Pub Date : 2025-02-12DOI: 10.1016/s2215-0366(24)00404-8
Tom H Rosenström, Suoma E Saarni, Samuli I Saarni, Jaakko Tammilehto, Jan-Henry Stenberg
Background
According to meta-analyses of randomised controlled trials (RCTs), therapist-guided internet-delivered cognitive behavioural therapy (iCBT) is as effective a treatment for depression as traditional face-to-face CBT (fCBT), despite its substantially lower costs. However, RCTs are not always representative of routine practice, which could inflate effectiveness estimates. We combined rich data with counterfactual causal statistical reasoning to provide an fCBT–iCBT comparison complementary to RCTs.
Methods
In this retrospective cohort study, we linked full archived therapist-guided iCBT and fCBT cohort registries with multiple Finnish social and health care registries. The therapist-guided iCBT programme with third-wave principles and the fCBTs were provided by HUS Helsinki University Hospital to people with depression without acute suicide or substance-misuse risk; fCBT was delivered in the Uusimaa region, whereas therapist-guided iCBT was nationwide and excluded people with treatment-interfering psychotic, neurological, or personality disorders, chronic or bipolar depression, or aged under 16 years. The primary outcome was the causal average treatment effect (ATE) for the difference in during-treatment symptom reductions between fCBT and therapist-guided iCBT, with symptoms measured by the Patient Health Questionnaire-9 (PHQ-9). If only one PHQ-9 report was recorded, no change was recorded, thereby penalising dropout. For an optimal and robust (a posteriori-balanced) ATE estimate, we applied targeted maximum likelihood machine learning. There was no involvement of individuals with lived experience in the research and writing process.
Findings
The guided iCBT registry recorded patients from Dec 12, 2018, to Dec 22, 2022, and the fCBT registry spanned Aug 28, 2018, to Sept 28, 2022. From the total of 32 343 registered therapies, 392 people were included from the fCBT registry and 5467 people from the iCBT registry. Four people in the fCBT group and 21 in the guided iCBT group had missing baseline data, therefore the main sample for analysis contained 5834 patients (4101 [70%] were female and 1733 [30%] were male) with a mean age of 35 years (SD 12). Altogether, 5455 (94%) patients were registered with Finnish as their native language. The ATE estimate indicated that the PHQ-9 score declined 0·745 points (95% CI 0·156–1·334) more in the iCBT group than in the fCBT group. Sensitivity analyses concurred.
Interpretation
Considered alongside previous RCTs, our findings suggest that short first-line treatments with therapist-guided iCBT are at least as effective and efficacious as fCBT. Our findings eliminate error sources and extend the representativeness of the population for this cost-effective treatment.
Funding
The Research Council of Finland (Academy of Finland).
Translation
For the Finnish translation of the abstract see Supplementary Materials section.
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Pub Date : 2025-02-11DOI: 10.1016/s2215-0366(24)00370-5
David J Nutt
The past 50 years have seen remarkable advances in the science of medicine. The pharmacological treatments of disorders such as hypertension, immune disorders, and cancer are fundamentally different from those used in the 1970s, and are now more often based on disorder-specific pathologies. The same cannot be said for psychiatric medicines: despite remarkable advances in neuroscience, very few innovative treatments have been developed in this field since the 1970s. For depression, schizophrenia, anxiety disorders, and ADHD, pharmacological classes of medicines discovered through serendipity in the 1950s are still used despite hundreds of billions of US dollars being spent on drug discovery attempts based on new neuroscience targets. This Personal View presents my opinion on the reasons innovation in psychiatric treatment has not progressed as well as in other disorders. As a researcher in the field, I offer suggestions as to how this situation must be rectified soon, as by most analyses mental illness is becoming a major health burden globally. Most of my evidence is referenced, but where I have unpublished knowledge gained from consulting with pharmaceutical companies, it is presented as an opinion.
{"title":"Drug development in psychiatry: 50 years of failure and how to resuscitate it","authors":"David J Nutt","doi":"10.1016/s2215-0366(24)00370-5","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00370-5","url":null,"abstract":"The past 50 years have seen remarkable advances in the science of medicine. The pharmacological treatments of disorders such as hypertension, immune disorders, and cancer are fundamentally different from those used in the 1970s, and are now more often based on disorder-specific pathologies. The same cannot be said for psychiatric medicines: despite remarkable advances in neuroscience, very few innovative treatments have been developed in this field since the 1970s. For depression, schizophrenia, anxiety disorders, and ADHD, pharmacological classes of medicines discovered through serendipity in the 1950s are still used despite hundreds of billions of US dollars being spent on drug discovery attempts based on new neuroscience targets. This Personal View presents my opinion on the reasons innovation in psychiatric treatment has not progressed as well as in other disorders. As a researcher in the field, I offer suggestions as to how this situation must be rectified soon, as by most analyses mental illness is becoming a major health burden globally. Most of my evidence is referenced, but where I have unpublished knowledge gained from consulting with pharmaceutical companies, it is presented as an opinion.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"63 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143393417","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}
Pub Date : 2025-02-11DOI: 10.1016/s2215-0366(25)00035-5
Dana Churbaji, Richard Bryant, Nexhmedin Morina
No Abstract
无摘要
{"title":"Towards collective healing: peacebuilding and mental health in Syria","authors":"Dana Churbaji, Richard Bryant, Nexhmedin Morina","doi":"10.1016/s2215-0366(25)00035-5","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00035-5","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"22 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143393416","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}
Pub Date : 2025-02-10DOI: 10.1016/s2215-0366(24)00442-5
Nav Kapur, Su-Gwan Tham, Pauline Turnbull, Nicola Richards, Cathryn Rodway, Caroline Clements, Saied Ibrahim, Roger T Webb, Tom Ayers, Emily Cannon, Louis Appleby, Leah Quinlivan
The prevention of suicide is an international priority. Self-harm is one of the most important antecedents to suicide and an important health and societal issue in its own right. Health care services have an important role to play in providing care and intervention after self-harm. As researchers, we often call for more research but there is already a substantial evidence base for the prevention of suicide and self-harm that has built up over the years. Perhaps the most pressing concern currently is the failure to implement what we know. In this Personal View, we summarise three recent national quality improvement programmes in England—one focused on suicide prevention, and two on self-harm. Aggregate observational data suggest that the initiatives might have been associated with positive outcomes in terms of reductions in the incidence of suicide and self-harm; but possibly more striking was the activity and innovation that the programmes generated. We argue that quality improvement approaches focused on suicide prevention and self-harm intervention have the potential to address the implementation gap in service provision and save lives.
{"title":"Quality improvement for suicide prevention and self-harm intervention: addressing the implementation gap and saving lives","authors":"Nav Kapur, Su-Gwan Tham, Pauline Turnbull, Nicola Richards, Cathryn Rodway, Caroline Clements, Saied Ibrahim, Roger T Webb, Tom Ayers, Emily Cannon, Louis Appleby, Leah Quinlivan","doi":"10.1016/s2215-0366(24)00442-5","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00442-5","url":null,"abstract":"The prevention of suicide is an international priority. Self-harm is one of the most important antecedents to suicide and an important health and societal issue in its own right. Health care services have an important role to play in providing care and intervention after self-harm. As researchers, we often call for more research but there is already a substantial evidence base for the prevention of suicide and self-harm that has built up over the years. Perhaps the most pressing concern currently is the failure to implement what we know. In this Personal View, we summarise three recent national quality improvement programmes in England—one focused on suicide prevention, and two on self-harm. Aggregate observational data suggest that the initiatives might have been associated with positive outcomes in terms of reductions in the incidence of suicide and self-harm; but possibly more striking was the activity and innovation that the programmes generated. We argue that quality improvement approaches focused on suicide prevention and self-harm intervention have the potential to address the implementation gap in service provision and save lives.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"160 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143385515","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}
Pub Date : 2025-02-05DOI: 10.1016/s2215-0366(25)00038-0
No Abstract
{"title":"Trump 2.0: a better way to show leadership","authors":"","doi":"10.1016/s2215-0366(25)00038-0","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00038-0","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"9 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143192505","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}
Pub Date : 2025-02-05DOI: 10.1016/s2215-0366(24)00411-5
Cagatay Ermis, Heidi Taipale, Antti Tanskanen, Eduard Vieta, Christoph U Correll, Ellenor Mittendorfer-Rutz, Jari Tiihonen
<h3>Background</h3>Long-term add-on antidepressant use for bipolar depression remains controversial. This study aimed to investigate primarily the association between psychopharmacological treatments and hospitalisation (ie, hospital admission) for bipolar depression, and secondarily the association between psychopharmacological treatments and hospitalisation for bipolar mania and somatic reasons in a registry-based national Swedish cohort.<h3>Methods</h3>In this within-subject analysis, people diagnosed with bipolar disorder were identified from Swedish nationwide registers of inpatient and specialised outpatient care, sickness absence, and disability pension between Jan 1, 2006, and Dec 31, 2021. Data for hospitalisations, and antidepressant, antipsychotic, and mood stabiliser medication use were also retrieved from national databases. Treatment periods were modelled using the PRE2DUP method. Data were analysed with a within-individual design with stratified Cox Regression models, to eliminate selection bias when calculating adjusted hazard ratios (aHRs) and 95% CIs. The main outcome was hospitalisation due to depression and secondary outcomes were mania-related and somatic hospitalisations to address the risk–benefit ratio of antidepressant treatment. The reference was non-use of antidepressant, antipsychotic, and mood stabiliser medications. We also did head-to-head comparisons (ie, comparing different drug use periods within the same individual against each other) between medications to obtain results on comparative effectiveness while minimising confounding by indication. Ethnicity data were not available. People with related lived experience were involved in the research and writing process.<h3>Findings</h3>The study cohort included 105 495 individuals (mean age 44·2 years, SD 18·8; 65 607 [62·2%] women and 39 888 [37·8%] men). In medication class-based analyses, a higher risk of depression-related hospitalisation was associated with the use of antidepressant only (aHR 1·25, 95% CI 1·16–1·34), antipsychotic only (1·39, 1·24–1·55), antidepressant–antipsychotic combination (1·28, 1·18–1·39), and antipsychotic–mood stabiliser combination treatment (1·13, 1·03–1·24). By contrast, use of mood stabilisers only (0·89, 0·81–0·98) was associated with lower risk. For specific monotherapies, only lithium was associated with lower depression-related hospitalisation risk (0·75, 0·67–0·85). No specific antidepressant monotherapy was associated with reduced depression-related hospitalisation, while several antidepressants and antipsychotics were related to an increased risk. In head-to-head comparisons, lithium monotherapy was associated with a superior outcome compared with antidepressant monotherapy (0·59, 0·51–0·68), antipsychotic monotherapy (0·54, 0·44–0·66), lamotrigine monotherapy (0·69, 0·53–0·91), and quetiapine monotherapy (0·54, 0·41–0·71). Lithium was associated with the lowest risk of somatic hospitalisation (0·86, 0·80–0·93) when compared w
{"title":"Real-world effectiveness of pharmacological maintenance treatment of bipolar depression: a within-subject analysis in a Swedish nationwide cohort","authors":"Cagatay Ermis, Heidi Taipale, Antti Tanskanen, Eduard Vieta, Christoph U Correll, Ellenor Mittendorfer-Rutz, Jari Tiihonen","doi":"10.1016/s2215-0366(24)00411-5","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00411-5","url":null,"abstract":"<h3>Background</h3>Long-term add-on antidepressant use for bipolar depression remains controversial. This study aimed to investigate primarily the association between psychopharmacological treatments and hospitalisation (ie, hospital admission) for bipolar depression, and secondarily the association between psychopharmacological treatments and hospitalisation for bipolar mania and somatic reasons in a registry-based national Swedish cohort.<h3>Methods</h3>In this within-subject analysis, people diagnosed with bipolar disorder were identified from Swedish nationwide registers of inpatient and specialised outpatient care, sickness absence, and disability pension between Jan 1, 2006, and Dec 31, 2021. Data for hospitalisations, and antidepressant, antipsychotic, and mood stabiliser medication use were also retrieved from national databases. Treatment periods were modelled using the PRE2DUP method. Data were analysed with a within-individual design with stratified Cox Regression models, to eliminate selection bias when calculating adjusted hazard ratios (aHRs) and 95% CIs. The main outcome was hospitalisation due to depression and secondary outcomes were mania-related and somatic hospitalisations to address the risk–benefit ratio of antidepressant treatment. The reference was non-use of antidepressant, antipsychotic, and mood stabiliser medications. We also did head-to-head comparisons (ie, comparing different drug use periods within the same individual against each other) between medications to obtain results on comparative effectiveness while minimising confounding by indication. Ethnicity data were not available. People with related lived experience were involved in the research and writing process.<h3>Findings</h3>The study cohort included 105 495 individuals (mean age 44·2 years, SD 18·8; 65 607 [62·2%] women and 39 888 [37·8%] men). In medication class-based analyses, a higher risk of depression-related hospitalisation was associated with the use of antidepressant only (aHR 1·25, 95% CI 1·16–1·34), antipsychotic only (1·39, 1·24–1·55), antidepressant–antipsychotic combination (1·28, 1·18–1·39), and antipsychotic–mood stabiliser combination treatment (1·13, 1·03–1·24). By contrast, use of mood stabilisers only (0·89, 0·81–0·98) was associated with lower risk. For specific monotherapies, only lithium was associated with lower depression-related hospitalisation risk (0·75, 0·67–0·85). No specific antidepressant monotherapy was associated with reduced depression-related hospitalisation, while several antidepressants and antipsychotics were related to an increased risk. In head-to-head comparisons, lithium monotherapy was associated with a superior outcome compared with antidepressant monotherapy (0·59, 0·51–0·68), antipsychotic monotherapy (0·54, 0·44–0·66), lamotrigine monotherapy (0·69, 0·53–0·91), and quetiapine monotherapy (0·54, 0·41–0·71). Lithium was associated with the lowest risk of somatic hospitalisation (0·86, 0·80–0·93) when compared w","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"9 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143192506","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}
Pub Date : 2025-02-01Epub Date: 2024-09-19DOI: 10.1016/S2215-0366(24)00288-8
Jennifer L Gordon, Sneha Chenji, Arianna Di Florio, Liisa Hantsoo, Sandi MacDonald, Jessica R Peters, Jaclyn M Ross, Katja Schmalenberger, Tory A Eisenlohr-Moul
{"title":"Suicidality should be considered for inclusion in the diagnostic criteria for PMDD.","authors":"Jennifer L Gordon, Sneha Chenji, Arianna Di Florio, Liisa Hantsoo, Sandi MacDonald, Jessica R Peters, Jaclyn M Ross, Katja Schmalenberger, Tory A Eisenlohr-Moul","doi":"10.1016/S2215-0366(24)00288-8","DOIUrl":"10.1016/S2215-0366(24)00288-8","url":null,"abstract":"","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":" ","pages":"90-92"},"PeriodicalIF":30.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299136","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}
Pub Date : 2025-01-23DOI: 10.1016/s2215-0366(24)00443-7
S M Yasir Arafat
No Abstract
{"title":"Suicide prevention in Bangladesh: the role of police","authors":"S M Yasir Arafat","doi":"10.1016/s2215-0366(24)00443-7","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00443-7","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"13 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143026317","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}
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