BJPsych Open最新文献

Background: Memory deficits are among the key risk factors in mental health problems, and are associated with dysfunctional cognitive factors.

Aims: The present study explored the relations between dysfunctional attitudes, rumination and mind-wandering, and emotional and non-emotional memory, respectively, aiming to inform the mechanism underlying the negative association of these cognitive factors with memory.

Method: A total of 123 undergraduate university students completed self-report measurements, including Dysfunctional Attitude Scale Form A, Rumination Responses Scale, Mind Wandering Frequency Scale and the Center for Epidemiological Studies Depression Scale. Additionally, they were invited to participate in an experiment consisting of two tasks (n = 111 completed the task for emotional memory and n = 110 for non-emotional memory). Pearson correlation analysis and a linear regression model examined the relationship between cognitive factors and memory performance.

Results: Based on correlational analyses, rumination, dysfunctional attitudes and depression are negatively correlated with the accuracy of negative emotional face memory (emotional memory, all P<0.05). The regression models suggest that dysfunctional attitude significantly predicts the accuracy of negative face memory (β = -0.205, P = 0.037). Digit memory accuracy (non-emotional memory) was associated with rumination and mind-wandering (all P<0.05), in which rumination was the significant predictor of accuracy (β = -0.231, P = 0.021).

Conclusions: The study indicated that dysfunctional attitudes are related mostly to negative emotional memories, and that rumination is mostly associated with non-emotional memories. Dysfunctional attitude and rumination represent potential treatment targets for emotional and non-emotional memory deficits, respectively, related to psychopathology.

Background: Dissociative identity disorder (DID) manifests with distinct trauma-avoidant and trauma-related identity states. Overtly conscious trauma-related knowledge processing is identity state-dependent. Previous research on covertly subconscious knowledge processing in DID lacks subject-specific trauma-related stimuli.

Aims: Our controlled functional magnetic resonance imaging (fMRI) study explored neural and behavioural differences of overt and covert knowledge processing of individualised self-relevant words in DID.

Method: Behavioural data were gathered while 56 participants underwent task-based fMRI: 14 with DID, 14 DID simulators and a paired control group of 14 healthy controls and 14 participants with post-traumatic stress disorder. Individuals with DID and simulators participated in a trauma-avoidant and a trauma-related identity state. Reaction times and brain activation following overtly and covertly presented individualised words were statistically analysed.

Results: Behavioural analyses showed a main effect of consciousness (P < 0.001). Post hoc between-group pairwise comparisons revealed slower reaction times for individuals with DID compared with simulating (P < 0.05) and paired controls (P < 0.05). Neural data analyses showed increased brain activation in frontal and parietal regions within the diagnosed DID group, especially during overt processing. Between-group comparisons mostly showed less pronounced activation in frontal, occipital and temporal areas.

Conclusions: The present study showed increased cognitive control during overt self-relevant knowledge processing in the trauma-avoidant identity state of DID, in line with previous research. The slower reaction times and increased frontoparietal activation shown in individuals with diagnosed DID, as compared with both control groups, support the notion of cognitive avoidance of trauma-related information in DID and further reinforce the authenticity of DID experiences.

Background: The COVID-19 pandemic disrupted daily social interactions, potentially affecting mental health. Understanding the risk of depressive and anxiety symptoms is essential for guiding mental health strategies during future crises.

Aims: To explore how social networks influenced mental health outcomes during the pandemic and how these relationships changed over time.

Method: Data from the Omtanke2020 study, a prospective cohort study of Swedish adults, were analysed using structural equation modelling (N = 10 918). Surveys at baseline and follow-up at 6 and 12 months assessed social networks, including structural components (e.g. relationship status, frequency of social contact) and perceived components (e.g. emotional support from family, feeling safe at home). Cross-lagged panel modelling was used to observe changes over time in the associations between social network indicators and depressive and anxiety symptoms.

Results: Stronger perceived social support - specifically closeness to family, perceived warmth or love from others and increased societal cohesion - were negatively correlated with depressive and anxiety symptoms across all time points (β coefficients = -0.14 to -0.23, all P < 0.001). Social network variables consistently predicted mental health outcomes, with effect sizes remaining relatively stable over time (β coefficient = -0.17 at baseline, β coefficient = -0.21 at 1-year follow-up).

Conclusions: This study highlights the protective role of the social network - namely perceived social support - in combatting depressive and anxiety symptoms during the COVID-19 pandemic. Interventions that strengthen close interpersonal ties and community cohesion may help mitigate mental health impacts during future public health crises.

Background: The Maudsley 3-item visual analogue scale (M3VAS) was developed as a novel and intuitive patient-reported measure for depression, focusing on core symptoms and suicidality.

Aims: To evaluate the longitudinal validity of M3VAS for capturing symptom change over time.

Method: Both M3VAS and the Patient Health Questionnaire (PHQ-9, as reference standard) were administered in an observational study (RHAPSODY, no. NCT04939818) at weeks 0, 2 and 4 to both depressed patients (n = 50) and matched controls (n = 24). We serially tested factor structure, internal consistency and convergence (correlation) over time, assessing responsiveness by both correlation of change in score and effect of time across scales (analysis of variance and effect size).

Results: M3VAS exhibited strong factor loadings and high item interrelatedness (Cronbach's alpha 0.78-0.83) at all time points. Total scores correlated strongly with PHQ-9 at each time point (r > 0.8, P < 0.001). Correlation of score change over the study period (r = 0.65, P < 0.001) also confirmed responsiveness. In the depressed group, an effect of time on score was seen for both M3VAS (F = 4.942, P = 0.010) and PHQ-9 (F = 12.505, P < 0.001), with standard response mean (Cohen's d) of 0.58 and 0.74, respectively. No effect of time was seen in the control group.

Conclusions: Following previous cross-sectional validation against the Quick Inventory of Depressive Symptomatology-Self-report, this present study demonstrated appropriate longitudinal measurement properties for M3VAS as a measure of depression, including responsiveness. Evaluating the ability of M3VAS to discern responses with a variety of treatments is a key future goal.

Background: Research on gender-based violence has shown the influence of Dark Tetrad personality traits (i.e. Machiavellianism, narcissism, psychopathy and sadism) on the development and perpetuation of sexist attitudes and cognitions that justify or condone harmful behaviours.

Aims: This study explored the potential mediating role of empathy in the relationship between the Dark Tetrad personality traits and support for vindictive rape, as a form of revenge for the perceived violation of traditional sexual norms.

Method: A sample of 1548 adult individuals from the general community (67.3% female, age range 18-83 years) completed the Dark Triad Dirty Dozen, the Short Sadistic Impulse Scale, the Basic Empathy Scale and the Vindictive Rape Attitude Questionnaire.

Results: The results showed that empathy partially mediated the relationship between sadism and attitudes supportive of vindictive rape, while a full mediation of empathy was found in the association between Machiavellianism, psychopathy and attitudes supportive of vindictive rape. Conversely, no significant association between empathy or vindictive rape and narcissism was observed.

Conclusions: Empathy plays an important role in mitigating the effects of Dark Tetrad personality traits on support for vindictive rape. Given the global prevalence of violence against women, these findings are discussed in the context of a social climate that may reinforce the perpetuation of gender inequalities and sex-based stereotypes that are at the root of the acceptance of violence.

Background: Studies have consistently found that up to 20% of people with anorexia nervosa experience a persistent illness, resulting in considerable psychosocial impairment, morbidity and mortality. This has been variously termed severe and enduring anorexia nervosa or longstanding anorexia nervosa (L-AN). Conflicting findings have hindered progress in distinguishing the nosological features of individuals with persistent illness.

Aims: This study aims to investigate the putative defining features of individuals reporting symptoms of L-AN, including consideration of their treatment trajectory.

Method: This cross-sectional study, drawing from a mixed-methods design, utilised a sample of symptomatic individuals who reported experiencing eating disorder treatment (n = 208). Several qualitative and quantitative data strands (a-c) were embedded within a single, self-report questionnaire measuring eating disorder severity and treatment experiences. Between-group comparisons were used to compare those of shorter (<3 years) and longer (>7 years) duration of illness.

Results: No between-group differences were found in measures of severity, including body mass index (kg/m²), eating disorder symptom scores, psychological distress or perceived health-related quality of life. However, those with L-AN had a significantly higher number of mental and physical health comorbidities, longer treatment delay, greater number of episodes of treatment and poorer subjective ratings of their treatment experiences.

Conclusions: Delineating L-AN by severity may be inappropriate; anorexia nervosa of any duration is a severe illness. This study suggests that treatments, or lack thereof, may have an inadvertent impact on duration of illness. Future focus needs to be on reconceptualising L-AN and its treatments. Treatment refinements informed by lived experience are proposed.

Background: An increasing number of children and adolescents are prescribed second-generation antipsychotic medications, which may lead to cardiometabolic or other physical health impairments. It is unknown whether lifestyle interventions can prevent or manage these adverse effects.

Aims: To evaluate the effectiveness of lifestyle interventions for preventing or managing cardiometabolic risks and other adverse physical health outcomes in this population.

Method: Four bibliographic databases were searched up to February 2024. Randomised controlled trials reporting a physical health outcome of children or adolescents (aged 6-17 years) taking antipsychotics and participating in a lifestyle intervention compared with treatment as usual (TAU) were eligible for inclusion. The Cochrane Risk of Bias 2 tool was used to assess risk of bias. Data were synthesised via a random-effects meta-analysis and narrative synthesis.

Results: Four studies with a total of 370 participants were included. Most (75%) had a high risk of bias. Lifestyle interventions resulted in moderate but statistically non-significant reductions in participants' body mass index (standard mean difference -0.70, 95% CI: -1.70 to 0.31) compared with TAU. Some studies reported improvements in other physical health outcomes favouring the intervention, although findings were inconsistent and varied across different measures. Reporting of secondary indicators of physical health, including participant or family health behaviours, was limited.

Conclusions: The effectiveness of lifestyle interventions for preventing or managing the cardiometabolic risk and other adverse physical health outcomes in this population is unclear due to the limited number of available trials, small samples and high risk of bias. Larger trials are needed.

Background: Subjective perspectives on aetiological factors in atypical depression have not been previously explored from the viewpoint of those with lived experience.

Aims: This study aimed to explore individuals' subjective experiences and explanations of atypical depression, and to examine whether perceived gender-specific influences might contribute to the observed gender disparity in atypical depression prevalence.

Method: Semi-structured, one-to-one interviews were conducted online with 16 individuals. Data were analysed using thematic analysis, employing an inductive approach and interpreted within a constructionist framework. Data coding was conducted using NVivo.

Results: Key themes centred on the prevalence of comorbid conditions and how they affected atypical depression presentation; how trauma was seen as both a causal factor and catalyst; the subjective impact of gender identity and roles; how environmental factors seemed to affect atypical depression onset and presentation; the difficulties experienced with atypical depression symptom variability in daily life; and reported coping behaviours.

Conclusions: These findings highlight how individuals with atypical depression believed onset to be linked to experiences of trauma and comorbidity, in addition to ongoing influences of varied environmental factors. The variability of atypical depression symptoms in both the short and long term appears to be a core challenge in this subgroup. The gender disparity of atypical depression is also explored through the lens of lived experience and gender identity. Future research would benefit from exploring further these potential contributing factors, to provide a better understanding of their complex influences on atypical depression onset and maintenance.

Background: Existing research demonstrates that insomnia is common, with significant negative impacts on health and quality of life. Cognitive-behavioural therapy for insomnia (CBT-I), the first-line treatment, is highly cost-effective. However, healthcare records have not been used in the UK to establish real-world insomnia prevalence, inequalities or unmet need.

Aims: This study's aim was to establish the above in North Central London.

Method: Data were extracted from primary care records across three London boroughs for 765 035 patients. Prevalence was determined by identifying those with a recent code for insomnia, insomnia treatment or sleeping tablet prescription.

Results: Insomnia prevalence was 4.3%. Prevalence increased steadily with age, and was highest for women (4.9%), those of Bangladeshi ethnicity (7.3%) and those in the most deprived quintile (5.2%). Prevalence was significantly higher in patients with comorbidities (including chronic obstructive pulmonary disease (17.5%), severe mental illness (16.6%) and depression (14.1%)). Only 1.7% of people with insomnia had been referred for CBT-I.

Conclusions: Findings suggested that insomnia is at least as common as illnesses receiving high levels of focus and resourcing in the UK, and that prevalence estimates were probably underestimates. Variation in prevalence by demographic factors and deprivation may represent health inequalities. Insomnia was particularly common among patients with certain comorbidities and of advancing age, indicating that those groups should be actively screened. Concerningly, referral rates for CBT-I were extremely low. This has important implications regarding population health management, commissioning and training. Prevalence and unmet need are likely to be high in many other areas and should be investigated locally.