BMC Psychiatry最新文献

Background: Several studies have indicated a potential association between obesity, depression, and sleep disorders. However, the role of depression in mediating the relationship between obesity and sleep disorders remains unclear. The Body Roundness Index (BRI), a more precise anthropometric measure of obesity than the traditional body mass index (BMI), is particularly effective in assessing body and visceral fat levels. This study examines the relationship between BRI and sleep disorders, with a focus on whether depression influences this association.

Methods: This study included data from 32,504 participants in the National Health and Nutrition Examination Survey (NHANES) 2005-2018 cycle. The association between BRI and sleep disorders was examined through subgroup analysis, restricted cubic spline (RCS) modeling, threshold effect analysis, and multivariable logistic regression. Furthermore, the predictive capabilities of various anthropometric indices-including BRI, weight-adjusted waist index (WWI), BMI, and weight-on sleep disorder incidence were assessed using Receiver Operating Characteristic (ROC) curve analysis. Finally, a Mediation analysis was also performed to explore the potential role of depression in this relationship.

Results: This study included 32,504 participants, of whom 4,568 reported sleep disorders. After adjusting for all covariates using multivariable logistic regression, each one-unit increase in BRI was associated with a 13% higher prevalence of sleep disorders (OR = 1.13, 95% CI: 1.09, 1.16) and an 8% higher prevalence of depression (OR = 1.08, 95% CI: 1.05, 1.11). Similar results were obtained when BRI was divided into tertiles, with a significant trend (P for trend < 0.05). RCS and threshold effect analyses revealed a nonlinear relationship between BRI and sleep disorder prevalence, with a breakpoint of 3.508. The ROC curve analysis revealed that BRI had a superior predictive capability compared to traditional obesity indices, with an area under the curve (AUC) of 0.637 (95% CI, 0.628-0.645, all P < 0.001). Mediation analysis further indicated that 14% of the association between BRI and sleep disorders was mediated by depression (P < 0.001).

Conclusion: Elevated BRI levels were linked to a higher prevalence of sleep disorders, with depression acting as a partial mediator in this relationship. These findings emphasize the potential connection between obesity, depression, and sleep disorders, highlighting the importance of managing visceral fat to mitigate the risk of sleep disorders.

Clinical trial number: Not applicable.

Background: Changes in cognitive impairments and their relationship with psychopathological symptoms during treatment in schizophrenia remain debatable. Especially, there is few studies specifically focusing on female patients. Further exploration of the characteristics of female schizophrenia patients can offer valuable sex-related considerations for clinicians in diagnosis and interventions.

Methods: Our study involved 94 female patients with drug-naïve or drug-withdrawal schizophrenia who received antipsychotic drug for 8 weeks, along with 71 age-matched female healthy controls. The MATRICS Consensus Cognition Battery was used to assess cognition in the healthy controls at baseline and in the schizophrenia patients before and after 8 weeks of treatment. The Positive and Negative Syndrome Scale (PANSS) was employed to evaluate the psychopathological symptoms of the patients before and after 8 weeks of treatment.

Results: After antipsychotic treatment, 90.43% of the patients showed a reduction rate of more than 25% in their PANSS scores. Psychopathological symptoms and overall cognitive functioning improved significantly (p < 0.05), with the exception of verbal learning and social cognition (p > 0.05). Most cognitive dimensions were negatively correlated with positive symptoms, negative symptoms, and general psychopathological symptoms (p < 0.05, Bonferroni correction), while verbal learning and social cognition were only correlated with negative symptoms (p < 0.05, Bonferroni correction). Multivariate linear regression analysis revealed that improvements in positive symptoms and negative symptoms can predict the improvement in visual learning (p < 0.05) and overall cognitive composite scores (p < 0.05), improved positive symptoms can predict the improvement in the speed of processing (p < 0.05), reasoning and problem-solving(p < 0.05), and improvement in negative symptoms can predict the improvement in attention/vigilance (p < 0.05).

Conclusions: Verbal learning and social cognition may serve as core independent cognitive impairments in female schizophrenia. Improvements in the overall cognitive function, along with most cognitive dimensions, appeared to be secondary to the improvement in positive and negative symptoms during the acute stages of antipsychotic treatment.

Trial registration: ClinicalTrials.gov Identifier: NCT03451734.

Background: Speech impairments significantly affect communication and are associated with social and psychological difficulties, particularly among adults aged 45 years and older. This study examines the relationship between speech impairments and depression using data from the China Health and Retirement Longitudinal Study (CHARLS).

Methods: A total of 67,014 participants aged 45 years and older were included in the analysis. The baseline characteristics of participants with and without speech impairments were compared using chi-square tests. Multivariable logistic and linear regression models were employed to assess the association between speech impairments and depression. Sensitivity and subgroup analyses were performed to explore variations across different demographic and lifestyle characteristics.

Results: Participants with speech impairments exhibited a significantly greater likelihood of depression, with adjusted odds ratios (Model II: OR = 2.16, 95% CI: 1.56-2.97, p < 0.0001) and higher depression scores (Model II: β = 3.03, 95% CI: 2.24-3.81, p < 0.0001) after controlling for confounders. Sensitivity analysis confirmed the robustness of these findings. Subgroup analysis revealed consistent associations across all the examined subgroups, with a statistically significant interaction between speech impairments and place of residence (p for interaction = 0.02), indicating a stronger association in urban residents.

Conclusion: Speech impairments are strongly associated with a greater likelihood of depression in middle-aged and elderly Chinese adults. This finding underscores the importance of targeted mental health interventions and support for this population, particularly in urban settings.

Clinical trial number: Not applicable.

Background: The psychological structural model of major depressive disorder (MDD) is complex and multifaceted, consisting of the environment factors (EF), cognitive function (CF), and behavioral-emotional manifestations (BEM). Currently, the diagnosis and treatment of MDD is difficult to improve the disease state as a whole through an intervention point. Constructing the psychological structural model of MDD and finding the critical node of the psychological structural model are meaningful for the diagnosis and treatment of MDD.

Methods: 308 MDD patients (MDDs) participated in this research. They completed assessments of 34 psychological factors, including EF, CF, BEM and interoception function (IF). Pearson correlation was used to investigate the relationship between IF and each factor in the depressive multidimensional psychological structural model (EF, CF and BEM) which was constructed by structural equation modeling (SEM). Critical nodes were identified by the goodness of fit of the model. The depressive multidimensional psychological structural model (EF, CF and BEM) was created through SEM. IF was added to the depressive multidimensional psychological structural model to further verify the pathways and effects of interoception in the network.

Results: IF was significantly correlated with all psychological factors. In the depressive multidimensional psychological structural model, EF (β_direct = 0.163, p = 0.033) and BEM (β_direct = 0.230, p = 0.003) can directly influence MDD. When adding IF to the model, interoception predicted all the factors in the model. The poorer EF led to the lower IF (β_direct = - 0.346, p < 0.001). Interoception dysfunction increased the risk of the CF (β_direct = -0.525, p = 0.002) and BEM (β_direct = - 0.250, p = 0.031) of the patients. EF had the largest total effect on MDD (β_direct = 0.365, β_indirect = 0.150, β_total = 0.515), IF (β_direct = - 0.309, β_indirect = - 0.126, β_total = - 0.434) are second only to EF.

Conclusions: IF is a part of the psychological structural model of MDD that predicts EF, CF, and BEM. It could be a potential intervention point to improve the depressive state as a whole.

Background: As the concept of empowerment is increasingly adopted across various mental health care contexts, there is a growing need for standardized measures to assess the effectiveness of empowerment approaches. The Empowerment Scale is widely utilized and translated within the field of mental health, despite its varied psychometric properties. This study aimed to translate the Empowerment Scale into French and assess its internal consistency, validity, and responsiveness.

Methods: This study was part of a larger research project involving 394 participants. The Empowerment Scale was translated into French following cross-cultural adaptation guidelines, with a translation committee consisting of experts and a professional translator. Psychometric properties were assessed using classical test theory. The factor structure was determined through principal component analysis, exploratory factor analysis, and confirmatory factor analysis. Internal consistency was measured using Cronbach's alpha, while validity was evaluated through convergent, discriminant, and concurrent validity analyses. Responsiveness was assessed by comparing empowerment scores to changes in recovery rates.

Results: The factor analyses supported a four-factor, 18-item model, showing good fit indices (CFI = 0.97, TLI = 0.97, AGFI = 0.97, SRMR = 0.07, RMSEA = 0.07). Internal consistency was acceptable for the overall scale (alpha = 0.84) and the "self-esteem-self-efficacy" dimension (alpha = 0.88) but lower for the other dimensions. The scale demonstrated moderate correlations with recovery (r = 0.47) and quality of life (r = 0.28). The Empowerment Scale demonstrated low or insignificant responsiveness, except for the "self-esteem-self-efficacy" dimension, which showed moderate responsiveness.

Conclusions: The French version of the Empowerment Scale has a good factor structure with 4 factors and 18 items. The "self-esteem" dimension demonstrates good concurrent validity and reliability, and moderate responsiveness, while other dimensions require additional validation.

Background: This study investigated the relationship between fragmented care (patient care provided at multiple hospitals) and incident mood disorders in elderly colorectal cancer patients. Fragmented care was defined as a change in the medical institution providing first cancer treatment within 180 days of cancer diagnosis. The aim of this study was to investigate the impact of fragmented care on the incidence of mood disorder after cancer diagnosis in elderly colorectal cancer patients.

Methods: This study used NHIS Senior cohort data between 2002 and 2019 in South Korea. The participants included individuals aged 60 to 80 years who were diagnosed with colorectal cancer between 2008 and 2014. The primary outcome measure was the incidence of mood disorders within five years after cancer diagnosis. The independent variable was fragmented care. Regression analysis was conducted using the Cox proportional hazard model, and a sensitivity analysis was performed to enhance the robustness of the study findings.

Results: Of the total 3,726 participants, 878 (23.6%) were diagnosed with mood disorders, and 328 (8.8%) experienced fragmented care. The mood disorder incidence rate per 100,000 person-days was higher among those who experienced fragmented care (18.9 cases) compared to those who did not (14.6 cases). Participants who received fragmented care had a significantly higher risk of incident mood disorders (hazard ratio 1.39, 95% confidence interval 1.10-1.77). The results of the sensitivity analysis, which extended the fragmented care observation period, remained consistent with the original findings. Additionally, subgroup analysis revealed that the effect of fragmented care on incident mood disorders was significantly associated with female sex, chronic diseases, lower economic status, and type of colon cancer (C18).

Conclusions: Fragmented care increased the risk of incident mood disorders within the first five years of diagnosis in elderly patients with colorectal cancer. The findings highlight the potentially important role of a cohesive health system in managing the mental health of patients with colorectal cancer, which is important considering that depression is relatively commonly found in these patients.

Background: Shared medication coordination (MedCo) is vital yet difficult to manage for residents living with severe mental disorders in residential care, where multidisciplinary teams provide support. A successful Shared MedCo model in one residence included three core components: "shared decision-making," "patient involvement" and "MedCo". This model was effective but transfer to other residential settings needed implementation adaptation. The aim of this study was to meet local MedCo requirements by achieving a good fit between a Shared MedCo intervention core components and a social psychiatric residential context.

Methods: The methodology was guided by a complex intervention adaptation framework involving co-creation with stakeholders to gather iterative feedback. The intervention was adapted through a systematic four-phase process and tested through shared consultations. Ten residents took part in the test, and the intervention's feasibility and acceptability were assessed.

Findings: The adaptation process ensured a good fit between the intervention's core components and the new context. Stakeholder input provided crucial content and contextual insights, while planned adaptations laid the foundation for modulating the individual residence Shared MedCo model. Iterative adaptations during the test phase refined the intervention, leading to near-routine performance by the tenth consultation. Residents gained a stronger voice in their healthcare, and all ten had their medication coordinated and optimised. The intervention was found feasible and acceptable.

Conclusion: For effective implementation, complex multidisciplinary Shared MedCo interventions require contextual adaptation and active stakeholder involvement. The shared MedCo intervention offers a guideline for achieving a good fit between the intervention core components and diverse residential contexts, ensuring successful medication coordination for residents living with severe mental disorders.

Background: Post-traumatic stress disorder (PTSD) and post-traumatic growth (PTG) are inspiratory areas of psychological research in which deliberate rumination has important implications. However, these relationships have not yet been assessed in the COVID-19 pandemic using longitudinal designs.

Methods: In this study, measures of PTSD, PTG, and deliberate rumination were collected from 2,292 healthcare staff members at two-time points six months apart in 2022-2023 from two general hospitals in Hubei Province, China. A cross-lagged analysis was used to simultaneously determine the directional relationships between these three variables.

Results: The results suggest that the relationship between PTG and deliberate behavior is bidirectional and mutually reinforcing (β = 0.133, P < 0.001; β = 0.129, P < 0.001). Significant prospective relations were observed between PTG and PTSD (β = 0.054, P < 0.01), and PTSD prospectively predicted changes in deliberate rumination (β = 0.204, P < 0.001). In addition, significant sex differences were observed in the cross-lagged models.

Conclusion: These findings highlighted the noteworthy cross-lagged relationship between PTSD, PTG, and deliberate rumination two years after the COVID-19 pandemic in Hubei Province, China. Therefore, interventions to reduce PTSD, promote PTG, and improve well-being among healthcare staff are important.

Background: Psychological resilience refers to maintaining or regaining psychological well-being after experiencing adversity, trauma, or stress. There is evidence suggesting that cognitive behavioral therapy (CBT) can significantly enhance an individual's coping skills. However, the overall effectiveness of CBT on resilience among cancer patients remains unclear. Therefore, this study systematically evaluated the impact of CBT on resilience among cancer patients.

Methods: The PubMed, PsycINFO, Cochrane Library, CINAHL, and Embase databases were searched using keywords. Two researchers independently conducted a rigorous evaluation of the quality of the evidence using the GRADE system and independently performed data extraction. A meta-analysis was conducted to calculate the experimental group's effect size and to explore the effects of CBT on enhancing resilience.

Results: Thirteen randomized controlled trials (RCTs) were included in this meta-analysis. The effect of CBT on increasing resilience among cancer patients was small but significant immediately after the intervention (g = 1.211; p < 0.001). The results showed that CBT delivered via mobile devices was more effective than face-to-face CBT (β = 0.284; P = 0.012). Additionally, group CBT also outperformed individual CBT (β = 0.181; P = 0.042). Furthermore, CBT was more effective among patients with existing tumors (β = 0.285; P = 0.037). The evidence regarding the effects of CBT on resilience was found to be of moderate strength.

Conclusions: The results of this study indicate CBT can improve resilience among cancer patients. These findings underscore the importance of considering delivery methods and formats when implementing CBT interventions, with mobile device delivery and group formats resulting in better outcomes. The positive effects of CBT on patients with existing tumors highlight the importance of delivering this therapy in specific clinical contexts. Overall, this study provided moderately strong evidence that CBT is a valuable tool for enhancing resilience among cancer patients.

Trial registration: CRD42021256841.

Background: Although social withdrawal is common among colorectal cancer (CRC) survivors with permanent stomas, it has been poorly addressed due to a lack of valid assessment tools. The social withdrawal subscale (SWS) from the Internalized Stigma of Mental Illness (ISMI) scale shows promise for assessing social withdrawal. However, there was no available data on its validity for this purpose. This study aimed to investigate the reliability and validity of the SWS as a screening tool for identifying survivors at risk of social withdrawal.

Methods: Two separate convenience samples of 127 and 245 CRC survivors with permanent stomas were selected. Item analysis and exploratory factor analysis (EFA) were conducted with the first sample of 127 survivors. Confirmatory factor analysis (CFA), reliability analysis, and tests for convergent and discriminant validity were performed with the second sample of 245 survivors. Additionally, the screening cut-off score and accuracy of the SWS scores were determined using receiver operating characteristic (ROC) curves.

Results: The item-total correlation coefficients of the SWS ranged from 0.530 to 0.787. The EFA demonstrated a single-factor structure for the SWS. The CFA confirmed appropriate construct validity (χ²/df = 103.115/52 = 1.983, goodness-of-fit index (GFI) = 0.925, comparative fit index (CFI) = 0.959, and root mean square error of approximation (RMSEA) = 0.068). The test-retest reliability was 0.849. Pearson correlation analysis showed significant and moderate to large relationships between the SWS and the chosen criterion measures, supporting its good convergent validity. ROC analysis identified SWS scores of ≥ 15 as the optimal screening cut-off, with a sensitivity of 86.5%, specificity of 50.5%, and an area under the curve (AUC) of 0.748 (95% CI: 0.673-0.823, P < 0.001).

Conclusion: The SWS demonstrates acceptable reliability and validity for measuring social withdrawal among CRC survivors with permanent stomas. Future studies should further evaluate its utility in clinical settings.