Andrea Fiorillo,Kristina Adorjan,Muhammad W Azeem,Debasish Basu,Bianca Della Rocca,Linda Lam,Roisin Mooney,Pratima Murthy,Victoria Mutiso,David Ndetei,Tarek Okasha,Janardhan Reddy,Dan J Stein,Kamaldeep S Bhui
{"title":"The evolving role of WPA Collaborating Centres: new perspectives and future directions.","authors":"Andrea Fiorillo,Kristina Adorjan,Muhammad W Azeem,Debasish Basu,Bianca Della Rocca,Linda Lam,Roisin Mooney,Pratima Murthy,Victoria Mutiso,David Ndetei,Tarek Okasha,Janardhan Reddy,Dan J Stein,Kamaldeep S Bhui","doi":"10.1002/wps.70033","DOIUrl":"https://doi.org/10.1002/wps.70033","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"8 1","pages":"161-162"},"PeriodicalIF":73.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aleksi Hamina,Justo Pinzón-Espinosa,Heidi Taipale,Johannes Schneider-Thoma,Joaquim Radua,Orestis Efthimiou,Narcís Cardoner,Christoph U Correll,Paolo Fusar-Poli,Ellenor Mittendorfer-Rutz,Brenda W J H Penninx,Henricus G Ruhe,Antti Tanskanen,Christiaan H Vinkers,Stefan Leucht,Eduard Vieta,Andrea Cipriani,Jari Tiihonen,Jurjen J Luykx
Randomized controlled trials (RCTs) are the foundation of current clinical treatment guidelines. However, they may not reflect real-world populations, due to strict eligibility criteria. We determined the proportion of individuals with major depressive disorder (MDD) receiving maintenance antidepressant treatment in routine care who would be ineligible for RCTs, and compared their outcomes with those who were eligible. Utilizing specialized health care registers in Finland (2004-2018) and Sweden (2006-2021), we identified adults diagnosed with non-psychotic MDD (ICD-10: F32, F33) who were stabilized on maintenance antidepressant monotherapy. Through multidisciplinary expert consensus on latest meta-analytic evidence, we derived a standardized list of RCT inclusion and exclusion criteria. These criteria were systematically applied to classify individuals as RCT-eligible or RCT-ineligible. We then used Cox proportional models to derive hazard ratios (HRs) of a composite primary outcome of hospitalization due to any psychiatric reason or suicide attempt, and all-cause mortality, during a 6-month follow-up. Secondary outcomes were treatment changes (i.e., discontinuation, switch or augmentation) and psychiatric sick leave ≥2 weeks. A total of 73,720 individuals in Finland and 135,092 in Sweden were included. More than one third of patients with MDD (33.5% in Finland and 35.3% in Sweden) were found to be ineligible for RCTs. The most common reasons for ineligibility were comorbidities (serious somatic disease, other psychiatric disorders, or substance use disorder). RCT-ineligible individuals had more than twice the risk of the composite primary outcome compared to eligible individuals (HR=2.44, 95% CI: 2.15-2.76 in Finland; HR=2.61, 95% CI: 2.37-2.87 in Sweden). Approximately one third of the composite primary outcome was attributable to RCT-ineligibility factors (32.5%, 95% CI: 27.9-37.1 for Finland; 36.2%, 95% CI: 32.6-39.8 for Sweden). Risk of treatment change was slightly but significantly higher in ineligible individuals. Findings were consistent in a wide range of sensitivity analyses. We conclude that more inclusive eligibility criteria for RCTs, and their integration with real-world data, are needed to improve the generalizability of antidepressant trial evidence and MDD clinical treatment guidelines.
{"title":"Representation and outcomes of individuals with major depression in routine care who are ineligible for randomized controlled trials: a nationwide register-based study.","authors":"Aleksi Hamina,Justo Pinzón-Espinosa,Heidi Taipale,Johannes Schneider-Thoma,Joaquim Radua,Orestis Efthimiou,Narcís Cardoner,Christoph U Correll,Paolo Fusar-Poli,Ellenor Mittendorfer-Rutz,Brenda W J H Penninx,Henricus G Ruhe,Antti Tanskanen,Christiaan H Vinkers,Stefan Leucht,Eduard Vieta,Andrea Cipriani,Jari Tiihonen,Jurjen J Luykx","doi":"10.1002/wps.70013","DOIUrl":"https://doi.org/10.1002/wps.70013","url":null,"abstract":"Randomized controlled trials (RCTs) are the foundation of current clinical treatment guidelines. However, they may not reflect real-world populations, due to strict eligibility criteria. We determined the proportion of individuals with major depressive disorder (MDD) receiving maintenance antidepressant treatment in routine care who would be ineligible for RCTs, and compared their outcomes with those who were eligible. Utilizing specialized health care registers in Finland (2004-2018) and Sweden (2006-2021), we identified adults diagnosed with non-psychotic MDD (ICD-10: F32, F33) who were stabilized on maintenance antidepressant monotherapy. Through multidisciplinary expert consensus on latest meta-analytic evidence, we derived a standardized list of RCT inclusion and exclusion criteria. These criteria were systematically applied to classify individuals as RCT-eligible or RCT-ineligible. We then used Cox proportional models to derive hazard ratios (HRs) of a composite primary outcome of hospitalization due to any psychiatric reason or suicide attempt, and all-cause mortality, during a 6-month follow-up. Secondary outcomes were treatment changes (i.e., discontinuation, switch or augmentation) and psychiatric sick leave ≥2 weeks. A total of 73,720 individuals in Finland and 135,092 in Sweden were included. More than one third of patients with MDD (33.5% in Finland and 35.3% in Sweden) were found to be ineligible for RCTs. The most common reasons for ineligibility were comorbidities (serious somatic disease, other psychiatric disorders, or substance use disorder). RCT-ineligible individuals had more than twice the risk of the composite primary outcome compared to eligible individuals (HR=2.44, 95% CI: 2.15-2.76 in Finland; HR=2.61, 95% CI: 2.37-2.87 in Sweden). Approximately one third of the composite primary outcome was attributable to RCT-ineligibility factors (32.5%, 95% CI: 27.9-37.1 for Finland; 36.2%, 95% CI: 32.6-39.8 for Sweden). Risk of treatment change was slightly but significantly higher in ineligible individuals. Findings were consistent in a wide range of sensitivity analyses. We conclude that more inclusive eligibility criteria for RCTs, and their integration with real-world data, are needed to improve the generalizability of antidepressant trial evidence and MDD clinical treatment guidelines.","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"39 1","pages":"117-124"},"PeriodicalIF":73.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Report from the WPA Section on Suicidology: recent advances and activities.","authors":"Vladimir Carli,Sara Sutori,Miriam Iosue","doi":"10.1002/wps.70038","DOIUrl":"https://doi.org/10.1002/wps.70038","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"20 1","pages":"160-161"},"PeriodicalIF":73.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Dismantling structural violence to enable structural transformation and consequently social inclusion.","authors":"Nev Jones","doi":"10.1002/wps.70009","DOIUrl":"https://doi.org/10.1002/wps.70009","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"29 1","pages":"92-93"},"PeriodicalIF":73.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Use of artificial intelligence to enhance social inclusion in mental health care: promises and pitfalls.","authors":"Samson Tse","doi":"10.1002/wps.70008","DOIUrl":"https://doi.org/10.1002/wps.70008","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"9 1","pages":"89-90"},"PeriodicalIF":73.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Psychotherapies have been found effective in the treatment of most mental disorders. However, substantial improvements are still much needed, and many innovations of therapies are currently being developed. We review the current status of promising innovations to improve the outcomes and uptake of psychotherapies for mental disorders, discussing the largest and most recent meta-analyses. Innovations are categorized into four domains: a) the digital field (including Internet-based interventions in general; mobile interventions; serious games; virtual and augmented reality; prescription digital therapeutics; blended therapy; avatar therapy; and chatbots/artificial intelligence-generated conversational agents); b) personalized treatments (research on predictors and moderators in large randomized controlled trials; use of individual patient data meta-analyses in personalization; machine learning approaches; personalized and modular therapies; and matching therapists to patients); c) new and improved therapies (cognitive bias modification; cognitive remediation; psychedelic-assisted psychotherapies; transdiagnostic therapies; research on effective components through factorial trials and component network meta-analyses; innovations in the understanding of the processes involved in psychotherapies, including research on common factors and the therapeutic alliance, and on the fidelity vs. flexibility question; research on prevention of adverse effects of therapies, the impact of increased session frequency or progress feedback on outcomes, and methodological innovations in trial designs); and d) dissemination and simplification of therapies (task sharing, digital interventions in low- and middle-income countries; and single-session interventions). These innovations vary in their maturity, from dozens of supporting trials to few or none. Methods to assess the strength of innovations suggest that no innovation will be a paradigm-shifting "silver bullet" that dramatically increases treatment outcomes, but that progress will only be possible through multiple, incremental improvements.
{"title":"Innovations to improve outcomes and uptake of psychotherapies for mental disorders: a state-of-the-art review.","authors":"Pim Cuijpers,Mathias Harrer,Toshi A Furukawa","doi":"10.1002/wps.70002","DOIUrl":"https://doi.org/10.1002/wps.70002","url":null,"abstract":"Psychotherapies have been found effective in the treatment of most mental disorders. However, substantial improvements are still much needed, and many innovations of therapies are currently being developed. We review the current status of promising innovations to improve the outcomes and uptake of psychotherapies for mental disorders, discussing the largest and most recent meta-analyses. Innovations are categorized into four domains: a) the digital field (including Internet-based interventions in general; mobile interventions; serious games; virtual and augmented reality; prescription digital therapeutics; blended therapy; avatar therapy; and chatbots/artificial intelligence-generated conversational agents); b) personalized treatments (research on predictors and moderators in large randomized controlled trials; use of individual patient data meta-analyses in personalization; machine learning approaches; personalized and modular therapies; and matching therapists to patients); c) new and improved therapies (cognitive bias modification; cognitive remediation; psychedelic-assisted psychotherapies; transdiagnostic therapies; research on effective components through factorial trials and component network meta-analyses; innovations in the understanding of the processes involved in psychotherapies, including research on common factors and the therapeutic alliance, and on the fidelity vs. flexibility question; research on prevention of adverse effects of therapies, the impact of increased session frequency or progress feedback on outcomes, and methodological innovations in trial designs); and d) dissemination and simplification of therapies (task sharing, digital interventions in low- and middle-income countries; and single-session interventions). These innovations vary in their maturity, from dozens of supporting trials to few or none. Methods to assess the strength of innovations suggest that no innovation will be a paradigm-shifting \"silver bullet\" that dramatically increases treatment outcomes, but that progress will only be possible through multiple, incremental improvements.","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"124 1","pages":"4-33"},"PeriodicalIF":73.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cognitive consequences of COVID-19 infection: current evidence and future directions.","authors":"Adam Hampshire","doi":"10.1002/wps.70027","DOIUrl":"https://doi.org/10.1002/wps.70027","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"26 1","pages":"51-52"},"PeriodicalIF":73.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Artificial intelligence and psychiatric diagnosis: a warning to the mental health community.","authors":"Allen Frances","doi":"10.1002/wps.70015","DOIUrl":"https://doi.org/10.1002/wps.70015","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"9 1","pages":"148-149"},"PeriodicalIF":73.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The art of prescribing psychotropic medications.","authors":"Carl Salzman","doi":"10.1002/wps.70034","DOIUrl":"https://doi.org/10.1002/wps.70034","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"180 1","pages":"141-142"},"PeriodicalIF":73.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：