Pub Date : 2025-09-09DOI: 10.1016/s2215-0366(25)00269-x
Tony Rousmaniere, Simon B Goldberg, John Torous
No Abstract
没有抽象的
{"title":"Large language models as mental health providers","authors":"Tony Rousmaniere, Simon B Goldberg, John Torous","doi":"10.1016/s2215-0366(25)00269-x","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00269-x","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"34 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043288","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 : 2025-09-08DOI: 10.1016/s2215-0366(25)00243-3
Paul D Campbell, Jason D E Proulx, Kate Sollis, Tegan Cruwys, Alison L Calear, Joanne Rathbone, Veronica Sheanoda, Katherine J Reynolds
<h3>Background</h3>Suicide and self-harm are serious health concerns and can emerge in childhood and adolescence. Research into childhood self-harm and suicidality and prevention has focused predominately on risk factors, whereas protective factors remain understudied. We aimed to explore the type and timing of early-life (age 6–13 years) factors that are protective against self-harm and suicidality in adolescence (age 14–15 years).<h3>Methods</h3>In this cohort study, we used four predictor waves (waves 4–7) and one outcome wave (wave 8) of the Longitudinal Study of Australian Children. Children in the cohort were born in 2003–04 (wave 1) and have been surveyed every 2 years. Predictors were aspects of childhood wellbeing that were drawn from an existing multidimensional participatory child wellbeing framework (the Nest framework), which used domains of valued, loved, and safe; material basics; healthy; learning; and participating. Dimensions of childhood wellbeing were coded by a previously developed indicator dashboard. Each dimension was operationalised with multiple subdomains, which were the key predictors. We used logistic regressions to model the degree to which these wellbeing dimensions, measured across four timepoints in middle childhood and pre-adolescence (age 6–13 years), predicted adolescent (age 14–15 years) self-harm ideation and behaviour and suicidal ideation and attempts in the past 12 months. We involved people with related lived experiences in the study design and implementation.<h3>Findings</h3>3044 children were in the wave 4–8 analytical sample: 1570 (51·6%) male participants and 1474 (48·4%) female participants. 3034 (99·7%) children in the cohort were born in Australia, but 858 (28·2%) children in the wave 4–8 analytical sample had at least one parent born overseas and 76 (2·5%) children were Aboriginal or Torres Strait Islander Australians. Across all ages, most children had most of their wellbeing needs met on individual subdomains of wellbeing. No variable showed consistent associations across ages and across the four outcome variables. The strongest protective factors against self-harm ideation were a good state of mind (odds ratio 0·55, 95% CI 0·42–0·71) and sense of belonging (0·60, 0·46–0·77) at age 12–13 years. For self-harm behaviour, relationships with parents (0·45, 0·21–0·97) and involvement in the community (0·53, 0·32–0·89) at age 10–11 years were most protective. For suicidal ideation, the strongest protective factors were sense of belonging at age 12–13 years (0·57, 0·42–0·78) and school satisfaction at age 10–11 years (0·32, 0·12–0·89). For suicide attempts, protective factors included school safety (0·59, 0·39–0·89) at age 6–7 years and school satisfaction at age 10–11 years (0·47, 0·26–0·85).<h3>Interpretation</h3>We identified various childhood wellbeing factors that relate to adolescent self-harm and suicidality across the four predictor waves, suggesting that the protective factors for self-harm an
{"title":"Early-life protective factors for adolescent self-harm and suicidality: a longitudinal cohort study in Australia","authors":"Paul D Campbell, Jason D E Proulx, Kate Sollis, Tegan Cruwys, Alison L Calear, Joanne Rathbone, Veronica Sheanoda, Katherine J Reynolds","doi":"10.1016/s2215-0366(25)00243-3","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00243-3","url":null,"abstract":"<h3>Background</h3>Suicide and self-harm are serious health concerns and can emerge in childhood and adolescence. Research into childhood self-harm and suicidality and prevention has focused predominately on risk factors, whereas protective factors remain understudied. We aimed to explore the type and timing of early-life (age 6–13 years) factors that are protective against self-harm and suicidality in adolescence (age 14–15 years).<h3>Methods</h3>In this cohort study, we used four predictor waves (waves 4–7) and one outcome wave (wave 8) of the Longitudinal Study of Australian Children. Children in the cohort were born in 2003–04 (wave 1) and have been surveyed every 2 years. Predictors were aspects of childhood wellbeing that were drawn from an existing multidimensional participatory child wellbeing framework (the Nest framework), which used domains of valued, loved, and safe; material basics; healthy; learning; and participating. Dimensions of childhood wellbeing were coded by a previously developed indicator dashboard. Each dimension was operationalised with multiple subdomains, which were the key predictors. We used logistic regressions to model the degree to which these wellbeing dimensions, measured across four timepoints in middle childhood and pre-adolescence (age 6–13 years), predicted adolescent (age 14–15 years) self-harm ideation and behaviour and suicidal ideation and attempts in the past 12 months. We involved people with related lived experiences in the study design and implementation.<h3>Findings</h3>3044 children were in the wave 4–8 analytical sample: 1570 (51·6%) male participants and 1474 (48·4%) female participants. 3034 (99·7%) children in the cohort were born in Australia, but 858 (28·2%) children in the wave 4–8 analytical sample had at least one parent born overseas and 76 (2·5%) children were Aboriginal or Torres Strait Islander Australians. Across all ages, most children had most of their wellbeing needs met on individual subdomains of wellbeing. No variable showed consistent associations across ages and across the four outcome variables. The strongest protective factors against self-harm ideation were a good state of mind (odds ratio 0·55, 95% CI 0·42–0·71) and sense of belonging (0·60, 0·46–0·77) at age 12–13 years. For self-harm behaviour, relationships with parents (0·45, 0·21–0·97) and involvement in the community (0·53, 0·32–0·89) at age 10–11 years were most protective. For suicidal ideation, the strongest protective factors were sense of belonging at age 12–13 years (0·57, 0·42–0·78) and school satisfaction at age 10–11 years (0·32, 0·12–0·89). For suicide attempts, protective factors included school safety (0·59, 0·39–0·89) at age 6–7 years and school satisfaction at age 10–11 years (0·47, 0·26–0·85).<h3>Interpretation</h3>We identified various childhood wellbeing factors that relate to adolescent self-harm and suicidality across the four predictor waves, suggesting that the protective factors for self-harm an","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"230 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145017380","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 : 2025-09-01DOI: 10.1016/s2215-0366(25)00197-x
Natalie Feldman, Alice Hibara, Jamie Ye, Anjeli Macaranas, Piper Larkin, Erin Hendrix, Taline Aydinian, Leena Mittal, Pamela Wiegartz, David Silbersweig, Cindy H Liu
Although there has been increasing interest in the study of postpartum anxiety in recent years, it remains an emerging field. We present a state-of-the-art review of postpartum anxiety, with the aim of comprehensively surveying postpartum anxiety literature and presenting a synthesis of the complete body of knowledge around postpartum anxiety. We found an estimated global prevalence of 12·3% for postpartum anxiety. Postpartum anxiety is associated with primiparity and younger maternal age. Multiple screening tools are validated for use in postpartum anxiety, although none of these tools are validated for ongoing assessment. There are very few studies of pharmacotherapy in postpartum anxiety, but cognitive behavioural therapy has promising evidence. Postpartum anxiety is associated with altered offspring biology and mental health, as well as poor maternal psychological outcomes and quality of life. We review gaps in literature, particularly in our understanding of the biology and clinical features of postpartum anxiety, as well as the limitations of current screening tools. This Review should serve as a call to action towards a rigorous and coordinated study of postpartum anxiety.
{"title":"Postpartum anxiety: a state-of-the-art review","authors":"Natalie Feldman, Alice Hibara, Jamie Ye, Anjeli Macaranas, Piper Larkin, Erin Hendrix, Taline Aydinian, Leena Mittal, Pamela Wiegartz, David Silbersweig, Cindy H Liu","doi":"10.1016/s2215-0366(25)00197-x","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00197-x","url":null,"abstract":"Although there has been increasing interest in the study of postpartum anxiety in recent years, it remains an emerging field. We present a state-of-the-art review of postpartum anxiety, with the aim of comprehensively surveying postpartum anxiety literature and presenting a synthesis of the complete body of knowledge around postpartum anxiety. We found an estimated global prevalence of 12·3% for postpartum anxiety. Postpartum anxiety is associated with primiparity and younger maternal age. Multiple screening tools are validated for use in postpartum anxiety, although none of these tools are validated for ongoing assessment. There are very few studies of pharmacotherapy in postpartum anxiety, but cognitive behavioural therapy has promising evidence. Postpartum anxiety is associated with altered offspring biology and mental health, as well as poor maternal psychological outcomes and quality of life. We review gaps in literature, particularly in our understanding of the biology and clinical features of postpartum anxiety, as well as the limitations of current screening tools. This Review should serve as a call to action towards a rigorous and coordinated study of postpartum anxiety.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"38 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144928114","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 : 2025-08-28DOI: 10.1016/s2215-0366(25)00193-2
Nils Opel, Ruth Hanssen, Lavinia A Steinmann, Jannik Foerster, Ole Köhler-Forsberg, Margaret Hahn, Fiora Ferretti, Christopher Palmer, Brenda W J H Penninx, Stefan M Gold, Andreas Reif, Christian Otte, Sharmili Edwin Thanarajah
Obesity is one of the most prevalent somatic comorbidities in individuals with major depressive disorder and greatly affects the course and prognosis of that disorder. The bidirectional relationship between major depressive disorder and obesity often creates a feedback cycle that challenges both patients and health-care providers. Gaps in interdisciplinary collaboration and limitations in knowledge transfer hinder the effective management of this patient population. This narrative Review synthesises current evidence from obesity and major depressive disorder research, offering a comprehensive risk stratification and monitoring framework that integrates psychological and metabolic parameters to enhance clinical decision making. We examine the latest evidence on pharmacological and psychotherapeutic interventions as well as lifestyle-based strategies—such as exercise, dietary modifications, and weight-loss medications—with the aim of alleviating depressive symptoms while supporting weight management and improving metabolic health. Bariatric surgery, which is a key component in obesity management, is not covered in this Review. Finally, we highlight the crucial need for an integrated, interdisciplinary treatment approach and provide practical guidance for optimising care to improve outcomes for individuals with major depressive disorder and comorbid obesity.
{"title":"Clinical management of major depressive disorder with comorbid obesity","authors":"Nils Opel, Ruth Hanssen, Lavinia A Steinmann, Jannik Foerster, Ole Köhler-Forsberg, Margaret Hahn, Fiora Ferretti, Christopher Palmer, Brenda W J H Penninx, Stefan M Gold, Andreas Reif, Christian Otte, Sharmili Edwin Thanarajah","doi":"10.1016/s2215-0366(25)00193-2","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00193-2","url":null,"abstract":"Obesity is one of the most prevalent somatic comorbidities in individuals with major depressive disorder and greatly affects the course and prognosis of that disorder. The bidirectional relationship between major depressive disorder and obesity often creates a feedback cycle that challenges both patients and health-care providers. Gaps in interdisciplinary collaboration and limitations in knowledge transfer hinder the effective management of this patient population. This narrative Review synthesises current evidence from obesity and major depressive disorder research, offering a comprehensive risk stratification and monitoring framework that integrates psychological and metabolic parameters to enhance clinical decision making. We examine the latest evidence on pharmacological and psychotherapeutic interventions as well as lifestyle-based strategies—such as exercise, dietary modifications, and weight-loss medications—with the aim of alleviating depressive symptoms while supporting weight management and improving metabolic health. Bariatric surgery, which is a key component in obesity management, is not covered in this Review. Finally, we highlight the crucial need for an integrated, interdisciplinary treatment approach and provide practical guidance for optimising care to improve outcomes for individuals with major depressive disorder and comorbid obesity.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"23 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144915431","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 : 2025-08-20DOI: 10.1016/s2215-0366(25)00242-1
Gemma Brisco, Gerard Drennan, David Forbes, Amr Abdel Aty
No Abstract
没有抽象的
{"title":"Integrating moral injury into forensic psychiatry","authors":"Gemma Brisco, Gerard Drennan, David Forbes, Amr Abdel Aty","doi":"10.1016/s2215-0366(25)00242-1","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00242-1","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"79 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899760","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 : 2025-08-18DOI: 10.1016/s2215-0366(25)00172-5
Stephen M Lawrie
Meta-analyses and mega-analyses of structural MRI and diffusion MRI studies in thousands of people with schizophrenia have shown reduced brain volumes and structural connectivity relative to healthy control participants. Some of these structural differences probably present pre-morbidly. Severity of schizophrenia symptoms and cognitive impairment consistently correlate. Convergent findings with different analytical methods show that the results are not artefactual. Post-mortem studies add validity and point to a pathophysiology of reduced neuronal size and dendritic arborisation, which is multifactorial. Structural MRI changes probably occur between being in the at-risk state and the first episode of psychosis, and ongoing reductions in brain volume might be associated with poor outcomes. By the standards of observational epidemiology, some findings are convincing or highly suggestive, but many are only suggestive or weak, and more studies are needed. Progress in scientific understanding and evaluating clinical applications will require clear hypotheses, adequately powered studies, and standardised methods and reporting.
{"title":"Brain structure in schizophrenia: what do we know and what next?","authors":"Stephen M Lawrie","doi":"10.1016/s2215-0366(25)00172-5","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00172-5","url":null,"abstract":"Meta-analyses and mega-analyses of structural MRI and diffusion MRI studies in thousands of people with schizophrenia have shown reduced brain volumes and structural connectivity relative to healthy control participants. Some of these structural differences probably present pre-morbidly. Severity of schizophrenia symptoms and cognitive impairment consistently correlate. Convergent findings with different analytical methods show that the results are not artefactual. Post-mortem studies add validity and point to a pathophysiology of reduced neuronal size and dendritic arborisation, which is multifactorial. Structural MRI changes probably occur between being in the at-risk state and the first episode of psychosis, and ongoing reductions in brain volume might be associated with poor outcomes. By the standards of observational epidemiology, some findings are convincing or highly suggestive, but many are only suggestive or weak, and more studies are needed. Progress in scientific understanding and evaluating clinical applications will require clear hypotheses, adequately powered studies, and standardised methods and reporting.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"15 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899764","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 : 2025-08-12DOI: 10.1016/s2215-0366(25)00238-x
Nicola J Reavley, Lakshmi Neelakantan, Amy J Morgan
No Abstract
没有抽象的
{"title":"Family dynamics and self-harm and suicidality in children and adolescents","authors":"Nicola J Reavley, Lakshmi Neelakantan, Amy J Morgan","doi":"10.1016/s2215-0366(25)00238-x","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00238-x","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"33 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144825207","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 : 2025-08-12DOI: 10.1016/s2215-0366(25)00245-7
No Abstract
没有抽象的
{"title":"Greater than its parts","authors":"","doi":"10.1016/s2215-0366(25)00245-7","DOIUrl":"https://doi.org/10.1016/s2215-0366(25)00245-7","url":null,"abstract":"No Abstract","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"95 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144825205","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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