Journal Of Affective Disorders[JOURNAL]
Sun
200 papers
Prospective association between long COVID and COVID-related post-traumatic stress disorder among a population-based cohort of adults diagnosed with COVID-19 in Michigan.
Patel A, Ryu S, Whittington B … +5 more , Chyu C, Chrzanowski E, Ahmed S, Slocum E, Fleischer NL
J Affect Disord · 2026 Oct · PMID 42167698 · Publisher ↗
OBJECTIVE: To better understand the mental health impacts of Long COVID, we examine the prospective association between Long COVID and risk of COVID-related post-traumatic stress disorder (PTSD) symptoms. METHODS: We use...
OBJECTIVE: To better understand the mental health impacts of Long COVID, we examine the prospective association between Long COVID and risk of COVID-related post-traumatic stress disorder (PTSD) symptoms. METHODS: We used baseline and follow-up data from the Michigan COVID-19 Recovery Surveillance Study, a population-based study of adults diagnosed with polymerase chain reaction-confirmed COVID-19 between March 2020 and May 2022 in Michigan (n = 3492). Baseline data were collected a median of 4.4 months (interquartile range (IQR): 3.4-5.7 months) and follow-up data were collected a median of 18.4 months (IQR: 15.0-21.3 months) after initial COVID-19 onset. We defined Long COVID at baseline as having not recovered to usual state of health 90 days or more after initial COVID-19 onset and having COVID-related PTSD symptoms at follow-up based on a six-item version of the PTSD Checklist for Civilians anchored to each individual's COVID-19 diagnosis. We ran modified Poisson regression models adjusting for sociodemographic characteristics, pre-existing comorbidities, COVID-19 illness severity, survey mode, and phase of the pandemic when diagnosed with COVID-19. RESULTS: At baseline, 17.0% of adults diagnosed with COVID-19 had Long COVID, and 10.1% of adults reported COVID-related PTSD symptoms at follow-up. In the fully adjusted model, the risk of COVID-related PTSD symptoms was 2.08 times higher (95% confidence interval: 1.65-2.63) among adults with Long COVID than among adults without Long COVID. CONCLUSION: Long COVID is prospectively associated with a higher risk of COVID-related PTSD symptoms suggesting a need to strengthen mental health screening, monitoring, and interventions among adults with this condition.
Lower resting state functional connectivity between the hippocampus and default network is associated with suicidal ideation.
Bergmann E, Miller JM, Sublette ME … +3 more , Burke A, Mann JJ, Lan MJ
J Affect Disord · 2026 Oct · PMID 42167697 · Full text
Suicidal ideation (SI) is a clinical risk factor for suicidal behavior. Elucidating the neural mechanism underlying SI may lay the groundwork for future methods for its assessment. Our group previously showed that SI is...
Suicidal ideation (SI) is a clinical risk factor for suicidal behavior. Elucidating the neural mechanism underlying SI may lay the groundwork for future methods for its assessment. Our group previously showed that SI is associated with altered resting hippocampal activity, as measured using functional magnetic resonance imaging Amplitude of Low Frequency Fluctuations (ALFF). However, the role of hippocampal functional connectivity (FC) in SI has not been fully characterized. Here, we compared resting-state FC data in unmedicated adult participants experiencing a major depressive episode and SI compared with those without SI. The previously identified hippocampal region of higher ALFF in individuals with SI was used as a seed region of interest (ROI), and we examined its whole-brain functional connectivity pattern. Across the entire sample, the hippocampal ROI connectivity pattern had a spatial distribution consistent with the Default Network (DN). FC from the hippocampal ROI to DN was lower in participants with SI (n = 24) compared with those without SI (n = 10), suggesting reduced coupling with DN. Intra-network FC between all the DN regions was not significantly associated with SI, suggesting a more specific association with hippocampus connectivity. The FC result was examined in a larger, publicly available dataset, REST-MDD. FC of the right hippocampus to DN was lower in participants with SI (n = 158) compared with those without SI (n = 60), demonstrating a cross-dataset convergence. These results indicate that hippocampal resting connectivity is associated with the presence of SI. Future studies using longitudinal designs should examine how changes in clinical status influence this FC pattern.
Patterns and treatment of sexual dysfunction in major depressive disorder: A cohort and case-control study in Sweden.
Isung J, Karlsson P, Tankaya O … +3 more , Johansson V, Gembert K, Reutfors J
J Affect Disord · 2026 Oct · PMID 42167696 · Publisher ↗
BACKGROUND: Sexual dysfunction (SD) is a consequence of major depressive disorder (MDD) and a common adverse effect of antidepressants. However, population-level evidence on SD in MDD remains limited. OBJECTIVE: To exami...
BACKGROUND: Sexual dysfunction (SD) is a consequence of major depressive disorder (MDD) and a common adverse effect of antidepressants. However, population-level evidence on SD in MDD remains limited. OBJECTIVE: To examine the incidence, prevalence, and predictors of SD among individuals with MDD. METHODS: We conducted a nationwide Swedish cohort study (2006-2014) of 169,430 adults (18-65 years) with incident MDD. SD was identified via diagnoses and prescriptions for erectile dysfunction medications (predominantly PDE5 inhibitors). We estimated 3-year incidence and prevalence pre- and post-diagnosis. A nested case-control analysis among men assessed associations between SD, antidepressants, and clinical factors using conditional logistic regression. RESULTS: Among 67,783 men and 101,647 women, SD incidence peaked within one year post-MDD diagnosis. Three-year prevalence increased from 6.1% pre-diagnosis to 8.5% post-diagnosis in men, and from 0.11% to 0.18% in women. In case-control analyses, SSRIs (aOR 1.36, 95% CI 1.15-1.61), SNRIs (aOR 1.75, 95% CI 1.40-2.18), and multiple antidepressants (aOR 1.68, 95% CI 1.39-2.02) were associated with increased SD risk within one year post-diagnosis. Mirtazapine showed no significant association. Bupropion was associated with increased odds for SD (aOR 2.01, 95% CI 1.16-3.48). CONCLUSION: SD is infrequently recorded in psychiatric care, particularly among women, which likely reflects differential ascertainment. Associations with SSRIs and SNRIs suggest pharmacological contributions, whereas the association for bupropion likely reflects confounding by indication, given its preferential prescribing for pre-existing anhedonia or SD.
Mapping heterogeneous predictors of problematic smartphone use in Chinese adolescents: A machine learning approach with a nationally representative sample.
Liu S, Lin Y, Hu W … +2 more , Meng Y, Liu X
J Affect Disord · 2026 Oct · PMID 42167695 · Publisher ↗
Problematic smartphone use (PSU) has become a significant global public health issue among children and adolescents. While previous research has identified various risk factors, studies utilizing nationally representativ...
Problematic smartphone use (PSU) has become a significant global public health issue among children and adolescents. While previous research has identified various risk factors, studies utilizing nationally representative samples and advanced predictive modeling to decipher the complex, multifactorial nature of PSU remain limited. We aim to develop and validate a high-performance model for predicting PSU severity by analyzing a large-scale national sample of Chinese students (grades 4-12) and systematically evaluating six machine learning algorithms. The K-nearest neighbors (KNN) algorithm demonstrated superior performance without hyperparameter tuning, outperforming other models. Self-inconsistency emerged as the most influential predictor, substantially exceeding other factors in importance. The analysis revealed a clear hierarchy of predictors, with psychological maladjustment, gender, and school integration forming a secondary tier. Furthermore, through clustering analysis, we identified three distinct high-risk PSU subtypes (the contextualized compensatory use subgroup, the identity rigidity and maladaptive escape subgroup, and the extreme emotional dysregulation subgroup), each characterized by unique configurations of risk factors. This study provides robust evidence that machine learning models, particularly KNN, can achieve high predictive accuracy for PSU severity. The identification of a core predictor and distinct risk subtypes offer valuable insights for developing targeted, personalized intervention strategies, moving beyond one-size-fits-all approaches to effectively address adolescent PSU.
Differential cerebral white matter tract alterations in generalized anxiety disorder revealed by ultra-high-field 7 T diffusion-weighted imaging.
Chen CL, Wu M, Chi Y … +10 more , Rose M, Weber JC, Lamb ST, Jin H, Ibrahim TS, Ladouceur CD, Chang YF, Tseng KY, Aizenstein HJ, Yang S
J Affect Disord · 2026 May · PMID 42167694 · Publisher ↗
Generalized anxiety disorder (GAD) is characterized by chronic worry and emotional dysregulation, yet its underlying white matter (WM) microstructural alterations remain unclear owing to inconsistent findings and technic...
Generalized anxiety disorder (GAD) is characterized by chronic worry and emotional dysregulation, yet its underlying white matter (WM) microstructural alterations remain unclear owing to inconsistent findings and technical limitations in prior neuroimaging studies. To address this gap, we employed ultra-high-field 7-Tesla (7 T) diffusion tensor imaging (DTI) and advanced correlational tractography to characterize WM alterations in GAD, examine their associations with symptom burden, and evaluate their diagnostic utility. Eighty-eight young participants (27 with GAD and 61 healthy controls [HCs]) underwent 7 T DTI at 1.5-mm isotropic resolution. Whole-brain correlational tractography was applied to identify WM tracts exhibiting significant group differences in diffusion indices. Associations of identified WM tracts with Hamilton Anxiety Rating Scale (HAM-A) and Penn State Worry Questionnaire (PSWQ) scores were examined, and machine learning-based models were used to assess the diagnostic utility of the WM features. Two right-hemispheric tract alterations were identified in GAD. First, fractional anisotropy (FA) in the right cingulum was significantly elevated in GAD (P < 0.001), particularly in the anterior portion of the tract. This elevated FA was positively correlated with HAM-A and PSWQ scores (P < 0.001 for both), indicating that greater microstructural coherence was associated with more severe anxiety and worry. Second, lower FA was observed in the right prefrontal pathway (P = 0.039), whereas this effect did not survive adjustment for medication use (P = 0.133). Combining WM features with clinical scores improved diagnostic classification. These findings reveal tract-specific microstructural correlates of emotional dysregulation in GAD and provide new insight into its neurobiological mechanisms.
The Functioning Assessment Scale for Mental Health: Development and validation.
Abdelhamid GSM, Guilera G, Barrios M … +1 more , Gómez-Benito J
J Affect Disord · 2026 Oct · PMID 42167693 · Publisher ↗
BACKGROUND: The goal of this study was to develop and validate the Functioning Assessment Scale for Mental Health (FAS-MH), a multidimensional instrument grounded in the International Classification of Functioning, Disab...
BACKGROUND: The goal of this study was to develop and validate the Functioning Assessment Scale for Mental Health (FAS-MH), a multidimensional instrument grounded in the International Classification of Functioning, Disability, and Health (ICF). The FAS-MH is designed to assess key functioning domains and environmental factors in individuals with mental disorders. METHODS: The development process involved item generation in both Spanish and English, followed by content validation through a two-round Delphi survey with expert panels (20 and 12 professionals, respectively). The Spanish version was then tested in a sample of 334 adults diagnosed with bipolar disorder, depression, or schizophrenia to examine its dimensional structure, internal consistency, and relationships with other variables. RESULTS: The final 37-item scale covers 34 second-level ICF categories across three domains: Body Functions, Activities and Participation, and Environmental Factors. Confirmatory factor analysis supported a hierarchical model with four first-order factors and one second-order Functioning factor. The FAS-MH showed excellent internal consistency (α = 0.85-0.95; ω = 0.90-0.96) and moderate to strong correlations with established measures of disability, health status, and quality of life. LIMITATIONS: Content validation was based on a small sample, only the Spanish version of the FAS-MH was tested psychometrically, and associations with clinical outcomes, symptom severity, or clinician-rated assessments were not explored. CONCLUSIONS: The FAS-MH is the first instrument to comprehensively incorporate all ICF components for assessing functioning in individuals with mental disorders. The Spanish version demonstrated strong psychometric properties, providing a brief and user-friendly tool for clinical and research use.
Functional connectivity alterations in post-traumatic stress disorder: A resting-state fMRI study of brain network dysfunction.
Hu Y, Shi Y, Hu M … +4 more , Jiang L, Xing W, Zhang Y, Zhang G
J Affect Disord · 2026 Oct · PMID 42167692 · Publisher ↗
INTRODUCTION: Emerging evidence positions post-traumatic stress disorder (PTSD) as a disease fundamentally involving disturbances in whole-brain network coordination. Nonetheless, comprehensive studies systematically int...
INTRODUCTION: Emerging evidence positions post-traumatic stress disorder (PTSD) as a disease fundamentally involving disturbances in whole-brain network coordination. Nonetheless, comprehensive studies systematically integrating time-invariant connectivity metrics with time-resolved dynamic assessments remain limited. METHOD: This case-control investigation enrolled 33 PTSD patients and 33 healthy controls who completed resting-state functional magnetic resonance imaging and cognitive assessment using the Addenbrooke's Cognitive Examination-III. We evaluated static connectivity via functional connectivity density mapping and assessed dynamic connectivity using sliding-window analysis to identify recurrent brain states and quantify temporal properties including state transitions and connection-level variability, while controlling for age, sex, education, and comorbidity. RESULTS: Patients with PTSD demonstrated increased global connectivity density in the left insula, indicating aberrant salience processing and impaired global network reconfiguration flexibility. Connection-level analysis revealed 25 significantly altered connections with elevated temporal variability in PTSD across sensorimotor, limbic, paralimbic, striatal, and thalamocortical circuits. Notably, after adjusting for comorbidity, no group differences were found in dynamic state transitions. In healthy controls, lower orbitofrontal and medial prefrontal connectivity variability correlated positively with cognitive performance, whereas in PTSD patients, elevated variability in sensorimotor, paralimbic, striatal and cingulate-temporal connections was negatively associated with attention and memory function. CONCLUSION: Our findings identify a profile of PTSD pathophysiology defined by left insular hyperconnectivity and circuit-specific temporal instability. These results reinforce the model of PTSD as a disorder of whole-network dysregulation and provide a foundation for developing biomarkers targeting its distinct spatiotemporal connectivity signatures.
Cost-effectiveness of integrated prevention for late-life depressive symptoms: Real-world findings from a large-scale pragmatic trial ("JoyAge").
Lu S, Liu T, Leung DKY … +11 more , Tse S, Wong P, Ng SM, Chan WC, Lou V, Tang J, Sze LCY, Kwok WW, Wong GHY, Knapp M, Lum TYS
J Affect Disord · 2026 Oct · PMID 42167691 · Publisher ↗
BACKGROUND: Integrated prevention, including stepped-care and task-sharing, is a theoretically resource-efficient approach to address late-life depression. Real-world evidence from large-scale community-based prevention...
BACKGROUND: Integrated prevention, including stepped-care and task-sharing, is a theoretically resource-efficient approach to address late-life depression. Real-world evidence from large-scale community-based prevention programmes is lacking. We conducted a cost-effectiveness study embedded in a pragmatic non-randomised controlled trial to evaluate JoyAge, an integrated prevention programme for late-life depression, which has been shown to reduce loneliness, anxiety and depressive symptoms compared with routine care. METHODS: We compared an intention-to-treat sample of people receiving JoyAge (n = 2975) with people receiving usual care (n = 441) for incremental depression-free days (DFDs), quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness at 1 year. Using a two-part model to estimate incremental costs, nonparametric bootstrap was used to simulate 5000 incremental cost-effectiveness ratios. Cost-effectiveness probability was evaluated against US, UK, and WHO willingness-to-pay thresholds for QALY gain. Subgroup analyses were performed by baseline depressive symptom/prevention levels. RESULTS: At an incremental cost of US$251, JoyAge has an incremental effectiveness of 31.86 DFDs and 0.01 QALYs. Incremental cost-effectiveness ratios were US$9 per DFD (95% CI: -9, 27) and US$20,063 per QALY (95% CI: -23,527, 82,287). JoyAge has a 95% likelihood of being cost-effective at willingness-to-pay thresholds of US$24 per DFD, and is 99.9% likely to be cost-effective per QALY using the WHO threshold. Selective prevention dominated in gaining DFDs and QALYs. Indicated prevention and treatment were more effective but more expensive than care-as-usual. CONCLUSIONS: JoyAge presented good value for money compared with care-as-usual. Decision-makers should consider integrated preventive programmes for late-life depression in rapidly ageing and lower-resource societies.
The long-term psychological and sleep-related consequences of the Halabja chemical attack: A cross-sectional and cross-generational study over three generations.
Mohammadi H, Seidi P, Kakakhan MH … +4 more , Jaff D, Brühl AB, Sadeghi-Bahmani D, Brand S
J Affect Disord · 2026 May · PMID 42167690 · Publisher ↗
BACKGROUND: In 1988, an Iraqi chemical attack on Halabja (Kurdistan Region of Iraq) killed about 3200-5000 people and injured about 7000-10,000. The aims were: To assess the general health status and sleep disturbances a...
BACKGROUND: In 1988, an Iraqi chemical attack on Halabja (Kurdistan Region of Iraq) killed about 3200-5000 people and injured about 7000-10,000. The aims were: To assess the general health status and sleep disturbances among three generations currently living in Halabja. To compare their health status. To compare prevalence rates of sleep disturbances and posttraumatic stress disorder (PTSD) with normative data. To explore which dimensions were associated with sleep disturbances. To identify possible sex-specific patterns. METHODS: We assessed three generations: VICTIMIZED AS ADULTS (VasAD); VICTIMIZED AS CHILDREN (VasCHI); NOT-AFFECTED (NOA/not exposed). Participants completed a booklet of self-rating questionnaires covering sociodemographic information, general health, critical life events/symptoms of PTSD, and sleep disturbances. RESULTS: 218 adults participated in the study; VasAD: n = 67; m 52.72y; 65.7% females; VasCHI: n = 75; m 43.37y; 10.7% females; NOA: n = 76; m 22.06y; 86.8% females. Compared to the NOA, VasCHI and VasAD reported lower scores for general health, including depression, and higher scores for PTSD symptom severity and sleep disturbances. Compared to normative data, all three cohorts had higher scores for probable PTSD and sleep disturbances. Female sex and higher symptoms of PTSD were independently associated with higher sleep disturbances. Compared to male participants, female participants reported higher scores for health-related issues, including depression, PTSD symptom severity, and sleep disorders, though the pattern was complex and non-uniform. CONCLUSIONS: Cohorts directly (VasAD; VasCHI) and not (NOA) exposed to the chemical attack reported higher mental health issues, including depression, PTSD symptom severity, and sleep disturbances. War-related atrocities appeared to impact the following generation. Females appeared to be particularly vulnerable to mental health issues.
From diffusion to focalization: The age-related divergence of emotional networks in bipolar disorder.
Hou D, Wang R, Zhong Y
J Affect Disord · 2026 Oct · PMID 42162625 · Publisher ↗
BACKGROUND: Emotional processing abnormalities are a core feature of bipolar disorder (BD), yet neuroimaging studies have yielded inconsistent results. The age-related divergence between pediatric (PBD) and adult (ABD) b...
BACKGROUND: Emotional processing abnormalities are a core feature of bipolar disorder (BD), yet neuroimaging studies have yielded inconsistent results. The age-related divergence between pediatric (PBD) and adult (ABD) bipolar disorder has been increasingly highlighted by physiological and clinical evidence. Therefore, previous findings were integrated to construct the emotional networks of PBD and ABD, with the aim of elucidating their age-related divergence. METHODS: Activation likelihood estimation was performed on 17 PBD (340 patients, 341 controls) and 20 ABD (681 patients, 582 controls) task-based fMRI studies. Activation network mapping was conducted using age-matched normative connectomes (550 pediatric and 1000 adult participants) to identify group-specific emotional networks, which were characterized through functional decoding. Transcriptomic analysis linked networks to gene expression, followed by enrichment analysis and cross-referencing with the latest BD genome-wide association study. RESULTS: PBD exhibited a diffuse emotional network spanning frontal, temporal, and subcortical regions involved in reward and cognitive systems. Conversely, ABD showed a focal network restricted to the salience network and basal ganglia-thalamic circuits. Transcriptomic analysis revealed that both networks were spatially associated with immune-inflammatory signaling and a Fringe glycosyltransferase subnetwork. Specifically, the PBD diffuse pattern was enriched for response to external stimulus, whereas the ABD focal pattern was enriched for cell migration. TTC12, which participates in dopaminergic reward processing, was identified as a prioritized convergent candidate across age stages. CONCLUSIONS: These findings suggest an age-related divergence from diffuse multi-system interference in PBD emotional network to focal specialization in ABD, providing new insights into the stage-specific pathophysiological correlates of BD.
Effects of aerobic vs. resistance exercise on anxiety reduction and emotional interference in young women with premenstrual syndrome: A randomized controlled fNIRS study.
Wu S, Ma Q, Zhan S … +1 more , Wang M
J Affect Disord · 2026 Oct · PMID 42162624 · Publisher ↗
BACKGROUND: Premenstrual syndrome (PMS) involves recurrent luteal-phase symptoms, including anxiety, attentional bias toward negative stimuli, and impaired emotional inhibition. While moderate-intensity aerobic exercise...
BACKGROUND: Premenstrual syndrome (PMS) involves recurrent luteal-phase symptoms, including anxiety, attentional bias toward negative stimuli, and impaired emotional inhibition. While moderate-intensity aerobic exercise is recommended for PMS and resistance training benefits anxiety and inhibition, their comparative efficacy is unclear. This study examined the effects of 8-week aerobic versus resistance exercise on anxiety and emotional interference inhibition in female university students with PMS, using functional near-infrared spectroscopy (fNIRS) to assess prefrontal hemodynamics. METHODS: Sixty participants were randomized to aerobic exercise (AE), resistance exercise (RE), or control (CG) groups. AE and RE groups completed 8 weeks of moderate-intensity training. Data from 56 participants (CG = 19, AE = 18, RE = 19) were analyzed. Pre- and post-intervention assessments during the mid-late luteal phase included the Self-Rating Anxiety Scale (SAS), an emotional Stroop task, and fNIRS. Analyses employed repeated-measures ANOVA and Pearson correlation. RESULTS: Compared to baseline, both exercise groups showed significant reductions in SAS scores and emotional Stroop reaction times. The RE group also exhibited increased oxyhemoglobin (Oxy-Hb) in prefrontal channels under negative conditions. Compared to CG, both AE and RE groups had lower SAS scores and reaction times. RE demonstrated lower SAS scores and reaction times (positive condition) than AE. Both exercise groups also showed greater Oxy-Hb changes in prefrontal channels versus CG under negative conditions. CONCLUSION: Both 8-week exercise programs improved anxiety, emotional inhibition, and prefrontal activity in students with PMS. Resistance exercise was superior to aerobic exercise in reducing anxiety and was linked to greater left dorsolateral prefrontal cortex activation.
Latent profiles of parental control and their association with adolescent anxiety: Evidence from latent profile and psychological network analyses.
Xiong Z, Shaheduola B, Yu X
J Affect Disord · 2026 Oct · PMID 42155859 · Publisher ↗
Adolescent anxiety disorders have become an increasing public health concern, associated with academic difficulties, social impairments, and long-term health risks. Family environment, particularly parental control, is w...
Adolescent anxiety disorders have become an increasing public health concern, associated with academic difficulties, social impairments, and long-term health risks. Family environment, particularly parental control, is widely viewed as an important correlate of adolescent anxiety, yet prior research has rarely examined the heterogeneous patterns of parental psychological control (PPC) and parental behavioral control (PBC) or their contemporaneous interrelations with adolescent anxiety symptoms. This study employed a multi-method framework integrating latent profile analysis (LPA) and psychological network analysis (PNA) to explore the relationship between parental control and adolescent anxiety. A total of 3011 high school students (M = 16.92, SD = 0.89) completed validated measures of PPC, PBC, and anxiety. LPA identified three distinct parental control profiles: low psychological control with high solicitation profile, moderate balanced control profile, and high-pressure strict control profile. Subsequent PNA revealed distinct network structures across profiles. In joint parental control-anxiety networks, different core and bridge symptoms emerged, such as "inability to control worry" and "authority assertion," highlighting subgroup-specific symptom association patterns. Network comparison tests further demonstrated significant structural differences between profiles. These findings underscore the necessity of considering heterogeneity in parental control and provide a basis for precision-informed hypothesis generation about subgroup-specific symptom co-occurrence patterns that should be validated in longitudinal and intervention studies before clinical targeting.
Dimensional and categorical approaches to behavioral-emotional problems in children and adolescents with mental disorders: A cross-sectional study.
Peyvandi A, Delvecchio G, Colli C … +5 more , Bonivento C, Garzitto M, Mauri M, Nobile M, Brambilla P
J Affect Disord · 2026 Oct · PMID 42155858 · Publisher ↗
INTRODUCTION: Many psychiatric disorders emerge during adolescence, but their manifestations show only partial overlaps with adult disorders. Child and adolescent mental disorders have long-term implications for adult fu...
INTRODUCTION: Many psychiatric disorders emerge during adolescence, but their manifestations show only partial overlaps with adult disorders. Child and adolescent mental disorders have long-term implications for adult functioning, underscoring the need for early intervention. Effective treatment strategies require accurate diagnostic approaches and consideration of potential confounders. Therefore, this study aims to compare dimensional and categorical assessment methods to identify emotional-behavioral differences across different disorder categories. METHODS: In a multi-center cross-sectional study, 1466 Italian children and adolescents, who referred to mental health services (aged 3-18) were categorized into 10 DSM-based diagnostic groups. Participants completed the Wechsler Intelligence Scale for Children-Revised, while parents completed the Child Behavior Checklist and the Barratt Simplified Measure of Social Status. RESULTS: Individuals with communication disorders showed fewer internalizing, externalizing, and attentional problems compared to other diagnostic categories. In addition, similar to individuals with intellectual developmental disorders, those with mixed neurodevelopmental disorders demonstrated greater IQ problems compared to several other groups. Furthermore, participants with disruptive disorders exhibited more internalizing symptoms than those with ADHD. Finally, the dimensional perspective proved more informative, revealing a broader pattern of between-group differences than the categorical approach. For example, when examining attentional differences in ADHD, the dimensional approach proved more efficient, identifying attentional challenges in ADHD compared to more diagnostic groups than the categorical approach did. DISCUSSION: These findings support using dimensional approaches for more comprehensive trans-diagnostic assessments and highlighting group differences in emotional-behavioral symptoms. Understanding these group differences can improve differential diagnosis and help to design tailored treatment plans.
Aberrant structural-functional connectivity coupling in patients with psychotic major depression.
Li X, Chen Z, Wang Y … +5 more , Li Z, Wang R, Liu Z, Ouyang X, Long Y
J Affect Disord · 2026 Oct · PMID 42155857 · Publisher ↗
BACKGROUND: Patients with psychotic major depression (PMD) experience significant distress and require specific therapy strategies. While previous studies have identified differences in brain structure and function betwe...
BACKGROUND: Patients with psychotic major depression (PMD) experience significant distress and require specific therapy strategies. While previous studies have identified differences in brain structure and function between PMD and non-psychotic major depression (NPMD), the distinct neural mechanisms underlying PMD from an integrated structure-function perspective, along with their microscopic biological basis, remain unclear. METHODS: We recruited 40 PMD patients, 80 NPMD patients, and 123 healthy controls (HCs), and then assessed group differences in their structural-functional connectivity (SC-FC) coupling. Subsequently, we further correlated these differences with underlying genetic/neurotransmitter profiles and clinical variables. RESULTS: Compared with HCs and NPMD group, patients with PMD showed significantly increased SC-FC coupling in the right ventrolateral inferior temporal gyrus and bilateral dorsal posterior cingulate cortex, as well as within the ventral attention network. The SC-FC coupling in these regions was positively correlated with psychotic symptoms, while its correlation with childhood trauma was observed only in the right dorsal posterior cingulate cortex. In the PMD group, regional SC-FC coupling alterations correlated with the spatial distributions of the 5-HT2a, GABA, and glutamate systems and with specific gene expression maps, but not with the dopamine system. CONCLUSIONS: These results provide new evidence supporting distinct neurobiological mechanisms in PMD compared to NPMD, as characterized by altered SC-FC coupling patterns. Elucidating these mechanisms may promote the development of more precise, tailored therapeutic strategies for patients with PMD.
Smartphone-delivered cognitive behavioral therapy for subthreshold depression with physical comorbidities: Evidence from the RESiLIENT trial.
Cui B, Luo Y, Tajika A … +5 more , Toyomoto R, Sakata M, Akechi T, Horikoshi M, Furukawa TA
J Affect Disord · 2026 May · PMID 42155856 · Publisher ↗
BACKGROUND: This study aimed to examine the effectiveness of smartphone-delivered cognitive behavioral therapy (CBT) in participants with subthreshold depression, considering the potential influence of physical comorbidi...
BACKGROUND: This study aimed to examine the effectiveness of smartphone-delivered cognitive behavioral therapy (CBT) in participants with subthreshold depression, considering the potential influence of physical comorbidities. METHODS: In this secondary analysis of the RESiLIENT trial, participants with subthreshold depression were randomized to various CBT interventions or control groups. Physical comorbidities were self-reported at baseline and categorized as no, past, or current. Depression severity was assessed by the Patient Health Questionnaire-9 (PHQ-9) at weeks 6 and 26. Mixed-effects models for repeated measures estimated treatment effects and tested interaction terms for comorbidity category. Latent class analysis (LCA) explored multimorbidity patterns and their impact on outcomes. RESULTS: A total of 3577 participants were analyzed (no comorbidity n = 1384; past comorbidity n = 1004; current comorbidity n = 1189). All CBT interventions improved PHQ-9 scores at week 6 across comorbidity groups. Behavioral activation (BA) combined with problem solving showed the largest effects in the no comorbidity (least-squares mean difference = -1.74, 95% confidence interval: -2.44 to -1.05) and current comorbidity groups (-1.94, -2.67 to -1.20), while BA alone was most effective in the past comorbidity group (-1.91, -2.69 to -1.14). By week 26, BA combined with cognitive restructuring maintained benefits across all groups. LCA identified five multimorbidity classes. Although the effect sizes showed small variations across subgroups, no significant effect modification by comorbidity type was found. CONCLUSIONS: Smartphone-delivered CBT effectively reduces depressive symptoms in subthreshold depression, including among individuals with physical comorbidities. Although comorbidity type did not significantly modify outcomes, the observed patterns may help inform personalized iCBT strategies.
Borderline personality features predicting depressive symptom trajectories among Chinese university students: The mediating role of difficulties in emotion regulation.
Li L, Wang Y, Liu X … +3 more , Jiang W, Wang J, Yu M
J Affect Disord · 2026 Oct · PMID 42144142 · Publisher ↗
BACKGROUND: Despite established heterogeneity in depressive trajectories, the psychological mechanisms driving adverse developmental courses remain understudied. This study examined how borderline personality features (B...
BACKGROUND: Despite established heterogeneity in depressive trajectories, the psychological mechanisms driving adverse developmental courses remain understudied. This study examined how borderline personality features (BPF) and difficulties in emotion regulation (DER) predict longitudinal symptom paths. METHODS: A large-scale, three-wave longitudinal design was utilized with 4884 adult university students (M = 19.28, SD = 0.84;82.1% female). Latent class growth analysis (LCGA) identified symptom trajectories. Multinomial logistic regression and mediation analysis within the 3-step framework were used to examine baseline predictors and internal mechanisms. RESULTS: Three distinct trajectories were identified: Low-Decreasing (57.8%), Moderate-Increasing (35.6%), and High-Quickly Increasing (6.7%). Baseline BPF and DER significantly predicted membership in adverse trajectories. Notably, the predictive effect of BPF was significantly mediated by DER. Additionally, male sex and older age were identified as significant risk factors for following the most severe escalation paths. CONCLUSION: The findings highlight a BPF-DER internal risk cascade. Early interventions should prioritize enhancing emotion regulation skills alongside providing vocational guidance and economic assistance to mitigate long-term depressive burdens in high-risk students.
The dual role of grief rumination in prolonged grief disorder among Chinese Shidu parents: A qualitative study.
Xu X, Qian W, Wen J … +2 more , Tang S, Wang J
J Affect Disord · 2026 Oct · PMID 42144141 · Publisher ↗
BACKGROUND: Chinese parents who have lost their only child, commonly referred to as Shidu parents, are at heightened risk for prolonged grief disorder (PGD). Rumination has been identified as a potential mechanism underl...
BACKGROUND: Chinese parents who have lost their only child, commonly referred to as Shidu parents, are at heightened risk for prolonged grief disorder (PGD). Rumination has been identified as a potential mechanism underlying PGD, yet its content and functions in this population remain poorly understood. This study aimed to explore the dimensions and effects of grief rumination among Shidu parents through a qualitative interview design. METHODS: Semi-structured interviews were conducted with 11 Shidu parents, and the data were analyzed using reflexive thematic analysis. RESULTS: Five dimensions of grief rumination were identified: meaning, relationships, counterfactuals, injustice, and reactions. Across these dimensions, rumination emerged as a double-edged process. On the one hand, it often intensified emotional suffering, worries about the future, avoidant coping, social withdrawal due to stigma, negative self-evaluation, and fear of losing mental control. On the other hand, it could also open up space for cognitive reappraisal, reconstruction of life meaning, recognition of remaining social resources, more bearable acceptance of the loss, future-oriented reorientation, and greater self-understanding. Throughout these dimensions, the content and effects of rumination were shaped by culturally embedded meanings, particularly bloodline continuity, filial obligations, collectivism, and fate or destiny. LIMITATIONS: The purposive, non-random sampling and potential self-selection bias may limit the transferability of the results. CONCLUSIONS: Grief rumination among Shidu parents is a complex, culturally situated phenomenon that can both exacerbate distress and facilitate adaptation. The study highlights the importance of culturally sensitive assessment and intervention for Shidu parents in the Chinese context.
Interdisciplinary, Delphi-driven consensus guidelines on the use of intravenous ketamine infusions for depressive disorders from the American Society of Ketamine Physicians, Psychotherapists, and Practitioners (ASKP3).
Mathai DS, Cluck M, Aslam AM … +17 more , Amato E, Azam A, Banov M, Barrett KA, Bonnett CJ, Feifel D, Grundmann N, Ko HS, McShane R, Prashad S, Santini T, Stewart LH, Sullivan P, Wolfsohn SD, Robinson JO, McGuire AL, McInnes LA
J Affect Disord · 2026 Oct · PMID 42144140 · Publisher ↗
BACKGROUND: Off-label use of intravenous ketamine (IVK) for depression is a widespread practice with limited regulation in the United States. There is an urgent need for current, evidence-informed treatment guidelines to...
BACKGROUND: Off-label use of intravenous ketamine (IVK) for depression is a widespread practice with limited regulation in the United States. There is an urgent need for current, evidence-informed treatment guidelines to facilitate patient safety, clinical decision-making, and care quality in real-world contexts. METHODS: The American Society of Ketamine Physicians, Psychotherapists and Practitioners (ASKP3) convened an interdisciplinary working committee tasked with creating guidelines for use of IVK for depression in outpatient settings. Guideline development followed a two-stage process: 1) a hybrid systematic and targeted evidence review and preliminary drafting by the committee, and 2) consensus refinement through a modified Delphi method using a panel composed of the committee and ASKP3 expert faculty. Panelists rated their agreement with proposed guideline items using a 9-point Likert scale, and consensus was predefined as a median rating ≥ 7 with an interquartile range ≤ 2 after Round 2. Consensus strength was evaluated using percentage agreement thresholds. RESULTS: Of 39 invited experts, 28 completed at least one round of the survey. Consensus was achieved on 73 of 75 of proposed guideline items (97%), with most items reaching very strong consensus (i.e., ≥90% of panelists rating a statement within the 7-9 range). Guideline items were organized across seven key practice areas. CONCLUSIONS: By combining a hybrid literature review and Delphi process, we developed expert consensus recommendations for the safe and effective use of IVK for depression. These guidelines can support decision-making, standardize clinical practice, improve patient outcomes, and promote equitable access to this emerging treatment, while informing ongoing research and policy development.
Brain structure and function changes in Crohn's disease with or without depression based on multi-modal MRI.
Guan Y, Peng X, Wu X … +4 more , Hu M, Zhou J, Gong J, Zhu P
J Affect Disord · 2026 Oct · PMID 42144139 · Publisher ↗
BACKGROUND: Crohn's disease (CD) is frequently comorbid with depression, yet the neural mechanisms underlying this association remain poorly understood. This study aimed to investigate brain structural and functional alt...
BACKGROUND: Crohn's disease (CD) is frequently comorbid with depression, yet the neural mechanisms underlying this association remain poorly understood. This study aimed to investigate brain structural and functional alterations in CD patients with and without depression, and to examine their relationship with depressive symptoms, inflammation, and disease activity. METHODS: Seventy CD patients and sixty healthy controls underwent resting-state functional MRI and structural MRI. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Hamilton Depression Rating Scale-24 (HAMD-24). CD patients were stratified into depressed (CD-D, n = 28) and non-depressed (CD-N, n = 42) groups based on PHQ-9 scores. Voxel-based morphometry (VBM) was used to identify gray matter volume (GMV) differences, with significant regions serving as seeds for functional connectivity (FC) analysis. Associations between imaging metrics and clinical variables (inflammatory markers, disease activity, depression scores) were examined. RESULTS: Compared to controls, CD patients exhibited reduced GMV in bilateral cerebellar lobule 8, which positively correlated with inflammatory markers (ESR/CRP), and increased GMV in the putamen and precentral gyrus. FC analysis revealed decreased connectivity between cerebellar lobule 8 and regions within sensorimotor, frontoparietal, and default mode networks. However, the changes in brain structure and function in each CD group were not significantly related to depression. CONCLUSION: CD is associated with inflammation-related brain structural and functional alterations, which are linked to both disease activity and depressive symptom severity. These findings suggest that depressive symptoms in CD may arise from inflammation-driven brain changes along the gut-brain axis, rather than from depression-specific neural pathology.
Depressive and insomnia symptoms and incident dementia risk: A 12-year study in U.S. older adults.
Liu S, He Z, Wang C … +3 more , Liu X, Lukkahatai N, Li J
J Affect Disord · 2026 Oct · PMID 42144138 · Full text
BACKGROUND: Depressive and insomnia symptoms are common in late life and have each been associated with increased dementia risk. However, their co-occurrence and potential combined effects on cognitive outcomes remain un...
BACKGROUND: Depressive and insomnia symptoms are common in late life and have each been associated with increased dementia risk. However, their co-occurrence and potential combined effects on cognitive outcomes remain understudied. We examined the independent and joint associations of time-varying depressive and insomnia symptoms with incident dementia among community-dwelling older adults. METHODS: Data were drawn from 13 rounds (2011-2023) of the National Health and Aging Trends Study (NHATS). Participants (N = 6226) without dementia at baseline were followed for up to 12 years. Depressive symptoms and insomnia symptoms were self-reported and classified as neither-symptom, depressive-only, insomnia-only, or co-occurring. Incident dementia was determined using self/proxy reports, cognitive testing, and the AD8. Survey-weighted Cox proportional hazards and competing-risk models estimated hazard ratios (HRs). RESULTS: Co-occurring symptoms were associated with higher dementia hazard than neither (HR = 1.37; 95% confidence interval [CI]: 1.23-1.53) and insomnia-only (HR = 1.25; 95% CI: 1.03-1.51) but did not differ from depression-only (HR = 0.94; 95% CI: 0.84-1.05). Age modified associations (p = 0.019), with contrasts more apparent before age 75 and the depression-only group showing higher dementia hazard than the co-occurring group at age ≥ 75. CONCLUSION: Findings support joint assessment of mood and sleep symptoms to identify older adults at elevated dementia risk and suggest that depressive symptoms may be more informative than insomnia symptoms for risk stratification in later life, with heterogeneity by age.
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