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Predicting suicidality with small sets of interpretable reward behavior and survey variables 利用少量可解释的奖励行为和调查变量预测自杀倾向
Pub Date : 2024-05-09 DOI: 10.1038/s44220-024-00229-x
Shamal Lalvani, Sumra Bari, Nicole L. Vike, Leandros Stefanopoulos, Byoung-Woo Kim, Martin Block, Nicos Maglaveras, Aggelos K. Katsaggelos, Hans C. Breiter
The prediction of suicidal thought and behavior has met with mixed results. This study of 3,476 de-identified participants (4,019 before data exclusion) quantified the prediction of four suicidal thought and behavior (STB) variables using a short reward/aversion judgment task and a limited set of demographic and mental health surveys. The focus was to produce a simple, quick and objective framework for assessing STB that might be automatable, without the use of big data. A balanced random forest classifier performed better than a Gaussian mixture model and four standard machine learning classifiers for predicting passive suicide ideation, active suicide ideation, suicide planning and planning for safety. Accuracies ranged from 78% to 92% (optimal area under the curve between 0.80 and 0.95) without overfitting, and peak performance was observed for predicting suicide planning. The relative importance of features for prediction showed distinct weighting across judgment variables, contributing between 40% and 64% to prediction per Gini scores. Mediation/moderation analyses showed that depression, anxiety, loneliness and age variables moderated the judgment variables, indicating that the interaction of judgment with mental health and demographic indices is fundamental for the high-accuracy prediction of STB. These findings suggest the feasibility of an efficient and highly scalable system for suicide assessment, without requiring psychiatric records or neural measures. The findings suggest that STB might be understood within a cognitive framework for judgment with quantitative variables whose unique constellation separates passive and active suicidal thought (ideation) from suicide planning and planning for safety. Applying machine learning to an objective framework for suicidality, the authors demonstrate that four suicidal thought and behavior variables can be predicted with high accuracy and may present a scalable system for suicide risk assessment.
对自杀想法和行为的预测结果不一。本研究对 3,476 名身份不明的参与者(数据排除前为 4,019 人)进行了研究,利用一个简短的奖励/厌恶判断任务和一组有限的人口统计学和心理健康调查,对四个自杀想法和行为(STB)变量进行了量化预测。研究的重点是建立一个简单、快速、客观的 STB 评估框架,该框架无需使用大数据即可实现自动化。在预测被动自杀意念、主动自杀意念、自杀计划和安全计划方面,平衡随机森林分类器的表现优于高斯混合模型和四种标准机器学习分类器。准确率在 78% 到 92% 之间(最佳曲线下面积在 0.80 到 0.95 之间),没有过拟合现象,预测自杀计划的性能达到了顶峰。各特征对预测的相对重要性在不同的判断变量中显示出不同的权重,按吉尼分数计算,对预测的贡献率在 40% 到 64% 之间。调解/调节分析表明,抑郁、焦虑、孤独和年龄变量对判断变量起到了调节作用,这表明判断与心理健康和人口统计指数之间的相互作用是高精度预测 STB 的基础。这些研究结果表明,无需精神病学记录或神经测量,高效、高度可扩展的自杀评估系统是可行的。研究结果表明,STB 可以在认知框架内通过定量变量进行判断,而定量变量的独特组合将被动和主动自杀想法(意念)与自杀计划和安全计划区分开来。作者将机器学习应用到自杀倾向的客观框架中,证明了四个自杀想法和行为变量可以被高精度预测,并可能为自杀风险评估提供一个可扩展的系统。
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引用次数: 0
Rethinking technology innovation for mental health: framework for multi-sectoral collaboration 反思心理健康技术创新:多部门合作框架
Pub Date : 2024-05-03 DOI: 10.1038/s44220-024-00232-2
Jina Suh, Sachin R. Pendse, Robert Lewis, Esther Howe, Koustuv Saha, Ebele Okoli, Judith Amores, Gonzalo Ramos, Jenny Shen, Judith Borghouts, Ashish Sharma, Paola Pedrelli, Liz Friedman, Charmain Jackman, Yusra Benhalim, Desmond C. Ong, Sameer Segal, Tim Althoff, Mary Czerwinski
The impact of technology on mental health has become a core concern for researchers and practitioners from the clinical science, public health and technology sectors. One factor that influences this impact is the large gap between the silos of technologies explicitly designed as mental health support tools and the everyday technologies that inadvertently affect mental health. Here we ground our position on findings from a workshop that brought together over 60 experts and emphasize the importance of a multi-sectoral collaboration across these silos to address the complexities of technology’s impact on mental health. Our specific recommendations include a push to align stakeholders, incentives and governance, adopting person-centered and proactive mental health evaluation, and empowering users and clinicians (and their interactions) through mental health and technology literacy. We highlight sector-specific adaptations that can support greater collaborations, toward a future in which users have consistently positive interactions between technology use and their mental health. In this Perspective, the authors make recommendations on better aligning stakeholders, including those in technology, practitioners and researchers, to increase collaboration and governance in technology and mental health.
技术对心理健康的影响已成为临床科学、公共卫生和技术领域的研究人员和从业人员关注的核心问题。影响这种影响的一个因素是,明确设计为心理健康支持工具的孤岛式技术与无意中影响心理健康的日常技术之间存在巨大差距。在此,我们以汇集了 60 多位专家的研讨会结论为基础,强调跨部门合作的重要性,以应对技术对心理健康影响的复杂性。我们的具体建议包括:推动利益相关者、激励机制和管理的协调,采用以人为本和积极主动的心理健康评估,以及通过心理健康和技术扫盲增强用户和临床医生(以及他们之间的互动)的能力。我们强调了特定行业的适应性,这些适应性可以支持更大范围的合作,从而实现用户在技术使用和心理健康之间持续积极互动的未来。在本《视角》中,作者就如何更好地协调利益相关者(包括技术、从业人员和研究人员)之间的关系提出了建议,以加强技术与心理健康方面的合作与管理。
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引用次数: 0
A call for immediate action to improve the mental health of left-behind children in the post-COVID-19 era 呼吁立即采取行动,在后 "COVID-19 "时代改善留守儿童的心理健康
Pub Date : 2024-05-03 DOI: 10.1038/s44220-024-00253-x
Jinkai Li, Qiuzhen Ren, Erga Luo, Chuanlong Ma, Chengfang Liu
The COVID-19 pandemic has caused profound mental health problems among left-behind children (LBC). Here we discuss the challenges that LBC are facing in the post-COVID-19 era and the potential underlying mechanisms, and provide recommendations for future policy priorities.
COVID-19 大流行给留守儿童(LBC)造成了严重的心理健康问题。在此,我们将讨论留守儿童在后 COVID-19 时代所面临的挑战及其潜在的内在机制,并就未来的政策重点提出建议。
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引用次数: 0
Declining human fertility and the epidemic of despair 人类生育率下降与绝望流行病
Pub Date : 2024-05-03 DOI: 10.1038/s44220-024-00241-1
Michael L. Platt, Peter Sterling
Increasing inequality and social fragmentation may give rise to a collective state of despair that may not only diminish the desire to live but also dampen the drive to reproduce, resulting in shrinking fertility and population decline.
日益加剧的不平等和社会分化可能会导致集体绝望,这不仅会削弱人们的求生欲望,还会抑制繁衍后代的动力,从而导致生育率下降和人口减少。
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引用次数: 0
Optimizing real-world benefit and risk of new psychedelic medications: the need for innovative postmarket surveillance 优化新迷幻药在现实世界中的收益和风险:需要创新性的上市后监控机制
Pub Date : 2024-05-03 DOI: 10.1038/s44220-024-00233-1
Joshua C. Black, Andrew A. Monte, Nabarun Dasgupta, Jennifer S. Jewell, Karilynn M. Rockhill, Richard A. Olson, Richard C. Dart
The encouraging results of late-phase clinical trials investigating psychedelic-assisted psychotherapy suggests that US Food and Drug Administration approval and subsequent expansion of use is imminent in the USA. Without fit-for-purpose postmarket surveillance to proactively monitor utilization by patients and providers, there is a risk that the real-world benefits of psychedelic-assisted psychotherapy will not be realized. Incorrect conclusions, such as misattribution of adverse events to illicit psychedelics, may result from ill-designed surveillance programs. A successful surveillance program should monitor appropriate, equitable access for patients and inform reasonable limitations to improve patient safety. Multiple domains, including environmental factors, personal factors and relevant effectiveness and safety outcomes, should be incorporated. Current data systems that monitor drug use are generally ill-suited to address the unique needs for psychedelic surveillance. An intentionally designed mosaic of data systems is required to monitor the safety and effectiveness of psychedelic surveillance. In this Perspective, authors argue for a more robust and comprehensive postmarket surveillance program of psychedelic-assisted psychotherapy to better ensure safe, appropriate and equitable care for patients.
研究迷幻药辅助心理疗法的后期临床试验结果令人鼓舞,这表明美国食品和药物管理局即将批准迷幻药辅助心理疗法,并随后扩大其在美国的使用范围。如果没有目的明确的上市后监测来主动监控患者和医疗机构的使用情况,迷幻药辅助心理疗法在现实世界中的益处就有可能无法实现。不正确的结论,如将不良事件错误地归因于非法迷幻药,可能是监测计划设计不当的结果。一个成功的监控项目应能监控患者适当、公平地使用迷幻药,并告知合理的限制,以提高患者的安全性。应纳入多个领域,包括环境因素、个人因素以及相关的有效性和安全性结果。目前监测药物使用情况的数据系统通常无法满足迷幻药监测的独特需求。要监测迷幻药监控的安全性和有效性,就需要有意识地设计一套完整的数据系统。在本《视角》中,作者主张对迷幻药辅助心理疗法进行更有力、更全面的上市后监测计划,以更好地确保为患者提供安全、适当和公平的治疗。
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引用次数: 0
Ensemble deep learning for Alzheimer’s disease characterization and estimation 用于阿尔茨海默病特征描述和估计的集合深度学习
Pub Date : 2024-05-03 DOI: 10.1038/s44220-024-00237-x
M. Tanveer, T. Goel, R. Sharma, A. K. Malik, I. Beheshti, J. Del Ser, P. N. Suganthan, C. T. Lin
Alzheimer’s disease, which is characterized by a continual deterioration of cognitive abilities in older people, is the most common form of dementia. Neuroimaging data, for example, from magnetic resonance imaging and positron emission tomography, enable identification of the structural and functional changes caused by Alzheimer’s disease in the brain. Diagnosing Alzheimer’s disease is critical in medical settings, as it supports early intervention and treatment planning and contributes to expanding our knowledge of the dynamics of Alzheimer’s disease in the brain. Lately, ensemble deep learning has become popular for enhancing the performance and reliability of Alzheimer’s disease diagnosis. These models combine several deep neural networks to increase a prediction’s robustness. Here we revisit key developments of ensemble deep learning, connecting its design—the type of ensemble, its heterogeneity and data modalities—with its application to AD diagnosis using neuroimaging and genetic data. Trends and challenges are discussed thoroughly to assess where our knowledge in this area stands. In this Review, the authors cover the latest understanding of ensemble deep learning models as a means to complement Alzheimer’s disease diagnosis.
阿尔茨海默病以老年人认知能力持续退化为特征,是最常见的痴呆症。神经成像数据,例如磁共振成像和正电子发射断层扫描数据,能够识别阿尔茨海默氏症在大脑中引起的结构和功能变化。诊断阿尔茨海默病在医疗环境中至关重要,因为它有助于早期干预和治疗规划,并有助于扩大我们对阿尔茨海默病在大脑中的动态变化的了解。最近,为了提高阿尔茨海默病诊断的性能和可靠性,集合深度学习开始流行起来。这些模型结合了多个深度神经网络,以提高预测的鲁棒性。在此,我们重温了集合深度学习的主要发展,将其设计--集合类型、异构性和数据模式--与利用神经影像和遗传数据进行阿兹海默症诊断的应用联系起来。文章对发展趋势和挑战进行了深入讨论,以评估我们在这一领域的知识水平。在这篇综述中,作者介绍了对作为阿尔茨海默病诊断补充手段的集合深度学习模型的最新理解。
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引用次数: 0
Educational attainment and psychiatric diagnoses: a national registry data and two-sample Mendelian randomization study 教育程度与精神病诊断:全国登记数据和双样本孟德尔随机研究
Pub Date : 2024-05-02 DOI: 10.1038/s44220-024-00245-x
Perline A. Demange, Dorret I. Boomsma, Elsje van Bergen, Michel G. Nivard
We investigate the causal relationship between educational attainment (EA) and mental health conditions using two research designs. Here we first compare the relationship between EA and 18 psychiatric diagnoses within-sibship in Dutch national registry data (N = 1.7 million), thereby controlling for unmeasured familial factors. Second, we apply two-sample Mendelian randomization, which uses genetic variants related to EA or psychiatric diagnosis as instrumental variables, to test whether there is a causal relation in either direction. Our results suggest that lower levels of EA causally increase the risk of major depressive disorder, attention-deficit/hyperactivity disorder, alcohol dependence, generalized anxiety disorder and post-traumatic stress disorder diagnoses. We also find evidence of a causal effect of attention-deficit/hyperactivity disorder on EA. For schizophrenia, anorexia nervosa, obsessive–compulsive disorder and bipolar disorder, the results were inconsistent across the different approaches, highlighting the importance of using multiple research designs to understand complex relationships, such as between EA and mental health conditions. Analyzing national registry data, the authors use within-sibling design and two-sample Mendelian randomization to identify bidirectional causal relationships between educational attainment (EA) and mental health conditions, demonstrating that lower levels of EA were differentially associated with some disorders, such as major depressive disorder, but that attention-deficit/hyperactivity disorder causally affected EA.
我们采用两种研究设计来探讨教育程度(EA)与精神健康状况之间的因果关系。在这里,我们首先比较了荷兰全国登记数据(N = 170 万)中 EA 与同胞兄弟姐妹中 18 种精神疾病诊断之间的关系,从而控制了未测量的家族因素。其次,我们采用双样本孟德尔随机化方法,将与 EA 或精神病诊断相关的基因变异作为工具变量,检验两者之间是否存在因果关系。我们的研究结果表明,较低的 EA 水平会增加患重度抑郁症、注意力缺陷/多动症、酒精依赖症、广泛性焦虑症和创伤后应激障碍的风险。我们还发现了注意力缺陷/多动障碍对 EA 产生因果效应的证据。对于精神分裂症、神经性厌食症、强迫症和双相情感障碍,不同方法得出的结果并不一致,这凸显了使用多种研究设计来理解复杂关系的重要性,例如 EA 与精神健康状况之间的关系。作者通过分析全国登记数据,采用同胞设计和双样本孟德尔随机法来确定教育程度(EA)与精神健康状况之间的双向因果关系,证明较低的教育程度与某些疾病(如重度抑郁症)有不同程度的关联,但注意力缺陷/多动症对教育程度有因果影响。
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引用次数: 0
Changes in alcohol consumption and alcohol problems before and after the COVID-19 pandemic: a prospective study in heavy drinking young adults COVID-19 大流行前后饮酒量和酒精问题的变化:对酗酒年轻人的前瞻性研究
Pub Date : 2024-05-02 DOI: 10.1038/s44220-024-00247-9
Kasey G. Creswell, Garrett C. Hisler, Greta Lyons, Francisco A. Carrillo-Álvarez, Catharine E. Fairbairn, Aidan G. C. Wright
Most past studies examining changes in alcohol use from before to during the COVID-19 pandemic used cross-sectional designs that required participants to retrospectively report on their pre-pandemic alcohol consumption. The few longitudinal studies conducted so far also commonly relied on retrospective reports of pre-pandemic alcohol use, and no previous longitudinal studies included multiple assessments that occurred both prior to and after the onset of the pandemic. Here, in 234 heavy drinking young adults (aged 21–29 years), we (1) prospectively examined within-person changes in alcohol consumption/patterns and alcohol problems assessed at multiple timepoints before and after the pandemic onset (February 2018 to March 2022), to examine trajectories of changes in alcohol involvement after the start of COVID in the context of deviations from pre-COVID trajectories (using individual growth models fitted in a multilevel structural equation modeling framework), and (2) tested theoretically informed mechanisms (that is, changes in negative affectivity, coping-motivated drinking and solitary drinking) in explaining pandemic-associated changes in alcohol consumption/patterns and alcohol problems using correlated slopes models. The results showed significant reductions in alcohol use quantity and frequency, as well as alcohol problems, from pre- to post-pandemic onset, which were largely driven by significant decreases in weekend (versus weekday) drinking quantity and frequency and drinks per drinking day. Negative affectivity significantly decreased, and solitary drinking significantly increased, from pre- to post-pandemic onset, with no significant change to coping drinking motives; changes in these variables were not related to decreases in alcohol involvement, and the magnitude of changes in all variables from pre- to post-pandemic onset did not generally differ for males and females. The results indicate that alcohol use and concomitant alcohol-related problems significantly decreased in these heavy drinking young adults during the pandemic, and these decreases were evident up to two years post pandemic onset. In this prospective longitudinal study of alcohol consumption and patterns in heavy drinking young adults, significant reductions in alcohol use quantity, frequency and problems were observed from pre- to post-pandemic onset.
以往研究 COVID-19 大流行前和流行期间饮酒量变化的大多数研究都采用了横断面设计,要求参与者回顾性报告其大流行前的饮酒量。迄今为止进行的少数纵向研究也通常依赖于对大流行前饮酒情况的回顾性报告,而且以前的纵向研究都没有包括大流行开始前和开始后的多次评估。在此,我们以 234 名酗酒严重的年轻人(21-29 岁)为研究对象,(1) 前瞻性地考察了在大流行爆发前后(2018 年 2 月至 2022 年 3 月)多个时间点评估的酒精消费/模式和酒精问题的人内变化、在偏离 COVID 前轨迹的背景下,研究 COVID 开始后酒精参与的变化轨迹(使用多层次结构方程建模框架下的个体成长模型),以及 (2) 使用相关斜率模型,检验理论上可解释与大流行相关的酒精消费/模式和酒精问题变化的机制(即负情感、应对动机饮酒和单独饮酒的变化)。结果表明,从大流行开始前到开始后,饮酒数量和频率以及酗酒问题明显减少,这主要是由于周末(相对于平日)饮酒数量和频率以及每饮酒日饮酒量明显减少。从大流行前到大流行后,消极情绪明显减少,独自饮酒明显增加,应付性饮酒动机没有明显变化;这些变量的变化与酗酒减少无关,而且从大流行前到大流行后,所有变量的变化幅度在男性和女性之间没有普遍差异。研究结果表明,在大流行期间,这些酗酒的年轻人的酒精使用量和伴随的酒精相关问题明显减少,而且这些减少在大流行开始后的两年内都很明显。在这项关于酗酒青年的饮酒量和模式的前瞻性纵向研究中,观察到从大流行开始前到开始后,饮酒量、频率和问题都明显减少。
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引用次数: 0
Investigating inflation, living costs and mental health service utilization in post-COVID-19 England 调查19世纪COVID之后英格兰的通货膨胀、生活费用和心理健康服务使用情况
Pub Date : 2024-05-02 DOI: 10.1038/s44220-024-00250-0
Shanquan Chen, Miaoqing Yang, Hannah Kuper
This study investigates the association between price inflation and mental health conditions in the general population during the post-coronavirus disease 2019 (COVID-19) era in England, beginning from April 2022. Here, utilizing data from the Office for National Statistics and the National Health Service, we examined the association between price inflation, reflected by an official index ‘Consumer Prices Index including owner occupiers’ housing costs’ and the number of people in contact with mental health services across different age groups. Our findings revealed that, compared with the pre-COVID-19 period (August 2016 to February 2020), significant associations emerged between specific living costs (including costs for ‘food and non-alcoholic beverages’, ‘housing, water and fuels’ and ‘miscellaneous goods and services’) and mental health service utilization during the post-COVID-19 era. This association was particularly noted for adults aged 19–64 years and the elderly population aged 65 years and over. The results highlight the importance of addressing the potential causes of mental health issues in the context of rising living costs and can inform targeted social and economic policies, such as financial subsidies for food and non-alcoholic beverages and the need to scale up mental health services. In this study, the authors investigate the association between price inflation and mental health service uptake in the United Kingdom, demonstrating that increasing costs of living exacerbate mental health needs, particularly among adults and older populations.
本研究调查了从 2022 年 4 月开始的英格兰 2019 年后冠状病毒病(COVID-19)时期价格上涨与普通人群精神健康状况之间的关联。在此,我们利用国家统计局和国民健康服务局的数据,研究了官方指数 "消费者价格指数(包括自住者的住房成本)"所反映的物价上涨与不同年龄段接触精神健康服务的人数之间的关系。我们的研究结果显示,与 COVID-19 之前的时期(2016 年 8 月至 2020 年 2 月)相比,在后 COVID-19 时代,特定生活成本(包括 "食品和非酒精饮料"、"住房、水和燃料 "以及 "杂项商品和服务 "的成本)与精神健康服务使用率之间出现了显著的关联。这种关联在 19-64 岁的成年人和 65 岁及以上的老年人口中尤为明显。研究结果凸显了在生活成本上升的背景下解决精神健康问题潜在原因的重要性,并可为制定有针对性的社会和经济政策提供依据,如对食品和非酒精饮料的财政补贴,以及扩大精神健康服务规模的必要性。在这项研究中,作者调查了英国物价上涨与心理健康服务使用率之间的关联,表明生活成本的增加会加剧心理健康需求,尤其是在成年人和老年人群中。
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引用次数: 0
Blunted stress reactivity as a mechanism linking early psychosocial deprivation to psychopathology during adolescence 应激反应能力减弱是早期社会心理剥夺与青春期精神病理学之间的联系机制
Pub Date : 2024-04-30 DOI: 10.1038/s44220-024-00249-7
Mark Wade, Margaret A. Sheridan, Stacy S. Drury, Florin Tibu, Charles H. Zeanah, Nathan A. Fox, Charles A. Nelson, Katie A. McLaughlin
Early psychosocial deprivation is associated with alterations in stress-response system development and later psychopathology. Using data from the Bucharest Early Intervention Project, we examined whether blunted reactivity to social stress served as a mechanism linking early deprivation to later psychopathology in 135 youths, 89 of whom were raised in institutions during early childhood (46 randomly assigned to foster care intervention). At 12 and 16 years, cortisol and sympathetic nervous system reactivity were assessed using the Trier Social Stress Test. Bifactor scores of general and specific psychopathology were estimated from caregiver and teacher reports. Blunted cortisol reactivity at 12 years mediated the association between deprivation and general psychopathology at 16 years, whereas blunted sympathetic nervous system reactivity mediated externalizing-specific problems. Increased stress reactivity did not mediate intervention effects on psychopathology. Early deprivation may shape stress-response system development in a way that confers broad risk for mental health problems during adolescence. Wade and colleagues analyze data from the Bucharest Early Intervention Project to examine whether stress reactivity measured at age 12 may serve as a mechanism linking early institutional deprivation with psychopathology at age 16.
早期的社会心理剥夺与压力反应系统的发展变化和日后的心理病理学有关。我们利用布加勒斯特早期干预项目(Bucharest Early Intervention Project)的数据,研究了135名青少年(其中89人在幼年时期在养育机构长大,46人被随机分配到寄养干预机构)是否对社会压力的反应迟钝是将早期剥夺与日后心理病理学联系起来的一种机制。在青少年 12 岁和 16 岁时,采用特里尔社会压力测试法对其皮质醇和交感神经系统反应性进行了评估。根据照顾者和教师的报告估算出一般和特殊精神病理学的 Bifactor 分数。12岁时皮质醇反应性减弱可介导16岁时匮乏与一般精神病理学之间的关联,而交感神经系统反应性减弱可介导特定外化问题。压力反应性的增加并不能介导对精神病理学的干预效果。早期匮乏可能会影响压力反应系统的发育,从而导致青少年时期出现心理健康问题的广泛风险。Wade 及其同事分析了布加勒斯特早期干预项目的数据,研究了 12 岁时测量的压力反应性是否可以作为早期制度剥夺与 16 岁时心理病理学之间的联系机制。
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引用次数: 0
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Nature mental health
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