Background Depression,anxiety and schizophrenia among older persons have become global public health challenges.However,the burden of these disorders in ageing and aged countries has not been analysed.Aims To investig...Background Depression,anxiety and schizophrenia among older persons have become global public health challenges.However,the burden of these disorders in ageing and aged countries has not been analysed.Aims To investigate the burden of depression,anxiety and schizophrenia among older adults in ageing and aged countries.Methods Using data from the Global Burden of Disease Study 2019,we calculated the estimated annual percentage change(EAPC)in the age-standardised incidence rates(ASiR)and age-standardised disability-adjusted life years(DALYs)rates(ASDR)for depression,anxiety and schizophrenia of older people in ageing countries(China,India,Indonesia)and aged countries(Japan,Italy,Portugal)between 1990 and 2019.Trends in incidence and DALYs were analysed by gender and age.Results In 2019,the highest incidence of depression,anxiety and schizophrenia in the older population in aged countries was in Japan(927271.3(752552.3-1125796.5),51498.2(37625.7-70487.3)and 126.0(61.0-223.2),respectively),while the highest incidence in ageing countries was in China(5797556.9(4599403.4-7133006.5),330256.1(246448.9-445987.4)and 1067.7(556.2-1775.9),respectively).DALYs for these disorders were similar,with the highest in Japan and China.From 1990 to 2019,the ASIR for depressive disorders decreased in aged countries but increased in ageing countries;the ASIR for anxiety disorders and schizophrenia declined in both ageing and aged countries.The ASDR for depressive disorders was consistent with the ASIR but not for anxiety disorders and schizophrenia.The ASIR for depressive disorders was higher in older women,while the opposite was observed in anxiety disorders and schizophrenia.Notably,the conditions of burden of depressive disorders,anxiety disorders and schizophrenia in the 65-70-year-old age group were the most burdensome.Conclusions The incidence and DALYs of these three mental disorders increased while exhibiting differences between ageing and aged countries.Raising awareness about formulating health policies for preventing and treating mental disorders in the older population is necessary to reduce the future burden posed by the ageing challenge.展开更多
Background In early adolescence,youth are highly prone to suicidal behaviours.Identifying modifiable risk factors during this critical phase is a priority to inform effective suicide prevention strategies.Aims To expl...Background In early adolescence,youth are highly prone to suicidal behaviours.Identifying modifiable risk factors during this critical phase is a priority to inform effective suicide prevention strategies.Aims To explore the risk and protective factors of suicidal behaviours(ie,suicidal ideation,plans and attempts)in early adolescence in China using a social-ecological perspective.Methods Using data from the cross-sectional project‘Healthy and Risky Behaviours Among Middle School Students in Anhui Province,China',stratified random cluster sampling was used to select 5724 middle school students who had completed self-report questionnaires in November 2020.Network analysis was employed to examine the correlates of suicidal ideation,plans and attempts at four levels,namely individual(sex,academic performance,serious physical llness/disability,history of self-harm,depression,impulsivity,sleep problems,resilience),family(family economic status,relationship with mother,relationship with father,family violence,childhood abuse,parental mental illness),school(relationship with teachers,relationship with classmates,school-bullying victimisation and perpetration)and social(social support,satisfaction with society).Results In total,37.9%,19.0%and 5.5%of the students reported suicidal ideation,plans and attempts in the past 6 months,respectively.The estimated network revealed that suicidal ideation,plans and attempts were collectively associated with a history of self-harm,sleep problems,childhood abuse,school bullying and victimisation.Centrality analysis indicated that the most influential nodes in the network were history of self-harm and childhood abuse.Notably,the network also showed unique correlates of suicidal ideation(sex,weight=0.60;impulsivity,weight=0.24;family violence,weight=0.17;relationship with teachers,weight=-0.03;school-bullying perpetration,weight=0.22),suicidal plans(social support,weight=-0.15)and suicidal attempts(relationship with mother,weight=-0.10;parental mental llness,weight=0.61).Conclusions This study identified the correlates of suicidal ideation,plans and attempts,and provided practical implications for suicide prevention for young adolescents in China.Firstly,this study highlighted the importance of joint interventions across multiple departments.Secondly,the common risk factors of suicidal ideation,plans and attempts were elucidated.Thirdly,this study proposed target interventions to address the unique influencing factors of suicidal ideation,plans and attempts.展开更多
Background Bipolar disorder is identified as a cause of severe damage to the physical,psychological and social functioning of adolescents and young adults.Aims The aim of this study is to ascertain the trends in the b...Background Bipolar disorder is identified as a cause of severe damage to the physical,psychological and social functioning of adolescents and young adults.Aims The aim of this study is to ascertain the trends in the burden of bipolar disorder among individuals aged 10-24 years at global,regional and national levels from 1990 to 2019.Methods The data analysed in this study were from the Global Burden of Diseases 2019.The numbers,rates per 100000 population,average annual percentage changes(AAPCs)of incidence,prevalence and years lived with disability(YLDs)of bipolar disorder are reported at the global,regional and national levels among individuals aged 10-24 years.Global trends by age,sex and Social Development Index(SDI)were further analysed.Results Globally,the incidence of bipolar disorder among adolescents and young adults increased from 79.21 per 100000 population(95%uncertainty interval(Ul):58.13 to 105.15)in 1990 to 84.97 per 100000 population(95%Ul:61.73 to 113.46)in 2019,AAPC 0.24(95%confidence interval(Cl):0.22 to 0.26).In the past three decades,there has been an increase in incidence,prevalence and YLDs in both males and females.The largest increase in incidence between 1990 and 2019 was observed in those aged 20-24 years old from 51.76 per 100000 population(95%Ul:26.81 to 87.20)in 1990 to 58.37 per 100000 population(95%UI:30.39 to 98.55)in 2019;AAPC 0.42(95%Cl:0.38 to 0.47).By the SDI quintile,the largest increase in incidence was observed in the middle SDl;however,the high SDI countries had the highest incidence.Regionally,the largest increase in incidence was observed in southern Latin America.At the national level,the most pronounced increase in the incidence was in Greenland.Conclusions The global increase in incidence among adolescents and young adults between 1990 and 2019 indicates that strategies to improve their mental health still need to be emphasised.展开更多
Recently,the glymphatic system has been recognised as an important‘waste solutes transport channel’within the brain.1 Studies have shown that blockage of the glymphatic system leads to increased beta-amyloid deposit...Recently,the glymphatic system has been recognised as an important‘waste solutes transport channel’within the brain.1 Studies have shown that blockage of the glymphatic system leads to increased beta-amyloid deposits,accelerating the onset and progression of Alzheimer’s disease(AD).12 Given that cervical lymph nodes receive cerebrospinal fluid from the brain’s glymphatic system,34 we speculated that decompression of the lymphatic trunk and cervical lymphatic-venous anastomosis(LVA)could facilitate the flow of cerebrospinal fluid in the cranial glymphatic system,potentially accelerating the clearance of harmful beta-amyloid and tau proteins.We collaborated with surgeons who specialise in LVA supermicrosurgery for maxillofacial tumours and lymphoedema to develop a procedure to relieve the blockage of the glymphatic system.This surgery employs supermicrosurgery techniques to create LVA connecting the bilateral cervical,deep lymphatic vessels to the veins,resulting in lymphatic trunk decompression,which allows the lymph fluid in the high-pressure lymphatic vessels to flow into the low-pressure venous system.The goal of the minimally invasive surgery is to enhance the removal of proteins,such as beta-amyloid and tau,from the brain’s lymphatic systems to the maxillofacial lymphatic vessels,unclogging protein blockages within the brain.This extracranial procedure is safer than intracranial approaches.展开更多
Background Although 15 mA transcranial alternating current stimulation(tACS)has a therapeutic effect on depression,the activations of brain structures in humans accounting for this tACS configuration remain largely un...Background Although 15 mA transcranial alternating current stimulation(tACS)has a therapeutic effect on depression,the activations of brain structures in humans accounting for this tACS configuration remain largely unknown.Aims To investigate which intracranial brain structures are engaged in the tACS at 77.5 Hz and 15 mA,delivered via the forehead and the mastoid electrodes in the human brain.Methods Actual human head models were built using the magnetic resonance imagings of eight outpatient volunteers with drug-naïve,first-episode major depressive disorder and then used to perform the electric field distributions with SimNIBS software.Results The electric field distributions of the sagittal,coronal and axial planes showed that the bilateral frontal lobes,bilateral temporal lobes,hippocampus,cingulate,hypothalamus,thalamus,amygdala,cerebellum and brainstem were visibly stimulated by the 15 mA tACS procedure.Conclusions Brain-wide activation,including the cortex,subcortical structures,cerebellum and brainstem,is involved in the 15 mA tACS intervention for first-episode major depressive disorder.Our results indicate that the simultaneous involvement of multiple brain regions is a possible mechanism for its effectiveness in reducing depressive symptoms.展开更多
Background Previous studies have shown that educational attainment(EA),intelligence and income are key factors associated with mental disorders.However,the direct effects of each factor on major mental disorders are u...Background Previous studies have shown that educational attainment(EA),intelligence and income are key factors associated with mental disorders.However,the direct effects of each factor on major mental disorders are unclear.Aims We aimed to evaluate the overall and independent causal effects of the three psychosocial factors on common mental disorders.Methods Using genome-wide association study summary datasets,we performed Mendelian randomisation(MR)and multivariable MR(MVMR)analyses to assess potential associations between the 3 factors(EA,N=766345;household income,N=392422;intelligence,N=146808)and 13 common mental disorders,with sample sizes ranging from 9907 to 807553.Inverse-variance weighting was employed as the main method in the MR analysis.Results Our MR analysis showed that(1)higher EA was a protective factor for eight mental disorders but contributed to anorexia nervosa,obsessive-compulsive disorder(OCD),bipolar disorder(BD)and autism spectrum disorder(ASD);(2)higher intelligence was a protective factor for five mental disorders but a risk factor for OCD and ASD;(3)higher household income protected against 10 mental disorders but confers risk for anorexia nervosa.Our MVMR analysis showed that(1)higher EA was a direct protective factor for attention-deficit/hyperactivity disorder(ADHD)and insomnia but a direct risk factor for schizophrenia,BD and ASD;(2)higher intelligence was a direct protective factor for schizophrenia but a direct risk factor for major depressive disorder(MDD)and ASD;(3)higher income was a direct protective factor for seven mental disorders,including schizophrenia,BD,MDD,ASD,post-traumatic stress disorder,ADHD and anxiety disorder.Conclusions Our study reveals that education,intelligence and income intertwine with each other.For each factor,its independent effects on mental disorders present a more complex picture than its overall effects.展开更多
Background Little is known about the association between stressors(especially positive stressors)during pregnancy and postpartum depression and anxiety.Aims We investigated the association between positive and negativ...Background Little is known about the association between stressors(especially positive stressors)during pregnancy and postpartum depression and anxiety.Aims We investigated the association between positive and negative stress events during different stages of pregnancy and postpartum mental health outcomes among low-income pregnant women with symptoms of anxiety in Pakistan and evaluated whether an intervention based on cognitive behavioural therapy(CBT)had a regulatory effect.Methods Participants were 621 pregnant Pakistani women with mild anxiety.Using the Pregnancy Experience Scale-Brief Version,six scores were created to assess positive and negative stressors.We performed a multivariate linear regression to examine whether these six scores,measured both at baseline and in the third trimester,were associated with postpartum anxiety and depressive symptoms.The effect of the intervention on this relationship was examined by adding an interaction term to the regression model.Results Hassles frequency measured in the third trimester was positively associated with depression(B=0.22,95%confidence interval(Cl):0.09 to 0.36)and anxiety(B=0.19,95%Cl:0.08to 0.30).At the same timepoint,uplifts intensity was negatively associated with symptoms of depression(B=-0.82,95%Cl:1.46 to-0.18)and anxiety(B=-0.70,95%Cl:-1.25 to-0.15),whereas hassles intensity was positively related to symptoms of depression(B=1.02,95%Cl:0.36 to 1.67)and anxiety(B=0.90,95%Cl:0.34 to 1.47).The intensity ratio of hassles to uplifts reported in the third trimester was positively related to both depression(B=1.40,95%Cl:0.59 to 2.20)and anxiety(B=1.26,95%Cl:0.57 to 1.96).The intervention strengthened the overall positive effects of uplfts and the negative effects of hassles.Pregnancy experiences at baseline during early pregnancy to mid-pregnancy were not associated with mental health outcomes.Conclusions Stressors in the third trimester but not earlier in pregnancy were associated with postpartum symptoms of anxiety and depression.The CBT intervention modified the association between pregnancy stressors and postpartum mental health outcomes.Programmes that promote positive experiences and reduce negative experiences,especially in late pregnancy,may mitigate postpartum mental health consequences.展开更多
Background There is limited evidence suggesting that osteoporosis might exacerbate depressive symptoms,while more studies demonstrate that depression negatively affects bone density and increases fracture risk.Aims To...Background There is limited evidence suggesting that osteoporosis might exacerbate depressive symptoms,while more studies demonstrate that depression negatively affects bone density and increases fracture risk.Aims To explore the relationship between major depressive disorder(MDD)and fracture risk.Methods We conducted a nested case-control analysis(32670 patients with fracture and 397017 individuals without fracture)and a matched cohort analysis(16496 patients with MDD and 435492 individuals without MDD)in the same prospective UK Biobank data set.Further,we investigated the shared genetic architecture between MDD and fracture with linkage disequilibrium score regression and the MiXeR statistical tools.We used the conditional/conjunctional false discovery rate approach to identify the specific shared loci.We calculated the weighted genetic risk score for individuals in the UK Biobank and logistic regression was used to confirm the association observed in the prospective study.Results We found that MDD was associated with a 14%increase in fracture risk(hazard ratio(HR)1.14,95%CI 1.14 to 1.15,p<0.001)in the nested case-control analysis,while fracture was associated with a 72%increase in MDD risk(HR 1.72,95%CI 1.64 to 1.79,p<0.001)in the matched cohort analysis,suggesting a longitudinal and bidirectional relationship.Further,genetic summary data suggested a genetic overlap between MDD and fracture.Specifically,we identified four shared genomic loci,with the top signal(rs7554101)near SGIP1.The protein encoded by SGIP1 is involved in cannabinoid receptor type 1 signalling.We found that genetically predicted MDD was associated with a higher risk of fracture and vice versa.In addition,we found that the higher expression level of SGIP1 in the spinal cord and muscle was associated with an increased risk of fracture and MDD.Conclusions The genetic pleiotropy between MDD and fracture highlights the bidirectional association observed in the epidemiological analysis.The shared genetic components(such as SGIP1)between the diseases suggest that modulating the endocannabinoid system could be a potential therapeutic strategy for both MDD and bone loss.展开更多
Background Depressive symptoms are established risk factors for various health outcomes.However,previous studies assessed depressive symptoms at a single time point,neglecting individual variations over time.Aims To i...Background Depressive symptoms are established risk factors for various health outcomes.However,previous studies assessed depressive symptoms at a single time point,neglecting individual variations over time.Aims To identify depressive symptoms trajectories through repeated measures and examine their associations with cardiovascular disease(CVD),cancer and mortality.Methods This study included 20634 UK Biobank participants free of CVD and cancer at baseline with two or more assessments of depressive symptoms during 2006-2016.Group-based trajectory modelling identified depressive symptoms trajectories.Incident CVD,cancer and mortality were followed up until 2021 through linked registries.Results Six depressive symptoms trajectories were identified:no symptoms(n=6407),mild-stable(n=11539),moderate-stable(n=2183),severe-decreasing(n=206),moderate-increasing(n=177)and severe-stable(n=122).During a median follow-up of 5.5 years,1471 CVD cases,1275 cancer cases and 503 deaths were documented.Compared with the no symptoms trajectory,the mildstable,moderate-stable and severe-stable trajectories exhibited higher CVD risk,with hazard ratios(HRs)(95%CIs)of 1.19(1.06 to 1.34),1.32(1.08 to 1.34)and 2.99(1.85 to 4.84),respectively.Moderate-increasing and severe-stable trajectories were associated with higher mortality risks,with HRs(95%CIs)of 2.27(1.04 to 4.93)and 3.26(1.55 to 6.88),respectively.However,the severedecreasing trajectory was not associated with higher risks of adverse outcomes.We did not find significant associations between any trajectory and cancer.Conclusions Trajectories related to stable and increasing depressive symptoms,but not the trajectory associated with severe depressive symptoms at the initial assessment but decreasing at the follow-up,were associated with higher risks of CVD and mortality.Alleviating severe depressive symptoms at the initial onset may mitigate CVD and mortality risks.展开更多
Background Anxiety disorders are the most common psychiatric problems,affecting approximately 1 in 12 children and 1 in 4 adolescents.Understanding the incidence,burden and correlated risks of anxiety disorders among ...Background Anxiety disorders are the most common psychiatric problems,affecting approximately 1 in 12 children and 1 in 4 adolescents.Understanding the incidence,burden and correlated risks of anxiety disorders among children and adolescents can help identify areas of success,stagnation and emerging threats,thereby facilitating effective improvement strategies.Aims To estimate the incidence and burden trends of anxiety disorders in children and adolescents from 1990 to 2019 in 204 countries and compare the incidence and disease burden in different countries.To examine the association between anxiety disorders and social indicators(healthcare access and quality of life).Methods Data were obtained from the Global Burden of Disease Study 2019.The age-standardised incidence rates(ASIRs)and disability-adjusted life years(DALYs)were reported to assess the burden of anxiety disorders,and the estimated annual percentage change was calculated to quantify the temporal trends.Pearson’s correlation was used to investigate country-level risk factors for incidence and DALYs.Results Globally,there were 932 million incident cases of anxiety disorders in children and adolescents,739.29 per 100000 ASIRs and 380.62 million DALYs in 2019.From 1990 to 2019,the estimated annual percentage change of incidence of anxiety disorders decreased by 2.2%.Significant variations were observed in the age-standardised burden rate and the changing trend of anxiety disorders among countries.Portugal reported the highest ASIR of anxiety disorders,while Mexico had the largest increase rate of ASIR.In 2019,Portugal reported the highest number of DALYs(1001.71 million),and India(212.09 million)reported the lowest number of DALYs.The burden of anxiety disorders was positively correlated with the average number of psychiatrists,psychologists and nurses in the mental health sector(per 100000),and quality of life and the correlation coefficients were 0.58,0.67,0.43 and 0.53,respectively.Conclusions The incidence and global burden of anxiety disorders in adolescents have continued to decrease over the past 30 years.However,the incidence and disease burden in developed countries are still increasing steadily.Policymakers should design and implement mental health strategies for adolescents based on their specific developmental status,as well as the cultural and regional characteristics of each country.展开更多
Background Kabukisyndrome(KS)is arare developmental disorder characterised by multiple congenital anomalies and intellectual disability.UTX(ubiquitously transcribed tetratricopeptide repeat,X chromosome),which encodes...Background Kabukisyndrome(KS)is arare developmental disorder characterised by multiple congenital anomalies and intellectual disability.UTX(ubiquitously transcribed tetratricopeptide repeat,X chromosome),which encodes a histone demethylase,is one of the two major pathogenic risk genes for KS.Although intellectual disability is a key phenotype of KS,the role of UTX in cognitive function remains unclear.Currently,no targeted therapies are available for KS.Aims This study aimed to investigate how UTX regulates cognition,to explore the mechanisms underlying UTX dysfunction and to identify potential molecular targets for treatment.Methods WegeneratedUTXconditional knockoutmice and found that UTX deletion downregulated calmodulin transcription by disrupting H3K27me3(trimethylated histone H3 at lysine 27)demethylation.Results UTX-knockout mice showeddecreased phosphorylation of calcium/calmodulin-dependent protein kinase I,impaired long-term potentiation and deficit in remote contextual fear memory.These effects were reversed by an Food and Drug Administration-approved drug desipramine.Conclusions Our results reveal an epigenetic mechanism underlying the important role of UTX in synaptic plasticity and cognitive function,and suggest that desipramine could be a potential treatment for KS.展开更多
Background Depressive symptoms and cognitive impairment often interact,rendering their associations controversial.To date,their joint trajectories and associations with dementia and death remain underexplored.Aims To ...Background Depressive symptoms and cognitive impairment often interact,rendering their associations controversial.To date,their joint trajectories and associations with dementia and death remain underexplored.Aims To explore the interactions between depressive symptoms and cognitive function,their developmental trajectories and the associations with all-cause dementia,Alzheimer’s disease(AD)and all-cause death in older adults.Methods Data were from the Health and Retirement Study.Depressive symptoms and cognitive function were measured using the 8-item Centre for Epidemiologic Studies Depression Scale and the Telephone Interview of Cognitive Status,respectively.All-cause dementia and AD were defined by self-reported or proxy-reported physician diagnoses.All-cause death was determined by interviews.The restricted cubic spline,group-based trajectory modelling and subdistribution hazard regression were used.Results Significant interactions between depressive symptoms and cognitive function in 2010 in their association with new-onset all-cause dementia and AD from 2010 to 2020 were found,especially in women(p for interaction<0.05).Independent trajectory analysis showed that emerging or high(vs no)depressive trajectories and poor or rapidly decreased cognitive trajectories(vs very good)from 1996 to 2010 were at significantly higher risk of subsequent all-cause dementia,AD and all-cause death.15 joint trajectories of depressive symptoms and cognitive function from 1996 to 2010 were determined,where rapidly decreased cognitive function was more common in those with no depressive symptoms.Compared with older adults with the trajectory of no depressive symptoms and very good cognitive function,those with the trajectory of no depressive symptoms but rapidly decreased cognitive function were much more likely to develop new-onset all-cause dementia and death,with subdistribution hazard ratios(95%confidence intervals)of 4.47(2.99 to 6.67)and 1.84(1.43 to 2.36),especially in women.Conclusions To effectively mitigate the risk of dementia and death,it is crucial to acknowledge the importance of preventing cognitive decline in older adults without depressive symptoms,particularly in women.展开更多
Background The alexithymia trait is of high clinical interest.The Perth Alexithymia Questionnaire(PAQ)was recently developed to enable detailed facet-level and valence-specific assessments of alexithymia.Aims In this ...Background The alexithymia trait is of high clinical interest.The Perth Alexithymia Questionnaire(PAQ)was recently developed to enable detailed facet-level and valence-specific assessments of alexithymia.Aims In this paper,we introduce the first Chinese version of the PAQ and examine its psychometric properties and clinical applications.Methods In Study 1,the PAQ was administered to 990 Chinese participants.We examined its factor structure,internal consistency,test-retest reliability,as well as convergent,concurrent and discriminant validity.In Study 2,four groups,including a major depressive disorder(MDD)group(n=50),a matched healthy control group for MDD(n=50),a subclinical depression group(n=50)and a matched healthy control group for subclinical depression(n=50),were recruited.Group comparisons were conducted to assess the clinical relevance of the PAQ.Results In Study 1,the intended five-factor structure of the PAQ was found to fit the data well.The PAQ showed good internal consistency and test-retest reliability,as well as good convergent,concurrent and discriminant validity.In Study 2,the PAQ was able to successfully distinguish the MDD group and the subclinical depression group from their matched healthy controls.Conclusions The Chinese version of the PAQ is a valid and reliable instrument for comprehensively assessing alexithymia in the general population and adults with clinical/subclinical depression.展开更多
Background Schizophrenia is a chronic mental disorder affecting individuals globally,emphasising the significance of personal recovery in mental healthcare.Understanding the recovery stages and the associated factors ...Background Schizophrenia is a chronic mental disorder affecting individuals globally,emphasising the significance of personal recovery in mental healthcare.Understanding the recovery stages and the associated factors can provide essential insights for targeted interventions.Aims This study aimed to discern the stages of personal recovery in Thai patients with schizophrenia and elucidate the associated factors with each stage.Methods A multistage sampling technique was employed,selecting 231 patients with schizophrenia from mental health outpatient departments of general and psychiatric hospitals.Data collected from March to May 2023 included screening for psychotic symptoms using the Brief Psychiatric Rating Scale and six self-report questionnaires—Stage of Recovery Scale,Beck Cognitive Insight Scale,Brief Resilience Scale,Family Support,Therapeutic Relationship-Patients Version and Social Support Questionnaire—along with personal data sheets.Pearson correlation and multinomial logistic regression were performed.Results The predominant personal recovery stage among participants was stage 3,‘living with disabilities’,comprising 42.4%of the participants.Key factors contributing to personal recovery,explaining approximately 38.4%of the variance,included resilience,family support,therapeutic alliance,hospitalisations since onset and recovery-oriented nursing service utilisation.Logit equations for stages 3 and 4 are as follows:stage 3(living with disability):logit=−4.44+0.74×resilience+0.07×therapeutic alliance+0.02×recovery-oriented nursing service utilisation;stage 4(living beyond disability):logit=−11.57-0.05×hospitalisation since onset+1.96×resilience+0.11×family support+0.06×therapeutic alliance.Conclusion The findings emphasise the significance of mental health nursing interventions.In conjunction with recovery-oriented nursing services,strengthening resilience,therapeutic alliances and family support may accelerate personal recovery and reduce hospitalisations among individuals with schizophrenia.展开更多
To the editor:Psychiatric theory,policy and practice are currently grappling with the risks and opportunities presented by artificial intelligence(AI)applications in mental healthcare.Synthesising data to generate dia...To the editor:Psychiatric theory,policy and practice are currently grappling with the risks and opportunities presented by artificial intelligence(AI)applications in mental healthcare.Synthesising data to generate diagnosis is an aspect of mental healthcare where AI is anticipated to have the greatest and soonest impact.1-4 While such technologies remain some distance from clinical application,preliminary evidence suggests AI-derived classifications may predict certain treatment outcomes and clinical trajectories,and could soon become available to supplement or replace traditional manual-based diagnostic assessment.展开更多
Background Cardiovascular risk burden is associated with dementia risk and neurodegeneration-related brain structure,while the role of genetics and incident cardiovascular disease(CVD)remains unclear.Aims To examine t...Background Cardiovascular risk burden is associated with dementia risk and neurodegeneration-related brain structure,while the role of genetics and incident cardiovascular disease(CVD)remains unclear.Aims To examine the association of overall cardiovascular risk burden with the risk of major dementia subtypes and volumes of related brain regions in a large sample,and to explore the role of genetics and CVD onset.Methods A prospective study among 354 654 participants free of CVD and dementia(2006-2010,mean age 56.4 years)was conducted within the UK Biobank,with brain magnetic resonance imaging(MRl)measurement availablefor 15104participants since 2014.CVD risk burden was evaluated by the Framingham General Cardiovascular Risk Score(FGCRS).Dementia diagnosis was ascertained from inpatient and death register data.Results Overamedian 12.0-yearfollow-up,3998 all-cause dementia cases were identified.Higher FGCRS was associated with increasedall-cause dementia risk after adjusting for demographic,major lifestyle,clinical factors and the polygenic risk score(PRS)of Alzheimer's disease.Comparing the high versus low tertile of FGCRS,the odds ratios(ORs)and 95%confidence intervals(Cls)were 1.26(1.12 to 1.41)for all-cause dementia,1.67(1.33 to 2.09)for Alzheimer's disease and 1.53(1.07 to 2.16)for vascular dementia(all p_(treng)<0.05).Incident stroke and coronary heart disease accounted for 14%(95%Cl:9% to 21%)of the association between FGCRS and all-cause dementia.Interactions were not detected for FGCRS and PRS on the risk of any dementia subtype.We observed an 83%(95%Cl:47%to 128%)higher all-cause dementia risk comparing the high-high versus low-low FGCRS-PRS category.For brain volumes,higher FGCRS was associated with greater log-transformed white matter hyperintensities,smaller cortical volume and smaller grey matter volume.Conclusions Our findings suggest that the positive association of cardiovascular risk burden with dementia risk also applies to major dementia subtypes.The association of cardiovascular risk burden with all-cause dementia is largely independent of CVD onset and genetic predisposition to dementia.展开更多
TToo tthhee eeddiittoorr::Eating disorder(ED),as defined by the Diagnostic and Statistical Manual of Mental Disorders(DSM-5),is a persistent disturbance of eating or eating-related behaviour that results in the altere...TToo tthhee eeddiittoorr::Eating disorder(ED),as defined by the Diagnostic and Statistical Manual of Mental Disorders(DSM-5),is a persistent disturbance of eating or eating-related behaviour that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning.^(1)The DSM-5 outlines criteria for EDs,including anorexia nervosa,bulimia nervosa,binge-eating disorder,pica,rumination disorder and avoidant/restrictive food intake disorder.EDs are relatively common in young people,affecting 5.5%-17.9%of young women and 0.6%-2.4%of young men by the time they reach early adulthood.展开更多
Background Postoperative sleep disturbance(PSD)is a common and serious postoperative complication and is associated with poor postoperative outcomes.Aims This study aimed to investigate the effect of transcranial dire...Background Postoperative sleep disturbance(PSD)is a common and serious postoperative complication and is associated with poor postoperative outcomes.Aims This study aimed to investigate the effect of transcranial direct current stimulation(tDCS)on PSD in older patients undergoing lower limb major arthroplasty.Methods In this prospective,double-blind,pilot,randomised,sham-controlled trial,patients 65 years and over undergoing lower limb major arthroplasty were randomly assigned to receive active tDCS(a-tDCS)or sham tDCS(s-tDCS).The primary outcomes were the objective sleep measures on postoperative nights(N)1 and N2.Results 116 inpatients were assessed for eligibility,and a total of 92 patients were enrolled;47 received a-tDCS and 45 received s-tDCS.tDCS improved PSD by altering the following sleep measures in the a-tDCS and s-tDCS groups;the respective comparisons were as follows:the promotion of rapid eye movement(REM)sleep time on N1(64.5(33.5-105.5)vs 19.0(0.0,45.0)min,F=20.10,p<0.001)and N2(75.0(36.0-120.8)vs 30.0(1.3-59.3)min,F=12.55,p<0.001);the total sleep time on N1(506.0(408.0-561.0)vs 392.0(243.0-483.5)min,F=14.13,p<0.001)and N2(488.5(455.5-548.5)vs 346.0(286.5-517.5)min,F=7.36,p=0.007);the deep sleep time on N1(130.0(103.3-177.0)vs 42.5(9.8-100.8)min,F=24.4,p<0.001)and N2(103.5(46.0-154.8)vs 57.5(23.3-106.5)min,F=8.4,p=0.004);and the percentages of light sleep and REM sleep on N1 and N2(p<0.05 for each).The postoperative depression and anxiety scores did not differ significantly between the two groups.No significant adverse events were reported.Conclusion In older patients undergoing lower limb major arthroplasty,a single session of anodal tDCS over the left dorsolateral prefrontal cortex showed a potentially prophylactic effect in improving postoperative short-term objective sleep measures.However,this benefit was temporary and was not maintained over time.展开更多
Background Growing evidence attests to the efficacy of mindfulness-based interventions(MBIs),but their effectiveness for healthcare workers remains uncertain.Aims To evaluate the evidence for MBIs in improving healthc...Background Growing evidence attests to the efficacy of mindfulness-based interventions(MBIs),but their effectiveness for healthcare workers remains uncertain.Aims To evaluate the evidence for MBIs in improving healthcare workers’psychological well-being.Methods A systematic literature search was conducted on Medline,Embase,Cumulative Index for Nursing and Allied Health Literature,PsycINFO and Cochrane Central Register of Controlled Trials up to 31 August 2022 using the keywords‘healthcare worker’,‘doctor’,‘nurse’,‘allied health’,‘mindfulness’,‘wellness’,‘workshop’and‘program’.Randomised controlled trials with a defined MBI focusing on healthcare workers and quantitative outcome measures related to subjective or psychological well-being were eligible for inclusion.R V.4.0.3 was used for data analysis,with the standardised mean difference as the primary outcome,employing DerSimonian and Laird’s random effects model.Grading of Recommendations,Assessment,Development and Evaluation framework was used to evaluate the quality of evidence.Cochrane’s Risk of Bias 2 tool was used to assess the risk of bias in the included studies.Results A total of 27 studies with 2506 participants were included,mostly from the USA,involving various healthcare professions.MBIs such as stress reduction programmes,apps,meditation and training showed small to large effects on anxiety,burnout,stress,depression,psychological distress and job strain outcomes of the participants.Positive effects were also seen in self-compassion,empathy,mindfulness and well-being.However,long-term outcomes(1 month or longer postintervention)varied,and the effects were not consistently sustained.Conclusions MBIs offer short-term benefits in reducing stress-related symptoms in healthcare workers.The review also highlights limitations such as intervention heterogeneity,reduced power in specific subgroup analyses and variable study quality.展开更多
Background The associations between sugary beverages and genetic predisposition to depression risk remain unclear.Aims This study aimed to investigate the associations of sugar-sweetened beverages(SSBs),artificially s...Background The associations between sugary beverages and genetic predisposition to depression risk remain unclear.Aims This study aimed to investigate the associations of sugar-sweetened beverages(SSBs),artificially sweetened beverages(ASBs)and natural juices(NJs)with depression and to assess whether these associations were modified by genetic predisposition.Methods We used data from the UK Biobank of 180599 individuals aged 39-72 years who were depression-free at baseline.Dietary intake of SSBs,ASBs and NJs was accessed by a 24-hour dietary recall between 2009 and 2012.The Polygenic Risk Score for depression was estimated and categorised as low(lowest tertile),intermediate(tertile 2)and high(highest tertile),.Cox proportional hazard and substitution models were conducted to evaluate hazard ratios(HRs)and 95%Cls.Results Over the 12-year follow-up,4915 individuals developed depression.Higher consumption(>2 units/day)of SSBs(HR:1.26,95%CI 1.12 to 1.43)and ASBs(HR:1.40,95%Cl 1.23 to 1.60)were both associated with an increased risk of depression.However,moderate consumption(>0-1 units/day)of NJs was associated with a lower risk of depression(HR:0.89,95%CI 0.83 to 0.95).Furthermore,genetic predisposition did not modify these associations(p interaction>0.05).In substitution models,the HRs for depression risk were 0.94(95%CI 0.89 to 0.99)and 0.89(95%CI 0.85 to 0.94),respectively,when 1 unit/day of SSBs or ASBs was replaced by an equivalent intake of NJs.Conclusions Higher consumption of SSBs and ASBs was associated with an increased risk of depression;in contrast,moderate consumption of NJs was inversely associated with a lower risk of depression.In theory,substituting SSBs and ASBswith NJs would suppose a reduction of depression risk.展开更多
基金Shanghai'Science and Technology Innovation Action Plan'medical innovation research(21Y11905600)Shanghai'Science and Technology Innovation Action Plan'Natural Science Foundation of Shanghai(21ZR1455100)+1 种基金the National Natural Science Foundation of China(81701344)the Shanghai Mental Health Center General Projects(2021-YJ-02).
文摘Background Depression,anxiety and schizophrenia among older persons have become global public health challenges.However,the burden of these disorders in ageing and aged countries has not been analysed.Aims To investigate the burden of depression,anxiety and schizophrenia among older adults in ageing and aged countries.Methods Using data from the Global Burden of Disease Study 2019,we calculated the estimated annual percentage change(EAPC)in the age-standardised incidence rates(ASiR)and age-standardised disability-adjusted life years(DALYs)rates(ASDR)for depression,anxiety and schizophrenia of older people in ageing countries(China,India,Indonesia)and aged countries(Japan,Italy,Portugal)between 1990 and 2019.Trends in incidence and DALYs were analysed by gender and age.Results In 2019,the highest incidence of depression,anxiety and schizophrenia in the older population in aged countries was in Japan(927271.3(752552.3-1125796.5),51498.2(37625.7-70487.3)and 126.0(61.0-223.2),respectively),while the highest incidence in ageing countries was in China(5797556.9(4599403.4-7133006.5),330256.1(246448.9-445987.4)and 1067.7(556.2-1775.9),respectively).DALYs for these disorders were similar,with the highest in Japan and China.From 1990 to 2019,the ASIR for depressive disorders decreased in aged countries but increased in ageing countries;the ASIR for anxiety disorders and schizophrenia declined in both ageing and aged countries.The ASDR for depressive disorders was consistent with the ASIR but not for anxiety disorders and schizophrenia.The ASIR for depressive disorders was higher in older women,while the opposite was observed in anxiety disorders and schizophrenia.Notably,the conditions of burden of depressive disorders,anxiety disorders and schizophrenia in the 65-70-year-old age group were the most burdensome.Conclusions The incidence and DALYs of these three mental disorders increased while exhibiting differences between ageing and aged countries.Raising awareness about formulating health policies for preventing and treating mental disorders in the older population is necessary to reduce the future burden posed by the ageing challenge.
文摘Background In early adolescence,youth are highly prone to suicidal behaviours.Identifying modifiable risk factors during this critical phase is a priority to inform effective suicide prevention strategies.Aims To explore the risk and protective factors of suicidal behaviours(ie,suicidal ideation,plans and attempts)in early adolescence in China using a social-ecological perspective.Methods Using data from the cross-sectional project‘Healthy and Risky Behaviours Among Middle School Students in Anhui Province,China',stratified random cluster sampling was used to select 5724 middle school students who had completed self-report questionnaires in November 2020.Network analysis was employed to examine the correlates of suicidal ideation,plans and attempts at four levels,namely individual(sex,academic performance,serious physical llness/disability,history of self-harm,depression,impulsivity,sleep problems,resilience),family(family economic status,relationship with mother,relationship with father,family violence,childhood abuse,parental mental illness),school(relationship with teachers,relationship with classmates,school-bullying victimisation and perpetration)and social(social support,satisfaction with society).Results In total,37.9%,19.0%and 5.5%of the students reported suicidal ideation,plans and attempts in the past 6 months,respectively.The estimated network revealed that suicidal ideation,plans and attempts were collectively associated with a history of self-harm,sleep problems,childhood abuse,school bullying and victimisation.Centrality analysis indicated that the most influential nodes in the network were history of self-harm and childhood abuse.Notably,the network also showed unique correlates of suicidal ideation(sex,weight=0.60;impulsivity,weight=0.24;family violence,weight=0.17;relationship with teachers,weight=-0.03;school-bullying perpetration,weight=0.22),suicidal plans(social support,weight=-0.15)and suicidal attempts(relationship with mother,weight=-0.10;parental mental llness,weight=0.61).Conclusions This study identified the correlates of suicidal ideation,plans and attempts,and provided practical implications for suicide prevention for young adolescents in China.Firstly,this study highlighted the importance of joint interventions across multiple departments.Secondly,the common risk factors of suicidal ideation,plans and attempts were elucidated.Thirdly,this study proposed target interventions to address the unique influencing factors of suicidal ideation,plans and attempts.
基金the National Natural Science Foundation of China(grant number 71974114)。
文摘Background Bipolar disorder is identified as a cause of severe damage to the physical,psychological and social functioning of adolescents and young adults.Aims The aim of this study is to ascertain the trends in the burden of bipolar disorder among individuals aged 10-24 years at global,regional and national levels from 1990 to 2019.Methods The data analysed in this study were from the Global Burden of Diseases 2019.The numbers,rates per 100000 population,average annual percentage changes(AAPCs)of incidence,prevalence and years lived with disability(YLDs)of bipolar disorder are reported at the global,regional and national levels among individuals aged 10-24 years.Global trends by age,sex and Social Development Index(SDI)were further analysed.Results Globally,the incidence of bipolar disorder among adolescents and young adults increased from 79.21 per 100000 population(95%uncertainty interval(Ul):58.13 to 105.15)in 1990 to 84.97 per 100000 population(95%Ul:61.73 to 113.46)in 2019,AAPC 0.24(95%confidence interval(Cl):0.22 to 0.26).In the past three decades,there has been an increase in incidence,prevalence and YLDs in both males and females.The largest increase in incidence between 1990 and 2019 was observed in those aged 20-24 years old from 51.76 per 100000 population(95%Ul:26.81 to 87.20)in 1990 to 58.37 per 100000 population(95%UI:30.39 to 98.55)in 2019;AAPC 0.42(95%Cl:0.38 to 0.47).By the SDI quintile,the largest increase in incidence was observed in the middle SDl;however,the high SDI countries had the highest incidence.Regionally,the largest increase in incidence was observed in southern Latin America.At the national level,the most pronounced increase in the incidence was in Greenland.Conclusions The global increase in incidence among adolescents and young adults between 1990 and 2019 indicates that strategies to improve their mental health still need to be emphasised.
基金supported by the National Key R&D Program of China(2023YFC36003200)Shanghai Mental Health Center investigator-initiated trial programme(2024-TX-001)+1 种基金Shanghai's Top Priority Research Center(2022ZZ01017)CAMS Innovation Fund for Medical Sciences(2019-12M-5-037).
文摘Recently,the glymphatic system has been recognised as an important‘waste solutes transport channel’within the brain.1 Studies have shown that blockage of the glymphatic system leads to increased beta-amyloid deposits,accelerating the onset and progression of Alzheimer’s disease(AD).12 Given that cervical lymph nodes receive cerebrospinal fluid from the brain’s glymphatic system,34 we speculated that decompression of the lymphatic trunk and cervical lymphatic-venous anastomosis(LVA)could facilitate the flow of cerebrospinal fluid in the cranial glymphatic system,potentially accelerating the clearance of harmful beta-amyloid and tau proteins.We collaborated with surgeons who specialise in LVA supermicrosurgery for maxillofacial tumours and lymphoedema to develop a procedure to relieve the blockage of the glymphatic system.This surgery employs supermicrosurgery techniques to create LVA connecting the bilateral cervical,deep lymphatic vessels to the veins,resulting in lymphatic trunk decompression,which allows the lymph fluid in the high-pressure lymphatic vessels to flow into the low-pressure venous system.The goal of the minimally invasive surgery is to enhance the removal of proteins,such as beta-amyloid and tau,from the brain’s lymphatic systems to the maxillofacial lymphatic vessels,unclogging protein blockages within the brain.This extracranial procedure is safer than intracranial approaches.
基金The study was partly funded by the National Natural Science Foundation of China(82371490)the National Key R&D Program of China(2022YFC2503900,2022YFC2503901)+1 种基金Beijing Hundred,Thousand and Ten Thousand Talents Project(2017-CXYF-09)Beijing Health System Leading Talent Grant(2022-02-10).
文摘Background Although 15 mA transcranial alternating current stimulation(tACS)has a therapeutic effect on depression,the activations of brain structures in humans accounting for this tACS configuration remain largely unknown.Aims To investigate which intracranial brain structures are engaged in the tACS at 77.5 Hz and 15 mA,delivered via the forehead and the mastoid electrodes in the human brain.Methods Actual human head models were built using the magnetic resonance imagings of eight outpatient volunteers with drug-naïve,first-episode major depressive disorder and then used to perform the electric field distributions with SimNIBS software.Results The electric field distributions of the sagittal,coronal and axial planes showed that the bilateral frontal lobes,bilateral temporal lobes,hippocampus,cingulate,hypothalamus,thalamus,amygdala,cerebellum and brainstem were visibly stimulated by the 15 mA tACS procedure.Conclusions Brain-wide activation,including the cortex,subcortical structures,cerebellum and brainstem,is involved in the 15 mA tACS intervention for first-episode major depressive disorder.Our results indicate that the simultaneous involvement of multiple brain regions is a possible mechanism for its effectiveness in reducing depressive symptoms.
基金Nanjing Medical Science and Technology Development Project(ZKX20027).
文摘Background Previous studies have shown that educational attainment(EA),intelligence and income are key factors associated with mental disorders.However,the direct effects of each factor on major mental disorders are unclear.Aims We aimed to evaluate the overall and independent causal effects of the three psychosocial factors on common mental disorders.Methods Using genome-wide association study summary datasets,we performed Mendelian randomisation(MR)and multivariable MR(MVMR)analyses to assess potential associations between the 3 factors(EA,N=766345;household income,N=392422;intelligence,N=146808)and 13 common mental disorders,with sample sizes ranging from 9907 to 807553.Inverse-variance weighting was employed as the main method in the MR analysis.Results Our MR analysis showed that(1)higher EA was a protective factor for eight mental disorders but contributed to anorexia nervosa,obsessive-compulsive disorder(OCD),bipolar disorder(BD)and autism spectrum disorder(ASD);(2)higher intelligence was a protective factor for five mental disorders but a risk factor for OCD and ASD;(3)higher household income protected against 10 mental disorders but confers risk for anorexia nervosa.Our MVMR analysis showed that(1)higher EA was a direct protective factor for attention-deficit/hyperactivity disorder(ADHD)and insomnia but a direct risk factor for schizophrenia,BD and ASD;(2)higher intelligence was a direct protective factor for schizophrenia but a direct risk factor for major depressive disorder(MDD)and ASD;(3)higher income was a direct protective factor for seven mental disorders,including schizophrenia,BD,MDD,ASD,post-traumatic stress disorder,ADHD and anxiety disorder.Conclusions Our study reveals that education,intelligence and income intertwine with each other.For each factor,its independent effects on mental disorders present a more complex picture than its overall effects.
基金the National Institute of Mental Health at the US National Institutes of Health(grant number:R01 MH111859).
文摘Background Little is known about the association between stressors(especially positive stressors)during pregnancy and postpartum depression and anxiety.Aims We investigated the association between positive and negative stress events during different stages of pregnancy and postpartum mental health outcomes among low-income pregnant women with symptoms of anxiety in Pakistan and evaluated whether an intervention based on cognitive behavioural therapy(CBT)had a regulatory effect.Methods Participants were 621 pregnant Pakistani women with mild anxiety.Using the Pregnancy Experience Scale-Brief Version,six scores were created to assess positive and negative stressors.We performed a multivariate linear regression to examine whether these six scores,measured both at baseline and in the third trimester,were associated with postpartum anxiety and depressive symptoms.The effect of the intervention on this relationship was examined by adding an interaction term to the regression model.Results Hassles frequency measured in the third trimester was positively associated with depression(B=0.22,95%confidence interval(Cl):0.09 to 0.36)and anxiety(B=0.19,95%Cl:0.08to 0.30).At the same timepoint,uplifts intensity was negatively associated with symptoms of depression(B=-0.82,95%Cl:1.46 to-0.18)and anxiety(B=-0.70,95%Cl:-1.25 to-0.15),whereas hassles intensity was positively related to symptoms of depression(B=1.02,95%Cl:0.36 to 1.67)and anxiety(B=0.90,95%Cl:0.34 to 1.47).The intensity ratio of hassles to uplifts reported in the third trimester was positively related to both depression(B=1.40,95%Cl:0.59 to 2.20)and anxiety(B=1.26,95%Cl:0.57 to 1.96).The intervention strengthened the overall positive effects of uplfts and the negative effects of hassles.Pregnancy experiences at baseline during early pregnancy to mid-pregnancy were not associated with mental health outcomes.Conclusions Stressors in the third trimester but not earlier in pregnancy were associated with postpartum symptoms of anxiety and depression.The CBT intervention modified the association between pregnancy stressors and postpartum mental health outcomes.Programmes that promote positive experiences and reduce negative experiences,especially in late pregnancy,may mitigate postpartum mental health consequences.
基金supported by the‘Pioneer’and‘Leading Goose’R&D Program of Zhejiang(#2023C03164 and#2024SSYS0032)the National Natural Science Foundation of China(#82370887)+1 种基金the Chinese National Key Technology R&D Program,Ministry of Science and Technology(#2021YFC2501702)the funds from the Westlake Laboratory of Life Sciences and Biomedicine(#202208014).
文摘Background There is limited evidence suggesting that osteoporosis might exacerbate depressive symptoms,while more studies demonstrate that depression negatively affects bone density and increases fracture risk.Aims To explore the relationship between major depressive disorder(MDD)and fracture risk.Methods We conducted a nested case-control analysis(32670 patients with fracture and 397017 individuals without fracture)and a matched cohort analysis(16496 patients with MDD and 435492 individuals without MDD)in the same prospective UK Biobank data set.Further,we investigated the shared genetic architecture between MDD and fracture with linkage disequilibrium score regression and the MiXeR statistical tools.We used the conditional/conjunctional false discovery rate approach to identify the specific shared loci.We calculated the weighted genetic risk score for individuals in the UK Biobank and logistic regression was used to confirm the association observed in the prospective study.Results We found that MDD was associated with a 14%increase in fracture risk(hazard ratio(HR)1.14,95%CI 1.14 to 1.15,p<0.001)in the nested case-control analysis,while fracture was associated with a 72%increase in MDD risk(HR 1.72,95%CI 1.64 to 1.79,p<0.001)in the matched cohort analysis,suggesting a longitudinal and bidirectional relationship.Further,genetic summary data suggested a genetic overlap between MDD and fracture.Specifically,we identified four shared genomic loci,with the top signal(rs7554101)near SGIP1.The protein encoded by SGIP1 is involved in cannabinoid receptor type 1 signalling.We found that genetically predicted MDD was associated with a higher risk of fracture and vice versa.In addition,we found that the higher expression level of SGIP1 in the spinal cord and muscle was associated with an increased risk of fracture and MDD.Conclusions The genetic pleiotropy between MDD and fracture highlights the bidirectional association observed in the epidemiological analysis.The shared genetic components(such as SGIP1)between the diseases suggest that modulating the endocannabinoid system could be a potential therapeutic strategy for both MDD and bone loss.
基金supported by the Zhejiang Provincial Natural Science Foundation of China(grant number LY23G030005)the National Natural Science Foundation of China(grant number 72204071)the Scientific Research Foundation for Scholars of HZNU(grant number 4265C50221204119).
文摘Background Depressive symptoms are established risk factors for various health outcomes.However,previous studies assessed depressive symptoms at a single time point,neglecting individual variations over time.Aims To identify depressive symptoms trajectories through repeated measures and examine their associations with cardiovascular disease(CVD),cancer and mortality.Methods This study included 20634 UK Biobank participants free of CVD and cancer at baseline with two or more assessments of depressive symptoms during 2006-2016.Group-based trajectory modelling identified depressive symptoms trajectories.Incident CVD,cancer and mortality were followed up until 2021 through linked registries.Results Six depressive symptoms trajectories were identified:no symptoms(n=6407),mild-stable(n=11539),moderate-stable(n=2183),severe-decreasing(n=206),moderate-increasing(n=177)and severe-stable(n=122).During a median follow-up of 5.5 years,1471 CVD cases,1275 cancer cases and 503 deaths were documented.Compared with the no symptoms trajectory,the mildstable,moderate-stable and severe-stable trajectories exhibited higher CVD risk,with hazard ratios(HRs)(95%CIs)of 1.19(1.06 to 1.34),1.32(1.08 to 1.34)and 2.99(1.85 to 4.84),respectively.Moderate-increasing and severe-stable trajectories were associated with higher mortality risks,with HRs(95%CIs)of 2.27(1.04 to 4.93)and 3.26(1.55 to 6.88),respectively.However,the severedecreasing trajectory was not associated with higher risks of adverse outcomes.We did not find significant associations between any trajectory and cancer.Conclusions Trajectories related to stable and increasing depressive symptoms,but not the trajectory associated with severe depressive symptoms at the initial assessment but decreasing at the follow-up,were associated with higher risks of CVD and mortality.Alleviating severe depressive symptoms at the initial onset may mitigate CVD and mortality risks.
基金This work was supported by the National Natural Science Foundation of China(82173636)the International Institute of Population Health,Peking University Health Science Center(Number:JKGL202302)the National Key Research and Development Plan Project(2022YFC3600904).The funders had no role in study design,data collection and analysis,decision to publish or preparation of the manuscript.
文摘Background Anxiety disorders are the most common psychiatric problems,affecting approximately 1 in 12 children and 1 in 4 adolescents.Understanding the incidence,burden and correlated risks of anxiety disorders among children and adolescents can help identify areas of success,stagnation and emerging threats,thereby facilitating effective improvement strategies.Aims To estimate the incidence and burden trends of anxiety disorders in children and adolescents from 1990 to 2019 in 204 countries and compare the incidence and disease burden in different countries.To examine the association between anxiety disorders and social indicators(healthcare access and quality of life).Methods Data were obtained from the Global Burden of Disease Study 2019.The age-standardised incidence rates(ASIRs)and disability-adjusted life years(DALYs)were reported to assess the burden of anxiety disorders,and the estimated annual percentage change was calculated to quantify the temporal trends.Pearson’s correlation was used to investigate country-level risk factors for incidence and DALYs.Results Globally,there were 932 million incident cases of anxiety disorders in children and adolescents,739.29 per 100000 ASIRs and 380.62 million DALYs in 2019.From 1990 to 2019,the estimated annual percentage change of incidence of anxiety disorders decreased by 2.2%.Significant variations were observed in the age-standardised burden rate and the changing trend of anxiety disorders among countries.Portugal reported the highest ASIR of anxiety disorders,while Mexico had the largest increase rate of ASIR.In 2019,Portugal reported the highest number of DALYs(1001.71 million),and India(212.09 million)reported the lowest number of DALYs.The burden of anxiety disorders was positively correlated with the average number of psychiatrists,psychologists and nurses in the mental health sector(per 100000),and quality of life and the correlation coefficients were 0.58,0.67,0.43 and 0.53,respectively.Conclusions The incidence and global burden of anxiety disorders in adolescents have continued to decrease over the past 30 years.However,the incidence and disease burden in developed countries are still increasing steadily.Policymakers should design and implement mental health strategies for adolescents based on their specific developmental status,as well as the cultural and regional characteristics of each country.
基金supported by STI2030-Major Projects(2022ZD0204900)the National Natural Science Foundation of China(NSFC)(91632103,31900732,31771157)+5 种基金the Program of Shanghai Subject Chief Scientist(17XD1401700)National Key Research and Development Program of China(2018YFE0126700)the Shanghai Education Commission Research and Innovation Program(2019-01-07-00-02-E00037)Natural Science Foundation of Chongqing cstc2021jcyjmsxmX1176,the‘111’Program of Higher Education Discipline Innovation,‘Eastern Scholar’(Shanghai Municipal Education Commission),Shanghai Municipal Commission of Science and Technology Program(21dz2210100)China Postdoctoral Science Foundation(202N1702133,2021M702137)The National Science Fund for Distinguished Young Scholars(31900732).
文摘Background Kabukisyndrome(KS)is arare developmental disorder characterised by multiple congenital anomalies and intellectual disability.UTX(ubiquitously transcribed tetratricopeptide repeat,X chromosome),which encodes a histone demethylase,is one of the two major pathogenic risk genes for KS.Although intellectual disability is a key phenotype of KS,the role of UTX in cognitive function remains unclear.Currently,no targeted therapies are available for KS.Aims This study aimed to investigate how UTX regulates cognition,to explore the mechanisms underlying UTX dysfunction and to identify potential molecular targets for treatment.Methods WegeneratedUTXconditional knockoutmice and found that UTX deletion downregulated calmodulin transcription by disrupting H3K27me3(trimethylated histone H3 at lysine 27)demethylation.Results UTX-knockout mice showeddecreased phosphorylation of calcium/calmodulin-dependent protein kinase I,impaired long-term potentiation and deficit in remote contextual fear memory.These effects were reversed by an Food and Drug Administration-approved drug desipramine.Conclusions Our results reveal an epigenetic mechanism underlying the important role of UTX in synaptic plasticity and cognitive function,and suggest that desipramine could be a potential treatment for KS.
基金This study is funded by the Major Project of the National Social Science Fund of China(21&ZD187).
文摘Background Depressive symptoms and cognitive impairment often interact,rendering their associations controversial.To date,their joint trajectories and associations with dementia and death remain underexplored.Aims To explore the interactions between depressive symptoms and cognitive function,their developmental trajectories and the associations with all-cause dementia,Alzheimer’s disease(AD)and all-cause death in older adults.Methods Data were from the Health and Retirement Study.Depressive symptoms and cognitive function were measured using the 8-item Centre for Epidemiologic Studies Depression Scale and the Telephone Interview of Cognitive Status,respectively.All-cause dementia and AD were defined by self-reported or proxy-reported physician diagnoses.All-cause death was determined by interviews.The restricted cubic spline,group-based trajectory modelling and subdistribution hazard regression were used.Results Significant interactions between depressive symptoms and cognitive function in 2010 in their association with new-onset all-cause dementia and AD from 2010 to 2020 were found,especially in women(p for interaction<0.05).Independent trajectory analysis showed that emerging or high(vs no)depressive trajectories and poor or rapidly decreased cognitive trajectories(vs very good)from 1996 to 2010 were at significantly higher risk of subsequent all-cause dementia,AD and all-cause death.15 joint trajectories of depressive symptoms and cognitive function from 1996 to 2010 were determined,where rapidly decreased cognitive function was more common in those with no depressive symptoms.Compared with older adults with the trajectory of no depressive symptoms and very good cognitive function,those with the trajectory of no depressive symptoms but rapidly decreased cognitive function were much more likely to develop new-onset all-cause dementia and death,with subdistribution hazard ratios(95%confidence intervals)of 4.47(2.99 to 6.67)and 1.84(1.43 to 2.36),especially in women.Conclusions To effectively mitigate the risk of dementia and death,it is crucial to acknowledge the importance of preventing cognitive decline in older adults without depressive symptoms,particularly in women.
基金This work was supported by a grant from the National Natural Science Foundation of China(32200906)STI 2030-Major Projects(2021ZD0201705)+2 种基金Major Project of Philosophy and Social Science Research of the Ministry of Education of China(22JZD044)Research Project of Shanghai Science and Technology Commission(20dz2260300)Fundamental Research Funds for the Central Universities and Starting Research Fund from Hangzhou Normal University.
文摘Background The alexithymia trait is of high clinical interest.The Perth Alexithymia Questionnaire(PAQ)was recently developed to enable detailed facet-level and valence-specific assessments of alexithymia.Aims In this paper,we introduce the first Chinese version of the PAQ and examine its psychometric properties and clinical applications.Methods In Study 1,the PAQ was administered to 990 Chinese participants.We examined its factor structure,internal consistency,test-retest reliability,as well as convergent,concurrent and discriminant validity.In Study 2,four groups,including a major depressive disorder(MDD)group(n=50),a matched healthy control group for MDD(n=50),a subclinical depression group(n=50)and a matched healthy control group for subclinical depression(n=50),were recruited.Group comparisons were conducted to assess the clinical relevance of the PAQ.Results In Study 1,the intended five-factor structure of the PAQ was found to fit the data well.The PAQ showed good internal consistency and test-retest reliability,as well as good convergent,concurrent and discriminant validity.In Study 2,the PAQ was able to successfully distinguish the MDD group and the subclinical depression group from their matched healthy controls.Conclusions The Chinese version of the PAQ is a valid and reliable instrument for comprehensively assessing alexithymia in the general population and adults with clinical/subclinical depression.
基金The study received invaluable financial support from"The 90th Anniversary of the Chulalongkorn University Scholarship and the Ratchadapisek Somphot Fund(GCUGR1125652074D)."。
文摘Background Schizophrenia is a chronic mental disorder affecting individuals globally,emphasising the significance of personal recovery in mental healthcare.Understanding the recovery stages and the associated factors can provide essential insights for targeted interventions.Aims This study aimed to discern the stages of personal recovery in Thai patients with schizophrenia and elucidate the associated factors with each stage.Methods A multistage sampling technique was employed,selecting 231 patients with schizophrenia from mental health outpatient departments of general and psychiatric hospitals.Data collected from March to May 2023 included screening for psychotic symptoms using the Brief Psychiatric Rating Scale and six self-report questionnaires—Stage of Recovery Scale,Beck Cognitive Insight Scale,Brief Resilience Scale,Family Support,Therapeutic Relationship-Patients Version and Social Support Questionnaire—along with personal data sheets.Pearson correlation and multinomial logistic regression were performed.Results The predominant personal recovery stage among participants was stage 3,‘living with disabilities’,comprising 42.4%of the participants.Key factors contributing to personal recovery,explaining approximately 38.4%of the variance,included resilience,family support,therapeutic alliance,hospitalisations since onset and recovery-oriented nursing service utilisation.Logit equations for stages 3 and 4 are as follows:stage 3(living with disability):logit=−4.44+0.74×resilience+0.07×therapeutic alliance+0.02×recovery-oriented nursing service utilisation;stage 4(living beyond disability):logit=−11.57-0.05×hospitalisation since onset+1.96×resilience+0.11×family support+0.06×therapeutic alliance.Conclusion The findings emphasise the significance of mental health nursing interventions.In conjunction with recovery-oriented nursing services,strengthening resilience,therapeutic alliances and family support may accelerate personal recovery and reduce hospitalisations among individuals with schizophrenia.
基金funded by a University College Dublin Career Development Award(ref.SF1881).
文摘To the editor:Psychiatric theory,policy and practice are currently grappling with the risks and opportunities presented by artificial intelligence(AI)applications in mental healthcare.Synthesising data to generate diagnosis is an aspect of mental healthcare where AI is anticipated to have the greatest and soonest impact.1-4 While such technologies remain some distance from clinical application,preliminary evidence suggests AI-derived classifications may predict certain treatment outcomes and clinical trajectories,and could soon become available to supplement or replace traditional manual-based diagnostic assessment.
基金grants from the National Key R&D Program of China(2023YFF1104301)(by Geng Zong)National Natural Science Foundation of China(82373576)(by Geng Zong)+2 种基金National Science Fund for Excellent Young Scholars(81922060)(by Geng Zong)Strategic Priority CAS Project(XDB38010300)(by Geng Zong)the Zhejiang University Education Foundation Global Partnership Fund(by Changzheng Yuan).
文摘Background Cardiovascular risk burden is associated with dementia risk and neurodegeneration-related brain structure,while the role of genetics and incident cardiovascular disease(CVD)remains unclear.Aims To examine the association of overall cardiovascular risk burden with the risk of major dementia subtypes and volumes of related brain regions in a large sample,and to explore the role of genetics and CVD onset.Methods A prospective study among 354 654 participants free of CVD and dementia(2006-2010,mean age 56.4 years)was conducted within the UK Biobank,with brain magnetic resonance imaging(MRl)measurement availablefor 15104participants since 2014.CVD risk burden was evaluated by the Framingham General Cardiovascular Risk Score(FGCRS).Dementia diagnosis was ascertained from inpatient and death register data.Results Overamedian 12.0-yearfollow-up,3998 all-cause dementia cases were identified.Higher FGCRS was associated with increasedall-cause dementia risk after adjusting for demographic,major lifestyle,clinical factors and the polygenic risk score(PRS)of Alzheimer's disease.Comparing the high versus low tertile of FGCRS,the odds ratios(ORs)and 95%confidence intervals(Cls)were 1.26(1.12 to 1.41)for all-cause dementia,1.67(1.33 to 2.09)for Alzheimer's disease and 1.53(1.07 to 2.16)for vascular dementia(all p_(treng)<0.05).Incident stroke and coronary heart disease accounted for 14%(95%Cl:9% to 21%)of the association between FGCRS and all-cause dementia.Interactions were not detected for FGCRS and PRS on the risk of any dementia subtype.We observed an 83%(95%Cl:47%to 128%)higher all-cause dementia risk comparing the high-high versus low-low FGCRS-PRS category.For brain volumes,higher FGCRS was associated with greater log-transformed white matter hyperintensities,smaller cortical volume and smaller grey matter volume.Conclusions Our findings suggest that the positive association of cardiovascular risk burden with dementia risk also applies to major dementia subtypes.The association of cardiovascular risk burden with all-cause dementia is largely independent of CVD onset and genetic predisposition to dementia.
基金Funding Effort for some personnel was supported by grants K12 DA041449(KYX,PI:Laura Bierut,Patricia Cavazos-Rehg),and the American Psychiatric Association Psychiatric Research Fellowship(KYX).Authors BYL and C-FS were American Psychiatric Association(APA)/APA Foundation(APAF)fellows at the time of publication.Research grant funding received from Gilead Pharmaceuticals,Liva Nova Therapeutics,Curemark and Alto Neuroscience(ASK).
文摘TToo tthhee eeddiittoorr::Eating disorder(ED),as defined by the Diagnostic and Statistical Manual of Mental Disorders(DSM-5),is a persistent disturbance of eating or eating-related behaviour that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning.^(1)The DSM-5 outlines criteria for EDs,including anorexia nervosa,bulimia nervosa,binge-eating disorder,pica,rumination disorder and avoidant/restrictive food intake disorder.EDs are relatively common in young people,affecting 5.5%-17.9%of young women and 0.6%-2.4%of young men by the time they reach early adulthood.
基金This study was supported in part by grants from the National Key R&D Program of China(2021ZD0203100 to JC)National Natural Science Foundation of China(NSFC81720108013,NSFC31771161 and NSFC81230025 to JC,NSFC81300957 and NSFC82171227 to HL,NSFC81771453 and NSFC31970937 to HZ)+6 种基金Jiangsu Provincial Special Program of Medical Science(BL2014029 to JC)Basic and Clinical Research Center in Anesthesiology of Jiangsu Provincial'Science and Education for Health'Project(JC),Zhejiang Provincial Natural Science Foundation(LY22H090019 to HL)Jiangsu Provincial Natural Science Foundation(BK20190047 to HZ)the Priority Academic Program Development of Jiangsu Higher Education Institutions(19KJA610005 to HZ)Distinguished Professor Program of Jiangsu(HZ),Jiangsu Province Innovative and Entrepreneurial Talent Program and Jiangsu Province Innovative and Entrepreneurial Team Program(HZ),Xuzhou Medical University start-up grant for excellent scientist(D2018010 and D2019025D to HZ)the Natural Science Foundation of Shanghai(21ZR1411300 to YH)Shenkang Clinical Study Foundation of Shanghai(SHDC2020CR4061 to YH).
文摘Background Postoperative sleep disturbance(PSD)is a common and serious postoperative complication and is associated with poor postoperative outcomes.Aims This study aimed to investigate the effect of transcranial direct current stimulation(tDCS)on PSD in older patients undergoing lower limb major arthroplasty.Methods In this prospective,double-blind,pilot,randomised,sham-controlled trial,patients 65 years and over undergoing lower limb major arthroplasty were randomly assigned to receive active tDCS(a-tDCS)or sham tDCS(s-tDCS).The primary outcomes were the objective sleep measures on postoperative nights(N)1 and N2.Results 116 inpatients were assessed for eligibility,and a total of 92 patients were enrolled;47 received a-tDCS and 45 received s-tDCS.tDCS improved PSD by altering the following sleep measures in the a-tDCS and s-tDCS groups;the respective comparisons were as follows:the promotion of rapid eye movement(REM)sleep time on N1(64.5(33.5-105.5)vs 19.0(0.0,45.0)min,F=20.10,p<0.001)and N2(75.0(36.0-120.8)vs 30.0(1.3-59.3)min,F=12.55,p<0.001);the total sleep time on N1(506.0(408.0-561.0)vs 392.0(243.0-483.5)min,F=14.13,p<0.001)and N2(488.5(455.5-548.5)vs 346.0(286.5-517.5)min,F=7.36,p=0.007);the deep sleep time on N1(130.0(103.3-177.0)vs 42.5(9.8-100.8)min,F=24.4,p<0.001)and N2(103.5(46.0-154.8)vs 57.5(23.3-106.5)min,F=8.4,p=0.004);and the percentages of light sleep and REM sleep on N1 and N2(p<0.05 for each).The postoperative depression and anxiety scores did not differ significantly between the two groups.No significant adverse events were reported.Conclusion In older patients undergoing lower limb major arthroplasty,a single session of anodal tDCS over the left dorsolateral prefrontal cortex showed a potentially prophylactic effect in improving postoperative short-term objective sleep measures.However,this benefit was temporary and was not maintained over time.
文摘Background Growing evidence attests to the efficacy of mindfulness-based interventions(MBIs),but their effectiveness for healthcare workers remains uncertain.Aims To evaluate the evidence for MBIs in improving healthcare workers’psychological well-being.Methods A systematic literature search was conducted on Medline,Embase,Cumulative Index for Nursing and Allied Health Literature,PsycINFO and Cochrane Central Register of Controlled Trials up to 31 August 2022 using the keywords‘healthcare worker’,‘doctor’,‘nurse’,‘allied health’,‘mindfulness’,‘wellness’,‘workshop’and‘program’.Randomised controlled trials with a defined MBI focusing on healthcare workers and quantitative outcome measures related to subjective or psychological well-being were eligible for inclusion.R V.4.0.3 was used for data analysis,with the standardised mean difference as the primary outcome,employing DerSimonian and Laird’s random effects model.Grading of Recommendations,Assessment,Development and Evaluation framework was used to evaluate the quality of evidence.Cochrane’s Risk of Bias 2 tool was used to assess the risk of bias in the included studies.Results A total of 27 studies with 2506 participants were included,mostly from the USA,involving various healthcare professions.MBIs such as stress reduction programmes,apps,meditation and training showed small to large effects on anxiety,burnout,stress,depression,psychological distress and job strain outcomes of the participants.Positive effects were also seen in self-compassion,empathy,mindfulness and well-being.However,long-term outcomes(1 month or longer postintervention)varied,and the effects were not consistently sustained.Conclusions MBIs offer short-term benefits in reducing stress-related symptoms in healthcare workers.The review also highlights limitations such as intervention heterogeneity,reduced power in specific subgroup analyses and variable study quality.
基金supported by National Natural Science Foundation of China(7191010700,91746205).
文摘Background The associations between sugary beverages and genetic predisposition to depression risk remain unclear.Aims This study aimed to investigate the associations of sugar-sweetened beverages(SSBs),artificially sweetened beverages(ASBs)and natural juices(NJs)with depression and to assess whether these associations were modified by genetic predisposition.Methods We used data from the UK Biobank of 180599 individuals aged 39-72 years who were depression-free at baseline.Dietary intake of SSBs,ASBs and NJs was accessed by a 24-hour dietary recall between 2009 and 2012.The Polygenic Risk Score for depression was estimated and categorised as low(lowest tertile),intermediate(tertile 2)and high(highest tertile),.Cox proportional hazard and substitution models were conducted to evaluate hazard ratios(HRs)and 95%Cls.Results Over the 12-year follow-up,4915 individuals developed depression.Higher consumption(>2 units/day)of SSBs(HR:1.26,95%CI 1.12 to 1.43)and ASBs(HR:1.40,95%Cl 1.23 to 1.60)were both associated with an increased risk of depression.However,moderate consumption(>0-1 units/day)of NJs was associated with a lower risk of depression(HR:0.89,95%CI 0.83 to 0.95).Furthermore,genetic predisposition did not modify these associations(p interaction>0.05).In substitution models,the HRs for depression risk were 0.94(95%CI 0.89 to 0.99)and 0.89(95%CI 0.85 to 0.94),respectively,when 1 unit/day of SSBs or ASBs was replaced by an equivalent intake of NJs.Conclusions Higher consumption of SSBs and ASBs was associated with an increased risk of depression;in contrast,moderate consumption of NJs was inversely associated with a lower risk of depression.In theory,substituting SSBs and ASBswith NJs would suppose a reduction of depression risk.