Journal Of Affective Disorders[JOURNAL]
Sun
200 papers
Is cyberhate victimization associated with suicidality and somatization in adolescence? Evidence from a four-wave longitudinal study.
Naranjo-Pou S, Espejo-Siles R, Zych I
J Affect Disord · 2026 Jun · PMID 42263876 · Publisher ↗
Cyberhate victimization is an emerging risk factor for adolescent mental health, yet longitudinal evidence remains limited. This study examined prospective associations between cyberhate victimization, suicidality, and s...
Cyberhate victimization is an emerging risk factor for adolescent mental health, yet longitudinal evidence remains limited. This study examined prospective associations between cyberhate victimization, suicidality, and somatization in 3493 Spanish adolescents (49.0% girls; M = 12.06) followed up across four annual waves. Methodological triangulation combined linear regressions, covariate-balancing generalized propensity scores, and random-intercept cross-lagged panel models. Regressions showed cyberhate victimization predicted greater suicidality and somatization at all subsequent waves. The random-intercept cross-lagged panel model revealed that only cyberhate victimization at age 12 predicted greater suicidality and somatization at age 13, suggesting a sensitive period. No other significant associations were found through other analyses, and analytical approach did not fully converged. Findings suggest that unadjusted associations may overestimate the true impact of cyberhate, and age 12-13 emerged as a potential sensitive period that warrants further investigation. Preventive interventions should target early adolescents transitioning to secondary education.
Effects of light therapy on sleep and anxiety in Parkinson's disease: A pilot trial.
Shen Y, Li HX, Dai J … +10 more , Zhou QJ, Tao MX, Xie WY, Lou H, Liu JY, Gao F, Hu H, Mao CJ, Wang F, Liu CF
J Affect Disord · 2026 Jun · PMID 42263875 · Publisher ↗
BACKGROUND: Light therapy (LT) may improve sleep and affective disorders in Parkinson's disease (PD), but effects of different intensities and underlying mechanisms remain unclear. METHODS: Thirty-three patients with PD...
BACKGROUND: Light therapy (LT) may improve sleep and affective disorders in Parkinson's disease (PD), but effects of different intensities and underlying mechanisms remain unclear. METHODS: Thirty-three patients with PD were randomized to receive either 1 month of bright LT (BLT) at 10000 lx or dim LT (DLT) at 200 lx, separated by a 1-month washout period, in a crossover fashion. All patients completed clinical assessments, polysomnography (PSG) and resting-state electroencephalogram (EEG) at baseline and after each intervention period. Functional connectivity was assessed using weighted Phase Lag Index (wPLI). RESULTS: Both BLT and DLT significantly reduced Pittsburgh Sleep Quality Index (PSQI). BLT showed a greater reduction in Epworth Sleepiness Scale (ESS) (P = 0.009), whereas DLT showed a greater reduction in Hamilton Anxiety Rating Scale (HAMA) (P = 0.030). In within-treatment comparisons, BLT was associated with increased slow wave energy (P = 0.001) and theta-band wPLI between specific visual network(VN) pairs, while DLT was associated with increased slow wave sleep proportion (P = 0.006) and alpha-band mean default mode network (DMN) wPLI. However, between-treatment comparisons revealed no significant differences in any PSG or EEG outcomes. CONCLUSIONS: BLT showed greater improvement in daytime sleepiness than DLT, while DLT showed greater reduction in anxiety than BLT. For brain networks, BLT showed significant within-treatment improvement in the visual network, and DLT showed significant within-treatment improvement in the DMN. However, between-treatment comparisons did not reveal significant differences. The hypothesis that different intensities of LT affect different brain networks warrants further validation.
Discriminating bipolar depression from major depressive disorder using functional and microstructural signatures of inferior fronto-occipital fasciculus: Promising results from an MRI study.
Chen Z, Li W, Dou R … +6 more , Shen Q, Zhang X, Cui D, Guo Y, Cui J, Jiao Q
J Affect Disord · 2026 Jun · PMID 42263874 · Publisher ↗
BACKGROUND: Bipolar depression (BD-d) and major depressive disorder (MDD) share overlapping clinical symptoms, posing a significant diagnostic challenge. The inferior fronto-occipital fasciculus (IFOF) is a critical long...
BACKGROUND: Bipolar depression (BD-d) and major depressive disorder (MDD) share overlapping clinical symptoms, posing a significant diagnostic challenge. The inferior fronto-occipital fasciculus (IFOF) is a critical long-range tract that integrates cognitive and affective processes across brain networks. However, it remains unexplored whether bilateral IFOF abnormalities differ between BD-d and MDD and have utility for machine learning classification. METHODS: Processed data from 47 BD-d, 56 MDD, and 44 healthy controls (HCs) were analyzed for structural and functional alterations in bilateral IFOF metrics (including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD), and amplitude of low-frequency fluctuations (ALFF)) were assessed at both the tract and node levels. Five machine learning models were then employed to evaluate the diagnostic utility of significant features. RESULTS: Tract-level analysis revealed significant alterations in the right IFOF (rIFOF), characterized by decreased FA and AD alongside increased RD among patient groups. Functional ALFF demonstrated opposite changes, being elevated in BD-d but reduced in MDD. Node-wise analysis revealed that structural and functional alterations co-localized within temporal segments. Besides, RD in the rIFOF correlated with HAMD scores in MDD, linking structure to clinical severity, while a k-nearest neighbor (KNN) classifier based on tract-level metrics distinguished BD-d from MDD with 86% accuracy. CONCLUSIONS: This multimodal study reveals both shared and distinct segmental alterations in the rIFOF within BD-d and MDD, highlighting a microstructure-function dissociation pattern. These alterations correlate with clinical severity and enable high-accuracy diagnostic differentiation, providing objective biomarkers for understanding depression pathophysiology and improving differential diagnosis.
Parental depressive symptoms and child education delay in Indonesia: Indirect associations via growth and morbidity in a structural equation model.
Devita S, Shorey S
J Affect Disord · 2026 Jun · PMID 42263873 · Publisher ↗
BACKGROUND: Parental depressive symptoms are associated with adverse child outcomes, but evidence simultaneously considering maternal and paternal depressive symptoms across multiple child domains remains limited. AIM: T...
BACKGROUND: Parental depressive symptoms are associated with adverse child outcomes, but evidence simultaneously considering maternal and paternal depressive symptoms across multiple child domains remains limited. AIM: To examine cross-sectional associations between parental depressive symptoms and child education delay, including statistical indirect associations involving child growth and morbidity. METHODS: We analysed Indonesia Family Life Survey wave 5 (2014-2015) data for 5898 children aged 7-14 years in two-parent households. Parental depressive symptoms were measured with the Centre for Epidemiologic Studies Depression scale (CES-D). Education delay was operationalized as the cumulative difference between expected grade-for-age and current grade level. Structural equation modelling used robust maximum likelihood (MLR) with full-information maximum likelihood (FIML). A targeted document analysis of national policies (2015-2025) was conducted to contextualize findings. RESULTS: Higher maternal and paternal depressive symptoms were associated with lower child height-for-age z-scores (HAZ), lower BMI-for-age z-scores (BAZ), and higher child acute morbidity count but not chronic morbidity. Indirect association estimates indicated a small but statistically significant association between maternal and paternal depressive symptoms and education delay involving lower HAZ. Total association of maternal depressive symptoms on education delay was statistically significant, whereas the total association of paternal depressive symptoms was not. The reviewed documents focused on nutrition and poverty-alleviation approaches, with less attention on parents' mental health within strategies for child growth or school-age wellbeing. CONCLUSIONS: Parental depressive symptoms were statistically indirectly associated with education delay primarily through lower child height-for-age. Integrating parental mental health screening and referral within child health and nutrition platforms may represent a scalable strategy to address educational disadvantage.
Association between lithium and arterial atherosclerosis in physically healthy bipolar disorder.
Tsai SY, Chang TH, Sajatovic M … +5 more , Chen PH, Huang YJ, Hung S, Chung KH, Kuo CJ
J Affect Disord · 2026 Jun · PMID 42263872 · Publisher ↗
BACKGROUND: Patients with bipolar disorder (BD) have an elevated risk of cardiovascular disease, primarily driven by atherosclerosis. This study aimed to identify clinical and medication-related features associated with...
BACKGROUND: Patients with bipolar disorder (BD) have an elevated risk of cardiovascular disease, primarily driven by atherosclerosis. This study aimed to identify clinical and medication-related features associated with accelerated atherosclerosis in medicated BD patients. METHODS: One hundred ten physically healthy patients with bipolar I disorder aged 20-60 years and 107 normal controls (NCs) underwent measurement of carotid intima-media thickness (CIMT) using high-resolution ultrasonography. BD patients were divided into normal and elevated CIMT groups using threshold defined by the American Society of Echocardiography. Clinical data were obtained through structured interviews and medical record review. RESULTS: Patients with BD exhibited significantly greater mean CIMT than NCs. BD patients with serum lithium levels ≤0.6 mEq/L had significantly higher odds of greater CIMT (95% confidence interval for odds ratio: 1.16-7.09). Multivariable logistic regression showed that longer illness duration and higher lithium level were significantly associated with normal CIMT. After controlling for age and BMI, lower lithium level, shorter illness duration, and higher triglyceride level remained independently associated with greater CIMT, accounting for 34.3% of the variance. Among current lithium-treated patients, only BMI was independently associated with CIMT (β = 0.249, p = 0.038). CONCLUSION: Among treatment-seeking adults with BD, higher serum lithium levels were associated with lower and normal CIMT, while illness chronicity showed the opposite trend. The present findings support a potential anti-atherosclerotic role of lithium therapy and underscore the importance of weight management in reducing cardiovascular risk in the BD population-even among those on lithium.
Striatal DAT-SPECT texture beyond mean binding in major depressive disorder.
Tamura T, Abe S, Matsui H … +3 more , Takagi S, Sugihara G, Takahashi H
J Affect Disord · 2026 Jun · PMID 42259492 · Publisher ↗
BACKGROUND: Dopaminergic dysfunction has been implicated in major depressive disorder (MDD), but dopamine transporter (DAT) imaging studies using conventional mean binding have yielded inconsistent findings. One possible...
BACKGROUND: Dopaminergic dysfunction has been implicated in major depressive disorder (MDD), but dopamine transporter (DAT) imaging studies using conventional mean binding have yielded inconsistent findings. One possible contributor is that mean binding reduces striatal uptake to a single value, so spatially heterogeneous alterations in DAT uptake may be attenuated or missed. Radiomic texture analysis may capture such spatial patterning, but features are numerous and difficult to interpret. METHODS: We retrospectively examined whether a low-dimensional texture signature from striatal DAT-SPECT (I-ioflupane) provides incremental information beyond mean binding. In 223 patients, bilateral striatal mean binding and texture metrics were quantified. Features were summarized into two domains: entropy/complexity and scale/run-length. Ordinal regression models adjusted for age, sex, and medication status tested associations with depressive severity and, in 151 depressed patients with evaluable treatment-course data, with a proxy for required treatment intensity (monotherapy/augmentation therapy, or electroconvulsive therapy [ECT]). RESULTS: In nested models, mean binding did not improve fit for either outcome, whereas adding the two texture domains improved fit for severity (p = 0.024) and treatment intensity (p = 0.0048). Higher texture scores were associated with higher probabilities of severe depression and of requiring ECT, and the treatment intensity association remained after adjustment for concurrent symptom severity. In a remission-pair subset (N = 40), texture score changes showed only limited evidence of a decrease and were not related to symptom improvement. CONCLUSIONS: A two-domain texture summary showed incremental associations beyond mean binding with depressive severity and a proxy for required treatment intensity in MDD.
Symptom presentation of childbirth-related post-traumatic stress in 31 countries: the INTERSECT study.
Constantinou G, Ayers S, Webb R … +54 more , Handelzalts J, Wright DB, Grollman C, Lucas G, Awad-Sirhan N, Baird K, Batool R, Batool S, Caparros-Gonzalez RA, Chorwe-Sungani G, Christoforou A, Coo S, Costa R, Dikmen-Yildiz P, Ďuríčeková B, Dušová B, Enea V, Garthus-Niegel S, Grundström H, Gureje O, Hadjigeorgiou E, Haga SM, Horsch A, Ionio C, Jarašiūnaitė-Fedosejeva G, Jomeen J, Kazmierczak M, Lalor J, Matijaš M, Milosavljevic M, Nagle U, Nakić Radoš S, Nieminen K, Oladeji BD, Osório FL, Pawlicka P, Peled Y, Pinto TM, Rattaz V, Riklikienė O, Schellong J, Sigurðardóttir VL, Thagunna NS, Theme-Filha MM, Škodová Z, Dörr P, Stepisnik Perdih T, Stewart RC, Swift EM, Uriko K, Vally Z, Vezmar M, Zedan HS, INTERSECT Consortium
J Affect Disord · 2026 Jun · PMID 42259491 · Publisher ↗
BACKGROUND: Childbirth-related post-traumatic stress disorder (CB-PTSD) is an important international health concern. Despite increasing recognition of the public health burden of CB-PTSD, little is known about how CB-PT...
BACKGROUND: Childbirth-related post-traumatic stress disorder (CB-PTSD) is an important international health concern. Despite increasing recognition of the public health burden of CB-PTSD, little is known about how CB-PTSD symptoms present across different countries. AIMS: This study examined cross-national differences in CB-PTSD symptom severity and presentation to inform culturally sensitive screening and intervention strategies. METHOD: Data were drawn from the International Survey of Childbirth-Related Trauma (INTERSECT) cross-sectional survey of 11,302 women 6-12 weeks postpartum in 31 countries using a standard protocol. CB-PTSD symptoms were assessed using the City Birth Trauma Scale, measuring DSM-5 symptom components (re-experiencing, avoidance, negative cognitions and mood, hyperarousal). RESULTS: Participants were mostly married, aged 30-34 years, with average household income, and higher education. CB-PTSD symptom severity varied substantially across countries, with the highest mean scores in Pakistan (M = 23.49, SD = 13.23) and lowest in Nigeria (M = 1.89, SD = 3.66). Despite these differences, symptom patterns were largely consistent across countries, with avoidance symptoms lowest and hyperarousal symptoms highest. Exceptions were observed in countries with particularly high symptom levels. Decision tree analysis identified avoidance symptoms (>3.1) as the strongest discriminator of CB-PTSD cases vs non-cases (F(1,11,204) = 4820.54, p = .000), followed by negative cognitions and mood (>10; F(1,716) = 143.69, p = .000). CONCLUSIONS: While CB-PTSD severity varies internationally, symptom presentation is largely consistent, supporting its relevance as an international construct. Avoidance symptoms were the least commonly endorsed yet the most discriminative for identifying CB-PTSD in decision tree analyses, suggesting they may serve as a useful clinical flag for women who warrant more detailed assessment. Variations in symptom expression in countries with high levels of symptoms highlight the importance of culturally sensitive approaches to screening and assessment.
Comparing transcranial magnetic stimulation and esketamine treatment response trajectories in resistant depression.
Benster LL, Kohn JN, Wade B … +5 more , Stapper N, Weissman CR, Miron JP, Daskalakis ZJ, Appelbaum LG
J Affect Disord · 2026 Jun · PMID 42259490 · Publisher ↗
OBJECTIVE: Repetitive transcranial magnetic stimulation (rTMS) and intranasal esketamine are FDA-approved for treatment-resistant depression (TRD), yet comparative real-world data on response trajectories and predictors...
OBJECTIVE: Repetitive transcranial magnetic stimulation (rTMS) and intranasal esketamine are FDA-approved for treatment-resistant depression (TRD), yet comparative real-world data on response trajectories and predictors of outcomes remain limited. METHODS: A retrospective analysis was performed using electronic medical records from UC San Diego Health. Adults with TRD treated with rTMS (n = 279) or intranasal esketamine (n = 93) between 2017 and 2025 were included. The primary outcome was clinical response (≥50% PHQ-9 reduction). Time-to-response was assessed using inverse probability treatment weighted (IPTW) Cox models; Kaplan-Meier curves and log-rank tests provided descriptive comparisons. Covariates included age, trauma history, anxiety comorbidity, benzodiazepine use, tobacco use history, BMI, and baseline symptom severity. Secondary outcomes included remission (PHQ-9 < 5) and suicidal ideation (SI). RESULTS: Esketamine demonstrated earlier response over 90 days (RMST difference = -11.94 days) and faster time-to-response in the IPTW Cox model (HR = 1.62, p = 0.005); KM estimates showed median response at 36 vs. 49 days (p = 0.0096) with convergence by ∼90 days. Cumulative response and remission rates were numerically higher for esketamine (68.8% / 45.2%) than rTMS (59.4% / 40.1%), supporting a speed-of-response difference rather than superior overall efficacy. SI improved more rapidly with esketamine (median 9 vs. 26 days; p = 0.001). In the rTMS cohort, comorbid anxiety (HR = 0.69, p = 0.039) and benzodiazepine use (HR = 0.73, p = 0.046) predicted slower response, while former tobacco use predicted faster response (HR = 1.31, p = 0.006). No significant predictors emerged for esketamine. CONCLUSIONS: Esketamine was associated with earlier observed antidepressant and anti-suicidal improvement than rTMS. Baseline factors, including benzodiazepine use, may help inform expectations regarding rTMS response trajectory.
A longitudinal network analysis of social connection and professional quality of life among healthcare workers during the COVID-19 pandemic.
Keshava P, Rubin M, Smirnova MO … +1 more , Lancaster CL
J Affect Disord · 2026 Jun · PMID 42259489 · Publisher ↗
BACKGROUND: Society depends on people willing to serve in high stress occupations, such as healthcare workers who served on the front lines during the COVID-19 pandemic. However, these roles can take a toll on psychologi...
BACKGROUND: Society depends on people willing to serve in high stress occupations, such as healthcare workers who served on the front lines during the COVID-19 pandemic. However, these roles can take a toll on psychological health, fueling turnover and staff shortages. This toll can be mitigated with social connection. Yet, little is known about how the multifaceted constructs of psychological health and social connection influence one another over time. Understanding these dynamics is critical for identifying effective intervention targets in high-stress professions. METHODS: We conducted a three-wave survey of U.S. healthcare workers (N = 230) within the first year of the COVID-19 pandemic. Each wave assessed facets of social connection (loneliness, giving and receiving support, and social ties) and psychological health (positive mental health, work satisfaction, burnout, and secondary traumatic stress). To identify the direction of associations across time, we modeled a longitudinal network in the form of a Bayesian Directed Acyclic Graph (DAG). RESULTS: Across waves, loneliness and positive mental health exerted the strongest downstream influence on all other psychological and social variables. Giving support had a mutually reinforcing relationship with positive mental health; giving support at wave 1 predicted positive mental health (and work satisfaction) at wave 2, which in turn predicted giving support at wave 3. CONCLUSIONS: Findings highlight promising intervention points for healthcare workers during a public health crisis. Using a DAG network on longitudinal data, this study revealed unique insights into the dynamic relationships between psychological health and social connection in the context of occupational stress.
Comparative effectiveness of antidepressant augmentation regimens in children and adolescents with major depressive disorder.
Lee H, Camelo Castillo W, Rose R … +3 more , Reeves G, Qato DM, dosReis S
J Affect Disord · 2026 Jun · PMID 42259488 · Publisher ↗
BACKGROUND: Limited evidence guides augmentation strategies after selective serotonin reuptake inhibitor (SSRI) in pediatric major depressive disorder (MDD). METHODS: We conducted an active-comparator, new-user cohort st...
BACKGROUND: Limited evidence guides augmentation strategies after selective serotonin reuptake inhibitor (SSRI) in pediatric major depressive disorder (MDD). METHODS: We conducted an active-comparator, new-user cohort study to evaluate depression-related outcomes among children and adolescents with MDD receiving SSRI augmentation. Using a 25% random sample of the US IQVIA PharMetrics® Plus Closed Health Plan claims from January 2010 to October 2022, we identified individuals aged 8 to 18 with MDD who initiated an atypical antipsychotic (AAP) or bupropion following ≥4 weeks of SSRI and ≥ 7 days of concomitant use with the SSRI. The primary outcome was time to a composite of depression-related hospitalization, emergency department (ED) visit, or a suicide-related outcome. Secondary analyses evaluated each event separately. Propensity scores with inverse-probability-of-treatment-weighting adjusted for baseline covariates, and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Sensitivity analyses were conducted to assess the robustness of our findings. RESULTS: The cohort included 4089 individuals (mean age 15.6 years [SD 2.1]; 65.1% female). Compared with bupropion, AAP augmentation was associated with a higher risk of the composite outcome (HR = 1.69; 95% CI:1.43-1.99), hospitalization (HR = 1.86; 95% CI: 1.52-2.26), ED visits (HR = 1.50; 95% CI: 1.15-2.90), and suicide-related outcomes (HR = 1.88; 95% CI: 1.07-3.33). Sensitivity analyses were consistent with the primary findings. CONCLUSIONS: Augmentation strategies for children and adolescents prescribed an AAP do not reduce the risk of hospitalization or suicide-related outcomes relative to bupropion. Further research is needed to guide evidence-based augmentation strategies.
Direct and indirect associations linking COVID-19 severity to internalizing disorders and symptoms among participants in New Haven, CT.
Davtian D, Qiu D, Cabrera-Mendoza B … +5 more , Nunez YZ, Krystal JH, Pietrzak RH, Gelernter J, Polimanti R
J Affect Disord · 2026 Jun · PMID 42259487 · Full text
While COVID-19 has a negative impact on mental health, the understanding of its association with distinct psychiatric disorders and symptoms is still limited. Leveraging the PsychGenCOV19 cohort including 1132 participan...
While COVID-19 has a negative impact on mental health, the understanding of its association with distinct psychiatric disorders and symptoms is still limited. Leveraging the PsychGenCOV19 cohort including 1132 participants enrolled in New Haven, CT, we observed that moderate COVID-19 severity was associated with greater odds of internalizing disorders (major depressive disorder, MDD OR = 3.74; generalized anxiety disorder, GAD OR = 2.85; and post-traumatic stress disorder, PTSD OR = 2.32) and with lower odds of panic disorder (OR = 0.44). After modeling comorbidities among these mental health outcomes, the association between moderate COVID-19 severity and MDD remained statistically significant (OR = 2.89, p = 0.006). Investigating internalizing traits, we observed several associations with COVID-19 moderate severity even after accounting for MDD diagnosis (e.g., "lost interest in most things lasting two weeks or more" OR = 3.84; "Feeling nervous, anxious or on edge" OR = 1.82). In the multivariable model accounting for the co-occurrence of PTSD symptoms, moderate COVID-19 severity was also inversely related to "being super-alert or watchful or on guard" (OR = 0.45). In addition to MDD symptoms, certain GAD and PTSD symptoms (e.g., "Feeling jumpy or easily startled", "Feeling nervous, anxious or on edge", "Worrying too much about different things") mediated the association between COVID-19 severity and MDD (proportion mediated 9% to 27%). Finally, a latent class analysis identified PsychGenCOV19 participants characterized by severity patterns of COVID-19 and internalizing symptoms. These findings highlight the symptom-specific association of COVID-19 severity with mental health, underscoring possible transdiagnostic effects across the internalizing spectrum.
Neural correlates and candidate mechanisms of suicidal thoughts and behaviors in youth: A review of task-based fMRI studies.
Walker JC, Parker AJ, Hernandez BN … +1 more , Wiggins JL
J Affect Disord · 2026 Jun · PMID 42259486 · Publisher ↗
Suicidal thoughts and behaviors (STBs) increase sharply during late childhood and adolescence, yet the neurodevelopmental mechanisms conferring risk remain poorly characterized. Mechanistic models of suicide emphasize di...
Suicidal thoughts and behaviors (STBs) increase sharply during late childhood and adolescence, yet the neurodevelopmental mechanisms conferring risk remain poorly characterized. Mechanistic models of suicide emphasize disruptions in emotion regulation, self-referential processing, reward sensitivity, and cognitive control, but task-based neuroimaging evidence supporting these frameworks has not been systematically consolidated. This scoping review synthesizes task-based functional magnetic resonance imaging (fMRI) studies of STBs in youth to evaluate neural correlates and candidate mechanisms associated with suicidal ideation and attempts, following PRISMA guidelines for 18 studies (N = 9902; ages 9-20 years). Across neurocognitive domains (emotion regulation, self-referential processing, reward sensitivity, cognitive control), findings implicate distributed circuit-level dysfunction rather than focal deficits. Suicidal ideation was most strongly associated with inefficient or context-dependent recruitment of prefrontal control and self-referential networks, whereas suicide attempt history was linked to broader and more stable disruptions in salience, limbic, and action-oriented systems. Altered social and reward processing further suggest heightened sensitivity to rejection and reduced responsiveness to positive outcomes. Effects were most evident in clinically severe samples and largely absent in younger community cohorts, indicating that neural alterations scale with symptom severity and developmental stage. Importantly, patterns diverged between ideation and attempts, suggesting partially distinct neurocognitive pathways that may differentiate risk for thinking about suicide from progressing to suicidal behavior. Overall, current evidence supports models of youth suicidality as emerging from inefficient regulation and motivational systems that compromise adaptive responding under stress. Task-based fMRI may therefore help identify mechanism-targeted intervention points that distinguish ideation from attempts.
Evaluating change in and predictors of depressive symptoms and parenting skills at a psychiatric mother-baby unit - a retrospective analysis of routine data.
Bringmann M, Ottenhus A, Aust S … +5 more , Cho AB, Köppel CJ, Böge K, Bajbouj M, Kemna S
J Affect Disord · 2026 Jun · PMID 42251902 · Publisher ↗
BACKGROUND: The postpartum period is a particularly vulnerable time in the lives of parents, leading to adverse mental health outcomes for them and, as a result, their children. Relative to demand, there is a pronounced...
BACKGROUND: The postpartum period is a particularly vulnerable time in the lives of parents, leading to adverse mental health outcomes for them and, as a result, their children. Relative to demand, there is a pronounced lack of inpatient treatment options for mother-baby-dyads in Germany and beyond, creating a need for additional mother-baby units and the assessment of their effectiveness. The present study is a retrospective evaluation based on routine data from the mother-baby unit at the Charité- Universitätsmedizin Berlin, Germany, examining symptom and parenting skills change and outcome predictors. METHODS: Data were extracted from electronic health records for all patients treated in the unit between October 2021 and June 2025, resulting in a sample of N = 156 women (mean age (years) = 31.10; SD = 6.39) after applying analysis inclusion criteria. Using the Montgomery Åsberg Depression Rating Scale for rater-based depressive symptoms and a custom scale assessing perceived parenting skills, symptom change was examined using unconditional linear mixed models, while descriptive linear mixed models were employed to identify moderators of treatment outcomes. RESULTS: For both outcomes, there was a significant fixed effect for time, indicating that participants showed above-chance improvements in depressive symptoms and parenting skills across the treatment period. While there were no significant predictors for post-treatment parenting skills beyond the baseline value, several diagnostic categories (PTSD, personality disorders, anxiety/OCD) were associated with a higher MÅDRS value at discharge, while educational and occupational status predicted a lower value. LIMITATIONS: Interpretations of the present results are limited by a lack of a control group and post-treatment assessments. Moreover, the main outcome (MÅDRS) only partially captures transdiagnostic symptoms and is not specifically designed to represent depression during the post-partum period. CONCLUSIONS: The present study indicates the effectiveness of the Charité mother-baby unit using routine, real-world data. This adds to a hitherto small evidence base on the effectiveness of MBUs in Germany and beyond, both in terms of symptom reduction and parenting skills improvement across the diagnostic spectrum. Overall, the findings highlight the importance of holistic treatment approaches in the postpartum period for the mental health of both parents and their children.
The mediating role of rumination in the relationship between traumatic childbirth perception, birth satisfaction, and postpartum depressive symptoms.
Aker MN, Yılmaz Sezer N, Alaca C … +3 more , Dinçer S, Köprülü MH, Özdemir F
J Affect Disord · 2026 Jun · PMID 42251901 · Publisher ↗
This study was conducted to examine the mediating role of ruminative thinking in the relationship between perceived traumatic birth, birth satisfaction, and postpartum depressive symptoms among mothers receiving care in...
This study was conducted to examine the mediating role of ruminative thinking in the relationship between perceived traumatic birth, birth satisfaction, and postpartum depressive symptoms among mothers receiving care in the postpartum unit. This descriptive study was conducted between April and December 2024 and included 309 postpartum women. Data were collected within the first 24-48 hour postpartum using the Personal Information Form, the Visual Analog Scale for Birth Satisfaction (VAS-BS), the Traumatic Childbirth Perception Scale (TCPS), the Ruminative Response Scale (RRS), and the Edinburgh Postnatal Depression Scale (EPDS). It was found that 25.9% of the participants were at risk for postpartum depression, while 21.4% perceived their childbirth as traumatic and 11.7% as very highly traumatic. The mediation analysis showed that TCPS had a significant positive effect on RRS, whereas VAS-BS had a significant negative effect. RRS positively predicted EPDS scores. The direct effect of TCPS on EPDS was not significant; however, its positive indirect effect through RRS was significant, indicating a full mediating role of RRS. VAS-BS had both a significant negative direct effect on EPDS and a significant negative indirect effect through RRS, suggesting partial mediation. The final model explained 40.7% of the variance in EPDS scores. Postpartum care should not be limited to depression screening. Women with traumatic childbirth perceptions or low birth satisfaction should also be assessed for ruminative thinking. Nurses and other healthcare professionals play a key role in supporting women's participation in birth-related decisions and helping them process their birth experiences to promote postpartum mental health.
Sociodemographic and clinical characteristics of suicide methods in Denmark: A nationwide registry-based study of suicides during 2010-2020.
Konieczna A, Reilev M, Stenager E … +1 more , Christiansen E
J Affect Disord · 2026 Jun · PMID 42250613 · Publisher ↗
BACKGROUND: Suicide mortality is influenced by the lethality of the method used, making it essential for effective suicide prevention. This nationwide study examined whether suicide methods differ by sociodemographic and...
BACKGROUND: Suicide mortality is influenced by the lethality of the method used, making it essential for effective suicide prevention. This nationwide study examined whether suicide methods differ by sociodemographic and clinical characteristics among individuals who died by suicide in Denmark. METHODS: We conducted a retrospective register-based cohort study including all suicide decedents in Denmark between 2010 and 2020 (n = 6257). Data were obtained from Danish national health registers. Multinomial logistic regression examined associations between individual characteristics and suicide methods, using hanging as the reference category. Statistical significance was assessed with Holm-Bonferroni-adjusted p-values. RESULTS: Compared with hanging, self-poisoning with drugs was significantly associated with female sex (male: OR = 0.37, 95%CI [0.31-0.44]), psychotropic drug treatment (OR = 1.61, 95%CI [1.25-2.07]), and previous suicide attempts (OR = 1.46, 95%CI [1.22-1.73]). Self-poisoning with other substances was more common among individuals without known health conditions. Firearms were significantly associated with male sex (OR = 10.11, 95%CI [5.58-18.32]), and absence of psychiatric history (OR = 0.42, 95%CI [0.27-0.64]). Suicide by jumping was significantly associated with recent psychiatric admissions (OR = 2.52, 95%CI [1.87-3.40]), psychotic disorders (OR = 1.69, 95%CI [1.25-2.27]) and OCD (OR = 3.65, 95%CI [1.71-7.76]). Hanging was the most used method among individuals with a history of affective disorders. CONCLUSIONS: Suicide methods were associated with distinct sociodemographic and clinical characteristics, indicating heterogeneity in method-specific profiles. Individuals using less lethal methods were more likely to have previous healthcare contact, indicating opportunities for targeted prevention, whereas violent methods appeared more strongly related to access to means and non-help-seeking. These findings support method-specific suicide risk assessment and prevention strategies.
The relationship between cognitive dysfunction and suicide crisis syndrome symptoms.
Ulch T, Prekas AS, Edwards AR … +4 more , Wheeler E, Johnson BN, Cohen LJ, Galynker I
J Affect Disord · 2026 Jun · PMID 42250612 · Publisher ↗
PURPOSE: Suicide Crisis Syndrome (SCS), a proposed diagnostic construct for the Diagnostic and Statistical Manual of Mental Disorders (DSM), represents an acute suicidal mental state. Because DSM inclusion requires evide...
PURPOSE: Suicide Crisis Syndrome (SCS), a proposed diagnostic construct for the Diagnostic and Statistical Manual of Mental Disorders (DSM), represents an acute suicidal mental state. Because DSM inclusion requires evidence of functional impairment, this study tested the hypothesis that SCS is associated with deficits in executive function (EF). METHODS: Eighty-five psychiatric inpatients were assessed at intake and 64 at discharge. The 15-item SCS checklist (SCS-C) evaluated symptoms across five domains: entrapment, affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal. EF was measured using a composite score derived from the Trail Making Test (A and B), Stroop Color and Word Test, and Digits Forward and Digits Sequencing tasks. Data were analyzed using Spearman rho correlations, repeated-measures ANOVA, and general linear models (GLM). RESULTS: SCS-C total score and all domain scores decreased from intake to discharge with small to medium effects. Only Trails A reduced similarly with a small effect size. At intake, there was a negative relationship between SCS Affective Disturbance and EF which was no longer present at discharge. By GLM, there was a significant interaction effect by time, showing that this change in association over time was significant, even when controlling for age. CONCLUSIONS: SCS symptoms, particularly affective disturbance, may be associated with executive dysfunction. This impairment is clinically significant, as it may compromise judgment and increase impulsivity. That the linkage between SCS affective symptoms and reduced cognitive function attenuated by discharge provides preliminary support for the notion that SCS is associated with state-dependent cognitive impairment.
Trajectories of internalizing problems during and after the COVID-19 pandemic: The effects of sex and early life stress.
Buthmann JL, Uy JP, Rocha SE … +2 more , Antonacci CA, Gotlib IH
J Affect Disord · 2026 Jun · PMID 42250611 · Full text
The COVID-19 pandemic and its associated lockdowns had a detrimental impact on adolescent mental health, exacerbating levels of emotional difficulties that were already increasing in this population. The course of these...
The COVID-19 pandemic and its associated lockdowns had a detrimental impact on adolescent mental health, exacerbating levels of emotional difficulties that were already increasing in this population. The course of these difficulties after lockdown protocols ended, however, is not fully understood. Further, the effects of early life stress (ELS) and biological sex on mental health during and following the pandemic are also not clear. This study leverages data from a longitudinal project examining adolescent mental health that predates the pandemic. Internalizing problems were assessed in 222 children (58.6% females) ages 9-13 years at recruitment (baseline; 2013-2016) and at four more timepoints, each approximately two years apart. Participants also completed an interview assessing ELS at baseline. We assessed internalizing problems across each phase of the pandemic (i.e., pre-COVID, during the COVID lockdown, after reopening) as a function of ELS and biological sex. We found that whereas unpredictability-related ELS was associated with internalizing problems in girls across all COVID phases, the association between threat-related ELS and internalizing problems from pre-lockdown to post-reopening decreased in girls and increased in boys. Further, threat-related ELS was associated with post-reopening internalizing problems in boys through lower adaptability. Sensitivity analysis showed that the attenuation of the threat-internalizing association in girls and strengthening of the association in boys was not due to aging. Collectively, these findings suggest that there are sex- and ELS-specific changes in psychological functioning in relation to the pandemic. Further research is needed to better understand mechanisms that foster risk or resilience following stress exposure.
Cortical morphometric correlates of childhood adversity and learning burnout in depressive adolescents with non-suicidal self-injury.
Gao M, Chen A, Gao W … +5 more , Jian M, Gong T, Wang P, Ma M, Luan R
J Affect Disord · 2026 Jun · PMID 42250610 · Publisher ↗
Childhood adversity is a well-established risk factor for non-suicidal self-injury (NSSI) in adolescents, but how these early experiences become biologically embedded to shape not only self-harm but also broader function...
Childhood adversity is a well-established risk factor for non-suicidal self-injury (NSSI) in adolescents, but how these early experiences become biologically embedded to shape not only self-harm but also broader functional outcomes such as academic functioning remains unclear. We examined cortical morphometry in 45 adolescents with major depression (MDD) and NSSI, and 45 matched healthy controls using structural MRI, as well as childhood experiences and learning burnout. Adolescents with MDD-NSSI showed a regionally specific pattern of cortical alterations: fronto-limbic thickening particularly in the orbitofrontal cortex (OFC), contrasted with thinning in the visual cortex, alongside reduced OFC surface area. These regionally specific cortical alterations were associated with learning burnout and early-experience: OFC cortical thickness was positively associated with learning burnout, visual cortical thickness was positively associated with physical abuse, and right PFC/ACC cortical thickness was negatively associated with paternal emotional warmth. Exploratory indirect-effect analysis suggested a possible pathway linking childhood sexual abuse, left OFC cortical thickness, and learning burnout. These findings suggest that early adversity may be biologically embedded in regionally specific cortical morphology in adolescents with MDD-NSSI and may be linked to broader functional outcomes such as learning burnout.
Changes in anxiety, quality of life, and functioning following psilocybin-assisted therapy in veterans with treatment-resistant depression.
Kelly CM, Fradet M, Bostian CM … +5 more , Donnelly A, Ellis S, Ostacher M, Aaronson S, Suppes T
J Affect Disord · 2026 Jun · PMID 42248535 · Publisher ↗
BACKGROUND: Psilocybin has demonstrated promise for improving depressive symptoms in treatment-resistant depression, but its effects on anxiety, quality of life, functioning, and posttraumatic stress symptoms are less we...
BACKGROUND: Psilocybin has demonstrated promise for improving depressive symptoms in treatment-resistant depression, but its effects on anxiety, quality of life, functioning, and posttraumatic stress symptoms are less well studied. This study reports exploratory findings from an open-label trial in Veterans with TRD. METHODS: Participants received a single 25-mg dose of psilocybin administered with psychological support. The primary endpoint was assessed 3 weeks post-dose, with follow-up extending to 12 months. Outcomes included anxiety severity (GAD-7), quality of life (Q-LES-Q-SF), functional impairment (WSAS), and posttraumatic stress disorder symptoms (PCL-5). Experiential outcomes were measured with the Mystical Experience Questionnaire (MEQ), Challenging Experiences Questionnaire (CEQ-30), and Emotional Breakthrough Inventory (EBI). Mixed-effects models were used to evaluate longitudinal changes, and correlation analyses examined associations between measures and changes in depressive symptoms on the Montgomery-Åsberg Depression Rating Scale. RESULTS: Fifteen participants were included, with ten completing long-term follow-up. GAD-7 scores demonstrated sustained improvements through 12 months, with a 59% reduction from baseline at Week 3. Q-LES-Q-SF gains were significant through Week 12, with a 24% increase at Week 3, and WSAS improvements persisted through Month 6 before declining, with a 46% reduction at Week 3. These effects were no longer statistically significant after accounting for improvements in depression. Unadjusted PCL-5 reductions were observed at all timepoints. Exploratory analyses of acute subjective experiences did not correlate to treatment response. LIMITATIONS: This study is limited by its small sample size and open-label design. CONCLUSIONS: Psilocybin with psychological support was associated with improvements in anxiety, quality of life, functioning, and PTSD symptoms which largely correlated to concurrent improvements in depressive symptoms. CLINICAL TRIAL: NCT04433858.
Risk configurations for anxiety symptoms among medical postgraduate students: A fuzzy-set qualitative comparative analysis.
Huang L, Kou J, Zhang Y … +4 more , Chen N, Chen J, Zhou X, Wu Y
J Affect Disord · 2026 Jun · PMID 42248534 · Publisher ↗
BACKGROUND: Medical postgraduate students face heightened risks for anxiety disorders due to intense academic and clinical demands. Previous studies, largely relying on regression models, may overlook the complex interpl...
BACKGROUND: Medical postgraduate students face heightened risks for anxiety disorders due to intense academic and clinical demands. Previous studies, largely relying on regression models, may overlook the complex interplay of multiple risk factors. This study aims to identify combinatorial conditions (configurations) sufficient for anxiety symptoms using fuzzy-set qualitative comparative analysis (fsQCA). METHODS: A cross-sectional survey was conducted among 1116 medical postgraduate students in China. Data on demographic, academic, work-related, lifestyle, and psychological factors were collected. Anxiety symptoms were assessed using the Generalized Anxiety Disorder 7-item scale (GAD-7). A series of multivariate linear regression models were fitted to examine variable associations preliminarily. Subsequently, fsQCA was employed to identify combinatorial conditions, analyzing five key factors: financial hardship (FH), long workdays (LW), physical exercise (PE), psychological resilience (PR), and adverse academic events (AAE). RESULTS: No single condition was necessary for anxiety. Three sufficient configurations were identified, explaining 24.6% of cases (overall coverage = 0.246, consistency = 0.811): 1) FH × ~PR × AAE (consistency = 0.847); 2) FH × LW × ~PR (consistency = 0.855); 3) LW × ~PE × ~PR × AAE (consistency = 0.862). Low psychological resilience was a core component across all configurations. LIMITATIONS: The cross-sectional design precludes causal inference, and the single-center sample may limit generalizability. CONCLUSIONS: Anxiety symptoms among medical postgraduate students arises from distinct combinations of academic, work patterns, and personal factors, rather than from any single factor. Interventions could consider moving beyond isolated variables to address synergistic risk profiles, with resilience training as a potential component.
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