering promising targets for future mechanistic research and therapeutic development.