Annals Of General Psychiatry[JOURNAL]
Sun
200 papers
Swedish preschool teacher's preferences and experiences of an applied learning intervention to support children with ESSENCE symptoms.
Gustafsson BM, Levander MS
Ann Gen Psychiatry · 2026 May · PMID 42144645 · Full text
The purpose was to study preschool teachers' preferences and experiences of an applied learning intervention to support children with ESSENCE symptoms. Preschool teachers (n = 164) filled out a questionnaire about their...
The purpose was to study preschool teachers' preferences and experiences of an applied learning intervention to support children with ESSENCE symptoms. Preschool teachers (n = 164) filled out a questionnaire about their experiences, and 20 participated in individual interviews about preferences and experiences of the intervention. We used descriptive statistics for the questionnaire and inductive qualitative content analysis to analyze the interviews and free text answers in the questionnaire. The results showed that 74% experienced that they increased their understanding of the child's difficulties, while 48% gained ideas that could be helpful in managing children. Specifically, the respondents emphasized the value of talking and reflecting together with guardians about a specific child. To share experiences from different contexts provided an understanding of the challenges the child, and the adults around them, faced in daily life. It also provided insight into the child's opportunities, abilities and resources. The qualitative latent analyses revealed that the preschool teachers' expectations corresponded well to their experiences after completing the training. The main categories Collaboration between guardians and preschool teachers and Professional knowledge about children with special needs describes their needs for supporting children with neurodevelopmental symptoms. Together they form the theme of a child-centered approach. In conclusion, the present findings add insights about collaborative learning, application of professional knowledge, and guardians and preschool teachers sharing experiences and reflecting together to support the child. In this way, the study contributes to the improvement and application of Child and Family Centered Care in practice.
Association between social isolation, loneliness and the incidence of irritable bowel syndrome: a prospective cohort study in the UK Biobank.
Yao M, Zhang X, Lei F … +4 more , Yan T, Jin B, Wang J, Xv D
Ann Gen Psychiatry · 2026 May · PMID 42143372 · Full text
BACKGROUND: Social isolation and loneliness represent significant public health issues in society. Irritable bowel syndrome (IBS) severely impacts quality of life and requires early prevention. However, the relationship...
BACKGROUND: Social isolation and loneliness represent significant public health issues in society. Irritable bowel syndrome (IBS) severely impacts quality of life and requires early prevention. However, the relationship between social isolation, loneliness, and IBS remains uncertain. We aim to investigate the association between social isolation, loneliness, and the incidence of IBS in a large-scale population cohort. METHODS: This prospective cohort study involved 369,653 participants without IBS from the UK Biobank. The genetic risk of IBS was evaluated using polygenic risk scores. The Cox proportional hazards model was employed to analyze the relationship between social isolation, loneliness, and the risk of IBS incidence. We examined whether depression and anxiety mediate the association between social isolation, loneliness, and IBS risk. RESULTS: Among the 369,653 participants (mean age: 56.7 ± 8.1 years; 47.7% male), 7,663 individuals were diagnosed with IBS during a median 13.6 years of follow-up. After comprehensive adjustment for socioeconomic status, lifestyle factors, health status, and genetic susceptibility, the HR for IBS incidence was 1.156 (1.073, 1.245) among socially isolated participants compared to non-socially isolated participants. The HR for IBS incidence was 1.361 (1.244, 1.490) among lonely participants compared to non-lonely participants. Subgroup analysis showed that, compared to participants without social isolation, the risk of developing IBS in participants without diabetes and those with diabetes under social isolation was 1.133 times (95% CI: 1.050-1.223) and 1.655 times (95% CI: 1.214-2.257) higher, respectively, with the risk being greater in the diabetic group (P for interaction = 0.022). CONCLUSION: Social isolation and loneliness were associated with an increased risk of developing IBS, although loneliness may have a more significant effect on risk. Participants with diabetes have a higher risk of developing IBS under conditions of social isolation. Depression and anxiety mediated the association between social isolation, loneliness, and the risk of developing IBS.
Impacts of climate change on mental health and its underlying mechanisms: an umberella review.
Davariniamotlaghquchan A, Niazmand Z, Shafiee M … +1 more , Ostadtaghizadeh A
Ann Gen Psychiatry · 2026 May · PMID 42121234 · Full text
BACKGROUND: Climate change represents a major global health challenge with potential implications for mental health. Exposure to climate-related stressors is associated with an elevated risk of psychiatric disorders, inc...
BACKGROUND: Climate change represents a major global health challenge with potential implications for mental health. Exposure to climate-related stressors is associated with an elevated risk of psychiatric disorders, including trauma- and stressor-related disorders (e.g., PTSD), depressive disorders, and anxiety disorders. Vulnerable populations-including children, women, older adults, individuals with pre-existing mental health conditions, and communities in low-income or disaster-prone regions-may be disproportionately affected. This umbrella review synthesizes current evidence on the mental health impacts of climate change, focusing on clinically relevant outcomes and underlying mechanisms. METHODS: A systematic literature search was conducted across Web of Science, PubMed, Scopus, and Google Scholar for systematic reviews published between January 2014 and October 2024. Data extraction and methodological quality assessment were performed using the Joanna Briggs Institute Critical Appraisal Checklist, which evaluates methodological rigor, clarity of research questions, and appropriateness of data synthesis. Only English-language systematic reviews scoring ≥ 5/11 on the JBI checklist-reflecting moderate to high methodological quality-were included. Non-systematic reviews and studies without accessible full texts were excluded. The review protocol was registered in PROSPERO (CRD420251133963). RESULTS: Climate change may affect mental health through both direct and indirect pathways. Direct impacts include elevated risk or worsening of PTSD, depressive disorders, anxiety disorders, and suicidal behaviors, which may be precipitated or exacerbated by climate-related stressors. Indirect effects operate via socioeconomic disruptions, such as food insecurity, forced migration, poverty, and weakened social networks. Psychological responses described as eco-anxiety and solastalgia further illustrate the range of mental health outcomes associated with environmental changes. CONCLUSION: Climate change is associated with clinically relevant psychiatric outcomes across established diagnostic categories. The mechanisms underlying these associations involve complex neurobiological, socioeconomic, environmental, and cultural pathways. These findings underscore the importance of targeted psychiatric interventions, including cognitive behavioral therapy, trauma focused therapies, resilience-building, strengthening social support, promoting adaptive coping strategies, and enhancing preparedness of mental health services. Prioritizing vulnerable populations for psychiatric assessment, prevention, and intervention is essential. Integrating these strategies into clinical practice and public health planning is critical to support evidence-based mental health care.
Decreased serum IGFBP-7 level is associated with cognitive impairment in first-episode drug-naïve adolescent-onset schizophrenia.
Yang H, Hou J, Luan L … +4 more , Han Y, Yang M, Tian Q, Zhang X
Ann Gen Psychiatry · 2026 May · PMID 42121223 · Full text
BACKGROUND: Adolescent-onset schizophrenia (AOS) is characterized by severe cognitive impairment. Insulin-like growth factor binding protein-7 (IGFBP-7), a biomarker of vascular aging and neuroinflammation, and hepatocyt...
BACKGROUND: Adolescent-onset schizophrenia (AOS) is characterized by severe cognitive impairment. Insulin-like growth factor binding protein-7 (IGFBP-7), a biomarker of vascular aging and neuroinflammation, and hepatocyte growth factor (HGF), involved in neurodevelopment, have been linked to cognitive decline, but their roles in AOS remain unexplored. METHODS: This case-control study enrolled 91 first-episode drug-naïve AOS patients and 40 healthy controls. Clinical symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS) and its five-factor model, and cognitive function was evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). RESULTS: AOS patients exhibited significantly lower serum IGFBP-7 levels compared to healthy controls (10.15 ± 3.62 vs. 11.75 ± 3.41 ng/mL, t = -2.377, P = 0.019), while HGF levels showed no significant difference (P > 0.05). IGFBP-7 levels were negatively correlated with PANSS cognitive factor scores (r = -0.308, P = 0.003) and positively correlated with RBANS total scores (r = 0.353, P = 0.001). IGFBP-7 was independently associated with RBANS total score (β = 0.284, P = 0.002) after controlling for confounding factors. Sex (β = 0.467, t = 5.325, P < 0.001) was identified as a confounder but did not moderate the IGFBP-7-cognition relationship (P > 0.05). Modified Poisson regression revealed that low IGFBP-7 levels independently predicted AOS risk (RR = 1.298, 95% CI: 1.037-1.624, P = 0.023), with attributable fractions of 23.0% in exposed individuals and 12.7% in the overall population. CONCLUSIONS: Decreased serum IGFBP-7 levels are associated with cognitive impairment in AOS and represent a significant risk factor, suggesting IGFBP-7 as a potential biomarker for cognitive dysfunction in AOS.
Suicidal ideation in family caregivers of patients with dementia, cancer, stroke, and ischemic heart disease.
Oh S, Lee J, Kim HJ … +2 more , Kang D, Cho J
Ann Gen Psychiatry · 2026 May · PMID 42108477 · Full text
BACKGROUND: Suicidal ideation among caregivers has drawn increasing attention. However, most prior studies have examined single diseases and provide limited comparative evidence. Furthermore, evidence focusing on family...
BACKGROUND: Suicidal ideation among caregivers has drawn increasing attention. However, most prior studies have examined single diseases and provide limited comparative evidence. Furthermore, evidence focusing on family caregivers of community-dwelling adults with chronic diseases remains limited. Using nationally representative data of community-dwelling adults, we assessed the association between caregiving and suicidal ideation across four high-burden conditions: dementia, cancer, stroke, and ischemic heart disease (IHD). METHODS: We conducted a cross-sectional analysis using 2007-2021 data from the Korean National Health and Nutrition Examination Survey (KNHANES). Patients with the four target diseases were identified and linked to family members through a household identification number. The final sample included 7,025 caregivers and 66,872 non-caregivers. Suicidal ideation was assessed using a standardized questionnaire. Multivariable logistic regression and subgroup analyses were performed. RESULTS: Suicidal ideation was reported by 6.1% of non-caregivers and 6.9% of caregivers (adjusted odds ratio [aOR] = 1.18;95%CI = 1.05-1.32). Compared to non-caregivers, the risk of suicidal ideation was highest among caregivers of patients with IHD (aOR = 1.46;95%CI = 1.18-1.80) and patients or sibling caregivers (aOR = 2.21;95%CI = 1.34-3.62), caring for female patients (aOR = 1.18;95%CI = 1.03-1.36) and these caring for younger patients (< 60 years). In subgroup analysis, the association was notably stronger among older and female caregivers than male caregivers. CONCLUSIONS: Mental health support should be tailored to disease and caregiving role. Interventions are especially needed for parents and spouses under high psychological burden. Policies must prioritize screening and access to mental health care for vulnerable caregivers.
Motivational deficits and anhedonia in schizophrenia: insights from behavioral activation and behavioral inhibition systems.
Akgül Ö, Hosgelen EI, Bilgin TS … +2 more , Akdede BB, Alptekin K
Ann Gen Psychiatry · 2026 May · PMID 42108453 · Full text
PURPOSE: Schizophrenia is a disorder characterized by significant motivational deficits, including anhedonia, that impair daily functioning. Approach and avoidance behaviors are regulated by two basic motivation systems:...
PURPOSE: Schizophrenia is a disorder characterized by significant motivational deficits, including anhedonia, that impair daily functioning. Approach and avoidance behaviors are regulated by two basic motivation systems: the Behavioral Inhibition System (BIS) and the Behavioral Activation System (BAS). Based on Gray's Reinforcement Sensitivity Theory, this study examined the relationships among BIS/BAS activity, depressive symptoms, and anhedonia in individuals with schizophrenia compared to healthy controls. METHODS: Sixty-one patients with schizophrenia (SZ) and 62 healthy participants participated in the study. Positive and Negative Syndrome Scale, Beck Depression Inventory, Calgary Depression Scale, BIS/BAS Scale, and physical, social, and chemosensory anhedonia scales were administered to the participants. This cross-sectional, between-groups study compared SZ and healthy controls to examine the associations among BIS/BAS activity, depressive symptoms, and anhedonia. T-test, Logistic regression, and regression analyses were performed. RESULTS: Logistic regression analyses determined that BAS activity and anhedonia significantly predicted being in the patient group. It revealed motivational deficits in schizophrenia compared to healthy subjects. Patients with schizophrenia showed reduced BAS activity associated with impaired reward sensitivity and goal-directed behavior. However, no differences in BIS activity were found. While BAS activity and depressive symptoms were found to be predictors of all subscales of anhedonia in healthy controls, they were only found to be predictive of physical anhedonia in schizophrenia. CONCLUSION: These results suggest that anhedonia in SZ results from deficits in anticipatory pleasure and reward processing, independent of mood-related mechanisms. It suggests that different mechanisms may underlie anhedonia. Future studies should investigate BAS dysregulation in SZ, including cognitive-behavioral therapies and pharmacological strategies that target dopaminergic pathways.
Diagnostic accuracy of machine learning approaches for suicide‑related outcomes: a meta‑analysis.
Kohnepoushi P, Afraie M, Rahmani H … +3 more , Seyedoshohadaei SA, Ghadirzadeh B, Moradi Y
Ann Gen Psychiatry · 2026 May · PMID 42106827 · Full text
OBJECTIVE: This diagnostic test accuracy meta-analysis aimed to provide clinically interpretable estimates (sensitivity, specificity, likelihood ratios (LR), predictive value (PV) and post‑test probabilities) for machine...
OBJECTIVE: This diagnostic test accuracy meta-analysis aimed to provide clinically interpretable estimates (sensitivity, specificity, likelihood ratios (LR), predictive value (PV) and post‑test probabilities) for machine‑learning (ML) models predicting suicide‑related outcomes. METHODS: A systematic search of PubMed, Embase, PsycINFO, and Web of Science identified studies published between January 2010 and December 2024. Eligible studies used a single-gate design (cross-sectional or longitudinal), included at least 100 participants, and reported diagnostic performance metrics (e.g., sensitivity, specificity, area under the receiver operating curve (AUC)) for ML algorithms. Models examined included Support Vector Machines (SVM), Logistic Regression, Random Forest, XGBoost, Artificial Neural Networks (ANN), Gradient Boosting, and Ensemble approaches. Two reviewers independently extracted data. Pooled estimates of sensitivity, specificity, PPV, NPV, and AUC were calculated using a bivariate random-effects model. Risk of bias was assessed using QUADAS-2. RESULTS: Of 500 screened records, 22 studies met inclusion criteria. Ensemble models demonstrated the highest pooled AUC (0.95; 95% CI, 0.92-0.96), with specificity of 0.97 (95% CI, 0.95-0.98) and sensitivity of 0.50 (95% CI, 0.29-0.71). Gradient-boosting and ensemble approaches showed strong discriminative performance overall; model-specific estimates are reported in the Results. At a pre-test probability of 25%, post-test probabilities for a positive result ranged from 64% (Logistic Regression) to 88% (Ensemble Models). CONCLUSION: Machine-learning approaches demonstrated promising diagnostic accuracy for suicide-related outcomes in heterogeneous clinical populations. However, because primary studies rarely reported diagnosis- or outcome-specific performance, these findings should not be assumed to generalize across specific disorders or to suicide mortality. Future research should incorporate diagnosis-stratified and outcome-resolved validation to clarify clinical applicability.
Normative modeling reveals functional connectivity heterogeneity in internet gaming disorder.
Wang Z, Xie Y, Wang Y … +2 more , Wang L, Dong GH
Ann Gen Psychiatry · 2026 May · PMID 42069658 · Full text
BACKGROUND: Internet gaming disorder (IGD) is associated with abnormal functional connectivity (FC) in brain networks. However, findings from resting-state functional magnetic resonance imaging studies are highly inconsi...
BACKGROUND: Internet gaming disorder (IGD) is associated with abnormal functional connectivity (FC) in brain networks. However, findings from resting-state functional magnetic resonance imaging studies are highly inconsistent, likely due to individual heterogeneity in IGD-related neural alterations-a feature commonly observed in other psychiatric disorders but understudied in IGD. METHODS: We applied normative modeling to nucleus accumbens (NAcc) seed-to-voxel resting-state FC to derive individualized deviation (Z) maps for 173 IGD participants relative to age- and sex-adjusted normative ranges from 232 healthy controls. We then performed exploratory unsupervised clustering of network-level deviation features across three sample data, three atlas templates, and two clustering algorithms, selecting the optimal number of clusters using the silhouette criterion. RESULTS: IGD showed marked heterogeneity in FC deviations: voxel-level deviations were largely idiosyncratic in both spatial distribution and direction. When deviations were summarized at the network level, clustering consistently selected a two-cluster solution across data, atlases, and algorithms, separating a majority "low-deviation" stratum from a smaller "high-deviation" stratum. CONCLUSIONS: IGD is characterized by pronounced individual variability in FC deviations. Network-level deviations yield a robust higher- vs. lower-deviation stratification, although the present findings do not support interpreting this pattern as evidence for discrete subtypes. The present study highlights the utility of individualized deviation mapping beyond conventional case-control analyses for characterizing heterogeneity in IGD.
Patient perspectives on the challenges, obstacles, and opportunities in discussing and managing anhedonia in major depressive disorder (MDD): a focus group study.
Portela R, Brister T, Mattingly G … +2 more , Drissen T, Bowrey HE
Ann Gen Psychiatry · 2026 Apr · PMID 42036697 · Full text
BACKGROUND: Major depressive disorder (MDD) is a common mental health disorder and a leading cause of disease burden. Anhedonia—defined for participants in this study as diminished interest, motivation, or ability to exp...
BACKGROUND: Major depressive disorder (MDD) is a common mental health disorder and a leading cause of disease burden. Anhedonia—defined for participants in this study as diminished interest, motivation, or ability to experience pleasure in daily activities—is a core symptom required for diagnosis of MDD and may persist despite treatment. Limited awareness and shared understanding of anhedonia between patients and healthcare professionals (HCPs) may complicate communication during clinical encounters, highlighting an ongoing need to better characterize how this symptom is recognized and discussed in clinical practice. METHODS: This Johnson & Johnson (J&J) Patient Engagement Research Council (PERC) focus group study explored patient perspectives on conversations with HCPs about anhedonia and perceived barriers to these discussions. Four focus group sessions were conducted virtually in Nov-Dec 2023, with n = 12 adult patients with moderate-to-severe MDD in the US, using a semi-structured discussion guide to stimulate discussion and patient feedback. RESULTS: Across discussions, participants reported that conversations about anhedonia were more commonly initiated by patients (n = 8/12) than by HCPs (n = 7/12 reporting that HCPs rarely or never initiated such discussions). Participants also reported that treatment options specifically addressing anhedonia were infrequently discussed (n = 9/12). Perceived barriers to effective communication included time-constrained appointments, uncertainty or limited awareness of anhedonia, and discouragement related to prior ineffective treatment experiences. Participant-derived recommendations focused on the potential value of patient and HCP education, including educational materials for patients and HCPs, proactive screening protocols or structured prompts to facilitate discussion, and regular follow-up visits to revisit symptoms over time. CONCLUSIONS: These findings from a small, purposive sample suggest that challenges in discussing anhedonia during clinical visits may contribute to its limited consideration in ongoing care, underscoring the need for approaches that better support recognition and dialogue around this multifaceted symptom within routine clinical practice.
Can art help us confront the health inequities faced by Europe's largest minority?
Courtet P, Kerbage H
Ann Gen Psychiatry · 2026 Apr · PMID 42035146 · Full text
BACKGROUND: Roma and Traveller populations constitute the largest ethnic minority in Europe and face persistent and profound mental health inequities. Elevated levels of psychological distress, depression, and suicidalit...
BACKGROUND: Roma and Traveller populations constitute the largest ethnic minority in Europe and face persistent and profound mental health inequities. Elevated levels of psychological distress, depression, and suicidality, as well as major barriers to accessing care, have been widely reported. Although structural determinants such as poverty, discrimination, and restricted access to healthcare are increasingly acknowledged, the role of social and symbolic representations in shaping mental health research and clinical practice remains insufficiently explored. MAIN BODY: In this commentary, we argue that artistic and cultural practices provide a valuable and underutilised lens for understanding and addressing mental health inequities affecting Roma communities. Through examples drawn from Roma visual arts, exhibitions, and literary traditions, we illustrate how art can challenge deficit-based narratives and reshape the emotional and symbolic frameworks through which Roma lives are perceived. These shifts in representation have implications for clinical encounters, trust in services, and recognition of mental health needs. Beyond public visibility, we propose that arts-based and narrative approaches can also function as methodological resources within mental health research. By foregrounding lived experience, meaning-making, and relational dimensions of health that are often overlooked by conventional quantitative approaches, these methods can support more inclusive and participatory forms of knowledge production. When developed in partnership with Roma communities, such approaches may reduce epistemic distance, challenge dominant research categories, and improve the cultural relevance of mental health interventions. CONCLUSION: Reducing mental health inequities among Roma and Traveller populations requires approaches that extend beyond documenting disparities. Integrating artistic and narrative perspectives into research design and dissemination may help transform representations, strengthen community engagement, and support more equitable and responsive mental health care.
Pre-/pro and synbiotics on anxiety and depression symptoms: a GRADE assessed systematic review and meta-analysis of randomized controlled trials.
Lian J, Yu W, Feng G … +1 more , Miao D
Ann Gen Psychiatry · 2026 Apr · PMID 42010690 · Full text
BACKGROUND: The influence of pre-/pro-/synbiotics on depressive and anxiety symptoms remains ambiguous. This systematic review and meta-analysis aimed to clarify the impact of these interventions on mental health outcome...
BACKGROUND: The influence of pre-/pro-/synbiotics on depressive and anxiety symptoms remains ambiguous. This systematic review and meta-analysis aimed to clarify the impact of these interventions on mental health outcomes in adults. METHODS: A systematic search was conducted across PubMed, Scopus, and Web of Science databases until May 10, 2025, to identify randomized controlled trials (RCTs) evaluating the effects of pre-/pro-/synbiotics on depressive and anxiety symptoms in adults. Random-effects models were used to compute pooled standardized mean differences (SMDs) and 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 statistic. Publication bias was evaluated using funnel plots and Egger’s test. RESULTS: A total of 70 RCTs (65 for depression and 49 for anxiety) met the inclusion criteria and had intervention durations ranging from 2 to 24 weeks. Pre-/pro-/synbiotics supplementation significantly reduced depressive symptoms (SMD = −0.57; 95% CI: −0.71, −0.43, p < 0.001; I2 = 83.0%) and anxiety symptoms (SMD = −0.43; 95% CI: −0.59, −0.28, p < 0.001; I2 = 80.5%). Subgroup analyses for depression revealed larger effects in studies with sample size < 50, and in participants aged ≥ 50 years. Probiotics and synbiotics significantly reduced depression, while prebiotics did not. All three intervention types significantly reduced anxiety, with synbiotics showing the largest effect. CONCLUSION: This meta-analysis suggests that supplementation with pre-/pro-/synbiotics may have beneficial effects on depressive and anxiety symptoms in adults. However, due to substantial heterogeneity and the overall moderate methodological quality of included studies, these findings should be interpreted with caution. Importantly, these interventions should be considered as an adjunctive option to support mental health, not as a replacement for standard evidence-based treatments such as pharmacotherapy and psychotherapy. Further high-quality RCTs with standardized protocols are warranted to confirm these findings and establish definitive clinical recommendations.
Antidepressant prescribing patterns and patient-reported adverse effects: a cross-sectional study from Pakistan.
Riaz S, Khuda F, Khan A … +5 more , Jan A, Ibenmoussa S, Alotaibi G, Ali SS, Albabtain BA
Ann Gen Psychiatry · 2026 Apr · PMID 41987272 · Full text
BACKGROUND: Antidepressant prescribing practices and Adverse-effect profiles are poorly characterised in Pakistan, highlighting the need for systematic evaluation. This study aimed to assess prescribing patterns, validat...
BACKGROUND: Antidepressant prescribing practices and Adverse-effect profiles are poorly characterised in Pakistan, highlighting the need for systematic evaluation. This study aimed to assess prescribing patterns, validate the Urdu version of the Antidepressant Side-Effect Checklist (U-ASEC), and document patient-reported adverse effects. METHODS: A cross-sectional questionnaire-based study was conducted at two psychiatry clinics in Lahore and Rawalpindi. All adult patients diagnosed with MDD according to the DSM-5-TR were invited to participate. Sampling was done through a convenient method. The Urdu-translated Antidepressant Side-Effect Checklist (U-ASEC) was developed through forward-back translation, expert panel review and pilot testing, and its psychometric properties such as internal consistency, construct validity were examined. Descriptive statistics were used to summarize demographic and clinical characteristics. Differences in adverse-effect scores across demographic and clinical groups were assessed with Kruskal-Wallis tests followed by Dunn's test with Bonferroni adjustment. Multivariable logistic regression models were fitted for each adverse-effect item to explore associations with antidepressant classes, adjusting for age, sex, tobacco use, comorbidity and duration of MDD. Multicollinearity was checked using variance inflation factors (VIF) (< 3 for all variables), and false discovery rate (FDR) control was used to account for multiple testing. RESULTS: Among the 457 participants, 54.9% were male and 60% of participants were married. Escitalopram was the most frequently prescribed single agent (12.9%), and Selective serotonin reuptake inhibitors as a class accounted for 32.1% of monotherapy prescriptions. Combination therapy was used by 26.7% of participants; typical pairs included mirtazapine + escitalopram (12.2%) and mirtazapine + fluoxetine (5.5%). The U-ASEC demonstrated good internal consistency (Cronbach's alpha = 0.78). Factor analysis identified three clusters of adverse effects: autonomic dysfunction, Central Nervous System effects, and metabolic effects. Dry mouth and insomnia were the most frequently reported adverse effects of SSRIs. Adverse effects varied by class: TCAs had higher rates of nausea/vomiting (41.3%); SNRIs were associated with a higher prevalence of urinary difficulties (32.4%); atypicals reduced dry mouth (18.8%) but increased dizziness (10.4%); and dual therapy showed more metabolic effects, including weight gain (29.5%) and increased body temperature (20.5%). Significant associations were identified for dry mouth (p = 0.0059), nausea and vomiting (p = 0.0202), problem with urination (p = 0.0248), feeling like the room is spinning (p = 0.041), and Tremor (p = 0.0382). Multivariable analysis showed TCAs increased odds of nausea (OR 3.96, 95% CI 1.72-9.03, p = 0.001), urination problems (OR 2.77, 1.10-6.63, p = 0.025), orthostatic symptoms (OR 2.59, 1.07-6.01, p = 0.030) and tremor (OR 2.66, 1.22-5.94, p = 0.015). SNRIs were associated with increased odds of urinary difficulties (OR 12.92, 1.19-284.32, p = 0.040). Atypicals reduced dry mouth (OR 0.18, 0.02-0.94, p = 0.050) but increased dizziness (OR 8.42, 1.47-48.41, p = 0.012). CONCLUSION: Escitalopram was the most commonly prescribed antidepressant, with dry mouth and insomnia as the most reported adverse effects. This study provides a culturally relevant tool, U-ASEC, for adverse effect monitoring, addressing critical gaps in Pakistan's clinical practices. Our findings underscore the importance of tailoring antidepressant choice to patient characteristics. TRIAL REGISTRATION: Not applicable.
Unraveling links between lifestyle behaviors and depressive symptoms: a network analysis using NHANES 2007-2018 data.
Yang F, Liu L, Zhang Y … +3 more , Cheng D, Yu R, Lin J
Ann Gen Psychiatry · 2026 Apr · PMID 41965760 · Full text
OBJECTIVE: Implementing effective interventions targeting specific depressive symptoms is essential for reducing the overall burden of depression. Our study employed network analysis to explore the complex interrelations...
OBJECTIVE: Implementing effective interventions targeting specific depressive symptoms is essential for reducing the overall burden of depression. Our study employed network analysis to explore the complex interrelationships between multiple lifestyle behaviors and depressive symptoms, and to compare network differences across different age groups. METHODS: Using data from the National Health and Nutrition Examination Survey (NHANES), we analyzed 4,040 participants between the ages of 20 and 80 from the 2007-2018 survey cycles. Depressive symptoms were assessed using the 9-item Patient Health Questionnaire (PHQ-9), and data on five lifestyle behaviors-healthy diet, alcohol consumption, screen time, smoking, and physical activity-were collected. Network models were estimated using R version 4.4.3 to calculate strength, bridge strength, and age-related differences. RESULTS: The network analysis revealed that smoking (bridge expected influence; BEI = 2.59), alcohol use (BEI = 2.19), and screen time (BEI = 2.17) were the most prominent bridging nodes linking lifestyle behaviors and depressive symptoms. In addition, healthy diet (LB1) was negatively associated with appetite problems (PHQ5; edge weight = -0.02), and psychomotor agitation or retardation (PHQ8; edge weight = -0.02); screen time (LB3) was positively linked to trouble sleeping (PHQ3; edge weight = 0.04), and appetite problems (PHQ5; edge weight = 0.03); smoking (LB4) was associated with appetite problems (PHQ5; edge weight = 0.04) and depressed mood (PHQ2; edge weight = 0.03); physical activity (LB5) was negatively related to fatigue (PHQ4; edge weight = -0.05). Finally, global network strength differed significantly across age groups, with a clear age-related decline in overall connectivity: the Youth group exhibited the highest global strength (4.56), followed by the Middle-aged group (4.07) and the Older group (3.45). CONCLUSIONS: These findings contribute to the development of more nuanced and effective public health strategies for the prevention and treatment of depression.
Alexithymia and self-harm in depressed adolescents: the mediating role of resting-state functional connectivity of the ventral hippocampal-fusiform gyrus.
Ma Y, Zhou Y, Fu H … +10 more , Lin X, Huang M, Zhang Y, Li Y, Liu Y, Zhou W, Chen R, Chen Y, Wu J, Tang J
Ann Gen Psychiatry · 2026 Apr · PMID 41957821 · Full text
BACKGROUND : Alexithymia is implicated in self-harm behaviors, including nonsuicidal self-injury (NSSI), suicide attempt (SA). However,, the neurobiological mechanisms underlying this association remain poorly understood...
BACKGROUND : Alexithymia is implicated in self-harm behaviors, including nonsuicidal self-injury (NSSI), suicide attempt (SA). However,, the neurobiological mechanisms underlying this association remain poorly understood, especially among clinically referred adolescents with depressive symptoms. METHODS: A total of 129 adolescents with depressive symptoms were recruited from Shenzhen Mental Health Center. NSSI, SA, alexithymia and its dimensions were measured using validated scales. Resting-state functional connectivity (rs-FC) was measured using functional magnetic resonance imaging (fMRI) within a predefined set of emotion regulation (ER)-related regions of interest (ROIs). RESULTS: Of the analytic sample, 37 adolescents met the criteria for NSSI and 59 met the criteria for SA. The externally oriented thinking (EOT) subscale scores were positively associated with SA (adjusted OR = 1.21, 95% CI, 1.03–1.43). Adolescents with SA exhibited heightened connectivity within ER regions compared to controls, including between the left orbitofrontal cortex and right medial orbital superior frontal gyrus (z score = 0.19, P < 0.001), left medial orbitofrontal cortex and left inferior occipital gyrus (z score = 0.16; P < 0.001), left dorsolateral prefrontal cortex and right medial orbital of the superior frontal gyrus (z score = 0.17; P < 0.001), right parahippocampal gyrus and right fusiform gyrus (z score = 0.17; P < 0.001), and between the right ventral hippocampus (vHC) and the right fusiform gyrus (FG) (z = 0.17; P < 0.001). Mediation analysis showed that the association between EOT and SA was fully mediated by right vHC-right FG connectivity (indirect effect β = 0.096, 95% CI, 0.027–0.190). No significant associations between alexithymia or rs-FC within ER regions and NSSI were found. CONCLUSIONS: In clinically referred adolescents with depressive symptoms, EOT-related alexithymia is associated with SA, and this association appears to be fully mediated by enhanced vHC-FG connectivity. The vHC-FG circuit, which plays a key role in ER, may represent a novel neurobiological target for interventions aimed at preventing self-harm behaviors in this vulnerable population.
Association of screen time and chronotype with depression and anxiety symptoms among Chinese adolescents.
Xu Y, Lin YF, Li L … +7 more , Li Y, Yang L, Wu H, Zhang C, Zhou W, Yang L, Lu C
Ann Gen Psychiatry · 2026 Apr · PMID 41947224 · Full text
BACKGROUND: Depression and anxiety symptoms among adolescents have increased in recent years, making the identification of modifiable risk factors important. Prolonged screen time (ST) and later chronotype may be indepen...
BACKGROUND: Depression and anxiety symptoms among adolescents have increased in recent years, making the identification of modifiable risk factors important. Prolonged screen time (ST) and later chronotype may be independently and jointly associated with adolescent mental health. This study aimed to examine the independent and joint associations of ST and chronotype with depression and anxiety symptoms among adolescents. METHODS: Data were drawn from the China Adolescent Health Screening Program (CAHSP), a large school-based health screening program conducted in Shenzhen, southern China, using a multistage cluster sampling design, including 10,083 adolescents (mean age: 13.7 [SD: 1. 6] years). ST was assessed using structured self-report items, while chronotype was measured using the Morningness-Eveningness Questionnaire-5 (MEQ-5). Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7), respectively. Logistic regression models adjusted for relevant covariates were employed to examine independent and joint associations of ST and chronotype with depression and anxiety symptoms. RESULTS: Excessive ST and later chronotype were significantly associated with depression and anxiety symptoms. Significant interaction indicated that the association between excessive ST and mental health symptoms differed across chronotype groups. Stratified analyses confirmed that within each chronotype group, adolescents with excessive ST had higher odds of depression and anxiety, with the strongest associations observed in evening chronotype (E-type) adolescents (depression: aOR = 2.54, 95% CI: 2.01-3.22; anxiety: aOR = 2.49, 95% CI: 1.98-3.13). Joint analyses further confirmed that E-type adolescents with excessive ST showed the highest odds of screening positive for depression and anxiety symptoms (depression: aOR = 5.55, 95% CI: 4.38-7.02; anxiety: aOR = 4.71, 95% CI: 3.73-5.93) compared with the non-excessive ST and M-type group. CONCLUSION: Higher levels of ST and later chronotype were associated with higher odds of screening positive for depression and anxiety symptoms among adolescents. Public health strategies to promote adolescents' mental well-being should focus on encouraging healthy screen behaviors and promoting sleep hygiene, particularly for E-type adolescents.
Sex differences in prevalence and clinical correlates for psychotic symptoms in first-episode drug-naïve patients with bipolar disorder: a cross-sectional study.
Chen Y, Zhai Y, Chen H … +1 more , Liu X
Ann Gen Psychiatry · 2026 Apr · PMID 41947159 · Full text
BACKGROUND: Psychotic symptoms, which affect a significant proportion of patients with bipolar disorder (BD), are associated with adverse prognostic outcomes. Currently, sex-specific patterns of psychotic symptoms remain...
BACKGROUND: Psychotic symptoms, which affect a significant proportion of patients with bipolar disorder (BD), are associated with adverse prognostic outcomes. Currently, sex-specific patterns of psychotic symptoms remain inadequately characterized in BD. This study seeks to investigate sex-based differences in psychotic symptoms among first-episode drug-naïve (FEDN) BD patients among Han Chinese population. METHODS: A total of 577 FEDN BD patients, comprising 271 males and 306 females, were recruited in this study. Demographic characteristics were collected using a specialized questionnaire. The positive subscale of the Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Scale, Young Mania Rating Scale, and Clinical Global Impression Scale-Severity of Illness were used to evaluate clinical symptoms. Moreover, fasting blood glucose, prolactin, lipids, and thyroid hormone levels, alongside metabolic syndrome (MetS) were assessed. RESULTS: The prevalence of psychotic symptoms showed no significant sex differences in the FEDN BD cohort (p = 0.968). Nevertheless, multiple linear regression revealed that MetS score (p = 0.001) was significantly associated with the PANSS Positive subscale score (PANSS-P) among males, whereas thyroid-stimulating hormone (TSH) levels (p < 0.001) and high-density lipoprotein cholesterol (HDL-C) levels (p < 0.001) were significantly associated with PANSS-P among females. Binary logistic regression revealed that MetS score (p = 0.002) was a significant correlate of the prevalence of psychotic symptoms among males only, whereas TSH levels (p < 0.001) significantly correlated with the prevalence of psychotic symptoms among females only. CONCLUSIONS: Among Han Chinese FEDN BD patients, our study revealed the following: (1) No significant sex difference was observed in the prevalence of psychotic symptoms; (2) HDL-C functions as a meaningful protective factor against the prevalence of psychotic symptoms in both males and females, while its association with symptom severity is observed exclusively in females; (3) Sex-specific indicators correlate with psychotic symptoms, specifically MetS dominates in males, while TSH in females. Our results call for sex-informed clinical protocols that integrate metabolic-endocrine monitoring and targeted interventions to reduce psychosis risk in BD.
Depression and the risk of myocardial infarction: evidence from a cross-sectional analysis of NHANES 2005-2020.
Zhu D, Ying F, Wei L … +1 more , He X
Ann Gen Psychiatry · 2026 Apr · PMID 41935301 · Full text
BACKGROUND: Depression is recognized as being linked to atherosclerosis and adverse cardiovascular outcomes; however, robust evidence from nationally representative cohorts regarding its association with myocardial infar...
BACKGROUND: Depression is recognized as being linked to atherosclerosis and adverse cardiovascular outcomes; however, robust evidence from nationally representative cohorts regarding its association with myocardial infarction (MI) is still insufficient. This study aimed to investigate the relationship between depressive symptoms, measured by the PHQ-9, and the odds of having a history of MI using data from NHANES 2005-2020, while further exploring possible nonlinear patterns and potential modifiers of this association. METHODS: We included 37,139 adults aged 20 years or older (1,574 with MI) and performed weighted analyses accounting for the NHANES complex survey design. Exposure was defined as PHQ-9 scores, analyzed both continuously and by severity categories (none, mild, moderate, severe), with self-reported MI as the outcome. We fitted three progressively adjusted weighted logistic regression models and employed restricted cubic spline (RCS) analysis to evaluate nonlinearity. We further performed prespecified subgroup and interaction analyses, along with a series of sensitivity analyses. RESULTS: Higher depressive burden was significantly associated with higher odds of MI, with MI prevalence rising progressively across depression severity groups (2.89% vs. 4.39% vs. 5.80% vs. 7.08%, p < 0.001). In the unadjusted model, every 1-point increase in PHQ-9 score corresponded to a 6.2% increase in the odds of MI (OR = 1.062, 95% CI: 1.047-1.077; p < 0.001), while severe depression was linked to approximately a 2.56-fold higher odds compared with non-depressed participants. The association remained robust after sequential full adjustment for potential confounders. Restricted cubic spline analysis revealed no evidence of nonlinearity (p > 0.05), supporting an approximately linear association. Subgroup analyses demonstrated consistent associations across most strata; however, significant interactions were detected for CHF, CHD, and higher V/MPA groups (P for interaction < 0.05), indicating attenuated associations in these groups. CONCLUSION: In a nationally representative sample of US adults, depressive burden was strongly associated with prevalent MI, with cardiovascular comorbidities and physical activity acting as potential modifiers of this association. These findings underscore the importance of integrating routine depression screening and holistic mind-body management into both general and high-risk populations, and highlight the necessity of prospective and interventional studies to clarify the temporal sequence and evaluate potential causality.
Genetic predictors of lithium response in an ethiopian cohort of patients with bipolar disorder.
Hailu AE, Teferra S, Engidawork E
Ann Gen Psychiatry · 2026 Apr · PMID 41935281 · Full text
BACKGROUND: Several lines of evidence suggest that genetic factors underlie variability in response to lithium, although pharmacogenetic studies, particularly in African populations, are limited. This study aimed to exam...
BACKGROUND: Several lines of evidence suggest that genetic factors underlie variability in response to lithium, although pharmacogenetic studies, particularly in African populations, are limited. This study aimed to examine the genetic factors associated with lithium response among Ethiopian patients diagnosed with bipolar disorder (BD). METHODOLOGY: This study was conducted at Amanuel Mental Specialized Hospital (AMSH) in Addis Ababa, Ethiopia, involving 101 patients diagnosed with BD and on lithium therapy for at least six months. Participants were selected from a larger cohort recruited for the Neuropsychiatric Genetics of African Populations - Psychosis, Ethiopia (NeuroGAP-P-E) project. The study investigated the association between lithium response and genetic polymorphisms of 22 genes with 53 SNPs implicated in lithium's mechanisms of action. Clinical response to lithium was assessed using the Alda scale, where those with total Alda > 7 were categorized as good responders (GR) and those with Alda < 7 as insufficient responders (IR). Genotyping was performed using PCR-free whole-genome sequencing. RESULTS: Among the participants, 32.5% were classified as GR, while 67.5% were IR. Significant associations were identified between lithium's response and specific SNPs. Notably, the BDNF rs6265 variant (Val166Met) showed stronger correlation, with the CC genotype being more frequent (p = 0.0001) in IR, while the rs2030324 A allele and AA genotype were more frequent in GR (p < 0.05). Variants in GSK-3β (rs334558) and dopamine receptor genes, such as DRD1 (rs4532) and DRD2 (rs1800497) also demonstrated significant associations with treatment outcomes (p < 0.05). However, after adjustment for multiple testing using false discovery rate (FDR), only polymorphisms within BDNF and DRD1 remain statistically significant. Multivariable analysis revealed that whilst AKT1_rs10138227 TT (p < 0.05) genotypes were positive predictors, BDNF_rs962339 GG, DRD2_rs1800497 AG/GG and GSK-3β_rs334558 AG were negative predictors of good response. CONCLUSIONS: The data collectively show that variants in BDNF, dopamine receptor genes, and the AKT1/GSK3B pathway were linked to lithium's response in BD. AKT1 rs10138227 TT genotypes predicted better response, while BDNF rs962339 GG, DRD2 rs1800497 AG/GG, and GSK-3β rs334558 AG were associated with poor outcomes. These findings highlight the role of genetic variations in predicting lithium's response.
Speech analysis for differentiating bipolar disorder and major depressive disorder during euthymic states.
Lai JW, Hu YH, Bai YM … +1 more , Shen CC
Ann Gen Psychiatry · 2026 Apr · PMID 41928250 · Full text
OBJECTIVE: Differentiating major depressive disorder (MDD) from bipolar disorder (BP) is crucial for early diagnosis and targeted treatment. This study investigates speech, linguistic biomarkers, and machine learning mod...
OBJECTIVE: Differentiating major depressive disorder (MDD) from bipolar disorder (BP) is crucial for early diagnosis and targeted treatment. This study investigates speech, linguistic biomarkers, and machine learning models to differentiate between the MDD and BP patients using speech analysis during symptom-free periods. METHODS: Voice recordings from 191 patients (41 BP, 150 MDD) during euthymic phases were analyzed. Linguistic metrics, sentiment scores, and acoustic features were extracted and compared between the groups. Various machine learning models were employed to classify diagnoses based on these features. RESULTS: Significant differences were observed between BP and MDD patients. BP patients exhibited a shorter pause durations per total speaking duration and total word count (0.19 vs. 0.29; p < 0.05, 0.07 vs. 0.12; p < 0.05). MDD patients showed greater variability in speech intensity and peak amplitude during euthymic states. Sentiment analysis revealed no significant differences in broader emotional dimensions. Among the models tested, the Random Forest classifier achieved the highest predictive performance (AUC = 0.807), underscoring its effectiveness in differentiating BP from MDD. CONCLUSION: Speech analysis during euthymic periods reveals distinct linguistic and acoustic patterns between MDD and BP patients. These findings highlight the potential of speech features as non-invasive biomarkers for mood disorder classification, offering promising avenues for enhancing clinical decision-making. However, given the sample size, the results are preliminary and warrant replication in larger, independent cohorts.
Global scientific trends on neuroimaging in obsessive-compulsive disorder in the early twenty-first century: a bibliometric analysis and visualization analysis.
Zhou C, Fan Y, Zhang A … +6 more , Cheng X, Cui J, Li K, Liu C, Yu H, Li S
Ann Gen Psychiatry · 2026 Mar · PMID 41913279 · Full text
OBJECTIVE: This bibliometric analysis aims to delineate the evolution, current trends, and future directions in neuroimaging research on obsessive-compulsive disorder (OCD) from 2000 to 2024. By synthesizing global resea...
OBJECTIVE: This bibliometric analysis aims to delineate the evolution, current trends, and future directions in neuroimaging research on obsessive-compulsive disorder (OCD) from 2000 to 2024. By synthesizing global research output, collaboration networks, and technological advancements, we seek to highlight knowledge gaps and propose strategies to enhance the equity, reproducibility, and translational impact of OCD neuroimaging studies. METHODS: Data were sourced from the Web of Science Core Collection, spanning January 1, 2000, to December 31, 2024. A structured search strategy identified 2,000 eligible articles and reviews. Bibliometric analysis was conducted using CiteSpace, VOSviewer, and Excel to examine publication trends, geographic and institutional collaborations, keyword co-occurrence, citation patterns, and journal influence. RESULTS: OCD neuroimaging research has shown sustained growth, with a shift from metabolic studies to network neuroscience, driven by advances in functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), and artificial intelligence (AI). High-income countries dominated research output, with the United States contributing 36.5% of publications. However, low- and middle-income countries (LMICs) remain underrepresented. Keyword analysis revealed emerging themes such as transdiagnostic biomarkers and neuromodulation therapies. High-impact journals like Biological Psychiatry and American Journal of Psychiatry dominated citations, while specialized journals struggled with visibility. Methodological heterogeneity and limited data sharing posed significant challenges to reproducibility. CONCLUSION: This bibliometric analysis maps the transformation of OCD neuroimaging into a central pillar of translational psychiatry, revealing sustained growth, a paradigm shift toward network-based methods, and persistent geographical disparities. These documented trends collectively highlight that advancing equitable and reproducible research requires prioritized global collaboration and the adoption of open science frameworks. Therefore, addressing these specific gaps is crucial for developing neuroimaging-informed biomarkers and interventions with broad clinical applicability.
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