BMC Psychiatry最新文献

Background: Major depressive disorder (MDD) is a recurrent and persistent mental illness. However, there is a lack of research that distinguishes the severity of comorbid anxiety disorders in MDD, and insufficient evidence exists regarding the prevalence of MDD patients with comorbid moderate-to-severe anxiety in the Chinese population.

Methods: The study included 1718 MDD patients (894 with moderate-to-severe anxiety symptoms and 824 without moderate-to-severe anxiety symptoms). Clinical symptoms and development were assessed using the Hamilton Depression Rating Scale-17 (HAMD-17), Hamilton Anxiety Rating Scale-14 (HAMA-14), Positive and Negative Syndrome Scale (PANSS), and Clinical Global Impression (CGI). The blood pressure and thyroid hormone levels were measured.

Results: We found that the incidence of MDD patients with moderate-to-severe anxiety symptoms was 52.04%. The prevalence of recent suicide attempts in MDD comorbid moderate-to-severe anxiety patients was 31.8%, which was 4.24 times higher than that in patients without moderate-to-severe anxiety. Additionally, suicide attempters had elevated levels of thyroid stimulating hormone (TSH), anti-thyroglobulin (TgAb), thyroid peroxidases antibody (TPOAb), systolic blood pressure (SBP), and diastolic blood pressure (DBP) compared to non-suicide attempters. We further identified CGI score, TSH, TPOAb, and DBP as influential factors for recent suicide attempts in MDD individuals who had moderate-to-severe anxiety symptoms. These indexes could distinguish between suicide attempts and non-suicide attempts in MDD patients with moderate-to-severe anxiety symptoms.

Conclusions: Our findings mainly indicated a high prevalence of recent suicide attempts in MDD patients with moderate-to-severe anxiety. Several clinical correlates, thyroid hormones, and blood pressure might contribute to recent suicide attempts in MDD patients with moderate-to-severe anxiety symptoms.

Background: Ongoing global crises are forcing an increasing number of people to seek refuge in other countries. Refugees have often experienced multiple potentially traumatic events before and during their flight and are burdened by psychosocial problems in exile. Epidemiological research suggests that many refugees suffer from depression and need psychological care. Yet, a systematic review of psychological interventions for refugees with depression is lacking.

Method: After registering in the International Prospective Register of Systematic Reviews (PROSPERO), a systematic search for trials of psychological interventions for adult refugees with depression was conducted across three electronic databases (MEDLINE, Web of Science, & PsycINFO). Relevant data reported in original journal publications were extracted, synthesized and assessed qualitatively by two independent raters. The methodological quality of included trials was assessed.

Results: Of 1316 publications, a total of 20 studies met eligibility criteria. Nine of these trials were carried out in an individual setting and ten in a group setting, with one of the trials being conducted digitally. Nine studies were designed as a randomized controlled trial (RCT), with only one of them using an active control group. In nine trials, the use of an interpreter was reported. Three of the trials applied multimodal treatments, and a total of sixteen studies applied manualized treatments. Seventeen interventions were adaptations of treatment programs developed in high income countries within a western context. Overall, nineteen out of twenty trials reported a significant improvement in depressive symptoms. Culturally adapted cognitive behavioural therapy (CA-CBT) was most frequently used (4 RCTs) and produced large effect sizes. Overall, all trials had limitations in study design.

Conclusions: Our current review suggests that psychological interventions, and in particular CA-CBT interventions, can significantly improve depressive symptoms in refugees. However, the small number of trials and limitations in study design underscore the need for more research in this field. The protocol for this review was registered in PROSPERO; registration number: CRD42021251943.

Background: The relationship between the systemic immune-inflammatory index (SII) and the mortality of adults with depression is uncertain.

Methods: This study included adults with depression who were surveyed in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. Cox proportional hazards regression models to compute hazard ratios (HR) and 95% confidence intervals (CI) for mortality.The restricted cubic spline(RCS), Kaplan-Meier curve analysis, time-dependent ROC analysis, subgroup and sensitivity analyses were also used.

Results: A total of 2442 adults with depression were included in the final analysis(average age: 46.51 ± 0.44 years). During a median follow-up of 89 months, there were 302 all-cause deaths and 74 cardiovascular deaths. The fully adjusted model showed that an increment of 100 unit in SII corresponded to an increased HR of 1.05(95% CI,1.02,1.08, p = 0.003) for all-cause mortality and 1.06(95% CI,1.02,1.10, p = 0.004) for cardiovascular mortality, respectively. The RCS analysis indicated a J-shape relationship between SII and all-cause mortality and a positive linear association between SII and cardiovascular mortality.The time-dependent ROC analysis exhibited excellent efficacy in SII for predicting all-cause and cardiovascular mortality at 1, 3, 5 and 10 years.

Conclusions: Higher SII levels were associated with increased risk of all-cause and cardiovascular mortality in adults with depression.

Clinical trial number: Not applicable.

Background: Suicide is a significant yet preventable public health issue. Body mass index (BMI) is a readily measurable indicator associated with various health outcomes. However, the relationship between BMI and suicidal death risk is complex and warrants further investigation, particularly within contemporary, non-Western contexts with consideration of potential confounders. The purpose of this study was to investigate the relationship between BMI and the risk of suicidal death.

Methods: This study was nationwide, retrospective, observational study based on Korean National Health Insurance Service database. We analyzed 4,045,081 participants who were aged > 19 years and underwent national health surveillance in 2009. The participants were categorized according to their BMI (underweight: < 18.5 kg/m², normal weight: 18.5-23 kg/m², overweight: 23-25 kg/m², class I obesity: 25-30 kg/m², and class II obesity: > 30 kg/m²). The primary outcome was the death events caused by suicide which was defined by International Classification of Disorders (ICD-10) codes (X60-X84) and death records documented by the Korea National Statistical Office. Multivariate Cox proportional hazard regression analysis was performed to estimate the risk of suicidal death with respect to BMI categories after adjusting for potential confounders (age, sex, income, diabetes, hypertension, dyslipidemia, smoking, drinking, exercise, self-abuse, waist circumference, schizophrenia, bipolar disorder, eating disorder, cancer, anxiety, and substance use disorder).

Results: Underweight individuals had an increased risk (hazard ratio [HR] 1.44, 95% confidence interval [CI] 1.31-1.57) while overweight (HR 0.79, 95% CI 0.76-0.83), class I (HR 0.76, 95% CI 0.71-0.80) and class II obesity (HR 0.71, 95% CI 0.63-0.81) were associated with decreased risks of suicidal deaths compared to those of the normal weight individuals (BMI 18.5-23). This trend was consistent regardless of the presence of major depressive disorder (MDD) or the type of living arrangements of the participants.

Conclusions: Suicidal death risk was inversely correlated with BMI categories, independent of MDD or living arrangements. Our data suggests the importance of physiological factors associated with body mass in understanding suicidal death risk. Furthermore, these data provide valuable insights to where the public health resources should be invested to reduce suicidal death rates.

Background: It is important to timely capture the fluctuation of the symptoms related to major depressive disorder (MDD). However, most conventionally used assessment tools for MDD symptoms are not designed for real-time assessment. The Immediate Mood Scaler (IMS) is suitable for the real-time evaluation of the mood of patients with MDD.

Methods: The original IMS was translated into Chinese and back-translated. At baseline, data from 368 patients with MDD, including demographic information and scores on the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and IMS, were collected. In total, 185 participants completed the retest at Week 2 which included the PHQ-9, GAD-7, and IMS. Internal structural validity, construct validity, and internal consistency were evaluated with the confirmatory factor analysis (CFA), the Pearson correlation, and Cronbach's α, respectively. Responsiveness was anchored by the change of the PHQ-9 total scores from baseline to Week 2 and predictability was tested using the multivariate linear mixed model for repeated measures (MMRM).

Results: Two factors with an eigenvalue greater than 1, corresponding to IMS-Depression and IMS-Anxiety subscales, were identified using CFA. The Cronbach's α that evaluated internal consistency was 0.96, 0.95, and 0.92 for the scores of the IMS, IMS-Depression subscale, and IMS-Anxiety subscale at baseline, respectively. The depression and anxiety subscales at baseline showed high subscale-total correlations (r = 0.96 for the depression subscale; r = 0.89 for the anxiety subscale). The test-retest ICC (0.65, 95%CI: 0.53-0.73) of the IMS at baseline and Week 2 show high reliability. The total score of IMS had significant correlations with that of the PHQ-9 (r = 0.52, P < 0.001) and GAD-7(r = 0.43, P < 0.001), indicating good construct validity. In patients with MDD who showed changes in mood, the changes in total scores of the IMS from baseline to the retest were statistically significant with a mean difference of 13.3 (SD: 20.1), an ES of 0.66, and an SRM of 0.3, showing good responsiveness. Also, the baseline IMS-Depression subscale score could predict the change in the PHQ-9 score over the two weeks (t = 2.19, P = 0.029).

Conclusions: Study findings suggest that the Chinese version of the IMS is a valid and reliable tool for assessing mood symptoms in patients with MDD in China. Further validation studies of the Chinese version IMS in different regions and at various levels of medical institutions are needed to further confirm the current findings.

Background: Childhood adversities and traumata (CAT) increase the risk for various mental disorders, including the clinical high-risk of psychosis (CHR-P) state and its main comorbidities, i.e., depression, and social phobia. However, these relations are likely mediated by personal coping behaviors. This cross-sectional study investigates the relationships between the main CAT domains, coping, CHR-P, depression, and social phobia.

Methods: Using path analyses, we analyzed data of 736 patients (mean age 24 years, 67% male) who presented at an early detection service between 2002 and 2013, answered questionnaires on CAT, coping, depressiveness, and social phobia, and underwent clinical examination for CHR-P according to the recommendations of the Guidance project of the European Psychiatric Association.

Results: All path models (total sample, males and females) showed good to excellent fit to the data. In all models, higher scores on maladaptive coping mediated the negative effect of emotional abuse on mental health outcomes. Additionally, in the total sample and males, lower scores on adaptive coping mediated the negative effect of emotional abuse and neglect, and physical neglect was associated with lower scores on adaptive coping that, in turn, were linked to depression and social phobia but not CHR-P. Overall, effects of maladaptive coping were higher than those of adaptive coping, although adaptive coping was more diversely associated with CAT. Furthermore, the interrelated depression and social phobia were more widely explained by the models than CHR-P, which was not significantly associated with them.

Conclusions: Our findings underscore the complex interplay of the CAT domains and their relevant mediators with mental health outcomes that likely reflect underlying sex-specific psychological, social, cultural and neurobiological mechanisms. Supporting a broader view on CAT than the traditional focus on sexual abuse, results indicate an important role of emotional abuse that, descriptively, is most strongly mediated by maladaptive coping strategies on mental health outcomes. A detailed understanding of the effects of CAT will in future help to develop a multi-dimensional, holistic and sex-specific approach to the treatment of patients who have experienced CAT.

Trial registration: The study was registered in the German Clinical Trial Register ( https://drks.de/ ) as DRKS00024469 at 02/24/2021.

Objective: The incidence of suicide is high among adolescents and young adults, especially those suffering from psychiatric diseases. Because of the reported association between depression and suicidality, exploring suicide risk factors in depressed patients is crucial for the identification of those at high risk and preventing suicide. In recent decades, electroencephalography parameters have been considered for identifying biomarkers of suicide ideation and attempts in depressed patients. This study aimed to review the available literature on resting-state EEG for suicidality in depressed patients.

Method: A systematic search was performed in five electronic databases, including APA PsycINFO, Embase, Medline (via PubMed), Scopus, and Web of Science. Papers with full text available in English in which resting-state EEG was evaluated in depressed patients with suicide ideation or suicide attempts compared to a control group of healthy subjects or non-suicidal depressed patients were included. The risk of bias was assessed by using the Newcastle-Ottawa scale.

Results: A total of 4665 references were retrieved from five electronic databases from which eleven studies were included in this systematic review. A meta-analysis was not performed due to the substantial heterogeneity of the studies. Five of the eleven reviewed papers were classified as high-quality, and six had moderate quality.

Conclusions: According to the included studies in this review, the EEG signals of depressed patients with suicide ideation or suicide attempts may be different from patients with low risk of suicidality or healthy subjects. Connectivity measures sound more promising parameters than the power spectral analysis and EEG asymmetry.

Protocol registration: The protocol of this review was registered in PROSPERO (No. CRD42024502056).

Background: Coronary artery bypass graft (CABG) is a common intervention for managing coronary artery disease, which is often accompanied by postoperative psychological challenges such as anxiety and depression. This systematic review aims to evaluate the benefits of cognitive behavioral therapy (CBT) in reducing anxiety and depression symptoms and improving overall health outcomes in patients' post-coronary artery bypass graft (CABG) surgery.

Methods: A search of Science Direct, PsycINFO, PubMed, Google Scholar, VHL, Cochrane, and Scopus databases was conducted until October 2023. Inclusion criteria encompassed randomized controlled trials reporting on CBT or CBT-based interventions tailored for CABG patients, with anxiety and depression symptoms, as well as quality of life, as primary outcomes. Hospital stay and satisfaction with therapy were considered secondary outcomes.

Results: The findings highlighted that CBT led to improvements in anxiety and depression symptoms, as well as reduced hospital stays, lowered hopelessness levels, and increased satisfaction with therapy. The long-term effects of CBT on CABG patients need to be studied, focusing on larger samples and patient compliance. Furthermore, assessment of CBT implementation in real-world clinical settings is important for feasibility, acceptability, and effectiveness across different regions.

Conclusion: This review underscores the positive impact of CBT on mitigating depression and anxiety symptoms and boosting the quality of life of individuals post-CABG surgery.

Background: Ketamine is a promising therapy for treatment-resistant depression due to its rapid onset, although benefits are often transitory, with patients needing maintenance therapy to prevent relapse. Most data supporting ketamine for treatment-resistant depression refers to the intravenous route of administration, leaving alternative routes lacking in data, especially as maintenance regimens. Moreover, the safety of ketamine maintenance therapy is poorly defined. This report aims to describe and evaluate a novel hospital-to-outpatient intranasal racemic ketamine maintenance therapy program.

Methods: This was an observational program evaluation study. Participants were adult inpatients with treatment-resistant depression who had been successfully treated with intranasal racemic ketamine in hospital and were being referred for outpatient maintenance therapy with an intranasal racemic ketamine spray, administered at a specialized community treatment centre. Effectiveness was assessed with the Self-Report Quick Inventory of Depressive Symptomatology, the Quality of Life Scale, and the Clinical Global Impression-Improvement scale.

Results: Five patients were enrolled, completing up to 14 treatment sessions over 192 days. The mean dose administered throughout treatment was 220 mg (100 to 400 mg). All patients had decreased (or stable) depressive symptoms and increased (or stable) quality of life. There were no serious adverse events or discontinuations due to adverse effects. Reported adverse effects included anxiety and nausea. Slight blood pressure increases were seen during treatment, none of which required intervention.

Conclusions: Intranasal racemic ketamine maintenance therapy for treatment-resistant depression appeared to be feasible and well tolerated, although effectiveness conclusions cannot be drawn from this small pilot study. Further investigations regarding the safety and effectiveness of intranasal ketamine maintenance therapy are warranted.