BJPsych Open最新文献

Background: People with severe COVID anxiety have significant fears of contagion, physiological symptoms of anxiety in response to a COVID stimulus and employ often disproportionate safety behaviours at the expense of other life priorities.

Aims: To characterise the long-term trajectory of severe COVID anxiety, and the factors that influence recovery.

Method: This prospective cohort study followed 285 people with severe COVID anxiety in the UK over 18 months. A nested randomised feasibility trial tested an online cognitive-behavioural therapy (CBT)-based intervention (no. ISRCTN14973494). Descriptive statistics and linear regression models identified factors associated with change in COVID anxiety over 18 months.

Results: Most participants experienced major reductions in COVID anxiety over time (69.8% relative cohort mean decrease, P < 0.001), but a quarter of people (23.7%, 95% CI: 17.8-30.1) continued to worry about COVID every day, and for 13% symptoms remained severe even after the ending of all public health restrictions. Increasing age, being from a minority ethnic background that confers greater risk from COVID-19, and the persistence of high levels of health anxiety and depressive symptoms, predicted slower improvements in severe COVID anxiety after adjusting for other clinical and demographic factors. Neither a trial CBT-based intervention, nor contextual factors including daily case rates, vaccination status or having contracted COVID-19, appeared to affect the trajectory of severe COVID anxiety.

Conclusions: For most people severe COVID anxiety improves significantly with time. However, interventions treating depression and health anxiety, and targeting older people and those from greater-risk minority backgrounds, warrant further investigation in future pandemics.

Background: Psilocybin-assisted psychotherapy (PAP) has gained attention as a promising intervention for conditions including depression, anxiety and post-traumatic stress disorder, but understanding of its side-effects is limited. This review evaluates the quality of side-effects reporting in PAP trials, to guide treatment, policy and research.

Aims: To assess side-effects reporting quality in PAP trials for psychiatric conditions, comparing published articles and ClinicalTrials.gov records.

Method: A PROSPERO-registered review (no. CRD42023458960) included English-language PAP trials (2005-2024) identified via Embase, CENTRAL, PubMed and reference searches. Reporting quality was assessed using the CONSORT Harms extension, categorised as either high (17-21), moderate (12-16), low (7-11) or very low (0-6). Randomised controlled trials underwent risk of bias analysis, and descriptive statistics compared side-effects across sources.

Results: Twenty-four trials were included. Reporting quality was high in six studies, moderate in four, low in nine and very low in five. All randomised controlled trials (n = 9) showed high risk of bias for side-effects outcomes. Variability in reporting hindered comparisons between articles and ClinicalTrials.gov, underscoring the need for standardisation. Overall, there was no evidence of systematic underreporting of side-effects in published articles compared with trial registers.

Conclusions: Side-effects reporting in PAP trials is inconsistent but is improving over time. Existing evidence has a high risk of bias. Future trials should align with best-practice guidelines for side-effects reporting. Discussions with patients should prioritise findings from high-quality studies and emphasise the current uncertainty regarding PAP side-effects.

Background: Trends in the US and Australian suicide mortality have shifted over the last 100 years, with notable differences between age groups and genders.

Aims: This study compared overall and gender- and age-specific suicide rates from 1921 to 2020 in the USA and Australia to determine long-term variation for each country.

Method: Suicide data (1921-2020, inclusive) were obtained from the US Centers for Disease Control and Prevention and the Australian Institute of Health and Welfare. Poisson regression was used to assess whether suicide rates between groups were significantly different.

Results: Overall suicide rates were higher in the USA compared to Australia, from 1921 to the 1940s, but were similar from the 1950s onwards. While male suicide rates fluctuated, female suicide rates were relatively stable (except for Australian women in the 1960s). In the USA and Australia, suicide rates for young males have significantly increased since the 1950s, while they have decreased for the older male population since the 1940s.

Conclusions: While overall national suicide rates were relatively stable over 100 years apart from during war and economic depression, male suicide rates in the USA and Australia experienced significant age-related changes over the century. These include major declines in males aged over 65 years but also an increase in suicides for those aged between 15 and 44. Suicide rates across age groups have therefore converged, regressing towards the mean for all age groups combined.

Background: Understanding gender identity in transgender and gender-diverse (TGD) individuals is crucial for effective care. The Gender Preoccupation and Stability Questionnaire (GPSQ) measures the preoccupation and stability of gender identity, but no Italian validation is available.

Aims: This study aimed to translate, culturally adapt and validate the Italian version of the GPSQ in a clinical sample of TGD adults.

Method: The GPSQ was translated with a forward-backward method and completed by 151 TGD adults at a gender clinic. Participants also filled out the Symptom Checklist-58 and Body Uneasiness Test. We assessed structural validity (EFA), internal consistency, test-retest reliability, and examined known-groups and predictive validity.

Results: The EFA supported a four-factor structure - Gender Identity Instability, Cognitive-Affective Salience, Preoccupation, and Distress/Intervention-Oriented Reflection - with good fit (root mean square error of approximation 0.06; Comparative Fit Index 0.95; Tucker-Lewis Index 0.93; standard root mean square residual 0.04). The GPSQ showed solid internal consistency (α = 0.78; ω = 0.73) and excellent test-retest reliability (r = 0.98; intraclass correlation coefficient 0.98). Higher scores correlated with psychological distress (r = 0.55, p < 0.001) and body image concerns (r = 0.48, p < 0.001). Preoccupation was most linked to obsessive-compulsive symptoms, and Cognitive-Affective Salience to body image concerns. Participants not on hormones scored higher (p = 0.010, Cohen's d = 0.36).

Conclusions: The Italian GPSQ is a reliable and valid tool to assess gender-related preoccupation and identity instability in TGD individuals. Its multidimensional structure makes it useful in both clinical practice and research in the Italian context.

Background: Prolonged grief disorder (PGD) is a chronic, impairing state of intense grief that is responsive to specialised intervention. Online journalling has the potential to reduce PGD symptoms.

Aims: To assess whether reminiscence via online journalling facilitates bereavement adjustment - specifically, to identify key themes in online grief journals and examine associations between types of reminiscence and changes in PGD symptom severity.

Method: A cohort of 96 bereaved adults completed 7 days of online journalling on the Living Memory Home (LMH) bereavement website. Participants were recruited from clinics, bereavement support groups and a National Institutes of Health-funded, web-based platform. The Prolonged Grief Disorder-Revised scale (PG-13-R) was administered at baseline and at 1-week and 1-month follow-up.

Results: Descriptive analysis revealed a reduction in PG-13-R scores from baseline to 1-week follow-up (mean difference -3.7, 95% CI: -4.9, -2.5, P < 0.001) and 1-month follow-up (mean difference -5.0, 95% CI: -6.4, -3.7. P < 0.001). Mixed-methods analysis revealed significant negative associations between reflection on negative traits of the deceased and PG-13-R score at all three time points, and between reflection on past experiences with the deceased and PG-13-R score at baseline. Expression of regret and guilt was significantly associated with reduction in PG-13-R scores from 1-week to 1-month follow-up.

Conclusions: Engagement in the LMH website demonstrated significant declines in PGD symptom severity after 1 week of online journalling and at 1-month follow-up. Guided reflection on memories of the deceased, and even on negative or emotionally challenging memories, shows potential for reducing symptoms of PGD.

Background: Behaviours that challenge are highly prevalent in children with an intellectual disability and can be detrimental to their quality of life and opportunities.

Aims: The systematic review aimed to investigate the effectiveness of current interventions in reducing behaviours that challenge in children with an intellectual disability (≤18 years-old).

Method: We searched five databases (PsychINFO, MEDLINE, Embase, Web of Science and CINAHL) on 26 April 2022 and 1 July 2024, and identified 18 randomised controlled trials (1443 participants) eligible for inclusion since 2014 - 11 investigated non-pharmacological and 9 investigated pharmacological interventions. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool.

Results: Non-pharmacological interventions (mostly psychosocial) were significantly effective (Hedges' g = -0.20; 95% CI [-0.35, -0.05]), whereas pharmacological interventions (including a wide range of drug classes and substances) were not (g = 0.03; 95% CI [-0.17, 0.24]). Studies using the Child Behaviour Checklist reported significant reductions (g = -0.18; 95% CI [-0.34, -0.02]), whereas studies using the Aberrant Behaviour Checklist did not (g = 0.04; 95% CI [-0.16, 0.25]). A random-effects meta-analysis indicated no overall significant reduction in behaviours that challenge (g = -0.12; 95% CI [-0.24, 0.00]).

Conclusions: It is important to note that most studies included were conducted in Western countries and had small sample sizes, and findings may be due to the outcome measures used. Findings support current recommendations that non-pharmacological interventions should be first-line treatment for behaviours that challenge in this population. Evidence highlighted the need for better quality, adequately powered randomised controlled trials.

Background: Withania somnifera (WS) is considered an adaptogen agent with reported antistress, cognition facilitating and anti-inflammatory properties, which may be beneficial in the treatment of mental disorders.

Aims: This systematic review investigated the efficacy and tolerability of Withania somnifera for mental health symptoms in individuals with mental disorders.

Method: The protocol of this review was registered with PROSPERO (CRD42023467959). PubMed, Scopus, PsycINFO, CINAHL, Embase and CENTRAL were searched for randomised controlled trials comparing Withania somnifera to any comparator, in people of any age, with any mental disorder. The meta-analyses were based on standardised mean differences (SMDs) and odds ratios with 95% confidence intervals, estimated through frequentist and Bayesian-hierarchical models with random-effects.

Results: Fourteen studies, corresponding to 360 people treated with Withania somnifera and 353 controls were included. Anxiety disorders were the predominant diagnostic category. Thirteen trials administered Withania somnifera orally (median dose 600 mg/day), one with Shirodhara therapy. The median follow-up time was 8 weeks. Although limited by the small number of studies, substantial between-study heterogeneity, and outlier effects, our investigation showed Withania somnifera effectiveness in improving anxiety (outlier-corrected SMD: -1.13 (95% CI: -1.65; -0.60), pooled SMD: -1.962 (95% CI: -2.66; -0.57)), depression (SMD: -1.28 (95% CI: -2.40; -0.16) and stress (SMD: -0.95 (95% CI: -1.46; -0.43) symptoms and sleep quality (SMD: -1.35 (95% CI: -1.79; -0.91). The effect size was confirmed using the Bayesian for anxiety but not for depression. No significant difference between Withania somnifera and the comparators was found for safety and tolerability.

Conclusions: We found evidence supporting the effectiveness of Withania somnifera in treating anxiety symptoms. Future trials should replicate this finding in larger samples and further clarify a possible Withania somnifera role in depression and insomnia treatment.

Background: Attention deficit hyperactivity disorder (ADHD) is often associated with psychosocial functioning difficulties and valid measures of disability are needed for this population. The 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is widely used to measure disability but has not been validated in the adult ADHD population.

Aims: This study aims to assess the psychometric properties of the WHODAS 2.0 in adults with ADHD, and to examine differences in disability levels between ADHD subtypes and gender.

Method: A cross-sectional study was conducted with 577 adults with ADHD (mean age: 38.24, s.d = 12.23; 52.3% male). ADHD severity was assessed using the ADHD Rating Scale (ADHD-RS) and Clinical Global Impression-Severity (CGI-S) Scale, while functionality was measured with the WHODAS 2.0 and the Functioning Assessment Short Test (FAST). Analyses included: (a) Cronbach's α for internal consistency, (b) Pearson's correlation for convergent validity, (c) Confirmatory Factor Analysis (CFA) for factor structure and (d) t-tests to compare disability levels across ADHD subtypes and gender.

Results: The WHODAS 2.0 demonstrated good internal consistency (Cronbach's α = 0.89). Scores were significantly correlated with psychosocial functioning (FAST, r = 0.476, p < 0.001) and clinical measures. CFA supported the original six-factor structure (root mean square error of approximation 0.039, Comparative Fit Index 0.998, Tucker-Lewis Index 0.996). When comparing ADHD subtypes, participants with the combined subtype had higher WHODAS 2.0 total scores than those with the inattentive subtype (p = 0.006). Additionally, gender differences were identified, with females displaying higher disability levels (p = 0.005).

Conclusions: The WHODAS 2.0 demonstrates psychometric properties that suggest it is a valid and reliable tool for assessing disability in adults with ADHD.

Background: Financial strain is increasingly recognised as a contributor to psychological distress, which may in turn elevate the risk of developing mental disorder. However, few large-scale longitudinal studies have investigated its predictive role using diagnostic outcomes among higher education students.

Aims: To examine whether financial strain predicts a major depressive episode (MDE) one year later among Norwegian students, and whether associations are explained by sociodemographic factors or baseline psychological distress.

Method: Data were drawn from the national Students' Health and Wellbeing Study 2022 (SHoT2022) survey (N = 53 362), with a diagnostic follow-up one year later (N = 10 460) using the self-administered Composite International Diagnostic Interview version 5.0 (CIDI 5.0). Inverse probability weighted Poisson regression with robust standard errors estimated the risk of 30-day DSM-5-defined MDE for each financial indicator.

Results: Financial strain was widespread: 6% reported frequent financial difficulties, 27% were unable to cover an emergency expense of 5000 Norwegian kroner (NOK; approximately €450/$500, and 35% spent 60% or more of their income on housing. Several indicators significantly predicted later MDE. Students frequently experiencing financial difficulties had a 3.55-fold increased risk (95% CI:2.97-4.22), attenuating to 1.53 (1.28-1.83) after full adjustment. Similar patterns emerged for most indicators. Associations were largely unaffected by sociodemographic adjustment, but were substantially reduced after accounting for baseline psychological distress.

Conclusions: Financial strain was associated with increased risk of MDE one year later, although much of the association was explained by baseline distress. Policies should address both financial and psychological vulnerabilities through strengthened financial support, alignment with living costs and targeted measures such as financial counselling and housing assistance.