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Association between olfactory function and metabolic syndrome in bipolar disorder patients: a cross-sectional study. 双相情感障碍患者的嗅觉功能与代谢综合征之间的关系:一项横断面研究。
IF 3.4 2区 医学 Q2 PSYCHIATRY Pub Date : 2024-10-22 DOI: 10.1186/s12888-024-06164-6
Huiqian Yuan, Yingying Li, Xianlin Liu, Langjun Su, Qiping Li, Chunhong Yang, Chao Chen, Chunyang Li

Background: Olfactory function is closely related to mood and the endocrine system. However, the role of olfactory function in bipolar disorder combined with metabolic syndrome remains unclear. The purpose of this study was to explore the associations among olfactory function, tumor necrosis factor alpha (TNF-α), and metabolic syndrome and its components in patients with bipolar disorder.

Methods: Ninety-six bipolar disorder patients were divided into two groups with and without metabolic syndrome. We also included 46 healthy controls. Olfactory function was assessed using the Sniffin' Sticks test. Blood samples were collected to measure metabolic indicators and serum TNF-α levels.

Results: Significant differences in olfactory function were found among the three groups. Compared with the healthy controls, the bipolar disorder without metabolic syndrome group showed poorer olfactory identification ability (P < 0.001) and the bipolar disorder with metabolic syndrome group showed impaired olfactory sensitivity (P = 0.003) and olfactory identification (P < 0.001). Moreover, the bipolar disorder with metabolic syndrome group had poorer olfactory identification ability than the bipolar disorder without metabolic syndrome group (P = 0.015). Both bipolar disorder groups showed lower TNF-α levels than healthy controls. However, there was no significant difference between the two patient groups. Correlation analysis showed that, in the bipolar disorder with metabolic syndrome group, olfactory identification was negatively correlated with systolic blood pressure (r = - 0.424, P = 0.031), and serum TNF-α level was negatively correlated with body mass index (BMI; r = - 0.398, P = 0.049), triglyceride (r = - 0.503, P = 0.010), total cholesterol (r = - 0.491, P = 0.013), low-density lipoprotein-cholesterol (r = - 0.491, P = 0.013), and high-density lipoprotein-cholesterol (r = - 0.454, P = 0.023).

Conclusions: The olfactory identification ability of patients with bipolar disorder is worse than that of healthy controls, and the occurrence of metabolic syndrome will further aggravate the olfactory identification impairment of those patients. Furthermore, there may be a stronger link between serum TNF-α level and multiple metabolic indicators in bipolar disorder patients with metabolic syndrome than in bipolar disorder patients without metabolic syndrome.

背景:嗅觉功能与情绪和内分泌系统密切相关:嗅觉功能与情绪和内分泌系统密切相关。然而,嗅觉功能在躁狂症合并代谢综合征中的作用仍不清楚。本研究旨在探讨双相情感障碍患者的嗅觉功能、肿瘤坏死因子α(TNF-α)、代谢综合征及其组成部分之间的关联:方法:我们将96名躁狂症患者分为有代谢综合征和无代谢综合征两组。我们还纳入了 46 名健康对照者。嗅觉功能通过嗅棒测试进行评估。我们还采集了血液样本以测量代谢指标和血清 TNF-α 水平:结果:三组患者的嗅觉功能存在显著差异。与健康对照组相比,无代谢综合征的双相情感障碍组的嗅觉识别能力较差(P 结论:与健康对照组相比,无代谢综合征的双相情感障碍组的嗅觉识别能力较差(P):双相情感障碍患者的嗅觉识别能力比健康对照组差,而代谢综合征的发生会进一步加重患者的嗅觉识别障碍。此外,与无代谢综合征的双相情感障碍患者相比,有代谢综合征的双相情感障碍患者的血清TNF-α水平与多种代谢指标之间可能存在更密切的联系。
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引用次数: 0
Improvement in symptoms of anxiety and depression in individuals with type 2 diabetes: retrospective analysis of an intensive lifestyle modification program. 改善 2 型糖尿病患者的焦虑和抑郁症状:对强化生活方式调整项目的回顾性分析。
IF 3.4 2区 医学 Q2 PSYCHIATRY Pub Date : 2024-10-22 DOI: 10.1186/s12888-024-06130-2
Pramod Tripathi, Baby Sharma, Nidhi Kadam, Diptika Tiwari, Thejas Kathrikolly, Anagha Vyawahare, Mayurika Das Biswas, Venugopal Vijayakumar, Maheshkumar Kuppusamy, Malhar Ganla, Banshi Saboo

Background: Type 2 diabetes (T2D) is a chronic metabolic disorder that has a notable influence on mental well-being, contributing to elevated morbidity and mortality rates. Depression and anxiety disorders are the most common mental health concerns among patients with T2D worldwide. Therefore, the present study aimed to assess the impact of an online intensive lifestyle intervention (ILI) on mental health outcomes (depression and anxiety) in patients with T2D in India.

Materials and methods: This retrospective pre-post analysis included adult patients (aged > 18 years) diagnosed with T2D who were enrolled in a diabetes management program in India between June 2021 and June 2023. The intervention consisted of lifestyle modifications such as a customized plant-based diet, regular physical activity, psychological support through group and individual therapy, and medical management. Data were extracted from the electronic database of the clinic, including anthropometry, medical history, biochemical parameters, symptoms of depression, and anxiety (assessed using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorders-7 (GAD-7) scale) at the start and end of the six-month intervention period.

Results: Of the 1061 eligible patients (177 with prediabetes), 40.3% were female. The mean age, duration of diabetes, and HbA1c levels were 52 ± 10.4 years, 9.8 ± 7.8 years, and 8 ± 1.7%, respectively. The prevalence of symptoms of depression and anxiety (ranging from mild to severe) was 46% and 44.3%, respectively, which reduced to 28.7% and 29.2%, respectively, post-intervention.

Conclusion: Integrated ILI successfully improved the symptoms of anxiety and depression, highlighting the importance of a multidisciplinary approach that includes diet, physical activity, psychological support, and medical management in enhancing mental health outcomes among patients with T2D. Future prospective studies are needed to explore the long-term effects of such interventions and develop effective strategies for promoting mental health in diverse populations.

Trial registration: The study was approved by the Freedom from Diabetes Research Foundation Institutional Ethics Committee (approval number FFDRF/IEC/2024/7) and registered in the Clinical Trials Registry of India (CTRI/2024/03/064596, registered on March 21, 2024).

背景:2 型糖尿病(T2D)是一种慢性代谢性疾病,对心理健康有显著影响,导致发病率和死亡率升高。抑郁和焦虑症是全球 T2D 患者最常见的心理健康问题。因此,本研究旨在评估在线强化生活方式干预(ILI)对印度 T2D 患者心理健康结果(抑郁和焦虑)的影响:这项回顾性前后分析包括 2021 年 6 月至 2023 年 6 月期间在印度参加糖尿病管理项目的被诊断为 T2D 的成年患者(年龄大于 18 岁)。干预措施包括调整生活方式,如定制植物性饮食、定期体育锻炼、通过集体和个人治疗提供心理支持以及医疗管理。数据提取自诊所的电子数据库,包括六个月干预期开始和结束时的人体测量、病史、生化指标、抑郁症状和焦虑症状(使用患者健康问卷-9(PHQ-9)和广泛性焦虑症-7(GAD-7)量表进行评估):在 1061 名符合条件的患者(177 名糖尿病前期患者)中,40.3% 为女性。平均年龄、糖尿病病程和 HbA1c 水平分别为 52 ± 10.4 岁、9.8 ± 7.8 岁和 8 ± 1.7%。抑郁和焦虑症状(从轻微到严重)的发生率分别为 46% 和 44.3%,干预后分别降至 28.7% 和 29.2%:综合 ILI 成功改善了焦虑和抑郁症状,凸显了包括饮食、体育锻炼、心理支持和医疗管理在内的多学科方法在改善 T2D 患者心理健康方面的重要性。未来需要开展前瞻性研究,以探索此类干预措施的长期效果,并制定有效策略,促进不同人群的心理健康:该研究已获得糖尿病研究基金会机构伦理委员会批准(批准号为 FFDRF/IEC/2024/7),并在印度临床试验注册中心注册(CTRI/2024/03/064596,注册日期为 2024 年 3 月 21 日)。
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引用次数: 0
Network analysis of resilience, anxiety and depression in clinical nurses. 临床护士复原力、焦虑和抑郁的网络分析。
IF 3.4 2区 医学 Q2 PSYCHIATRY Pub Date : 2024-10-22 DOI: 10.1186/s12888-024-06138-8
Yi Zhou, Weina Gao, Huijun Li, Xing Yao, Jing Wang, Xinchao Zhao

Background: Resilience is a protective feature against anxiety and depression disorders. However, the precise relationship and structure of resilience and anxiety and depression remain poorly understood. This study sought to investigate the link among resilience' components and anxiety as well as depression.

Methods: 1,279 clinical nurses were recruited. 10-item Connor-Davidson Resilience Scale, Generalized Anxiety Disorder 7, and Patient Health Questionnaire 9 were employed to evaluate resilience, anxiety, and depression, respectively. The regularized partial-correlation network was generated utilizing data from cross-sectional survey and the bridge expected influence index was utilized to quantify bridge components.

Results: The rates of anxiety and depression within clinical nurses were 67.3% and 67.2%, accordingly. Four strongest bridge edges appeared in the resilience-anxiety network, like "Adapt to change"- "Fear that something might happen", and "Stay focused under pressure"- "Uncontrollable worry". Two strongest bridge edges appeared in the resilience-depression network, like "Adapt to change"- "Concentration difficulties" and "Stay focused under pressure"- "Fatigue". "Adapt to change" was recognized as bridging nodes in both the resilience-anxiety network and the resilience-depression network.

Conclusions: Interventions targeting the bridge component "Adapt to change" within resilience, may mitigate the intensity of anxiety and depression symptoms among clinical nurses.

背景:抗逆力是焦虑症和抑郁症的保护性特征。然而,人们对抗逆力与焦虑症和抑郁症的确切关系和结构仍然知之甚少。本研究试图调查抗逆力成分与焦虑和抑郁之间的联系。采用 10 项康纳-戴维森复原力量表、广泛性焦虑症 7 和患者健康问卷 9 分别评估复原力、焦虑和抑郁。利用横截面调查数据生成正则化偏相关网络,并利用桥接预期影响指数量化桥接成分:结果:临床护士的焦虑率和抑郁率分别为 67.3% 和 67.2%。在复原力-焦虑网络中出现了四条最强的桥边,如 "适应变化"--"担心可能发生的事情","在压力下保持专注"--"无法控制的担忧"。抗逆力-抑郁网络中出现了两个最强的桥边,如 "适应变化"--"注意力难以集中 "和 "在压力下保持专注"--"疲劳"。在抗逆力-焦虑网络和抗逆力-抑郁网络中,"适应变化 "都被认为是桥接节点:结论:针对复原力中 "适应变化 "这一桥梁部分的干预措施可减轻临床护士焦虑和抑郁症状的强度。
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引用次数: 0
Genetic polymorphism involved in major depressive disorder: a systemic review and meta-analysis. 重度抑郁障碍的基因多态性:系统回顾和荟萃分析。
IF 3.4 2区 医学 Q2 PSYCHIATRY Pub Date : 2024-10-22 DOI: 10.1186/s12888-024-06195-z
Areeya Suktas, Tipaya Ekalaksananan, Sirinart Aromseree, Sureewan Bumrungthai, Nopparat Songserm, Chamsai Pientong

Background and objective: Genetic polymorphism studies in families and twins indicated the heritability of depression. However, the association between genes with genetic polymorphism and depression provides various findings and remains unclear. Therefore, we conducted a systematic review and meta-analysis to determine the genes with their polymorphism associated with the symptomatic depression known as major depressive disorder (MDD).

Materials and methods: PubMed and Scopus were searched for relevant studies published before May 22, 2023 (1968-2023), and 62 were selected for this review. The study's bias risk was investigated using the Newcastle-Ottawa scale. Gene functional enrichment analysis was investigated for molecular function (MF) and biological process (BP) and pathways. A meta-analysis of the studied genes that were replicative in the same single nucleotide polymorphism was conducted using a random-effect model.

Results: The 49 genes involved in MDD were studied and engaged in several pathways, such as tryptophan metabolism or dopaminergic and serotonergic synapses. Based on gene overlapping in MF and BP, 13 genes with polymorphisms were identified as related to MDD. Most of them were only studied once. Solute carrier family 6 member 4 (SLC6A4) overlapping between MF and BP and brain-derived neurotrophic factor (BDNF) as unique to BP were replicative studied and used in the meta-analysis. The polymorphism of SLC6A4 SS and LS genotypes increased the occurrence of MDD development but not significantly [odd ratio (OR) = 1.39; 95% confidence interval (CI) = 0.87-2.22; P = 0.16 and OR = 1.13; 95% CI = 0.84-1.53; P = 0.42, respectively]. A similar result was observed for BDNF rs6265 GG (OR = 1.26; 95% CI = 0.78-2.06; P = 0.35) and BDNF rs6265 AA genotypes (OR = 1.12; 95% CI = 0.77-1.64; P = 0.56). These studies indicated low bias and significant heterogeneity.

Conclusion: At least 13 studied genes with polymorphisms were involved in MDD development according to MF and BP, but not significantly. These results suggest that MDD development risk factors might require genetic and other factors for interaction and induction.

背景和目的:对家族和双胞胎进行的基因多态性研究表明,抑郁症具有遗传性。然而,遗传多态性基因与抑郁症之间的关联研究结果各异,仍不明确。因此,我们进行了一项系统综述和荟萃分析,以确定与症状性抑郁症(即重度抑郁障碍(MDD))相关的基因及其多态性:在PubMed和Scopus上搜索了2023年5月22日(1968-2023年)之前发表的相关研究,并选择了62项研究进行综述。研究的偏倚风险采用纽卡斯尔-渥太华量表进行调查。对分子功能(MF)、生物过程(BP)和通路进行了基因功能富集分析。采用随机效应模型对同一单核苷酸多态性中具有重复性的研究基因进行了荟萃分析:结果:研究了与 MDD 相关的 49 个基因,这些基因参与了多个通路,如色氨酸代谢或多巴胺能和血清素能突触。根据 MF 和 BP 的基因重叠情况,确定了 13 个与 MDD 有关的多态性基因。其中大多数基因只被研究过一次。对MF和BP中重叠的溶质运载家族6成员4(SLC6A4)和BP特有的脑源性神经营养因子(BDNF)进行了重复研究,并将其用于荟萃分析。SLC6A4 SS 和 LS 基因型的多态性增加了 MDD 的发生率,但并不显著[奇异比(OR)= 1.39;95% 置信区间(CI)= 0.87-2.22;P = 0.16 和 OR = 1.13;95% CI = 0.84-1.53;P = 0.42]。BDNF rs6265 GG(OR = 1.26;95% CI = 0.78-2.06;P = 0.35)和 BDNF rs6265 AA 基因型(OR = 1.12;95% CI = 0.77-1.64;P = 0.56)也观察到类似的结果。这些研究表明偏倚较低且异质性显著:结论:根据 MF 和 BP,至少有 13 个具有多态性的研究基因与 MDD 的发生有关,但并不显著。这些结果表明,MDD发生的风险因素可能需要遗传因素和其他因素的相互作用和诱导。
{"title":"Genetic polymorphism involved in major depressive disorder: a systemic review and meta-analysis.","authors":"Areeya Suktas, Tipaya Ekalaksananan, Sirinart Aromseree, Sureewan Bumrungthai, Nopparat Songserm, Chamsai Pientong","doi":"10.1186/s12888-024-06195-z","DOIUrl":"10.1186/s12888-024-06195-z","url":null,"abstract":"<p><strong>Background and objective: </strong>Genetic polymorphism studies in families and twins indicated the heritability of depression. However, the association between genes with genetic polymorphism and depression provides various findings and remains unclear. Therefore, we conducted a systematic review and meta-analysis to determine the genes with their polymorphism associated with the symptomatic depression known as major depressive disorder (MDD).</p><p><strong>Materials and methods: </strong>PubMed and Scopus were searched for relevant studies published before May 22, 2023 (1968-2023), and 62 were selected for this review. The study's bias risk was investigated using the Newcastle-Ottawa scale. Gene functional enrichment analysis was investigated for molecular function (MF) and biological process (BP) and pathways. A meta-analysis of the studied genes that were replicative in the same single nucleotide polymorphism was conducted using a random-effect model.</p><p><strong>Results: </strong>The 49 genes involved in MDD were studied and engaged in several pathways, such as tryptophan metabolism or dopaminergic and serotonergic synapses. Based on gene overlapping in MF and BP, 13 genes with polymorphisms were identified as related to MDD. Most of them were only studied once. Solute carrier family 6 member 4 (SLC6A4) overlapping between MF and BP and brain-derived neurotrophic factor (BDNF) as unique to BP were replicative studied and used in the meta-analysis. The polymorphism of SLC6A4 SS and LS genotypes increased the occurrence of MDD development but not significantly [odd ratio (OR) = 1.39; 95% confidence interval (CI) = 0.87-2.22; P = 0.16 and OR = 1.13; 95% CI = 0.84-1.53; P = 0.42, respectively]. A similar result was observed for BDNF rs6265 GG (OR = 1.26; 95% CI = 0.78-2.06; P = 0.35) and BDNF rs6265 AA genotypes (OR = 1.12; 95% CI = 0.77-1.64; P = 0.56). These studies indicated low bias and significant heterogeneity.</p><p><strong>Conclusion: </strong>At least 13 studied genes with polymorphisms were involved in MDD development according to MF and BP, but not significantly. These results suggest that MDD development risk factors might require genetic and other factors for interaction and induction.</p>","PeriodicalId":9029,"journal":{"name":"BMC Psychiatry","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142494687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Sleep timing and the prevalence of hypertension in middle-aged and older populations: the sleep heart health study. 睡眠时间与中老年人群高血压患病率:睡眠心脏健康研究。
IF 3.4 2区 医学 Q2 PSYCHIATRY Pub Date : 2024-10-22 DOI: 10.1186/s12888-024-06174-4
Sijie Zhao, Juan Zhao, Suhua Wei, Wenjuan Wang, Yanhua Wu, Bin Yan

Objectives: Sleep characteristics such as duration, continuity, and irregularity are associated with the risk of hypertension. This study aimed to investigate the association between sleep timing (including bedtime, wake-up time, and sleep midpoint) and the prevalence of hypertension.

Methods: Participants were selected from the Sleep Heart Health Study (n = 5504). Bedtime and wake-up times were assessed using sleep habit questionnaires. The sleep midpoint was calculated as the halfway point between the bedtime and wake-up time. Restricted cubic splines and logistic regression analyses were performed to explore the association between sleep timing and hypertension.

Results: A significant nonlinear association was observed between bedtime (Poverall<0.001; Pnonlinear<0.001), wake-up time (Poverall=0.024; Pnonlinear=0.076), sleep midpoint (Poverall=0.002; Pnonlinear=0.005), and the prevalence of hypertension after adjusting for potential confounders. Multivariable logistic regression showed that both late (> 12:00AM and 23:01PM to 12:00AM) and early (≤ 22:00PM) bedtimes were associated with an increased risk of hypertension compared to bedtimes between 22:01PM and 23:00PM. In addition, individuals with late (> 7:00AM) and early (≤ 5:00AM) wake-up times had a higher prevalence of hypertension than those with wake-up times ranging between 5:01AM and 6:00AM. Delaying the sleep midpoint (> 3:00AM) was also associated with an increased risk of hypertension. Furthermore, no significant interaction effect was found in the subgroup analyses stratified by age, sex, or apnea-hypopnea index.

Conclusions: Our findings identified a nonlinear association between sleep timing and hypertension. Individuals with both early and late sleep timing had a high prevalence of hypertension.

目的:睡眠的持续时间、连续性和不规律性等睡眠特征与高血压风险有关。本研究旨在调查睡眠时间(包括就寝时间、起床时间和睡眠中点)与高血压患病率之间的关系:方法:参与者选自睡眠心脏健康研究(n = 5504)。使用睡眠习惯问卷对就寝时间和起床时间进行评估。睡眠中点计算为就寝时间和起床时间的中间点。对睡眠时间与高血压之间的关系进行了限制性三次样条分析和逻辑回归分析:结果:在调整了潜在的混杂因素后,就寝时间(Poverallnonlinearoverall=0.024;Pnonlinear=0.076)、睡眠中点(Poverall=0.002;Pnonlinear=0.005)与高血压患病率之间存在明显的非线性关系。多变量逻辑回归显示,与22:01PM至23:00PM之间的就寝时间相比,晚睡(> 12:00AM和23:01PM至12:00AM)和早睡(≤ 22:00PM)都与高血压风险增加有关。此外,与起床时间在 5:01am 至 6:00am 之间的人相比,起床时间晚(> 7:00am)和早(≤ 5:00am)的人患高血压的风险更高。推迟睡眠中点(>凌晨 3:00)也与高血压患病风险增加有关。此外,在按年龄、性别或呼吸暂停-低通气指数进行的亚组分析中,没有发现明显的交互效应:我们的研究结果表明,睡眠时间与高血压之间存在非线性关系。结论:我们的研究结果发现了睡眠时间与高血压之间的非线性关系,睡眠时间过早和过晚的人高血压发病率都很高。
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引用次数: 0
The combined effects of depression or anxiety with high-sensitivity C-reactive protein in predicting the prognosis of coronary heart disease patients. 抑郁或焦虑与高敏 C 反应蛋白在预测冠心病患者预后方面的联合作用。
IF 3.4 2区 医学 Q2 PSYCHIATRY Pub Date : 2024-10-22 DOI: 10.1186/s12888-024-06158-4
Bingqing Bai, Han Yin, Haochen Wang, Fengyao Liu, Yanting Liang, Anbang Liu, Lan Guo, Huan Ma, Qingshan Geng

Background: Depression, anxiety and high-sensitivity C-reactive protein (hs-CRP) are individually associated with poor prognosis in patients with coronary heart disease (CHD). However, the combined effects of depression with inflammation or anxiety with inflammation on the prognosis have been rarely explored.

Methods: This prospective cohort study included 414 patients diagnosed with CHD. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess depression and anxiety. A score ≥ 5 points was defined as elevated depression or anxiety. High hs-CRP was defined as ≥ 3 mg/L. Follow-up was performed 2 years after the patients were discharged. The clinical results included noncardiac readmission, cardiac readmission, major cardiovascular events (MACEs), and composite events. The composite events included noncardiac readmission and MACEs. The Cox proportional hazard regression model was used to analyze the prognostic risk.

Results: After full adjustment, patients with elevated depression and high hs-CRP had a higher risk in predicting noncardiac readmission (hazard ratio (HR) = 3.87, 95% confidence interval (CI) = 1.10-9.02, p = 0.002) and composite events (HR = 1.93, 95% CI = 1.13-3.30, p = 0.016) than those with high hs-CRP alone. For the anxiety and hs-CRP group, high hs-CRP alone predicted a higher risk of noncardiac readmission (HR = 3.32, 95% CI = 1.57-7.03, p = 0.002) and composite events (HR = 1.75, 95% CI = 1.12-2.76, p = 0.015) than references. Elevated anxiety had no significant effects on all the endpoints. Furthermore, we didn't find interactions between depression and hs-CRP or anxiety and hs-CRP.

Conclusion: In patients with CHD, elevated depression with high hs-CRP was found to be significant in predicting the risk of noncardiac readmission and composite events. Early diagnosis and treatment of depression with inflammation are necessary in CHD patients.

背景:抑郁、焦虑和高敏C反应蛋白(hs-CRP)单独与冠心病(CHD)患者的不良预后有关。然而,抑郁与炎症或焦虑与炎症对预后的联合影响却鲜有研究:这项前瞻性队列研究纳入了 414 名确诊为冠心病的患者。患者健康问卷-9(PHQ-9)和广泛性焦虑症-7(GAD-7)用于评估抑郁和焦虑。得分≥5分定义为抑郁或焦虑升高。hs-CRP 高定义为≥ 3 mg/L。患者出院两年后进行随访。临床结果包括非心脏病再入院、心脏病再入院、重大心血管事件(MACE)和综合事件。综合事件包括非心脏再入院和 MACEs。采用 Cox 比例危险回归模型分析预后风险:经全面调整后,抑郁和高 hs-CRP 患者在预测非心脏病再入院(危险比 (HR) = 3.87,95% 置信区间 (CI) = 1.10-9.02,p = 0.002)和复合事件(HR = 1.93,95% CI = 1.13-3.30,p = 0.016)方面的风险高于单纯高 hs-CRP 患者。对于焦虑和高 hs-CRP 组,仅高 hs-CRP 预测的非心脏病再入院风险(HR = 3.32,95% CI = 1.57-7.03,p = 0.002)和复合事件风险(HR = 1.75,95% CI = 1.12-2.76,p = 0.015)高于参考值。焦虑升高对所有终点均无明显影响。此外,我们没有发现抑郁与hs-CRP或焦虑与hs-CRP之间存在相互作用:结论:在冠心病患者中,抑郁情绪升高和高 hs-CRP 在预测非心脏病再入院风险和复合事件方面具有重要意义。对于患有冠心病的患者,有必要对伴有炎症的抑郁症进行早期诊断和治疗。
{"title":"The combined effects of depression or anxiety with high-sensitivity C-reactive protein in predicting the prognosis of coronary heart disease patients.","authors":"Bingqing Bai, Han Yin, Haochen Wang, Fengyao Liu, Yanting Liang, Anbang Liu, Lan Guo, Huan Ma, Qingshan Geng","doi":"10.1186/s12888-024-06158-4","DOIUrl":"10.1186/s12888-024-06158-4","url":null,"abstract":"<p><strong>Background: </strong>Depression, anxiety and high-sensitivity C-reactive protein (hs-CRP) are individually associated with poor prognosis in patients with coronary heart disease (CHD). However, the combined effects of depression with inflammation or anxiety with inflammation on the prognosis have been rarely explored.</p><p><strong>Methods: </strong>This prospective cohort study included 414 patients diagnosed with CHD. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess depression and anxiety. A score ≥ 5 points was defined as elevated depression or anxiety. High hs-CRP was defined as ≥ 3 mg/L. Follow-up was performed 2 years after the patients were discharged. The clinical results included noncardiac readmission, cardiac readmission, major cardiovascular events (MACEs), and composite events. The composite events included noncardiac readmission and MACEs. The Cox proportional hazard regression model was used to analyze the prognostic risk.</p><p><strong>Results: </strong>After full adjustment, patients with elevated depression and high hs-CRP had a higher risk in predicting noncardiac readmission (hazard ratio (HR) = 3.87, 95% confidence interval (CI) = 1.10-9.02, p = 0.002) and composite events (HR = 1.93, 95% CI = 1.13-3.30, p = 0.016) than those with high hs-CRP alone. For the anxiety and hs-CRP group, high hs-CRP alone predicted a higher risk of noncardiac readmission (HR = 3.32, 95% CI = 1.57-7.03, p = 0.002) and composite events (HR = 1.75, 95% CI = 1.12-2.76, p = 0.015) than references. Elevated anxiety had no significant effects on all the endpoints. Furthermore, we didn't find interactions between depression and hs-CRP or anxiety and hs-CRP.</p><p><strong>Conclusion: </strong>In patients with CHD, elevated depression with high hs-CRP was found to be significant in predicting the risk of noncardiac readmission and composite events. Early diagnosis and treatment of depression with inflammation are necessary in CHD patients.</p>","PeriodicalId":9029,"journal":{"name":"BMC Psychiatry","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142494706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Early gesture development as a predictor of autism spectrum disorder in elevated-likelihood infants of ASD. 早期手势发育是自闭症谱系障碍高危婴儿的预测指标。
IF 3.4 2区 医学 Q2 PSYCHIATRY Pub Date : 2024-10-21 DOI: 10.1186/s12888-024-06173-5
Linru Liu, QianYing Ye, Yu Xing, Yanting Xu, HuiLin Zhu, Shaoli Lv, XiaoBing Zou, HongZhu Deng

Background: Gesture difficulties have been reported in later-born siblings of children with autism spectrum disorder (ASD). Careful observation of gesture development during the first two years of children at elevated likelihood (EL) of developing ASD may identify behavioral indicators that facilitate early diagnosis.

Methods: This study enrolled 47 EL infants and 27 low-likelihood (LL) infants to explore gesture developmental trajectories and the predictive value of gesture to expedite the early detection of core characteristics of ASD. Gesture frequency, communication function, and integration ability were observed and coded from a semi-structured assessment administered longitudinally across 9-19 months of age. We conducted the Autism Diagnostic Observation Schedule assessment at 18-19 months for ASD's core characteristics.

Results: The development of joint attention (JA) gestures was slower in the EL than in the LL group. The trajectories of the two groups began to diverge at 14-18 months. Children who reached the diagnostic cutoff point for ASD showed reductions in social interaction gestures at 12-13 months, in gestures integrated with any two communication skills (G-M) at 15-16 months; and in gestures integrated with eye contact (G-E) at 18-19 months. Overall gesture and G-M integration were associated with an overall ADOS communication and social interaction score.

Conclusions: The developmental trajectories of JA gestures of EL and LL children differed. G-M gestures represent early indicators that may be a predictor of ASD.

背景:据报道,自闭症谱系障碍(ASD)患儿的晚期兄弟姐妹存在手势障碍。仔细观察自闭症谱系障碍(ASD)患病可能性较高(EL)的儿童头两年的手势发育情况,可以发现有助于早期诊断的行为指标:本研究招募了47名EL婴儿和27名低可能性(LL)婴儿,以探索手势的发展轨迹以及手势的预测价值,从而加速早期发现ASD的核心特征。我们通过对 9-19 个月大的婴儿进行纵向半结构式评估,对其手势频率、交流功能和整合能力进行了观察和编码。我们在儿童18-19个月时进行了自闭症诊断观察表评估,以了解自闭症的核心特征:联合注意(JA)手势在 EL 组的发展比在 LL 组慢。两组儿童的发展轨迹在 14-18 个月时开始出现分化。达到自闭症诊断临界点的儿童在12-13个月时社交互动手势有所减少,在15-16个月时与任何两种交流技能相结合的手势(G-M)有所减少,在18-19个月时与目光接触相结合的手势(G-E)有所减少。整体手势和G-M整合与ADOS沟通和社会互动总分相关:结论:英语语言学儿童和英语语言学儿童的 JA 手势发展轨迹不同。G-M手势代表了早期指标,可能是ASD的预测指标。
{"title":"Early gesture development as a predictor of autism spectrum disorder in elevated-likelihood infants of ASD.","authors":"Linru Liu, QianYing Ye, Yu Xing, Yanting Xu, HuiLin Zhu, Shaoli Lv, XiaoBing Zou, HongZhu Deng","doi":"10.1186/s12888-024-06173-5","DOIUrl":"10.1186/s12888-024-06173-5","url":null,"abstract":"<p><strong>Background: </strong>Gesture difficulties have been reported in later-born siblings of children with autism spectrum disorder (ASD). Careful observation of gesture development during the first two years of children at elevated likelihood (EL) of developing ASD may identify behavioral indicators that facilitate early diagnosis.</p><p><strong>Methods: </strong>This study enrolled 47 EL infants and 27 low-likelihood (LL) infants to explore gesture developmental trajectories and the predictive value of gesture to expedite the early detection of core characteristics of ASD. Gesture frequency, communication function, and integration ability were observed and coded from a semi-structured assessment administered longitudinally across 9-19 months of age. We conducted the Autism Diagnostic Observation Schedule assessment at 18-19 months for ASD's core characteristics.</p><p><strong>Results: </strong>The development of joint attention (JA) gestures was slower in the EL than in the LL group. The trajectories of the two groups began to diverge at 14-18 months. Children who reached the diagnostic cutoff point for ASD showed reductions in social interaction gestures at 12-13 months, in gestures integrated with any two communication skills (G-M) at 15-16 months; and in gestures integrated with eye contact (G-E) at 18-19 months. Overall gesture and G-M integration were associated with an overall ADOS communication and social interaction score.</p><p><strong>Conclusions: </strong>The developmental trajectories of JA gestures of EL and LL children differed. G-M gestures represent early indicators that may be a predictor of ASD.</p>","PeriodicalId":9029,"journal":{"name":"BMC Psychiatry","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11492737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142457431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A pre-post trial to examine biological mechanisms of the effects of time-restricted eating on symptoms and quality of life in bipolar disorder. 研究限时进食对躁郁症状和生活质量影响的生物机制的前后试验。
IF 3.4 2区 医学 Q2 PSYCHIATRY Pub Date : 2024-10-21 DOI: 10.1186/s12888-024-06157-5
Sheri L Johnson, Greg Murray, Emily N C Manoogian, Liam Mason, J D Allen, Michael Berk, Satchidananda Panda, Nandini A Rajgopal, Jake C Gibson, Carter D Bower, Eline F Berle, Keanan Joyner, Robert Villanueva, Erin E Michalak, Lance J Kriegsfeld

Background: The primary objective of this trial is to examine the mechanisms of time-restricted eating (TRE) as an adjunct to psychiatric care for people with bipolar disorder (BD) with sleep or circadian disruptions. This study builds on prior studies of circadian disruption in BD as well as growing evidence that TRE improves circadian functioning.

Methods: One-hundred fifty participants diagnosed with BD 1 or II will be recruited via advertising in the local community. Main inclusion criteria include: obtaining medical treatment for BD; current sleep or circadian problems; self-reported eating period of ≥ 12 h; no eating disorder or other health conditions that would hinder or limit the safety of following TRE; and not currently experiencing a mood episode, acute suicidality, psychosis, alcohol or substance use disorder. Participants will be asked to complete a baseline period in which daily food intake is logged online for two weeks. After baseline, participants will be asked to follow TRE for 8 weeks and to continue to complete daily food logging during this time. Symptom severity interviews will be conducted by phone or videoconference at baseline, mid-intervention (6 weeks post-baseline), end of intervention (10 weeks post-baseline), and 6 months post-baseline. Self-rated symptom severity and quality of life data will be gathered online at the same time points as symptom severity interviews, and at 16 weeks post-baseline (6 weeks after the TRE period ends). To assess potential mechanisms of change, we will examine the change in diurnal amplitude of 'clock' gene expression as a primary mediator at 8 weeks compared to baseline. We will further test whether diurnal amplitude of clock gene expression is predictive above and beyond the role of two covariate potential mediators, glucose tolerance and inflammation at 8 weeks relative to baseline. To provide an index of whether TRE successfully decreases emotional lability, participants will be asked to complete 5 mood assessments per day for 7 days at baseline and at 10 weeks. These mood assessments will be optional.

Discussion: The planned research will provide novel and important information on whether TRE improves sleep/circadian rhythm problems, along with reductions in mood symptoms and improvements in quality of life, for individuals with BD.

Trial registration: ClinicalTrials.gov ID: NCT06555406.

背景:本试验的主要目的是研究限时进食(TRE)的机制,作为对睡眠或昼夜节律紊乱的双相情感障碍(BD)患者进行精神治疗的辅助手段。这项研究建立在之前对昼夜节律紊乱的研究以及越来越多的证据表明 TRE 可以改善昼夜节律功能的基础之上:将通过在当地社区发布广告的方式招募 150 名被诊断为 BD 1 或 II 的参与者。主要纳入标准包括:正在接受 BD 治疗;目前存在睡眠或昼夜节律问题;自我报告的进食时间≥ 12 小时;没有进食障碍或其他会妨碍或限制 TRE 安全性的健康状况;目前没有情绪发作、急性自杀、精神病、酒精或药物使用障碍。参与者将被要求完成为期两周的基线期,在此期间,每天的食物摄入量都将被在线记录。基线期结束后,参与者将被要求跟踪 TRE 8 周,并在此期间继续完成每日食物记录。在基线期、干预中期(基线期后 6 周)、干预末期(基线期后 10 周)和基线期后 6 个月时,将通过电话或视频会议进行症状严重程度访谈。在症状严重程度访谈的同一时间点以及基线后 16 周(TRE 期结束后 6 周),将在线收集症状严重程度和生活质量的自评数据。为了评估潜在的变化机制,我们将检测 "时钟 "基因表达的昼夜振幅变化,作为8周后与基线相比的主要介导因素。我们还将进一步检测时钟基因表达的昼夜振幅在 8 周后相对于基线时的预测作用是否超过了葡萄糖耐量和炎症这两个协变量潜在介质的作用。为了提供 TRE 是否成功降低情绪不稳定性的指标,我们将要求参与者在基线期和 10 周后的 7 天内每天完成 5 次情绪评估。这些情绪评估是可选的:讨论:计划中的研究将提供新颖而重要的信息,说明 TRE 是否能改善 BD 患者的睡眠/昼夜节律问题,同时减轻情绪症状并提高生活质量:试验注册:ClinicalTrials.gov ID:试验注册:ClinicalTrials.gov ID:NCT06555406。
{"title":"A pre-post trial to examine biological mechanisms of the effects of time-restricted eating on symptoms and quality of life in bipolar disorder.","authors":"Sheri L Johnson, Greg Murray, Emily N C Manoogian, Liam Mason, J D Allen, Michael Berk, Satchidananda Panda, Nandini A Rajgopal, Jake C Gibson, Carter D Bower, Eline F Berle, Keanan Joyner, Robert Villanueva, Erin E Michalak, Lance J Kriegsfeld","doi":"10.1186/s12888-024-06157-5","DOIUrl":"10.1186/s12888-024-06157-5","url":null,"abstract":"<p><strong>Background: </strong>The primary objective of this trial is to examine the mechanisms of time-restricted eating (TRE) as an adjunct to psychiatric care for people with bipolar disorder (BD) with sleep or circadian disruptions. This study builds on prior studies of circadian disruption in BD as well as growing evidence that TRE improves circadian functioning.</p><p><strong>Methods: </strong>One-hundred fifty participants diagnosed with BD 1 or II will be recruited via advertising in the local community. Main inclusion criteria include: obtaining medical treatment for BD; current sleep or circadian problems; self-reported eating period of ≥ 12 h; no eating disorder or other health conditions that would hinder or limit the safety of following TRE; and not currently experiencing a mood episode, acute suicidality, psychosis, alcohol or substance use disorder. Participants will be asked to complete a baseline period in which daily food intake is logged online for two weeks. After baseline, participants will be asked to follow TRE for 8 weeks and to continue to complete daily food logging during this time. Symptom severity interviews will be conducted by phone or videoconference at baseline, mid-intervention (6 weeks post-baseline), end of intervention (10 weeks post-baseline), and 6 months post-baseline. Self-rated symptom severity and quality of life data will be gathered online at the same time points as symptom severity interviews, and at 16 weeks post-baseline (6 weeks after the TRE period ends). To assess potential mechanisms of change, we will examine the change in diurnal amplitude of 'clock' gene expression as a primary mediator at 8 weeks compared to baseline. We will further test whether diurnal amplitude of clock gene expression is predictive above and beyond the role of two covariate potential mediators, glucose tolerance and inflammation at 8 weeks relative to baseline. To provide an index of whether TRE successfully decreases emotional lability, participants will be asked to complete 5 mood assessments per day for 7 days at baseline and at 10 weeks. These mood assessments will be optional.</p><p><strong>Discussion: </strong>The planned research will provide novel and important information on whether TRE improves sleep/circadian rhythm problems, along with reductions in mood symptoms and improvements in quality of life, for individuals with BD.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov ID: NCT06555406.</p>","PeriodicalId":9029,"journal":{"name":"BMC Psychiatry","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11492775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142457427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Nourishing the mind: how the EAT-Lancet reference diet (ELD) and MIND diet impact stress, anxiety, and depression. 滋养心灵:EAT-Lancet 参考饮食(ELD)和 MIND 饮食如何影响压力、焦虑和抑郁。
IF 3.4 2区 医学 Q2 PSYCHIATRY Pub Date : 2024-10-19 DOI: 10.1186/s12888-024-06165-5
Farzam Kamrani, Amirhossein Ataei Kachouei, Seyyed Reza Sobhani, Maryam Khosravi

Background: Previous studies have suggested a link between diet and mental health. However, there is a lack of evidence regarding the association between emerging diets such as the EAT-Lancet reference diet (ELD) and the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet, and mental health in different societies. This study aimed to determine the association between adherence to ELD and MIND diets and the risk of depression, anxiety, and stress.

Methods: This research involved 4579 participants from the PERSIAN Organizational Cohort Study in Mashhad (POCM). To assess dietary intake, a comprehensive 118-item semi-quantitative food frequency questionnaire (FFQ) was employed. The Planetary Health Diet Index (PHDI) was used to assess adherence to the ELD. Mental health status was evaluated using the Depression, Anxiety, and Stress Scale-21 items (DASS-21) questionnaire. Binary logistic regression was utilized to examine the relationship between these scores and mental health indicators.

Results: In the adjusted model, the highest quartile of PHDI showed a 35% reduced risk of depression compared to those in the lowest quartile (OR: 0.653, 95% CI: 0.483-0.883; P = 0.008). However, compared to the reference quartile, participants in the highest quartile of MIND diet exhibited significantly lower risks of depression (OR: 0.611, 95% CI: 0.447-0.836; P = 0.005), anxiety (OR: 0.559, 95% CI: 0.418-0.746; P < 0.001), and stress (OR: 0.629, 95% CI: 0.419-0.944; P = 0.008).

Conclusions: The ELD and MIND diet were both associated with reduced odds of depression. Additionally, MIND diet was associated with decreased likelihood of anxiety and stress. However, no connection was observed between ELD and anxiety or stress. Further large-scale interventions are required to confirm these findings.

背景:以往的研究表明,饮食与心理健康之间存在联系。然而,关于新兴饮食(如 EAT-Lancet 参考饮食(ELD)和地中海-DASH 神经退行性延迟干预饮食(MIND))与不同社会的心理健康之间的关系,还缺乏证据。本研究旨在确定坚持 ELD 和 MIND 饮食与抑郁、焦虑和压力风险之间的关系:这项研究涉及马什哈德 PERSIAN 组织队列研究(POCM)的 4579 名参与者。为了评估膳食摄入量,采用了 118 项半定量食物频率调查问卷(FFQ)。行星健康饮食指数(PHDI)用于评估ELD的坚持情况。心理健康状况采用抑郁、焦虑和压力量表-21项(DASS-21)问卷进行评估。采用二元逻辑回归法研究这些分数与心理健康指标之间的关系:在调整模型中,与最低四分位数的人相比,PHDI 最高四分位数的人患抑郁症的风险降低了 35%(OR:0.653,95% CI:0.483-0.883;P = 0.008)。然而,与参照四分位数相比,MIND饮食最高四分位数的参与者患抑郁症(OR:0.611,95% CI:0.447-0.836;P = 0.005)和焦虑症(OR:0.559,95% CI:0.418-0.746;P 结论:ELD和MIND饮食对抑郁症和焦虑症的风险显著降低:ELD和MIND饮食都与抑郁几率的降低有关。此外,MIND 饮食与焦虑和压力的可能性降低有关。然而,ELD与焦虑或压力之间没有关联。要证实这些发现,还需要进一步的大规模干预措施。
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引用次数: 0
Cross-sectional study about suicide ideation and attempts among Brazilian pre-adolescents. 关于巴西青少年自杀意念和企图的横断面研究。
IF 3.4 2区 医学 Q2 PSYCHIATRY Pub Date : 2024-10-18 DOI: 10.1186/s12888-024-06153-9
Cosme Marcelo Furtado Passos da Silva, Simone Gonçalves de Assis, Joviana Quintes Avanci

Background: Suicide is a global public health problem. In childhood, the risk factors are less clear, highlighting family and individual factors. This study aims to investigate the prevalence and sociodemographic, social, family, and individual factors associated with suicide ideation and attempts in pre-adolescents in a Brazilian city.

Methods: The sample comes from a cohort of 500 schoolchildren of a city in Rio de Janeiro/Brazil. The data are analyzed cross-sectionally. The research incorporated data from the years 2005, 2006, and 2008 to evaluate suicide ideation and attempts in childhood, as reported by parents/caregivers, teachers and children. A hierarchical logistic model evaluated the association between the explanatory variables related to sociodemographic, social, family, and individual factors and the outcome.

Results: 22.2% of the children (95% CI 18.0%-27.0%) had suicide ideation/attempts, reported either by their mothers, teachers, or the child at some point in a cohort. The following variables were associated with suicidal ideation/attempts in the final adjusted model: regular or poor quality of relationship with friends (OR = 1.84; 95% CI 1.31-2.58), having a family member incarcerated (OR = 1.44; 95% CI 1.07-1.92) and having worse performance in portuguese or mathematics than other students (OR = 2.05; 95% CI 1.29-3.26).

Conclusion: Suicidal behavior in childhood is severe and affects everyone around the case, demanding to promote friendships, helping with school activities, and providing greater support and attention to children at risk. Bad relationships with friends and incarcerated family members are particularly key risk factors for suicide ideation and attempts. It is essential to improve prevention policies and to disseminate protective behaviors. There is a critical need to augment community mental health resources, mainly in less developed countries and regions that lack these services.

背景:自杀是一个全球性的公共健康问题。在儿童时期,自杀的风险因素并不明确,主要是家庭和个人因素。本研究旨在调查巴西某城市青少年自杀倾向和自杀未遂的发生率,以及与之相关的社会人口、社会、家庭和个人因素:样本来自巴西里约热内卢某市的 500 名学龄前儿童。数据采用横截面分析。研究纳入了 2005 年、2006 年和 2008 年的数据,以评估父母/监护人、教师和儿童报告的儿童期自杀意念和企图。分层逻辑模型评估了与社会人口、社会、家庭和个人因素相关的解释变量与结果之间的关联。结果:22.2%的儿童(95% CI 18.0%-27.0%)有自杀意念/企图,由其母亲、教师或儿童在队列中的某个时间点报告。在最终调整模型中,以下变量与自杀意念/自杀未遂相关:与朋友关系固定或关系质量差(OR = 1.84; 95% CI 1.31-2.58)、家庭成员被监禁(OR = 1.44; 95% CI 1.07-1.92)、葡萄牙语或数学成绩比其他学生差(OR = 2.05; 95% CI 1.29-3.26):儿童时期的自杀行为非常严重,会影响到案例周围的每一个人,因此需要增进友谊、帮助开展学校活动,并为高危儿童提供更多支持和关注。与朋友的不良关系和被监禁的家庭成员尤其是自杀意念和企图自杀的关键风险因素。改进预防政策和宣传保护行为至关重要。亟需增加社区心理健康资源,主要是在缺乏这些服务的欠发达国家和地区。
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引用次数: 0
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