Psychiatry research communications最新文献

Recent studies have documented that post-traumatic stress disorder (PTSD) symptoms are robustly associated with depressive symptoms and may mediate the relationship between trauma exposure and depressive symptoms. However, no study has explored the differential mediating effects of four specific PTSD symptom clusters. This study made the first attempt to examine the mediating effects of different PTSD symptom clusters on the linkage between trauma exposure and depressive symptoms. We analyzed data from two large samples of Chinese middle school students (N = 693 and 957) who had experienced the 2013 Ya'an earthquake. Participants completed standardized measures of trauma exposure, PTSD symptoms, and depressive symptoms. The prevalence of probable PTSD was 3.4% and 3.6%, respectively, in the two samples. Mediation analyses revealed that negative alterations in cognitions and mood and alterations in arousal and reactivity were statistically significant mediators in the relationship between trauma exposure during the earthquake and depressive symptoms. The results are very consistent in both samples. The findings suggest that symptom-specific tailored management of these two specific PTSD symptom clusters might have the potential to change the trajectory of developing depressive symptoms among trauma-exposed populations.

Regardless of baseline psychiatric symptom severity, individuals can improve from psychotherapy, including from low-intensity psychosocial treatments. We conducted a secondary analysis of a randomized trial of low-intensity mindfulness interventions to explore if and how specific indices of baseline symptom severity were associated with well-being trajectories during treatment and follow-up. In the original study, participants (N = 4, 411) with physical and mental health conditions were randomly assigned to one of two low-intensity mindfulness interventions (eight-session mindfulness-based cognitive therapy or a three-session mindfulness intervention). In this secondary analysis, we pooled across treatment groups and stratified participants into subgroups based on self-reported baseline levels of anxiety, depression, and social functioning. We used linear mixed effects models and descriptive trajectory plots to evaluate differences in well-being trajectories between subgroups. Baseline symptom severity was associated with well-being trajectory such that those with more severe anxiety, depression, or social functioning at baseline had generally lower well-being across time. All subgroups experienced initial improvement in well-being during the treatment period, though individuals with worse symptom severity tended not to sustain improvements and rebounded back towards baseline well-being levels during follow-up. These data suggest that, for individuals with more severe mental health symptoms, eight or three-session mindfulness-based interventions may still be clinically useful (as patients with more severe symptoms in this study were able to experience initial improvement in well-being from such interventions). However, for such patients, offering these mindfulness-based interventions for a longer duration may have prevented symptom rebounding.

Background

Understanding the relationship between depression severity, patient recovery, and treatment continuity may help optimize the delivery of behavioral health services.

Methods

Using Cox proportional hazards regression, this study measures the association between treatment dropout and baseline depression severity, as measured by the Patient Health Questionnaire (PHQ-9), and the association between treatment dropout and baseline recovery, as measured by the Recovery Assessment Scale (RAS). The study also explores heterogeneity by service line (general mental health, substance use disorder, and eating disorder), residential versus intermediate level of care setting, age groups (adolescent and adult), and dropout factors. The data include 14,689 patients treated at a multi-state behavioral health care provider, discharged between 2021 and 2022. Premature dropout from behavioral health care treatment for any cause, patient factors and administrative factors were used as separate outcomes.

Findings

A unit increase in baseline PHQ-9 was associated with a 1.2% reduced treatment dropout risk (hazard ratio (HR): 0.988; 95% confidence interval [0.983–0.992]). A unit increase in baseline RAS score was associated with 0.5% increased dropout likelihood (HR: 1.005; 95% CI [1.004, 1.007]). Subgroup analyses show associations are driven by general mental health, adolescent, and intermediate level of care subgroups. Patients with higher baseline suicidality and lower willigness to ask for helphad a reduced risk of dropout.

Interpretation

Patients with greater depression severity and lower recovery scores at admission were more likely to stay in behavioral health treatment, especially among adolescents, patients with general mental health issues, and outpatients.

This retrospective study sought to identify patient-, provider-, and system-level characteristics associated with anxiety diagnostic specificity in mental health clinics in the Veterans Health Administration. It used administrative data extracted from Veteran Health Administration outpatient records to identify patients with a new anxiety or trauma-related diagnosis in fiscal year 2019 (N = 383,418). Logistic regression was used to model the probability of receiving an unspecified anxiety diagnosis as a function of patient-, provider-, and system-level characteristics. Unspecified anxiety disorder was diagnosed in 27% of the sample, with higher rates in primary care mental health integration clinics (42.6%) than in general mental health clinics (22.4%). Patient demographic and clinical characteristics including gender and comorbid diagnoses; provider type; provider use of an anxiety screening instrument; and facility size, complexity, and location were significant predictors of unspecified anxiety diagnosis. Anxiety diagnosis is a complex process influenced by multiple patient-, provider-, and system-level characteristics. Additional assessment tools and guidance for differential diagnosis are needed to support mental health providers in busy clinical settings to facilitate accurate and timely diagnosis of anxiety disorders.

With near ubiquitous use and access to digital devices across most settings, there is emerging evidence and growing potential for leveraging these devices to address a wide range of behavioral health challenges, including intervention for alcohol use disorder (AUD). This narrative review aimed to summarize recent evidence on the use of digital interventions for AUD, and to critically assess the promise and pitfalls of these digital approaches, while considering the impact of these interventions on advancing prevention, treatment, and management of AUDs. Specifically, following a database search, a total of 11 empirical studies evaluating the impact of digital interventions for AUD, spanning a range of devices including smartphone apps, online platforms, and wearable devices were identified. Characteristics of the included studies were summarized, and the findings were organized across three broad categories: prevention of AUD, treatment of AUD, and recovery from AUD. These categories were chosen as they best represent the predominant domains of our findings as reflected within the literature. Most of the studies and reviews on digital technology and alcohol use disorder featured the different phases of the disease along this continuum-prevention, treatment, and recovery. Challenges and drawbacks with these digital approaches were considered, such as overcoming barriers to reach vulnerable patient populations, ensuring patient privacy and safety, and sustaining engagement and impact. Despite these limitations, digital interventions in the management of AUD can potentially provide flexibility, ease of access to treatment, improved patient-centered care, a sense of empowerment and autonomy, and encourage compliance with standardized care.

Steeper delay discounting (DD) reflects greater impulsivity and has been reported in individuals with schizophrenia (SCZ) and those with substance use disorder, who also tend to report high psychological stress. We sought to compare DD in people with SCZ, cannabis use disorder (CUD), and comorbid SCZ-CUD, and determine its relationship to psychological stress in these groups, to inform treatment improvements. Participants were healthy controls (HC; n = 31) and individuals with DSM-IV diagnoses of SCZ (n = 21), CUD (n = 61), and comorbid SCZ-CUD (n = 40). After one week or more of verified abstinence from substances, participants completed the Delay Discounting Questionnaire and the Perceived Stress Scale. DD and perceived stress were greater in all three clinical groups compared to HC, though the clinical groups did not differ. Analyses did not detect a consistent relationship between stress and DD in any group, though females showed greater DD with increased stress when all clinical groups were combined. Findings indicate that, overall, perceived stress cannot account for steeper DD in patients with SCZ, CUD, and SCZ-CUD; thus, interventions for stress would not be expected to impact DD.

Self-harm (SH) is one of the strongest predictors of eventual death by suicide. This study examines the potential protective role of reasons for living (RFL) and hope in youth with a history of self-harm using data from a randomized control trial (RCT) of brief cognitive behavioural therapy (BCBT). A single-blind, pilot RCT examined the efficacy of BCBT for suicide prevention versus an attentional control in youth aged 15-25 admitted to hospital following self-harm. Subjects’ reasons for living and hope were measured weekly by the Reasons for Living Scale (RFL) and Adult Hope Scale (AHS), respectively, for 10 weeks of acute treatment. Logistic regression was performed to evaluate whether baseline RFL and AHS scores predicted repeat self-harm. Mann-Whitney U tests were used to compare median RFL and AHS scores. Our study did not find associations between reasons for living or hope and repeat self-harm in youth. Treatment with BCBT was also not associated with improved scores on either measure.

Despite high public stigma towards individuals with borderline personality disorder (BPD), no research has examined whether stigma differs among the various proposed BPD subtypes. The primary purpose of this research was to examine two potential contributors to stigma towards individuals with BPD: 1) gender, and 2) BPD subtype of the individuals. The three subtypes utilized in this study were emotional, low anxiety, and inhibited (Sleuwaegen, 2018). A total of 415 participants read 1 of 6 randomly assigned vignettes about an individual and then completed the Attribution Questionnaire which encompasses 6 aspects of stigma. Male individuals (featured in a vignette) led to greater overall and 5 aspects of stigma than female individuals. Higher public stigma was also expressed towards individuals with the emotional subtype for overall and 4 aspects of stigma than the other subtypes. The aggression portrayed in the emotional subtype may be a particularly worthy area of investigation, given the potential for over-appraisal of threat to one's personal safety. The findings here suggest that accurate portrayals of BPD need to be infused in education or contact anti-stigma interventions.

Introduction

Esketamine has been approved in Australia and New Zealand as a third-line antidepressant treatment for treatment resistant depression. This study describes changes in quality of life, depressive symptoms and productivity in participants treated with esketamine in real-world settings.

Methods

Participants were recruited from an esketamine early access program and had not responded to two or more different antidepressants and not received neurostimulation for their current depressive episode. Participants received esketamine for 16 weeks or longer. Data collected included Assessment of Quality-of-Life scale (AQoL-8D), Hamilton Depression Rating Scale (HAM-D) and Work Productivity Activity Index (WPAI).

Results

Participants (n = 105) had a mean age of 38.7 years (standard deviation (SD) = 14.6) and were predominantly female (59.0%). The mean duration of major depressive disorder was 7.2 years (SD = 4.2) and almost half of participants had been treated with 3–5 prior therapies. After 16-weeks on esketamine, participants showed improvement of greater than 10% across all dimensions of AQoL-8D, HAM-D scores decreased 8.0 points, and activity impairment decreased 20.4% as measured by WPAI.

Limitations

This was a non-randomized and unblinded study and may have selection and reporting bias. The population was not necessarily representative of the broader Australian and New Zealand population. It is not possible to determine if the results will be sustained or changed if participants received treatment for longer.

Conclusions

Esketamine early access program participants, who were a real-world cohort with extensive prior treatment, showed clinically significant improvements in quality of life, depression severity and productivity after 16-weeks on treatment.

Psychological resilience refers to the capacity to adapt and recover from challenging situations, stress, or traumatic events. However, there is currently no universally accepted standard for assessing resilience in research, leading to heterogeneity in approaches and measures across different studies. Thus, the present study aimed to test the hypothesis that spectral analysis of the resting-state electroencephalograms (EEG) can be correlated to resilience scores, and ultimately used as the standard method of measuring psychological resilience of patients. We recorded the Perceived Stress Scale (PSS) and the Social Readjustment Rating Scale (SRRS) scores of 299 participants recruited at the Centre for Addiction and Mental Health. The PSS and SRRS scores were used to generate a regression model and residuals were utilized as a measure of resilience to stress. Resting-state EEG data were recorded from 55 healthy subjects extracted from the total sample, and the relative power spectrum of 8 EEG electrodes (F3, F4, C3, C4, P3, P4, O1, O2) for each frequency band (delta, theta, alpha, and beta) were calculated to compare with the resilience scores was tested using the Pearson coefficient. A significant positive correlation between PSS scores and SRRS scores was identified. The EEG power spectrum analysis did not yield any significant findings, except for a trend towards significance in the theta band at electrode P4 (p-value = 0.081). Therefore, the results provide a limited possibility of utilizing EEG to measure psychosocial resilience.