Asian journal of psychiatry最新文献

{"title":"Comparative diagnostic performance of artificial intelligence models in structural MRI for schizophrenia: A systematic review and meta-analysis","authors":"Martin Kotochinsky ,&nbsp;Pandora Eloa Oliveira Fonseca ,&nbsp;Veronica Ramirez Lopera ,&nbsp;Laura Mora ,&nbsp;Wellgner Fernandes Oliveira Amador ,&nbsp;Eduardo Cesar Teixeira Sirena ,&nbsp;Felipe Bandeira de Melo Guimarães ,&nbsp;Delfina Lahitou Herlyn ,&nbsp;Nima Norbu Sherpa ,&nbsp;Andrea Gonzalez Lezana ,&nbsp;Thales Pardini Fagundes","doi":"10.1016/j.ajp.2025.104759","DOIUrl":"10.1016/j.ajp.2025.104759","url":null,"abstract":"<div><h3>Introduction</h3><div>Timely diagnosis of schizophrenia is essential to ensure prompt treatment initiation and adherence. Structural magnetic resonance imaging (sMRI), when combined with artificial intelligence (AI), offers a promising avenue to enhance diagnostic accuracy. However, its performance and clinical use is a matter of debate.</div></div><div><h3>Methods</h3><div>PubMed, Embase, and Cochrane databases were searched for studies using AI models with sMRI to diagnose schizophrenia in adults. Eligible models encompass traditional machine learning methods and deep learning (DL) architectures, utilizing diverse neuroanatomical inputs, including gray matter (GM) features and whole-brain (WB) structural data. The outcomes of interest were diagnostic performance metrics as: sensitivity (SE), specificity (SP), area under the curve (AUC).</div></div><div><h3>Results</h3><div>A total of 16 studies were included, comprising 3601 participants. Overall pooled SE and SP were 0.76 (95 % CI: 0.71–0.80) and 0.78 (95 % CI: 0.73–0.82), respectively. When compared, DL models outperformed Support Vector Machine (SVM), achieving higher SP of 0.83 (95 % CI: 0.80–0.86) vs. 0.78 (95 % CI: 0.72–0.83), and AUC of 0.892 (95 % CI: 0.81–0.90) vs. 0.782 (95 % CI: 0.70–0.82). WB input models also outperformed GM performance, with SP of 0.86 (95 % CI: 0.78–0.92) vs. 0.80 (95 % CI: 0.73–0.85), and AUC of 0.89 (95 % CI: 0.70–0.93) vs. 0.816 (95 % CI: 0.71–0.84).</div></div><div><h3>Conclusion</h3><div>AI models using sMRI show promising but provisional diagnostic performance for schizophrenia. Across studies, DL architectures and WB inputs generally achieved higher specificity and AUC than SVM and GM features. Prospective, multi-site external validation cohorts are needed before routine clinical implementation.</div></div>","PeriodicalId":8543,"journal":{"name":"Asian journal of psychiatry","volume":"114 ","pages":"Article 104759"},"PeriodicalIF":4.5,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145464346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The stability paradox: Why high prediction accuracy does not guarantee reliable feature importance in psychiatric research","authors":"Yoshiyasu Takefuji","doi":"10.1016/j.ajp.2025.104762","DOIUrl":"10.1016/j.ajp.2025.104762","url":null,"abstract":"<div><div>This study examines the critical disconnect between prediction accuracy and feature importance reliability in machine learning applications for psychiatric research. Using a hikikomori dataset with 611 instances, we compared feature selection stability across supervised models (random forest, XGBoost, logistic regression), unsupervised methods (feature agglomeration, highly variable gene selection), and statistical approaches (Spearman correlation). Despite achieving highest classification accuracy (66.20 %), logistic regression exhibited significant instability in feature rankings when the top feature was removed. In contrast, unsupervised methods and statistical approaches demonstrated perfect stability in feature ranking orders. Our findings reveal that supervised models suffer from label-driven instability while unsupervised methods provide more consistent feature importance assessments, suggesting that psychiatric researchers should supplement high-accuracy supervised models with unsupervised approaches for reliable feature interpretation.</div></div>","PeriodicalId":8543,"journal":{"name":"Asian journal of psychiatry","volume":"114 ","pages":"Article 104762"},"PeriodicalIF":4.5,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145464343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing the Asia-Pacific perinatal mental health consensus in Japan: A task-shifting perinatal liaison model","authors":"Kyohei Otani,&nbsp;Nobuyasu Imbe,&nbsp;Ryota Shindo,&nbsp;Shogo Kurushima,&nbsp;Kyoko Yamada","doi":"10.1016/j.ajp.2025.104761","DOIUrl":"10.1016/j.ajp.2025.104761","url":null,"abstract":"","PeriodicalId":8543,"journal":{"name":"Asian journal of psychiatry","volume":"114 ","pages":"Article 104761"},"PeriodicalIF":4.5,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145464347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hair-pulling since toddlerhood: A rare case of very early-onset trichotillomania","authors":"Suresh Yuvasree,&nbsp;Kiruthika Asokan,&nbsp;Karthick Subramanian","doi":"10.1016/j.ajp.2025.104760","DOIUrl":"10.1016/j.ajp.2025.104760","url":null,"abstract":"","PeriodicalId":8543,"journal":{"name":"Asian journal of psychiatry","volume":"114 ","pages":"Article 104760"},"PeriodicalIF":4.5,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145450695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The adjunctive efficacy of repetitive transcranial magnetic stimulation with non-pharmacological interventions in cognitive disorders: A meta-analysis of randomized sham-controlled trials","authors":"Mengxia Yang ,&nbsp;Zhi Wang ,&nbsp;Qian Zhou ,&nbsp;Qianqian Zhang ,&nbsp;Yaqin Li ,&nbsp;Ziqi Wang","doi":"10.1016/j.ajp.2025.104758","DOIUrl":"10.1016/j.ajp.2025.104758","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;This meta-analysis aimed to systematically evaluate the specific, adjunctive efficacy of repetitive transcranial magnetic stimulation (rTMS) when combined with non-pharmacological interventions-namely, transcranial direct current stimulation (tDCS), Tai Chi, or cognitive training (CT)-in patients with Alzheimer's disease (AD) or mild cognitive impairment (MCI). The goal is to isolate the net therapeutic contribution of rTMS beyond the effects of the base interventions alone.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A comprehensive search of Chinese and English databases was conducted from their inception until April 26, 2025. Randomized controlled trials (RCTs) that compared \"a non-pharmacological intervention plus active rTMS\" versus \"the same non-pharmacological intervention plus sham rTMS\".This \"add-on\" study design was selected to precisely isolate the effect of rTMS. The risk of bias was assessed using the PEDro scale and Cochrane tools. Statistical analyses were performed using Review Manager 5.4 software.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;9 studies involving 391 participants were included. The pooled analysis revealed that the adjunctive use of rTMS was significantly superior to the sham control in improving global cognitive function at the immediate post-treatment assessment (SMD=0.38, 95 %CI[0.20,0.56], &lt;em&gt;P&lt;/em&gt; &lt; .001, n = 9). This benefit was consistent across the MMSE (SMD=0.38, n = 6), MoCA (SMD=0.37, n = 2), and ADAS-cog (SMD=0.39, n = 3) scores. Subgroup analysis suggested that the rTMS-tDCS combination might offer a short-term advantage in improving MMSE scores (MD=4.67, &lt;em&gt;P&lt;/em&gt; = .008). Furthermore, the adjunctive effect of rTMS was sustained, as particularly evidenced by the ADAS-cog at follow-up (SMD=0.74, &lt;em&gt;P&lt;/em&gt; = .02). The pooled analysis indicated that rTMS combined with non-pharmacological therapy demonstrated a short-term, sustained (4–8weeks) improvement in global cognitive function (SMD=0.34, 95 % CI[0.07, 0.60], &lt;em&gt;P&lt;/em&gt; = .01). Subgroup analysis revealed that this sustained benefit reached statistical significance on the ADAS-cog scale (SMD = 0.41, 95 %CI[0.01, 0.81], &lt;em&gt;P&lt;/em&gt; = .04) but showed a non-significant positive trend on the MMSE (SMD=0.26, 95 %CI[-0.19, 0.72], &lt;em&gt;P&lt;/em&gt; = .26). However, a key limitation was that most studies did not systematically report outcomes related to activities of daily living or behavioral function.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;The evidence indicates that rTMS as an adjunct to non-pharmacological interventions provides a significant specific effect on global cognitive function in patients with AD and MCI shortly after treatment, which may be sustained in the short-term. However, long-term follow-up data are extremely limited, and the effect on activities of daily living remains to be validated. The combination of rTMS and tDCS shows promise,but conclusions are constrained by the small number of studies,limited sample sizes,and het","PeriodicalId":8543,"journal":{"name":"Asian journal of psychiatry","volume":"114 ","pages":"Article 104758"},"PeriodicalIF":4.5,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145450734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal trajectories of neuropsychological functions of MCI subtypes in population-based cohort of older adults","authors":"Xianxian Long ,&nbsp;Zeyun Zhang ,&nbsp;Shuqin Wen ,&nbsp;Luhui Mo ,&nbsp;Jianlin Lin ,&nbsp;Mingming Xu ,&nbsp;for the Alzheimer’s Disease Neuroimaging Initiative (ADNI)","doi":"10.1016/j.ajp.2025.104757","DOIUrl":"10.1016/j.ajp.2025.104757","url":null,"abstract":"<div><h3>Objectives</h3><div>To identify different mild cognitive impairment (MCI) subtypes depending on overall cognitive function and daily function, and then describe the complex changes of neuropsychological functions in MCI subtypes over time.</div></div><div><h3>Methods</h3><div>815 MCI participants were recruited from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) at baseline. Data-driven MCI subtypes were obtained on the basis of group-based multi-trajectory modeling (GBMTM) to analyze longitudinal trajectory changes in overall cognitive function and daily function. Neuropsychological functions were characterized in terms of longitudinal trajectory changes by linear mixed models.</div></div><div><h3>Results</h3><div>This study included MCI subjects with an average age of 73.71 ± 6.85 years (range: 60–91 years), of whom 77.7 % were married. Three data-driven subtypes of MCI were obtained through the GBMTM modeling, defined as the “Rapid cognitive decline group” (RCD, 15.5 %), the “Slow cognitive decline group” (SCD, 34.4 %), and the “No cognitive decline group” (NCD, 50.1 %). The RCD individuals had the greatest mean age (75.22 years) at baseline, the most APOE ε4 carriage (66.4 %), the highest dementia conversion rates (89.6 %) and the shortest time to dementia progression (10.41 months). Importantly, the fastest changes in neuropsychological function trajectories were observed in the RCD subtype during the first 36 months, with attention declining the fastest, followed by visuospatial function, whereas the slowest changes were detected in the NCD subtype.</div></div><div><h3>Conclusion</h3><div>MCI subjects may produce finer-grained cognitive subtypes with unique longitudinal neuropsychological function declines. Identifying the above may improve prediction of clinical course, which has important implications for providing more accurate risk assessment for MCI individuals.</div></div>","PeriodicalId":8543,"journal":{"name":"Asian journal of psychiatry","volume":"114 ","pages":"Article 104757"},"PeriodicalIF":4.5,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145464344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The nature and correlates of childhood trauma in individuals at clinical-high risk (CHR) for psychosis: A cross-country study in Brazil, China and Turkey","authors":"Ana Caroline Lopes-Rocha ,&nbsp;Cailan Hou ,&nbsp;Feten Fekih-Romdhane ,&nbsp;Ezgi Ince Guliyev ,&nbsp;Alp Uçok ,&nbsp;Alexandre Andrade Loch","doi":"10.1016/j.ajp.2025.104747","DOIUrl":"10.1016/j.ajp.2025.104747","url":null,"abstract":"<div><h3>Background</h3><div>The clinical high-risk (CHR) state for psychosis has been extensively studied in psychiatry. However, there remain significant gaps in the literature concerning populations in low- and middle-income countries. This is especially relevant given the sociocultural factors that influence the development of psychosis, such as childhood trauma. The present study aims to explore sociodemographic characteristics and childhood trauma among CHR individuals from Brazil, China, and Turkey, as well as to examine differences between CHR individuals and healthy controls across these countries combined.</div></div><div><h3>Methods</h3><div>A cross-cultural sample of 253 CHR individuals and 281 healthy controls from Brazil, China, and Turkey was assessed using standardized interviews (SIPS or CAARMS) and the Childhood Trauma Questionnaire-Short Form (CTQ-SF). Sociodemographic data and CTQ scores were compared across CHR individuals from each country, and between the combined CHR group and healthy controls, to examine how childhood trauma and sociodemographic factors differ between groups.</div></div><div><h3>Results</h3><div>CHR individuals showed significantly higher levels of childhood trauma compared to controls across nearly all trauma types, except physical neglect. Cross-country comparisons revealed notable differences: Brazilian CHR subjects had higher levels of physical abuse, emotional abuse and neglect, while Chinese CHR individuals reported more emotional neglect and physical abuse.</div></div><div><h3>Conclusion</h3><div>Childhood trauma is highly prevalent among CHR individuals in LAMIC and varies significantly across countries, likely reflecting sociocultural differences. These findings emphasize the importance of considering cultural context in the assessment and intervention of early psychosis risk, particularly in underrepresented regions.</div></div>","PeriodicalId":8543,"journal":{"name":"Asian journal of psychiatry","volume":"114 ","pages":"Article 104747"},"PeriodicalIF":4.5,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145450713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic signatures predict social-cognitive trajectories in ultra-high-risk psychosis: A 24-month longitudinal study","authors":"Zohreh Doborjeh ,&nbsp;Alexander Sumich ,&nbsp;Oleg N. Medvedev ,&nbsp;Khan Buchwald ,&nbsp;Maryam Doborjeh ,&nbsp;Balkaran Singh ,&nbsp;Sugam Budhraja ,&nbsp;Alexander Merkin ,&nbsp;Max Lam ,&nbsp;Jie Yin Yee ,&nbsp;Tih-Shih Lee ,&nbsp;Wilson Goh ,&nbsp;Jimmy Lee ,&nbsp;Margaret Williams ,&nbsp;Edmund M.-K. Lai ,&nbsp;Nikola K. Kasabov","doi":"10.1016/j.ajp.2025.104749","DOIUrl":"10.1016/j.ajp.2025.104749","url":null,"abstract":"<div><h3>Background</h3><div>Identifying biomarkers that predict social and cognitive outcomes in individuals at ultra-high risk (UHR) for psychosis remains a key challenge in preventive psychiatry. While genetic factors contribute to psychosis vulnerability, specific markers that predict individual trajectories of functional decline or resilience are still unclear.</div></div><div><h3>Methods</h3><div>In a 24-month longitudinal study involving UHR (n = 45) and healthy control participants (n = 54), we investigated for the first time the predictive causal relationship between key immunological genes (FABP5 family and immunoglobulins) and social-cognitive outcomes. Participants completed comprehensive assessments at baseline and four 6-month intervals. We used regression modelling and dynamic Bayesian network analysis to identify predictive relationships between gene expression and behavioral outcomes over time.</div></div><div><h3>Results</h3><div>FABP5 family genes (FABP5P1, FABP5P11, FABP5P9) significantly predicted verbal memory (β = 0.233, p = 0.002); working memory (β = 0.225, p = 0.004), and social skills (β =-0·190, p &lt; 0.029), respectively, at 24 months in the UHR group. Immunoglobulin-related genes showed distinct effects: FCGR2B predicted object recognition ability (β = 0.233, p = 0.014), while GOT2 inversely predicted planning ability (β = -0.147, p = 0.067). Network analysis revealed UHR-specific temporal dependencies absent in controls, with FCGRT emerging as a central node linking genetic markers to changes in processing speed and perceptual closure.</div></div><div><h3>Conclusions</h3><div>This study provides the first evidence that FABP5 and immunoglobulin-related genetic markers can predict social-cognitive trajectories in individuals at risk for psychosis. These findings support the use of genetic profiling for early identification and highlight new opportunities for personalized preventive strategies in psychiatry.</div></div>","PeriodicalId":8543,"journal":{"name":"Asian journal of psychiatry","volume":"114 ","pages":"Article 104749"},"PeriodicalIF":4.5,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145464345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electroconvulsive therapy improves functional connectivity of the frontoparietal network and language network in patients with treatment-resistant depression","authors":"Leyi Zhang ,&nbsp;Yiding Han ,&nbsp;Dongsheng Lv ,&nbsp;Ping Yao ,&nbsp;Lixia Chen ,&nbsp;Yonggui Yuan ,&nbsp;Jingping Zhao ,&nbsp;Wenbin Guo ,&nbsp;Zhiguo Guo ,&nbsp;Yangpan Ou","doi":"10.1016/j.ajp.2025.104756","DOIUrl":"10.1016/j.ajp.2025.104756","url":null,"abstract":"<div><div>Previous studies have reported abnormal functional connectivity (FC) in patients with treatment-resistant depression (TRD); however, the FC patterns of the frontoparietal network (FPN) and language network (LN) remained unclear. Electroconvulsive therapy (ECT) is regarded as a one of the most effective treatments for patients with TRD. Despite its high efficacy, the underlying mechanisms of ECT remain largely unknown. Seed-based FC analysis was performed using imaging data from 72 patients with TRD (with 52 finishing the follow-up) and 63 healthy controls (HCs) to detect FC patterns of the FPN and LN before and after ECT. Neuroimaging–transcription association analyses were also performed. At baseline, patients with TRD presented decreased FCs within the FPN (inferior frontal gyrus, middle frontal gyrus, and superior frontal gyrus) as well as between the FPN/LN and the somatomotor network (SMN, precentral gyrus, postcentral gyrus, and supplementary motor area) and the default mode network (DMN, supramarginal gyrus and hippocampus). Following ECT, the clinical symptoms of patients showed a significant reduction. There were increased FCs within the FPN (inferior frontal gyrus and superior frontal gyrus), as well as between the FPN/LN and DMN (anterior cingulate cortex, precuneus, and angular gyrus). Genes associated with baseline case–control FC alterations were primarily enriched in ion channel activity and synaptic function. TRD might involve reduced functional integration between higher-order cognitive, sensory, and self-referential systems. The antidepressant effects of ECT may involve modulating FCs within the higher-order cognitive regions and between cognitive and self-referential systems to support emotion and cognitive regulation.</div></div>","PeriodicalId":8543,"journal":{"name":"Asian journal of psychiatry","volume":"114 ","pages":"Article 104756"},"PeriodicalIF":4.5,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145399356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pooled frequency meta-analysis of family-accommodation (FA) in obsessive-compulsive disorder (OCD): A pervasive phenomenon","authors":"Luca Pellegrini ,&nbsp;Giovanni Tardivo ,&nbsp;Riccardo Zandonella Callegher ,&nbsp;Federico Strani ,&nbsp;Naomi A. Fineberg ,&nbsp;Umberto Albert","doi":"10.1016/j.ajp.2025.104744","DOIUrl":"10.1016/j.ajp.2025.104744","url":null,"abstract":"<div><h3>Introduction</h3><div>Family accommodation (FA) in obsessive-compulsive disorder (OCD) refers to caregivers’ involvement in the OCD symptomatology affecting a relative or a loved one. FA has a detrimental impact on caregivers' quality of life. This meta-analysis, for the first time, aims to define pooled estimates of how frequent FA and specific accommodating behaviors are in OCD.</div></div><div><h3>Materials and methods</h3><div>Our protocol was pre-registered with PROSPERO (CRD42024566821) and we followed PRISMA-guidelines. To be eligible, studies were required to include patients diagnosed with OCD and at least one caregiver, and to include data describing the presence or absence of FA. Meta-analysis of proportions based on random-effects (Der-Simonian-and-Laird-method) was used to derive the pooled estimates.</div></div><div><h3>Results</h3><div>A total of 39 studies were included in the meta-analysis. FA was found to occur on a monthly and weekly basis in over 90 % of OCD cases, and in nearly 50 % of cases on a daily basis. The most frequent FA behaviors involved providing reassurance and waiting for compulsions completion. No significant associations were found between FA frequency and OCD severity or treatment outcome. Meta-regression analyses showed a positive association between male gender in caregivers and the pooled-rate frequencies of several accommodating behaviors.</div></div><div><h3>Conclusions</h3><div>Family accommodation is a pervasive and intrinsic feature of OCD, though its presence may not be linked to symptom severity or treatment response. Male figures may be more frequently involved in FA behaviors compared to females. FA could be considered an epiphenomenon and a marker of OCD, and part of its diagnostic framework.</div></div>","PeriodicalId":8543,"journal":{"name":"Asian journal of psychiatry","volume":"114 ","pages":"Article 104744"},"PeriodicalIF":4.5,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145430239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}