BMC Psychiatry最新文献

Background: Depression is common among adolescents, particularly in low- and middle-income countries, such as Ghana. Yet, access to mental health care in these settings remains limited. There is a need for research to focus on innovative strategies to improve access to care. The African Youth in Mind consortium, together with a group of young people with depression and relevant stakeholders have developed a novel six-session lay professional intervention (Y-MIND) to treat depression.

Method: As part of the early phase of intervention development, we conducted a case series aimed at testing the feasibility, acceptability, and preliminary safety of Y-MIND when delivered by a trained clinical psychologist within Navrongo, Ghana. Four adolescents, aged 16-18 years, with a primary DSM-5 diagnosis of major depressive disorder were purposively recruited and received the intervention. The Patient Health Questionnaire-9 (PHQ-9) was administered at baseline and weekly, and each session audiotaped. In addition, semi-structured interviews were conducted after each session and at two weeks' follow-up. PHQ-9 data were analysed using Stata 17 to generate descriptive statistics. A deductive framework guided the analysis of semi-structured interview transcripts and participant evaluations using NVivo 12.

Results: Three of four adolescents completed all six sessions. The mean session duration was 58 minutes (SD = 12.0). All four participants demonstrated a ≥50% reduction in PHQ-9 scores by end of treatment. Mean PHQ-9 scores decreased from 14.5 (SD = 0.6) at baseline to 2.3 (SD = 4.0) at endline. By the beginning of session five, two participants had PHQ-9 scores ≤5. No participant showed symptom deterioration during the intervention. Qualitative interviews indicated that participants found the intervention understandable and relevant to their context. The interventionist identified areas for refinement, including clarifying sections of the manual and worksheets, addressing variability in remission rates, and strengthening the emphasis on mutual respect within the therapeutic relationship.

Conclusion: The Y-MIND intervention appeared to be feasible, acceptable, and safe for treating depression among senior high students in Ghana. Planned piloting with non-specialists will include adaptations for training, supervision, and fidelity monitoring.

Trial registration: Clinical Trials.gov Trial registration number ID NCT06740084, Trial registration data, December 9, 2024.

Background: Non-suicidal self-injury (NSSI) is highly prevalent among adolescents and is associated with significant psychosocial impairment. Although alexithymia has been linked to NSSI in previous studies, the psychological mechanisms that may explain this association remain unclear. The present study aimed to concurrently examine emotion regulation difficulties, impulsivity, and self-esteem as mediators of the association between alexithymia and NSSI in a clinical adolescent sample.

Methods: The study sample consisted of 437 adolescent outpatients (79.4% girls; Mage = 15.4 years), including 147 who reported NSSI in the past year and 290 who did not. Alexithymia, emotion regulation difficulties, impulsivity and self-esteem were measured. Gender-stratified structural equation modeling (SEM) was conducted to examine whether emotion regulation difficulties, impulsivity, and self-esteem mediated the association between alexithymia and NSSI, with indirect effects evaluated using bootstrapping.

Results: The NSSI group exhibited higher levels of alexithymia, emotion regulation difficulties, impulsivity and lower self-esteem than non-NSSI peers. Alexithymia was associated with all three mediators in both genders. Mediation analyses revealed significant indirect effects for emotion regulation difficulties, impulsivity, and self-esteem in the alexithymia-NSSI association among girls. Among boys, none of the specific indirect effects reached statistical significance; however, the total indirect effect was significant.

Conclusions: These findings highlight emotion dysregulation, impulsivity, and self-esteem as clinically relevant processes associated with alexithymia and NSSI in a clinical adolescent sample, particularly among girls. Addressing these processes in clinical assessment and intervention may contribute to more targeted approaches for reducing NSSI in adolescents. Longitudinal studies, particularly including larger male samples, are needed to clarify the directionality of these associations and to further examine gender-specific patterns.

Clinical trial number: Not applicable.

Objectives: Focusing on the acute phase of major depressive disorder(MDD), this study aimed to systematically explore the specific correlations between core functional markers of the hypothalamic-pituitary-adrenal (HPA) axis and the seven factor dimensions of the 24-item Hamilton Depression Rating Scale (HAMD-24), moving beyond the conventional coarse-grained analytical framework that only associates HPA axis activity with the overall diagnostic status of depression to provide refined clinical evidence for elucidating the pathophysiological role of the HPA axis at the symptomatic dimensional level.

Methods: Ninety-nine outpatients with acute episodes of MDD and Eighty-seven healthy controls were selected. Serum samples were collected once in the morning from both groups to measure the serum cortisol levels. Multiple dimensions of clinical characteristics of the depressive group was assessed using the HAMD-24.

Results: Serum cortisol levels during acute depression episodes were significantly higher than those in the healthy control group. In the MDD group, serum cortisol levels were significantly positively correlated with the anxiety, cognitive impairment, diurnal variation and retardation factors and the total HAMD-24 score (ρ > 0, P < 0.05). It tended to be positively not significantly correlated with the despair factor (ρ > 0, P > 0.05), and tended to be negatively but not significantly correlated with the weight and sleep disturbance factors (ρ < 0, P > 0.05).

Conclusion: These findings refine HPA axis pathophysiology understanding in acute MDD, emphasizing symptom-specific associations over generalized depressive status links. Aberrant HPA axis activity emerges as a potential biological marker for acute MDD and a promising novel therapeutic target for antidepressant development.

Clinical trial number: Not applicable.

Background: Obsessive-Compulsive Disorder (OCD) and Trichotillomania (TTM) are classified together as Obsessive-Compulsive and Related Disorders, yet their distinct neurobiological underpinnings remain poorly understood. This study represents the first untargeted metabolomic analysis comparing adolescents with OCD and TTM to identify differential metabolic signatures.

Method: This cross-sectional study included 62 female adolescents aged 10-18 years: 20 with OCD, 22 with TTM, and 20 healthy controls. Plasma samples were analyzed using liquid chromatography-quadrupole time-of-flight mass spectrometry (LC-Q-TOF/MS). Metabolomic data were processed using MZmine 2.53 and MetaboAnalyst 6.0, with metabolites showing |log₂(fold change)| > 0.585 (corresponding to fold change > 1.5 or < 0.67) and p < 0.05 considered significant.

Results: Exploratory principal component analysis showed visual separation of the OCD group from healthy controls, while the TTM group showed partial overlap with controls. In OCD versus controls, linoleic acid (LA) was markedly decreased (FC: 0.02), while trihexosylceramide (FC: 15.48) and 7a,12a-dihydroxy-cholestene-3-one (FC: 4.33) were significantly elevated. TTM showed elevated arachidonic acid (AA) (FC: 9.60) and trihexosylceramide (FC: 13.42), with severely reduced biocytin (FC: 0.01) compared to controls. Direct comparison between disorders revealed LA (FC: 51.39) and AA (FC: 3.55) were higher in TTM versus OCD, while biocytin (FC: 0.10) was lower. These findings suggest that OCD and TTM exhibit distinct patterns of metabolite differences.

Conclusion: OCD showed reduced LA levels, consistent with potential perturbations in omega-6 metabolism. TTM showed elevated AA levels and reduced biocytin, consistent with previously reported oxidative stress and altered energy metabolism in this disorder. These metabolic differences represent candidate metabolites warranting targeted validation and may provide preliminary insights into distinct neurobiological mechanisms rather than direct clinical applicability.

Clinical trial number: Not applicable.