BMC Psychiatry最新文献

Background: Decreased physical activity and overnutrition among adolescents have become important public health problems shared by countries around the world. In addition, the prevalence of psychological symptoms among adolescents continues to increase, which negatively affects schooling and future quality of life. However, no studies have been found in the past on the association of moderate-to-vigorous physical activity(MVPA) and body roundness index(BRI) with psychological symptoms in Chinese adolescents. This study may provide theoretical support for the prevention and intervention of psychological symptoms among adolescents in mainland China.

Methods: From September to November 2023, MVPA, BRI, and psychological symptoms were assessed in 43,031 adolescents aged 12-17 years from different regions of mainland China. The chi-square test, t-test, logistic regression analysis, and ordered logistic regression were used to analyze the associations that existed between MVPA and BRI with psychological symptoms.

Results: The prevalence of psychological symptoms among adolescents in mainland China was 20.3%. The proportions of adolescents with MVPA of < 30 min/day, 30-60 min/day, and > 60 min/day were 46.0%, 40.0%, and 14.0%, respectively. The adolescent BRI value was (2.02 ± 0.95); boys (2.12 ± 1.03) had a higher BRI value than girls (1.92 ± 0.86), and the difference was statistically significant (t = 22.111, P < 0.001). After adjusting for relevant covariates, ordered logistic regression analysis showed that, overall, adolescents in the group with MVPA > 60 min/day and BRI quartiles Q1 as the reference group, adolescents in the group with MVPA of 30-60 min/day and BRI quartiles Q2 (OR = 0.65, 95% CI:0.51 ∼ 0.82) had a lower risk of developing psychological symptoms (P < 0.001); adolescents in the MVPA < 30 min/day group and BRI quartiles Q4 group (OR = 1.62, 95% CI: 1.30-2.02) had a higher risk of psychological symptoms (P < 0.001).

Conclusions: There is an association between MVPA and BRI and psychological symptoms among adolescents in mainland China. A decrease in MVPA and an increase in BRI were associated with an increase in the prevalence of psychological symptoms. In the future, we should effectively improve the MVPA level and maintain a reasonable BRI value in adolescents in mainland China to better promote adolescents' mental health development.

Clinical trial number: Not applicable.

Background: Mental health conditions represent a significant global public health issue, affecting millions of people worldwide. To meet the increasing demands on mental health services in Switzerland, the development of a competence centre for mental health can provide the necessary structures and resources for a comprehensive and innovative approach to mental health care. This paper outlines the participatory process used in the development and implementation of a competence centre for mental health in Eastern Switzerland for the promotion of positive mental health.

Methods: The process was conducted using a participatory design and a co-creation approach. This involved the collaborative engagement of all relevant mental health stakeholders, working together as equals throughout all stages of the process. A key stakeholder group was established with N = 10 individuals, including persons with lived experience, (mental) health care professionals, researchers, educators, and decision-makers at institutional and regional levels. Between March 2020 and June 2021, four conceptualisation meetings were conducted using participatory methods and tools to facilitate collaborative, reflexive, and innovative engagement.

Results: The participatory process resulted in a framework for a competence centre for mental health, informed by the needs and experiences of key mental health stakeholders. Three main areas were identified in which the competence centre could effect change for the promotion of positive mental health and the improvement of mental health services in Eastern Switzerland: (1) Academic teaching of future health professionals; (2) further education for current health professionals; and (3) a research agenda that provides a scientific contribution to the improved mental health care of the population.

Conclusions: The co-creation process resulted in an inclusive, practice-oriented framework for a competence centre for mental health at the intersection of research, education, and practice. By continuing to adopt a participatory approach, the competence centre can provide evidence-based training for health professionals, foster innovative and needs-based models of care, advocate for policy change, and promote best practices for the promotion and recovery of mental health. The successful development and implementation of the competence centre using a co-creation process provides encouraging support for the use of participatory approaches in the field of mental health.

Purpose: Substance use and traumatic events are prevalent in Afghanistan, but their relationship is under-investigated.

Methods: A nationally-representative, cross-sectional survey was conducted in 8 regions of Afghanistan in 2017 (N = 4474). First, we examined the burden of substance use, and demographic correlates (e.g., gender, age) in the Afghan general population; second, we examined the association between traumatic and stressful experiences, including PTSD, and any substance use, tobacco use and sedative use.

Results: Substance use disorder is prevalent in Afghanistan, with prevalence of any substance use at 5.03%, tobacco use at 21.82%, and sedative use prevalence at 6.71%. Women and people with middle and high economic status were less likely to use any substance and tobacco, however, women were more likely use sedative compared to men. People who had collective violence and experienced any traumatic event more likely to use any substances, tobacco and sedative compared to their counterparts. Finally, individuals with PTSD, depression and generalized anxiety were more likely to use any substances, tobacco and sedative compared to individuals without these psychiatric disorders.

Conclusion: Substance use and dependence are prevalent in Afghanistan, an area with exposure to conflict and trauma for a majority of the population, underscoring the pervasive impact of trauma exposure on population health in this area. As resources are deployed to assist the Afghan population through conflict, attention to substance use and psychiatric disorders is needed to fully address population health.

Background: Accurately diagnosing Anxiety-Depression Comorbidity Syndrome in Gastroenterology Inpatients (ADCS-GI) shows significant challenges as traditional diagnostic methods fail to meet expectations due to patient hesitance and non-psychiatric healthcare professionals' limitations. Therefore, the need for objective diagnostics highlights the potential of machine learning in identifying and treating ADCS-GI.

Methods: A total of 1186 ADCS patients were recruited for this study. We conducted extensive studies for the dataset, including data quantification, equilibrium, and correlation analysis. Eight machine learning models, including Gaussian Naive Bayes (NB), Support Vector Classifier (SVC), K-Neighbors Classifier, RandomForest, XGB, CatBoost, Cascade Forest, and Decision Tree, were utilized to compare prediction efficacy, with an effort to minimize the dependency on subjective questionnaires.

Results: Among eight machine learning algorithms, the Decision Tree and K-nearest neighbors models demonstrated an accuracy exceeding 81% and a sensitivity in the same range for detecting ADCS in patients. Notably, when identifying moderate and severe cases, the models achieved an accuracy above 88% and a sensitivity of 90%. Furthermore, the models trained without reliance on subjective questionnaires showed promising performance, indicating the feasibility of developing questionnaire-free early detection applications.

Conclusion: Machine learning algorithms can be used to identify ADCS among gastroenterology patients. This can help facilitate the early detection and intervention of psychological disorders in gastroenterology patients' care.

Background: Understanding factors influencing the use of coercive practices in clinical psychiatry is necessary to develop strategies to reduce their use. However, there is little evidence regarding staff perceptions of such factors, particularly in inpatient child and adolescent psychiatry (CAP).

Methods: We conducted semi-structured interviews with nurses, senior consultants and heads of units in inpatient CAP in Sweden 2021 (N = 9). The interviews were transcribed verbatim and analysed using reflexive thematic analysis. Data on informal coercion were analysed separately using a deductive approach based on previously proposed hierarchies for informal coercion.

Results: We identified one overarching theme of factors reported to influence the use of coercive practices: "Trust and distrust in coercive and non-coercive approaches", in turn encompassing the two subthemes "Ward culture" and "Available resources and strain". Our findings suggest a risk of a negative spiral of coercion emerging when there is low professional trust in non-coercive approaches and high trust in coercive methods. Informal coercion was used frequently and observed to occur in two distinct processes: one concerning continuous coercive escalation, and the other involving sustained efforts at the same coercion level.

Conclusions: Trusting the efficacy of non-coercive approaches in inpatient CAP care appears critical for their success; a finding that may inform strategies to reduce coercion and address frequent use with individual patients.

Background: Depression in late-life is linked to an increased risk of Alzheimer's dementia (AD), with the risk potentially varying according to the age at onset of depression. Previous studies have typically dichotomized depression onset ages between 55 and 65 years; however, the specific age at which depression onset increases AD risk in older adults remains unclear. In this study, we aimed to investigate the relationship between the age at onset of depression and AD risk, and compare the characteristics between different age groups.

Methods: A longitudinal cohort of 251 older patients diagnosed with major depressive disorder was followed for up to 22 years. Participants were categorized into four groups based on depression onset age: ≤ 54 years, 55-64, 65-74, and ≥ 75 years. Annual cognitive assessments were conducted using the Korean Mini-Mental State Examination, with further neuropsychological testing when cognitive decline was suspected. Cox proportional hazards models were used to assess AD conversion risk across groups, adjusting for covariates.

Results: During follow-up ranging from 1.0 to 22.9 years, 75 patients (29.88%) converted to AD. Depression onset after age 75 years was significantly associated with a higher risk of AD conversion (hazard ratio [HR], 8.95; 95% confidence interval [CI], 3.41-23.48; p < 0.0001) and a shorter time to conversion compared to onset before age 55 (40.93 vs. 83.40 months). After adjusting for covariates, depression onset after age 75 remained significantly associated with AD conversion (adjusted HR, 5.20; 95% CI, 1.04-25.93; p = 0.0431). This group also had milder depressive symptoms and a higher prevalence of hypertension and cerebrovascular disease than those with depression onset before 55 years of age.

Conclusions: The onset of depression after the age of 75 years was strongly associated with an increased risk of AD and a shorter time to dementia onset. Individuals with depression onset after age 75 appear more closely linked to vascular comorbidities, while those with depression onset before age 55 are characterized by severe and recurrent depressive episodes. The mechanisms underlying AD in individuals with depression may differ from those in individuals without prior depression.

Background: This feasibility study evaluated adherence and effectiveness to a digital multimodal intervention (cognitive and physical training) for cancer-related cognitive impairment (CRCI) in patients with breast cancer.

Methods: Breast cancer patients undergoing radiotherapy and with significant cognitive complaints impacting quality of life participated in a 12-week intervention, combining non-simultaneous 20-min cognitive and 30-min physical sessions, twice weekly. Assessments included perceived cognitive impairment (PCI), objective cognition, fatigue, anxiety/depression, sleep and satisfaction. High level of adherence was defined as completing 9/12 weeks of the program. A week was complete when at least 70% of each of the planned sessions was completed. Physical activity intensity was defined by max age-related heart rate.

Results: Among 419 radiotherapy-treated patients with breast cancer, 170 had cognitive complaints (41%), 83 were eligible (49%), 29 were not included (35%) due to organizational issue and 20 among eligible contacted patients agreed to participate (37%). The majority of participants (48.3 ± 8 years of age) received chemotherapy (18/20) and 17 had I-II cancer stage. Eleven of twenty participants were highly adherent (higher adherence in physical (95%) than cognitive training (55%)). All expressed satisfaction. Post-intervention, overall objective cognition (p = 0.016), PCI (p = 0.004), fatigue (p = 0.011), and depression (p = 0.049) significantly improved. Post-intervention, high adherence was associated with significant improvements in PCI (p = 0.01) and fatigue (p = 0.03). High-intensity physical training was associated with significant improvements in PCI (p < 0.05), fatigue (p = 0.011) and depression (p = 0.037).

Conclusions: This intervention showed to be feasible and potentially efficient for the management of CRCI in patients with breast cancer.

Trial registration: NCT04213365, 27/12/2019.

Background: Patients experiencing a mental health crisis often present to the emergency department and are admitted to an inpatient facility for treatment. This can cause incontinuity in care, increased costs, and may worsen clinical outcomes compared to treatment in the outpatient setting. An innovative behavioral health clinic (BHC) was established to provide a number of critical mental health services such as individual therapy, crisis stabilization, partial hospitalization, substance abuse intensive outpatient services, specialized intensive adult group therapy, medication management (including long-acting injectable antipsychotic administration), and a peer living room. The primary outcome of this study was to assess the impact of the BHC on length of stay (LOS), psychiatric rehospitalization rate, and all-cause emergency department (ED) visits. The secondary outcome was to analyze the interaction of various patient characteristics with the primary outcome.

Methods: The study site was a community-based health system in the southeastern United States. A retrospective review of medical records was performed for adult patients with a psychiatric hospitalization in 2019 (pre-BHC) and 2022 (post-BHC). Primary outcomes were analyzed using Chi-Square testing and Mann-Whitney U testing. Secondary outcomes were analyzed using Poisson and logistic regression modeling. This study was deemed exempt from review by the health system and university institutional review boards.

Results: Following the establishment of the BHC, mean LOS was significantly longer (+ 1.26 days, p = 0.001) and there was a statistically significant reduction in 30-day (-10.3%, p < 0.001) and 1-year (-28.2%, p < 0.001) rehospitalization as well as 30-day (-8.3%, p = 0.004) and 1-year (-13.5%, p < 0.001) ED visit rate. A diagnosis of schizophrenia and prescription of a LAI were associated with a significant increase in LOS, while being uninsured was associated with a significant decrease. Male gender and a diagnosis of schizophrenia were associated with a significant increase in ED visits, while identifying as White or Caucasian, being uninsured or carrying private insurance, and prescription of a LAI were associated with a significant decrease.

Conclusions: The implementation of an innovative BHC positively impacted patient care outcomes in the study population. Patient characteristics were identified which independently interacted with these outcomes.

Background: Post-stroke depression (PSD) constitutes an important complication of stroke, affecting approximately one-third of stroke patients. PSD decreases rehabilitation motivation, delays function recovery, and increases the family and social burden of stroke patients. Motivational interviewing (MI) may be an effective and practical intervention strategy, but its effectiveness in improving PSD remains uncertain.

Methods: A parallel two-group quasi-experimental study was conducted. Patients with early PSD were recruited from the neurology department of a hospital in southeast China and were allocated to the control group and intervention group by wards. Patients in the intervention group received one session of face-to-face motivational interviewing and three sessions of telephone motivational interviewing, while patients in the control group received routine nursing and follow-up of the neurology department. Outcomes including depression, sleep quality, and quality of life were evaluated at baseline (T0), after intervention immediately (T1) and three months after intervention (T2). Descriptive statistics, t-test, Mann-Whitney U test, Wilcoxon signed rank sum test and generalized estimating equation were used to analyze data.

Results: There were no significant differences in patients' sociodemographic and clinical information between the intervention and control groups at baseline. The scores for depression were statistically different between the two groups (Z=-5.757, p < 0.001) at T1 and T2 (t=-7.964, p < 0.001). The scores for sleep quality were statistically different between the two groups at T1 (Z=-2.840, p = 0.005). The result of the generalized estimating equation modeling analyses indicated that interaction effects were statistically significant in depression and sleep quality scores. The intervention group showed a significantly higher rate of decrease in the depression score from T0 to T1 (95% CI: -11.227 to -7.748, p < 0.001) and T0 to T2 (95% CI: -11.683, -6.170, p < 0.001), compared with the control group; the intervention group had a greater reduction in the sleep score from T0 to T1 (95% CI: -2.502 to -0.962, p < 0.001), compared with the control group.

Conclusions: MI could effectively improve depression and sleep quality in patients with early PSD. However, MI failed to improve quality of life in patients with early PSD. These findings provide a foundation for future large-scale randomized controlled trials to further evaluate the efficacy of MI in patients with early PSD.

Trial registration: Retrospectively Registered, Chinese Clinical Trial Registry ( http://www.chictr.org.cn || ChiCTR2200064386|| Registration Date: 2022/10/06).

Background: Growing evidence indicates a link between insulin resistance and post-stroke depression (PSD). This study employed the triglyceride glucose (TyG) index as a measure of insulin resistance to investigate its relationship with PSD.

Methods: This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (2005-2018). PSD was assessed using data from patient health questionnaires, while the TyG index was calculated based on fasting venous blood glucose and fasting triglyceride levels. The formula used for the TyG index is ln[triglycerides (mg/dL) × fasting blood glucose (mg/dL)/2]. Participants were categorized into four groups according to the TyG index quartiles. A weighted multivariable logistic regression model was applied to examine the relationship between the TyG index and PSD.

Results: A total of 1217 patients were included in the study, of which 232 were diagnosed with PSD. The TyG index was divided into quartiles (Q1-Q4) for analysis. After adjusting for potential confounders, we found a significant positive association between the highest quartile of the TyG index (Q4: ≥9.33) and PSD (OR = 2.51, 95% CI: 1.04-6.07, p = 0.041). This suggests that in the U.S. adult stroke population, individuals with higher TyG indices are more likely to experience depressive symptoms. Subgroup analysis further confirmed a stable and independent positive association between the TyG index and PSD (all trend p > 0.05).

Conclusion: In this large cross-sectional study, our results suggest that among US adults who have experienced a stroke, those with higher TyG index levels are more likely to exhibit depressive symptoms. This provides a novel approach for the clinical prevention of PSD. Patients with higher TyG indices in the stroke population may require closer psychological health monitoring and timely intervention. Additionally, since the TyG index is calculated using only fasting blood glucose and triglyceride levels, it can help identify high-risk PSD patients, particularly in regions with limited healthcare resources.