Annals of General Psychiatry最新文献

Background: The study's objective was to (1) assess the prevalence among women and associated factors of major depressive disorder (MDD) and generalized anxiety disorder (GAD); (2) identify associated factors and regional variations in the relationship between GAD-7 and PHQ-9 scores; and (3) yield insights to support and strengthen mental health policy and service delivery in Bangladesh.

Methods: Data from 19,987 women (aged 15-49 years) who participated in the 2022 Bangladesh Demographic and Health Survey and completed the mental health module were analyzed. Descriptive statistics assessed MDD/GAD prevalence. SEM analyzed factors associated with psychological distress, and regional variations were examined via linear regression.

Results: Among 2388 Bangladeshi women aged 15-49 who had MDD and/or GAD, who provided complete responses for all related variables, sociodemographic factors, resource-related determinants, and negative life events were significantly associated with higher levels of depression and anxiety. The path analysis model indicated that sociodemographic factors (β = 0.69), resource-related factors (β = 0.19), and negative life events (β = 0.05) contributed to depression (PHQ score: β = 0.81, p < 0.001) and anxiety (GAD score: β = 0.84, p < 0.001). Age (β = 0.21, p < 0.001) and marital status (β = 0.20, p < 0.001) were the strongest sociodemographic factors associated with psychological distress, while education (β = 0.41, p < 0.001) and wealth status (β = 0.41, p < 0.001) were the most important resource-related factors. The model demonstrated an acceptable to good fit (Chi-square = 240.67, df = 63, RMSEA = 0.050, GFI = 0.967, AGFI = 0.952, and CFI = 0.826). Regionally, Sylhet City indicated the strongest relationship between GAD and MDD (R² = 0.567), followed by Khulna (R² = 0.543) and Rajshahi (R² = 0.508). An R² Value of 0.567 indicated that approximately 57% of the variability in MDD score in Sylhet can be explained by GAD score.

Conclusion: Path analysis highlighted a multidimensional approach to understanding psychological distress. Sociodemographic, resource factors, and negative life events as determinants collectively serve as associated factors of psychological distress among Bangladeshi females, highlighting the need for culturally tailored interventions with early anxiety screening and coping skills training to improve mental health outcomes.

Purpose: Transcranial direct current stimulation (tDCS) is a novel non-invasive brain stimulation therapy that is a potential treatment for major depressive disorder (MDD). Acceptability impacts patient preference, treatment adherence and outcomes, however, it has typically been assessed through measures of attrition, self-reported satisfaction levels, or adverse events. We sought to explore participant acceptability using structured questionnaires and individual interviews.

Methods: Acceptability was assessed in a fully remote, multisite, double-blind, placebo-controlled, randomized superiority trial of a 10-week course of home-based tDCS for MDD. Questionnaires were conducted at baseline and at the 10-week end of treatment. Participants were 174 adults (120 women) with MDD in a current depressive episode of at least moderate severity. Active or sham tDCS was self-administered over 10 weeks with remote supervision at regular intervals. A thematic analysis was conducted.

Results: Four themes were revealed: acceptability, ease of use, side effects, and trial participation. The themes indicated generally high acceptability of tDCS as a treatment of MDD in both the active and sham treatment groups. Some participants noted concerns about the technical functionality of the device and the impact of side effects.

Conclusions: The first three themes are central to understanding participant perspectives of tDCS and its feasibility as a treatment option. In addition, the theme of trial participation highlights the value of participant support when introducing a new treatment, which may underscore treatment options in general. Furthermore, acceptability is a dynamic concept as participant views changed during treatment.

Trial registration: NCT05202119, registered on 9th January 2022.

Background: Children's mental health in high-altitude areas is influenced by various environmental, socioeconomic, and biological factors. This study aims to explore the knowledge framework and key research areas in this domain, using bibliometric methods to analyze trends, collaboration patterns, and essential themes related to children's mental health at high altitudes.

Methods: A bibliometric analysis was conducted on publications from 1979 to 2024 retrieved from the Web of Science Core Collection database. The R package "Bibliometrix," VOSviewer, and CiteSpace were used to analyze publication trends, collaboration patterns, and research themes.

Results: A total of 520 English-language articles were included. The United States was the most prolific country (226 articles), and Duke University was the leading institution (66 articles). The Journal of the American Academy of Child and Adolescent Psychiatry was the most influential journal. E. Jane Costello was the most prolific author (50 publications). Co-occurrence network analysis identified four major clusters: possible mechanisms, outcomes, psychopathology, and management of mental health issues. Academic research in very high HDI countries focuses more on quality-of-life and mental health issues, whereas low and medium HDI countries prioritize fundamental public health and common disease prevention.

Conclusions: This study provides a bibliometric foundation for quantitatively assessing research trends on mental health among children in high-altitude regions. Current research primarily focuses on underlying mechanisms, outcomes, mental health conditions, and management strategies. For countries at different development levels, research should be tailored to their specific social development stages and health challenges.

Background: This systematic review aimed to assess the efficacy and safety of acupuncture for generalized anxiety disorder (GAD), with a particular focus on acupuncture alone and acupuncture combined with medication, compared with medication or sham acupuncture.

Methods: We searched MEDLINE/PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Database for Chinese Technical Periodicals, Chinese Biomedical Literature Database (CBM), and ClinicalTrials.gov up to August 31, 2025. Randomized controlled trials (RCTs) of acupuncture for GAD were independently screened and extracted by two reviewers following strict quality assessment. Risk of bias was evaluated using the RoB 2.0 tool, evidence certainty was assessed with the GRADE approach, and meta-analyses were conducted with RevMan 5.3. Subgroup analyses were performed according to comparator type and acupuncture parameters (treatment modality, duration, frequency, and sessions).

Results: A total of 41 RCTs involving 3,209 participants were included. Meta-analysis showed that acupuncture alone (MD -1.79, 95% CI -2.69 to -0.88; 19 studies) and acupuncture combined with medication (MD -2.26, 95% CI -3.05 to -1.48; 20 studies) were superior to medication alone in reducing Hamilton Anxiety Rating Scale (HAMA) scores. Acupuncture also outperformed sham acupuncture (MD -3.46, 95% CI -4.76 to -2.16; 3 studies). Significant improvements were also observed in total effective rate, Self-Rating Anxiety Scale (SAS) scores, and Clinical Global Impression-Efficacy Index (CGI-EI), with lower rates of adverse events in the acupuncture groups. Subgroup analyses suggested that a treatment duration of 4-6 weeks was associated with better outcomes; for stand-alone acupuncture, a frequency of seven sessions per week was more effective than medication, while for combined therapy, a frequency of 2-4 sessions per week was more effective than medication.

Discussions: This meta-analysis indicates that acupuncture, either as a monotherapy or in combination with medication, may provide superior efficacy to medication and sham acupuncture, with fewer adverse events. However, most included studies were rated as having "some concerns" in risk of bias by RoB 2.0, and GRADE assessment suggested low or very low certainty of evidence for the primary outcome (HAMA). Egger's test indicated no significant publication bias in HAMA. Further high-quality, large-scale RCTs are required to confirm these findings.

Registration: The protocol of the review was registered in PROSPERO (CRD42015016033).

Background: Disturbances of the minimal self, or anomalous self-experiences (ASEs), are increasingly regarded as a core feature of primary psychotic disorders (PPDs). However, it remains unclear whether similar self-disorders are present in substance-induced psychosis (SIP), a condition that often mimics PPDs in its early stages.

Objective: The study aims to compare ASEs between PPD and SIP using the EASE interview, to evaluate the diagnostic specificity of ASEs and determine whether these disturbances are exclusive to primary psychoses or also present in SIP.

Methods: A total of 54 clinically stable patients were recruited from psychiatric centers in Italy (27 with schizophrenia spectrum disorders (SSD), mean age ≈ 27 years; 27 with substance-induced psychosis, mean age ≈ 28 years).. Diagnoses were established according to DSM-5 criteria. ASEs were assessed using the Examination of Anomalous Self-Experience (EASE) interview, and scores were compared across five experiential domains. Non-parametric statistics and logistic regression were employed to identify domain-specific differences and their diagnostic utility.

Results: While total EASE scores did not differ significantly between groups, Domain 4 (Demarcation/Transitivism) was significantly higher in the SIP group (p < .0001, r = .72), contrary to classical phenomenological models that typically associate self-world boundary disturbances with schizophrenia spectrum disorders. In contrast, Domain 2 (Self-awareness and Presence) trended higher in the PPD group (p = .049, r = .27) and Domain 5 (Existential Reorientation) showed a similar trend (p = .098, r = .22)., aligning with classical phenomenological models of schizophrenia. Logistic regression confirmed the predictive value of these domains for group classification.

Conclusion: ASEs are not exclusive to PPDs and may also manifest in SIP, particularly in the domain of "self-world boundary" disturbances. These findings challenge the assumption that self-disorders are unique to endogenous psychosis and highlight the need for refined phenomenological assessment in early diagnostic work. Longitudinal studies are needed to clarify whether ASEs in SIP represent transient phenomena or prodromal markers of schizophrenia.

Introduction: The study assesses proinflammatory factors in major depressive disorder (MDD) patients with and without suicidal behaviors, and healthy controls, to identify potential biomarkers for suicidal behaviors and prevention strategies.

Methods: We conducted a systematic review, which we have registered in Prospero (#CRD42024547764), and searched through five databases until March 2024. We included observational studies in English that reported on depressed patients with and without suicidal behaviors, as well as healthy controls, and measured the levels of pro-inflammatory cytokines. The Newcastle- Ottawa Scale was used for quality evaluation of the studies and the main analysis was performed using Stata 17.

Results: One systematic review resulted in 4,369 articles but only 24 were selected for the review. The meta-analysis showed depressed patients with suicidal behaviors had significantly higher interleukin (IL)-6 levels compared to the control group with a standardized mean difference (SMD) of 1.26 [0.07, 2.45]; I² = 98.81%. There was no significant difference noted between the depressed patients suffering from suicidal behaviors and those not suffering (SMD 0.42 [-0.58, 1.42]; I² = 98.50%). There is no significant difference between the groups in the levels of tumor necrosis factor-alpha (TNF-α) and IL-10. Further analysis of IL-4, IL-2, IL-1β, IF-γ, and TGF-β1 also indicated no significant group differences.

Conclusion: The review found no significant cytokine differences (including IFN-γ, IL-1β, IL-2, IL-4, IL-8, IL-10, TGF-β1, TNF-α) between depressed individuals with or without suicidal ideation and controls. Variations likely reflect methodological differences, highlighting the need for standardized, longitudinal research.

Purpose: As previous research has linked smoking to suicidal behavior, it is possible that smoking may have played a role in suicidality during the COVID-19 pandemic. However, relatively little research has examined this association. To address this gap, the present study examined the relationship between smoking status and the onset of suicidal ideation in Japan during the pandemic.

Methods: Data were analyzed from 3,164 adults from the Japanese general population who participated in an online survey in early 2023. Information was collected on smoking status and incident suicidal ideation during the COVID-19 pandemic. Logistic regression was conducted to examine associations.

Results: In a fully adjusted analysis, current smoking was associated with significantly higher odds of the onset of suicidal ideation in the total sample (OR: 2.31, 95%CI: 1.37, 3.90). In a sex-stratified analysis, both former (OR: 4.49, 95%CI: 1.75, 11.50) and current smoking (OR: 6.12, 95%CI: 2.67, 14.01) were associated with the onset of suicidal ideation in men, whereas no such association was observed in women.

Conclusion: Smoking was associated with the onset of suicidal ideation among adults in Japan during the COVID-19 pandemic, with the association observed in men but not women.

Background: Major Depressive Disorder (MDD) is a prevalent mental health condition characterized by persistent feelings of sadness, loss of interest or pleasure, and a range of physical and cognitive symptoms. Despite the availability of various treatment options, many MDD patients continue to experience significant impairment in their daily lives.

Purpose: This multicenter study aimed to evaluate the therapeutic benefits of vortioxetine in routine clinical practice for patients with MDD in Saudi Arabia.

Methods: A total of 499 eligible patients participated in the study. This is a Phase IV study that included 30 psychiatric sites across Saudi Arabia. Data collection occurred at baseline and routine visits. Patients treated with vortioxetine experienced a significant reduction in depressive symptom severity, as indicated by the PHQ-9 total score, throughout the study period (p < 0.001).

Results: Significant improvements were also observed in various areas of functioning and cognitive depression symptoms, and safety. Results demonstrated a significant reduction in depressive symptoms, and sexual well-being, indicating vortioxetine as an effective treatment option for MDD in the Middle East and Africa (MEA) region.

Conclusions: These findings support the real-world effectiveness of vortioxetine as a promising treatment option for MDD patients in the MEA region, highlighting its potential to reduce depressive symptoms.

Background: The link between sleep onset time and depression is not well understood. We aimed to investigate the association of sleep onset time with depression.

Methods: Data from the 2015 to March 2020 National Health and Nutrition Examination Survey were analyzed. Sleep onset time was categorized into five intervals: [22:00-23:00), [23:00-00:00), [00:00-01:00), [01:00-20:00), and [20:00-22:00). Depression was assessed using the Patient Health Questionnaire. Multivariate logistic regression and generalized linear regression analyses were conducted to evaluate the association of sleep onset time with depression.

Results: The study sample consisted of 6991 adults (weighted mean age 45.6 years [SE, 0.5]; 49.5% female). Depression prevalence varied by sleep onset time intervals: 4.12% for [00:00-01:00), 5.94% for [01:00-20:00), 3.89% for [20:00-22:00), 1.98% for [22:00-23:00), and 3.26% for [23:00-00:00). After adjusting for sleep duration and other covariates, the odds ratios (ORs) for depressive symptoms were significantly greater at sleep onset time during [01:00-20:00) (OR, 2.39; 95% CI 1.20-4.74) and marginally higher at [20:00-22:00) (OR, 1.78; 95% CI 0.99-3.20) compared to the sleep onset time during [22:00-23:00). Higher PHQ-9 scores were associated with sleep onset time outside [22:00-23:00).

Conclusion: Sleep onset time between [22:00-23:00) was associated with the lowest odds of depression. This suggests new directions for depression research and interventions, emphasizing the importance of considering sleep onset time in mental health strategies.

Background: Childhood maltreatment is a major risk factor for mental and substance use disorders particularly among adolescents however, there's no comprehensive report of its attributable burden on anxiety, depression, and substance use disorder in Africa. This research sort to delineate the Disability-adjusted life years (DALYs) trend and age-period-cohort effects on these disorders attributable to childhood maltreatment among 10-24-year-olds in Africa.

Methods: DALY estimates and 95% uncertainty intervals for anxiety, depression, and substance use disorder attributable to childhood maltreatment among adolescents in Africa were extracted from the Global Burden of Disease Study (GBD) 2021. Trends between 1990 and 2021 were analyzed using Joinpoint regression analysis. The Age-Period-Cohort model was used to determine the effect of age, period, and cohort on these disorders.

Results: In 2021, the DALY rate for anxiety was 95.41 (37.32-185.13), 117.57 (54.31-209.16) for depression, and 3.82 (0.63-10.38) for substance use disorder per 100,000 population among adolescents in Africa. Trend analysis showed an increase in anxiety [AAPC: 0.88 (0.84-0.91)] and depressive disorders [AAPC: 0.71(0.68-0.74)]. Niger recorded the highest growth in average annual percentage change (AAPC): 3.17 [95% CI 3.08-3.27] for anxiety, Burkina Faso recorded the highest rise in AAPC: 1.96 [95% CI 1.85-2.08] for depression, and Uganda recorded the highest incline in AAPC: 0.65 [95% CI 0.59-0.72] for substance use disorder. Higher age effects were noted in all disorders, particularly in the 15-19-year group. Period effects were higher for anxiety and depressive disorders and lower for substance use disorders. A higher cohort effect was observed in all disorders during the study period.

Conclusions: Anxiety and depressive disorders due to childhood maltreatment have been on the rise for 3 decades in Africa. Given the implications of the early onset and lifetime burden of mental and substance use disorders, a comprehensive policy framework that facilitates increased access to specialists in childhood maltreatment-related mental disorder services is essential.