Abstract

Background
Depression results from interactions between biological, social, and psychological factors. Literature shows that depression is associated with abnormal brain structure, and that socioeconomic status (SES) is associated with depression and brain structure. However, limited research considers the interaction between each of these factors.
Methods
Multivariate regression analysis was conducted using UK Biobank data on 39,995 participants to examine the relationship between depression and brain volume in 23 cortical regions for the whole sample and then separated by sex. It then examined whether SES affected this relationship.
Results
Eight out of 23 brain areas had significant negative associations with depression in the whole population. However, these relationships were abolished in seven areas when SES was included in the analysis. For females, three regions had significant negative associations with depression when SES was not included, but only one when it was. For males, lower volume in six regions was significantly associated with higher depression without SES, but this relationship was abolished in four regions when SES was included. The precentral gyrus was robustly associated with depression across all analyses.
Limitations
Participants with conditions that could affect the brain were not excluded. UK Biobank is not representative of the general population which may limit generalisability. SES was made up of education and income which were not considered separately.
Conclusions
SES affects the relationship between depression and cortical brain volume. Health practitioners and researchers should consider this when working with imaging data in these populations.

Introduction

Mental health problems are significant public health issues within the UK and worldwide, with depression being one of the most prevalent. Research shows that there is a relationship between depression and brain structure (Tang et al., 2007; Kronmüller et al., 2009; Bos et al., 2018; Maggioni et al., 2019), and that social factors, including socioeconomic status (SES), are associated with both depression (Delgadillo et al., 2016; Marmot, 2010; Freeman et al., 2016) and changes in brain structure (Kweon et al., 2022; Colich et al., 2020; Jednoróg et al., 2012; Noble et al., 2015). However, these three factors are rarely all considered together. Given the impact of depression on both the individual and society, as discussed below, understanding the mechanisms of this disorder, to improve prevention and treatment options, is of critical importance.

Around 1 in 6 adults in England met the criteria for a common mental health disorder in the week prior to being surveyed (McManus et al., 2016). Mental health problems are one of the leading contributors to overall worldwide disease burden and are reported to account for 16 % of Disability Adjusted Life Years (DALYs, Arias et al., 2022). They confer substantial societal and economic implications with an estimated annual cost in England of £77 billion (Kirkwood et al., 2010). Depression is one of the most prevalent mental health problems, affecting approximately 5 % of adults (World Health Organization, WHO, 2023) and 280 million people globally (Institute of Health Metrics and Evaluation, 2023). Depression can be long-lasting with a single chronic episode, or recurrent, with many episodes over a long time, and has a substantial impact on an individual’s ability to function and cope with daily life. The risk of suicide is reported to be about 15 times higher in those with depression than the general population (Cipriani et al., 2005). This is however likely to be an underestimate as many who die by suicide have undiagnosed depressive symptoms.

Conclusion

This study is, to our knowledge, the first study to examine the relationship between depression, cortical volume, and SES in a middle-aged to older sample of this size. Given that SES appears to impact the relationship between depression and brain structure, we posit that SES should be a consideration for clinicians and scientists working with imaging data in these populations. Future research involving large-scale longitudinal data is needed to elucidate the causal relationships between the factors examined in this study.

Abstract

Excessive reassurance-seeking in OCD has been linked to the maintenance of OCD, functioning as a type of checking ritual. Current treatments recommend the imposition of the extinction of seeking and providing reassurance; however, this is not well tolerated. Although it has been suggested that the provision of support may provide a more helpful alternative, there is no empirical evidence for this. In the present study, 36 participants with OCD engaged with two personalised semi-idiographic scenarios in which they imagined seeking and receiving reassurance and seeking and receiving emotional support in counterbalanced order. The primary outcome measure was anticipated urge to seek reassurance, which was found to significantly decrease in the imagined support condition relative to the imagined reassurance condition regardless of order of presentation. Emotional support was perceived as significantly more acceptable when compared to imagining reassurance in terms of higher ratings of perceived helpfulness in managing emotions, feelings of calmness and closeness, and the sense that they were fighting OCD together. These findings provide preliminary evidence for the value of encouraging the seeking and giving of emotional support as an alternative to reassurance. Implications for clinical work and further research are discussed.

Introduction

Obsessive-compulsive disorder (OCD) is a common and pervasive mental health disorder characterised by the presence of severe and disabling obsessions and compulsions, (American Psychological Association, 2023). Thought to have a lifetime prevalence of around 2% (Cervin, 2023). OCD is associated with increased autoimmune disorders (de la Cruz et al., 2022), long-term socioeconomic difficulties (Pérez-Vigil et al., 2018), significantly impaired quality of life (Eisen et al., 2006; Macy et al., 2013), and significant strains on peer and family relationships (Grover & Dutt, 2011; Walseth et al., 2017).

Cognitive theories of OCD focus on the threat of harm to self and/or others, and an inflated sense of responsibility for such harm, as the precipitating factors and motivators of the responses that maintain OCD (Rachman, 2002; Salkovskis, 1985; Salkovskis & Warwick, 1985; Smith et al., 2022). Compulsive behaviours motivated by responsibility beliefs are considered key maintaining responses, functioning as safety-seeking behaviours (SSB) intended to achieve certainty that harm or responsibility for it is eliminated (Salkovskis, 1991). Like most SSBs, however, checking has the effect of preventing disconfirmation and maintaining pre-occupation (Osborne & Williams, 2013). For example, with each instance of checking the memory of previous checks is tarnished (Radomsky et al., 2006). As such, the level of certainty of safety tends to decrease, and checking is perpetuated (Rachman, 2002; Tolin et al., 2002). Recent work thus suggests that excessive reassurance-seeking (ERS) is a special type of checking. Defined as the “verbal and/or non-verbal interaction with someone who you perceive has access to potentially threat relieving information, with the intention of increasing your perceived sense of certainty from harm” (Halldorsson & Salkovskis, 2023), in practice, this often looks like requests or comments (verbal or non-verbal) that search for certainty that their feared outcome is untrue (e.g., “did I do that properly?“, “am I a bad person?” etc.) with responses provided that attempt to provide this certainty (e.g., “Yes you did”, “No you aren’t a bad person”. Unlike most other forms of checking, this interaction has the additional function of transferring responsibility onto others (Rachman, 2002; Salkovskis, 1999).

Conclusion

The present study highlights the anticipated advantages of seeking and receiving emotional support as opposed to reassurance. People with OCD imagined support as not only more effective in the long-term, but also as more acceptable when compared to reassurance. Future research may benefit from assessing these outcomes in caregivers of those with OCD also, in addition to in-vivo experiments that can investigate the effectiveness and acceptability of reassurance in practice.

Abstract

Background
Perinatal depression is a significant concern affecting both women and men during pregnancy and postpartum periods. While maternal postpartum depression has been extensively studied, paternal depression remains under-researched despite its prevalence and impact on family well-being. This study aimed to estimate the trajectories of perinatal and postpartum depression in Japanese parents over ten years and to determine the details of the symptoms of postpartum depression for each trajectory group, considering reciprocal effects between maternal and paternal depression.

Methods
A total of 789 couples used the Edinburgh Postnatal Depression Scale to rate their depressive symptoms prenatally; at 5 weeks, 3 months, 6 months, and 1 year postpartum; and then yearly thereafter until the 10th year. Parallel-process latent class growth analysis was used to group participants according to their longitudinal patterns of depressive symptoms.

Results
For both mothers and fathers, four depressive symptom trajectories fit the data best and were most informative (escalating: 6.5 %; mothers low and fathers moderate: 17.2 %; mothers high and fathers low: 17.9 %; low: 58.4 %). A variance analysis showed significant class-parent interactions across anhedonia, anxiety, and depression subscales, indicating distinct patterns of depressive symptomatology.

Discussion
Tailored mental health programs and universal screening using the Edinburgh Postnatal Depression Scale are recommended to address the specific needs of each trajectory class. This study contributes to the understanding of long-term depressive symptom trajectories in parents and emphasizes the necessity of comprehensive support strategies to enhance family well-being and resilience.

Introduction

Perinatal depression is a significant concern that affects a considerable number of women during pregnancy and after childbirth, with prevalence rates ranging from 7 % to 20 % (Dadi et al., 2022). Similarly, postpartum depression was found to be prevalent in 14.3 % of Japanese women one month after childbirth (Tokumitsu et al., 2020a). However, both men and women are affected by postnatal depression. A meta-analysis of 74 studies with 41,480 participants found that paternal depression was present in 8 % of men in the included studies (Cameron et al., 2016). Approximately 10 % of Japanese men experience perinatal depression, highlighting that this condition is a concern for both sexes (Tokumitsu et al., 2020b). The mental health of both parents during the perinatal and postpartum periods is crucial, as it can significantly impact the overall well-being of children and families. A meta-analysis further revealed that 3.18 % of couples might experience perinatal depression simultaneously (Smythe et al., 2022). Longitudinal studies have also shown that depressive symptom trajectories can persist for up to 11 years postpartum (Mughal et al., 2023). Therefore, this study’s primary objective was to estimate the trajectories of perinatal and postpartum depression in Japanese parents and their associated risk factors, considering the reciprocal effects of postpartum depression on fathers and mothers.

Conclusion

This 10-year longitudinal study identified four distinct joint trajectories of mothers and fathers’ depressive symptoms from pregnancy to postpartum: low and stable for both parents, high for mothers and low for fathers, moderate for fathers and low for mothers, and escalating for both parents. The findings emphasize the importance of early detection and continuous monitoring of depressive symptoms, including anhedonia, anxiety, and depression, in both parents. Tailored mental health support programs are critical, especially for mothers in Class 2 and fathers in Class 4, who exhibit higher and prolonged symptoms. Despite limitations such as sample size reduction and external factors influencing results, the study adds to the growing body of knowledge on postpartum depression, underscoring the need for comprehensive and targeted approaches to support families and improve mental health outcomes through timely and appropriate interventions. Future research should include larger, more diverse populations to enhance generalizability and explore effective long-term intervention strategies.

Abstract

The ability model of emotional intelligence (EI) specifies that four related abilities are involved: perceiving emotions, facilitating thought using emotions, understanding emotions, and managing them. Several performance-based assessments have been developed to measure those four abilities. Although some researchers find empirical support for the four abilities, others have argued that emotional intelligence divides into three abilities, two or even a single, unitary ability (Legree et al., 2014; Palmer, Gignac, Manocha, & Stough, 2005). We reanalyzed archival data from four ability tests of emotional intelligence, Ns = 503, 5000, 1000, and 2000, conducting item-level exploratory factor models of all four assessments for the first time. Based on those analyses, we suggest possible revisions of the 4-factor model to guide future research and assessment.

Overview of the present studies

In our research here, we analyzed the four assessments, the MEIS, MSCEIT, MSCEIT YRV, and MSCEIT-2, all at the level of their individual items—allowing their items to form factors with one another freely and apart from the tasks to which they had been assigned. Our purpose was forward-looking and focused on the question, “If one were to take a fresh look, what would be the nature and number of abilities one might ‘see’ in existing tests?”

Conclusions and implications for assessment

Theory is a powerful tool in the sciences but it is also important to adjust theories as new empirical findings improve our understanding. The theory of emotional intelligence has been associated with two key ideas: That emotional intelligence can be assessed as a mental ability using intelligence tests, and further, that the intelligence divides into four more specific abilities: accuracy at perceiving emotion, facilitating thought, understanding feelings, and emotion management. Of the first claim—that EI is an intelligence and can be assessed with intelligence tests—there is little doubt: Research from the MEIS forward demonstrates that the four-area model of emotional intelligence can be operationalized as a series of ability-based assessments (MacCann et al., 2014).

The research here, however, indicates that the four-area model could benefit from some reconsideration. The findings indicate the robustness of scores reflecting Understanding and Managing abilities, but that the Emotion Perception area may be more multi-dimensional than the original theory indicated, and that a “Connecting Emotional Features” score may better represent certain tasks than the earlier-conceived “Facilitating Thought” area. The findings make room, as well, for as-of-yet unclassified tasks (see Fig. 1). Collectively, the results encourage us to rethink EI in ways that have plain implications for future measures.

To the degree such new understanding closer approximates the reality of mental abilities in this area, it can inform applied practice so that the consultant and the clinician can provide people with more accurate feedback as to their abilities. A better understanding, such as this research provides, can help ensure that test scores convey distinctive meanings that are better understood than before—a key contributor to meeting the standards of optimal assessment (Joint_Committee, 2014; Sinharay et al., 2011). It is our hope that the findings obtained here, along with further research in the area, will help promote a better understanding of the nature of the ability model of emotional intelligence and its application.

Abstract

Developmental prosopagnosia (DP) is a condition that indicates the inability to recognize individuals by their faces from birth, without any history of brain damage. The assessment of face recognition ability and diagnosis of DP involve the use of face tests such as the Cambridge Face Memory Test (CFMT) and the Cambridge Face Perception Test, along with self-reported measures like the 20-Item Prosopagnosia Index (PI20). Face recognition accuracy is affected by anxiety. However, previous studies on the relationship between face recognition ability and anxiety have not used the PI20 measure. This study aimed to investigate the relationship between self-reported measures of face recognition ability and anxiety tendencies among healthy young individuals for DP diagnosis and its implications. We used a face recognition test, involving the PI20, CFMT, Visual Perception Test for Agnosia–Famous Face Test (VPTA–FFT), and State-Trait Anxiety Inventory (STAI). We assessed the performance of 116 Japanese young adults (75 females, median age of 20.7 years, with a standard deviation of 1.2). Subsequently, we conducted a statistical analysis to examine the relationship between the outcomes of the face recognition tests and STAI scores using Pearson correlation analysis and single correlation coefficients. The results showed a positive correlation between state anxiety and PI20 (r = 0.308, p = 0.007), and a weak positive correlation was also observed between trait anxiety and PI20 (r = 0.268, p = 0.04). In contrast, there was no correlation between CFMT and VPTA–FFT with respect to STAI. The results of the hierarchical multiple regression analysis also suggested that the correlation between the performance on the PI20 (self-report) and objective measures of face recognition performance (the CFMT and the VPTA–FFT) are driven by differences in anxiety. This study is the first to explore the relationship between face recognition abilities and anxiety using the PI20 self-report measure. There are implications for future research on the diagnosis of DP and the relationship between anxiety and face recognition.

Introduction

Face recognition ability enables individuals to differentiate and identify faces, playing a crucial role in interpersonal recognition and everyday communication. Clinical and functional imaging studies have highlighted that brain lesions, particularly in regions such as the fusiform gyrus, can lead to face recognition impairment. In recent years, there has been a growing interest in the field of face recognition research regarding developmental prosopagnosia (DP). DP refers to a condition in which individuals experience lifelong impairments in face recognition despite possessing normal visual and intellectual capabilities since birth. Clinically, there is no indication of overt central nervous system disorders, and neuroimaging studies also reveal the absence of organic brain lesions (Bate & Tree, 2017; Behrmann & Avidan, 2005; Cook & Biotti, 2016; Duchaine & Nakayama, 2006a). Epidemiological studies in Europe and Asia have reported a prevalence rate of approximately 1.9 %–2.9 % of the population (Bowles et al., 2009; Kennerknecht et al., 2006; Kennerknecht et al., 2008). People with DP encounter challenges and psychosocial difficulties in their interpersonal interactions due to impaired face recognition (Yardley et al., 2008). Early diagnosis and support are crucial, especially before adulthood and entering the workforce.

Currently, diagnosing DP presents challenges due to the absence of established strict objective criteria or biological markers (Barton & Corrow, 2016; Susilo & Duchaine, 2013). Previous studies have revealed ambiguous criteria for diagnosing DP and differentiating it from conditions other than DP in face recognition tests (Bate & Tree, 2017; Dalrymple & Palermo, 2016). Dalrymple and Palermo (2016) provided guidelines that define DP as objectively poor performance on face memory tests and a subjective feeling of repeated face recognition failures in daily life. The authors emphasized the importance of using questionnaires and interviews to assess face recognition difficulties in daily life and highlighted the limitations of relying solely on questionnaires for DP diagnosis, as individuals with DP may lack accurate insight into their own face recognition abilities.

Conclusions

The present study is the first to investigate the relationship between self-reported face recognition abilities and anxiety in young, healthy Japanese individuals using the self-perception face recognition test PI20. The findings indicated that unlike the objective face recognition tests CFMT and VPTA–FFT that showed no association with anxiety, the self-perception test scores may be influenced by state anxiety. Self-reporting, at least in its current form, provides limited insights into predicting face recognition performance in young individuals and diagnosing DP. Therefore, self-reporting is insufficient to evaluate face recognition abilities in young individuals, and DP cannot be diagnosed solely based on self-perception tests. It is necessary to combine self-perceived indicators of face recognition impairment with other perception-based face recognition function tests and consider the presence and extent of anxiety tendencies. Our findings have significant psychological implications for understanding face recognition impairments, DP diagnosis, and clinical practices. In the future, expanding research to investigate the interaction between facial and expression recognition abilities and anxiety is expected to enhance the accurate diagnosis and support for young individuals with facial recognition impairments.

Abstract

Positive Psychology has reconstructed how we understand happiness. The practices and discourses it presents to perform that reconceptualization appear as if free from political interest or intentionality. However, this article will show that its proposals define a subtle new form of government which we will call Psychopolitics. Instead of placing the population or the body of the citizen at the centre of political struggles, it focuses on the psyche. Through an extreme defence of positive emotions and happiness as the key to a good life, Positive Psychology promotes a type of friendly power relations, which instead of punishing motivates and empowers the individual’s creativity. To illustrate all of this, we conducted a case study with a Positive Psychology training course taught in a Spanish state university. Content analysis was used to explain the recurring themes and practices of this new discipline of positivity, showing how health is redefined around the happiness axis, and how happiness becomes an individual responsibility. We conclude that all these dimensions are simply a categorical definition of a new type of power relations which may characterise the 21st century.

Introduction: Happiness and positive psychology

As several authors (Arguís et al., 2010; Diener & Seligman, 2002; Fordyce, 1977) have remarked, happiness is one of the major goals regarded as exceptionally valuable in the sociocultural imaginary of our contemporary societies. It is a commonplace in academic literature to state that this is a construct which varies both diachronically – that is, over history, and synchronically – through culture and political axes. If we go back to Classical Greece, we quickly find that it was considered a greater good (Aristotle, 2009). On the other hand, in the Middle Ages, happiness appears as something we obtain in the next life (Aquinas, 2010; Augustine of Hippo, 2019). If we look at its definition in other cultures, past and present, but characterised by their distance from our own cultural coordinates, we find that happiness is included with values centred in the body or in collective well-being. All these examples show that its definition varies and multiplies depending on temporal, local, social, religious, and political coordinates (see Table 3, Table 4, Table 5, Table 6, Table 7).

More recently, and in our immediate context, in the Modern Age, with the American Declaration of Independence (1776) and the French Declaration of the Rights of Man (1789), happiness was proclaimed to be a right. Along these lines, a plethora of movements have emerged in the Contemporary Age which approach this right and feeling from a more practical perspective, based on scientific principles (Lyubomirsky, 2008; Seligman, 2002; Seligman & Csikszentmihalyi, 2014). The most recent conception, considered to belong to the 21st century, suggests that happiness may not be governed only by rulings which control people’s lives through their bodies or their religious values, but also through the immediate and productive management of the psyche (Han, 2014; Stiegler, 2013). This notion should not be understood as a genetic, idiosyncratic and deep-rooted dimension of the individual which could be externalised through words or observation as it was in the 19th century, with the clearest examples being psychoanalysis or classic cognitive psychology, but more from an existential perspective of meaning in life, initially explored in the 20th century by the psychiatrist Viktor Frankl (1959), whose experience of being a prisoner in a Nazi concentration camp can be used to address today’s global psychological problem of suicidal behaviours (Costanza et al., 2020, Costanza et al., 2020) after the financial crisis (Economou et al., 2013) and the COVID-19 pandemic (Costanza et al., 2021). Nowadays, the psychic realm has received a new, much broader and more operational definition, which makes it a set of relationships between internal aspects of the human being (which pass through the body and cognition) and other external aspects which pass directly through knowledge and the technologies which have recently begun to dominate our everyday lives (apps focusing on health, mindfulness, balanced diets, etc.). This is the result, among other things, of the fact that although in recent years we have put much more emphasis on looking for the so-called society of wellbeing (Rose et al., 2006), which emphasises care for the somatic, at present being physically well is no longer enough, and we are required to go a step further. Thus, the transformation of different world organisations in relation to the concept of health is clear. While in 1948 the World Health Organization defined health as “a state of complete physical, mental and social wellbeing, and not the mere absence of disease or infirmity” (WHO, 1946), by the end of the 20th century it was considered “a positive concept emphasizing social and personal resources, as well as physical capacities” (PAHO, 1986). In this new accepted sense, “personal” covers everything which was formerly called mental, but many more axes too, such as our relationship with the information generated by certain healthcare apps, the results we get from psychological or intelligence tests, or our interpersonal skills. In this pivot by the WHO we see health become an assumption, and the new goal of every citizen becomes achieving absolute and overall or comprehensive positive well-being. At this crossover of dimensions is when the so-called “psyche” acquires a new definition and value.

Conclusions

Positive Psychology has reconstructed how we must understand happiness. Its practices and discourses have spread to every action of our everyday life. Although it is presented as a discipline taking no part in the main mechanisms of power, we have found that it subtly reproduces a new modality of power and control, called Psychopolitics. Here, the arena of political struggle and conflict have moved from the notion of the bios to that of the psyche. This is what enables us to define a productive, active individual aligned with the requirements of the status quo, the practical consequences of which are spreading into the spheres of our everyday reality through the creation of more happiness programs in the field of education, well-being workshops to manage one’s emotional health at work, new positive applications to the “citizen science”, and obviously training in the field of psychology as well, where life coaching has become so important that it is now the new definition of Popular Psychology.

However, Positive Psychology does something more than just reproduce a power mechanism; it creates it to maintain itself and it has established a variant or nuance of Psychopolitics which we have called the Psychopolitics of Well-being. Here and now, the good life, the life worth living, is the life that is constantly seeking the well-being generated by positive thoughts and emotions.

Abstract

Background
General practitioners play a pivotal role in the diagnosis attention-deficit/hyperactivity disorder (ADHD) in adults. This systematic review aims to determine the effectivity and feasibility of screening tools for ADHD in adults in primary care.

Method
A literature search was performed in PubMed, Cochrane Library, Ovid, ERIC, PsycInfo, PSYNDEX and Embase in November 2022. Sensitivity and specificity were considered as primary outcomes. Further psychometric properties, feasibility in general practice as well as digital practicability were evaluated as secondary outcomes. Risk of bias was assessed via QUADAS-2/C. A narrative data synthesis and meta-analysis was performed (PROSPERO: CRD42022374597).

Results
A total of fifty-eight studies were included in data analysis. These studies referred to eighty-four various screening tools. ASRS-6 (DSM-V), WURS-25, CAARS-s:sV and TRAQ10 are suitable instruments for screening of ADHD in adults in primary care. The highest test accuracy was shown by ASRS 6 (DSM-V) (Sensitivity=0.83 [0.67–0.92], Specificity=0.87 [0.93–0.8], AUC=0.92, I2=8.6–12.3 %).

Limitations
Included studies used rating scales as reference standard. Some studies compared study groups to control groups with an unknown ADHD status and there is a large degree of heterogeneity between the populations. Some studies referred to the best-balanced results of sensitivity and specificity under a certain cut-off, that has not been determined before.

Conclusion
Feasibility studies are needed to provide more evidence for WURS-25 and CAARS-s:sV. The determination of sufficient cut-offs is important, to improve the identification of ADHD in adults by general physicians.

Introduction

Attention-deficit/hyperactive disorder (ADHD) according to the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) and hyperkinetic disorder (F90) or attention deficit without hyperactivity (F98.8) according to the International Classification of Diseases, editions 10 and 11 (ICD-10/11)) is commonly known as a childhood disorder which is characterized by altered hyperactivity, inattention and impulsivity (Drechsler et al., 2020). These symptoms persist until adulthood in about 50 % of all diagnosed patients (Sibley et al., 2017, 2022). Moreover, patients show characteristic features, which include executive dysfunction, disorganization and emotional distress, leading to an impairment of their daily lives (Barkley, 1997; Wender, 1998). Common comorbidities are depression, borderline personality disorder, social phobia, anxiety, or substance abuse (Fayyad et al., 2017; Kessler et al., 2006). Although a prevalence of approximately 2–3 % of ADHD in adults is estimated, only 0.2–0.4 % are actually diagnosed in Germany (Fayyad et al., 2017; Bachmann et al., 2017; de Zwaan et al., 2012). A possible reason seems to be a gap in medical care for young adults in a time of transition after leaving the pediatric setting (Eklund et al., 2016; Robb and Findling, 2013). Moreover, ADHD might be masked by other psychiatric symptoms and comorbidities (Retz et al., 2013). A missing or failed diagnosis prevents access to optimal medical care in the form of an evidence-based treatment of affected adults. General practitioners are considered to act as so-called „gatekeepers“, a role that is characterized by the initial identification of patients (Kwon et al., 2023; French et al., 2020). Consequently, there is a distinct need for appropriate diagnostic tools in primary care, as has already been identified in relevant guidelines (Eom and Kim, 2023; National Institute for Health and Care Excellence: Guidelines, 2018). There are many different screening tools, which differ in relevant aspects of the disorder. Some screening tools evaluate childhood symptoms, whereas others focus on current adult symptoms. Some screening tools are based on DSM-5 criteria, others on Utah criteria or no specified criteria. They differ in time or way of application, number of items, and scoring methods. For example, the choice of cutoff scores in ADHD screening tools directly influences clinical decision-making, including the initiation of treatment interventions. A higher cutoff score may exclude individuals who, despite exhibiting significant symptoms, do not meet the stringent criteria, potentially denying them access to necessary interventions. Conversely, a lower cutoff score could lead to the inclusion of individuals with mild symptoms, leading to over-treatment. The variability in cutoff points complicates the determination of treatment eligibility, potentially affecting the efficacy and efficiency of ADHD management strategies. Until, there is no comprehensive overview of validated studies including a quantitative meta-analysis (Taylor et al., 2011). Therefore, the aim of the study was to evaluate screening tools for ADHD in adults, considering sensitivity, specificity and feasibility for primary care.

Conclusion

Our findings show that screening tools as the ASRS-6 (DSM-V), the WURS-25, the CAARS-s:sV and the TRAQ10 are suitable instruments for screening of ADHD in adults in primary care due to their high validity and perceived feasibility in this setting. The best evidence exists for the ASRS-6, which was included in our meta-analysis. For more evidence concerning feasibility of the WURS-25 as well as the CAARS-s:sV, which also were part of the meta-analysis, feasibility studies are required. Regarding other tests like the TRAQ10 with equivalent promising results but insufficient options of comparison there is a need of further validation studies to create more evidence in that part. The determination of cut-offs is of great importance since it affects the ability of a screening tool distinguishing between real and false positives respectively negatives. Further research is required to identify the optimal cut-off of the different tests for a general population sample as we find it in primary care. Hence, the identification of ADHD in adults by general physicians would be improved without leading to increased misdiagnoses.

Abstract

Suicide is a major public health problem worldwide with far-reaching effects on families, communities, and societies. Influencing factors range from macro-level interventions like alcohol control policies and suicide prevention programs to individual contributors such as alcohol abuse and domestic violence. This study aimed to examine the relationship between Chile’s suicide rate changes from 2002 to 2015 and the Alcohol Act of 2004, a national suicide prevention program implemented in 2007, alcohol abuse, and domestic violence. Assembling a unique longitudinal dataset from Chilean public institutions, the study employed an instrumental variable time-series cross-regional design. Results indicated that the Alcohol Act was not associated with suicide rates, domestic violence exhibited a significant association with increased suicide rates, and the national suicide prevention program was linked to reductions in suicide rates, especially among males. These findings align with research from neighbouring countries, showcasing the efficacy of suicide prevention programs in decreasing suicide rates in Chile. Results highlight the importance of integrating protocols to early-detect domestic violence in suicide prevention programs, as well as the need to further improving alcohol control policies to complement suicide prevention programs.

Introduction

Suicide is a major public health problem worldwide with effects on families, communities, and society. Globally, there are 703,000 annual deaths by suicide (World Health Organization, 2021). The global age-standardized suicide rate in males (12.6 per 100,000) is more than double that in females (5.4 per 100,000) (World Health Organization, 2021). Suicide prevention is a priority for the WHO and is included as an indicator in the United Nations Sustainable Development Goals (World Health Organization, 2021).

Alcohol use is a substantive risk factor for both deaths by suicide and suicide attempts (Amiri and Behnezhad, 2020; Isaacs et al., 2022; Perez et al., 2022). Furthermore, acute high-dose alcohol use increases the risk of suicide (Borges et al., 2017; Conner and Bagge, 2019; Razvodovsky, 2009) and contributes to the adoption of more violent suicide means (Choi et al., 2018; Yeskendir et al., 2022). Studies have consistently found that alcohol abuse and intoxication are prevalent in suicidal behavior (Norström and Rossow, 2016). Hence, strategies to control alcohol abuse and intoxication could impact suicides attributable to alcohol use (Anderson et al., 2009; Babor et al., 2010; Ilhan and Yapar, 2020).

Conclusion

The reduction in suicide mortality following the implementation of Chile’s Suicide Prevention Program leads us to the conclusion that, despite using a crude operationalization, this policy incorporates changes that help anticipate triggers of suicidal behavior in targeted populations. Future research as well improvements in Chile’s Suicide Prevention Program should aim to better understand the mechanisms linking alcohol abuse, domestic violence, and suicide. From a research perspective, better relevant variables, including policy implementation and design, and other measurements of alcohol abuse and domestic violence should be explored further. From a suicide prevention policy perspective, it is advisable to consider a more explicit integration of at-risk groups, such as victims of domestic violence and/or individuals with alcohol related risks, into the early warning systems of Chile’s Suicide Prevention Program.

Abstract

Background
A range of factors including mental disorders, adverse events and history of self-harm are associated with suicide risk. Further examination is needed of the characteristics of suicides which occur without established risk factors, using national surveillance systems.

Methods
Data on all suicides in Ireland from 2015 to 2017 were drawn from the Irish Probable Suicide Deaths Study (IPSDS). Variables examined included socio-demographics, psychiatric history and precipitant stressors. Suicide data were linked with data on prior self-harm from the National Self-Harm Registry Ireland (NSHRI). Latent Class Analysis (LCA) was used to identify sub-groups of suicide cases.

Results
Of the 1809 individuals who died by suicide, 401 (22.2 %) had a history of hospital-treated self-harm. Four distinct profiles of suicides were identified. One group was marked by high levels of prior self-harm and mental health conditions. Two of the groups included few individuals with a history of self-harm but had notably high levels of mental health conditions. These two groups had relatively high levels of reported chronic pain or illness but differed in terms of socio-demographics. The final group, predominantly male, had markedly low levels of mental health conditions or self-harm but high levels of personal stressors and substance use.

Limitations
The use of coronial data may be limited by bias in the collecting of information from the deceased’s family members.

Conclusions
A sub-group of suicide cases exists without any psychiatric or self-harm history but with salient occupational or health-related proximal stressors. Suicide prevention interventions should include occupational settings and should promote mental health literacy.

Introduction

Suicide is a major global health concern, with over 700,000 people around the world dying by suicide every year (WHO, 2021). The causes of suicide are complex, encompassing individual factors such as genetic influences and mental disorders, contextual factors such as family influences, history of abuse, socioeconomic conditions, exposure to suicidal behaviour by others, access to means for a suicidal act and lack of support in a crisis (Hawton and Pirkis, 2017). Self-harm is associated with a significant risk of subsequent death through suicide (Hawton et al., 2015; Vuagnat et al., 2019). Risk of suicide among individuals in the year after a suicide attempt has been estimated to be up to 100 times higher than matched community controls (Tidemalm et al., 2015), while a meta-analysis of psychological autopsy studies reported that self-harm history was associated with a ten-fold increase in suicide risk (Favril et al., 2022). A recent national Irish study reported one-year risk of suicide following an episode of hospital-treated self-harm to be 0.8 % (Griffin et al., 2023).

Conclusion

The majority of suicides occurred in individuals with no prior history of hospital-treated self-harm. Those who had previously presented to hospital had higher levels of known risk factors from socio-demographic and psychiatric domains. Among males in particular, a sub-group was identified without any psychiatric history and low levels of known risk factors, but with salient occupational or health-related proximal stressors. Suicide prevention interventions should include occupational settings as well as promoting support for those with chronic physical health conditions.

While mental illness remains a major risk factor, these findings suggest that emphasis needs to be placed on the broader psychosocial issues which may influence the pathway to suicide. In addition, it may be that the relative contribution of mental health conditions and other factors is fluid in relation to both life stage and life circumstances.

Abstract

Background. Psychological distress is a progressive health problem that has been linked to decreased quality of life among university students. This meta-analysis reviews existing randomized controlled trials (RCTs) that have examined the effects of mindfulness-based stress reduction (MBSR) on the relief of psychosomatic stress-related outcomes and quality of life among university students. Methods. The PubMed, EMBASE, Web of Science, PsycINFO (formerly PsychLit), Ovid MEDLINE, ERIC, Scopus, Google Scholar, ProQuest, and Cochrane Library databases were searched in November 2023 to identify the RCTs for analysis. Data on pathology (anxiety, depression, and perceived stress), physical capacity (sleep quality and physical health), and well-being (mindfulness, self-kindness, social function, and subjective well-being) were analyzed. Results. Of the 276 articles retrieved, 29 met the inclusion criteria. Compared with control therapies, the pooled results suggested that MBSR had significant effects, reducing anxiety (SMD = −0.29; 95% CI: −0.49 to −0.09), depression (SMD = −0.32; 95% CI: −0.62 to −0.02), and perceived stress (SMD = −0.41; 95% CI: −0.60 to −0.29) and improving mindfulness (SMD = 0.34; 95% CI: 0.08 to 0.59), self-kindness (SMD = 0.57; 95% CI: 0.30 to 1.12), and physical health (SMD = −0.59; 95% CI: −1.14 to −0.04). No significant differences were observed in sleep quality (SMD = −0.20; 95% CI: −0.06 to 0.20), social function (SMD = −0.71; 95% CI: −2.40 to 0.97), or subjective well-being (SMD = 0.07; 95% CI: −0.18 to 0.32). The quality of the evidence regarding sleep quality and physical health outcomes was low. Conclusions. MBSR therapy appears to be potentially useful in relieving functional emotional disorders. However, additional evidence-based large-sample trials are required to definitively determine the forms of mindfulness-based therapy that may be effective in this context and ensure that the benefits obtained are ongoing. Future studies should investigate more personalized approaches involving interventions that are tailored to various barriers and students’ clinical characteristics. To optimize the effects of such interventions, they should be developed and evaluated using various designs such as the multiphase optimization strategy, which allows for the identification and tailoring of the most valuable intervention components.

Introduction

Mindfulness therapy is a standardized psychological intervention that aims to reduce stress, encourage mindful thinking habits, and allow recipients to manage difficult emotional processing. It focuses on the concentration of one’s attention in the moment, nonsubjective judgment, and openness to accepting personal experience and involves corresponding behavioral training, such as attention training, body scanning, and sitting meditation [1]. Previous research on psychological interventions has found that mindfulness therapy can help reduce stress among university students and affects their overall quality of life and the psychological functions to which they adapt [2].

The theoretical support and the understanding of the operating mode are reasonable but still have differences. Thus, the mental health benefits, potential effects, and limitations of mindfulness therapy for university students warrant further examination. Although education and social support can be effective in preventing and treating the underlying psychological problems among university students with poor mental health, such interventions do not always affect or improve psychological well-being [3, 4].

The most prevalent psychological symptoms among university students are anxiety, mental stress, and emotional distress, which can result in decreased functioning in the context of academic and interpersonal stress. Global mental health surveys conducted by the World Health Organization (WHO) indicate that mental disorders are highly prevalent among university students, with 12-month prevalence rates ranging from 20.3% to 45% of university students over the age of 18 [5–7]. The prevalence rates of insomnia, depressive symptoms, and anxiety symptoms were 37.80%, 48.20%, and 36.70%, respectively, among Chinese university students during the COVID-19 pandemic [8]. In a randomized controlled trial with 11,169 university students conducted by the WHO, students had increasing intentions to use mental health services: The results indicated lifetime use rates of 12.6% and 7.3% for psychotherapy and medication for emotional problems, respectively. Suicidal thoughts and behaviors and nonsuicidal self-injury within the preceding 12 months were also common, with 21.1% of students in the sample reporting suicidal ideation, 10.6% reporting suicide plans, 0.4% reporting suicide attempts, and 6.8% reporting nonsuicidal self-injury [5]. Furthermore, one previous study found that high-compliance mental health services had a significant effect on students’ intention to seek mental health services in the next semester [9–11].

Results

3.1. Description of Studies
A total of 276 studies items were initially obtained through the database search. Using NoteExpress, 193 deduplicated studies were obtained, and the remaining 220 items were obtained. After reviewing their titles and abstracts, 135 studies that were of incompatible research types were excluded. A total of 13 articles were further excluded after reading the full text, and the remaining 29 studies [24–53] were retained for data extraction. The baselines of the trials were comparable. The literature search process and results are shown in Figure 1.

Abstract

Research on burnout has garnered considerable attention since its inception. However, the ongoing debate persists regarding the conceptual model of burnout and its relationship with depression. Thus, we conducted a network analysis to determine the dimensional structure of burnout and the burnout-depression overlap. The Maslach Burnout Inventory-Student Survey and Patient Health Questionnaire-9 were used to measure burnout and depression among 1096 college students. We constructed networks for burnout, depression, and a burnout-depression co-occurrence network. The results showed that cynicism symptom was the most central to the burnout network. In the co-occurrence network, depressive symptoms (“anhedonia”, “fatigue”) and burnout symptom (“doubting the significance of studies”) were the most significant in causing burnout-depression comorbidity. Community detection revealed three communities within burnout symptoms, aligning closely with their three dimensions identified through factor analysis. Additionally, there was no overlap between burnout and depression. In conclusion, our findings support a multidimensional structure of burnout, affirming it as a distinct concept separate from depression. Cynicism, rather than exhaustion, plays the most important role in burnout and the burnout-depression comorbidity.

Introduction

Burnout has long been recognized as an occupational hazard in various human service occupations (Lacy and Chan, 2018; Maslach and Leiter, 2016; Sullivan et al., 2022; Weigl, 2022). Since its emergence, the concept of burnout has attracted increasing attention worldwide and has gradually expanded to include a more general range of occupations (Aronsson et al., 2017; Embriaco et al., 2007; Shanafelt et al., 2019). Burnout is now defined as a psychological syndrome, caused by prolonged occupational stressors. Additionally, personality traits, particularly neuroticism, play an important role in the development of burnout (Angelini, 2023). People with high levels of neuroticism may adopt maladaptive coping strategies that magnify the impact of adverse events in the workplace, leading to greater anxiety and exhaustion from work. In summary, both external and internal factors influence the development of burnout.

The widely accepted conceptual model of burnout is a multidimensional model that stratifies burnout into three dimensions: exhaustion, cynicism or depersonalization, and a lack of professional efficacy (Maslach and Leiter, 2016). However, in contrast to the increasing research on burnout, minimal advances have been achieved in the establishment of clinical diagnoses. An undetermined definition of burnout is reportedly the primary issue for a diagnostic consensus (Rotenstein et al., 2018). The evolving definitions of burnout contribute to variability in estimating its prevalence, posing challenges in policy development. Initially, exhaustion was identified as the most central and obvious manifestation of burnout (Maslach et al., 2001). Accordingly, in a few northern European countries, the diagnosis of burnout has been simplified to exhaustion; consequently, the focus of the public and policy has been limited to exhaustion alone. Meanwhile, some argued that despite the importance of exhaustion, it was not the most central component of burnout (Maslach and Leiter, 2008) and that focusing on exhaustion devalued the significance of burnout as a distinct construct. A recent study on the relationship between the three dimensions of burnout suggested that exhaustion is not the most closely associated dimension (Wu et al., 2021). Measurements using an alternative burnout structure exhibit better validity (Shoman et al., 2021). To date, there has been minimal consensus on the definition or dimensional structure of burnout, as well as the most important symptoms of burnout (Tavella et al., 2021).

Conclusion

The current study was designed to determine the structure of burnout and the burnout-depression overlap among college students at the network level. It specifically identified cynicism symptoms as crucial factors for burnout and burnout-depression comorbidity. Additionally, community detection analysis suggested a multidimensional structure for burnout, emphasizing that burnout should be considered distinct from the concept of depression. This study provides insights into the structure of burnout from the perspective of network analysis, and delineates the overlap between burnout and depression.

Abstract

Background
Progress has been achieved in many fields in understanding the biological mechanisms of depression, including genome-wide association analysis, neurotransmitter system function, brain regions and neural networks, inflammatory response, neuroplasticity, neuroimaging, and neuro electrophysiology. These progresses provide a reliable basis for developing the medical and physical therapies for depression. However, the current treatments developed from biological mechanisms can only address less than 60% of depressive symptoms and have limited efficacy in improving social functioning and reducing recurrence. Studies have explored the non-biological mechanisms of depression in mental fields. These progresses are helpful to develop more interventions that could alleviate depressive symptoms, improve functional impairments, and reduce recurrence, thereby promoting a more comprehensive recovery in depressed patients. However, there is not a systematic and deep review to highlight the non-biological mechanisms of depression.

Methods
This study summarizes the recent progress in the non-biological fields of depression by searching publications on human studies in PubMed, PMC, and Google Schooler with exclusion of animal studies.

Results
This study reviews the intergenerational transmission characteristics, the relationship between depression and emotional trauma, cognitive deficit, relationship impairment, self-function, sense of the meaning of life, motivation deficit, and psycho-rationality of depression.

Conclusions
This study was clarified the non-biological mechanisms and characteristics of depression and provided a theoretical basis for the development of non-drug interventions.

Introduction

To date, studies on the pathogenesis of depression are mainly focus on its biological mechanisms (Miao & Chang, 2021), including studies on epigenetic alterations, genome-wide association, neurotransmitter system, brain regions and neural networks, inflammatory responses, neuroplasticity, neuroimaging, and neuro electrophysiological changes (Li et al., 2021). The outstanding contributions of these studies provide a theoretical basis for pharmacotherapy and physical therapy of depression (Li et al., 2019). However, the current treatments developed from biological mechanisms can only relieve 58% of depressive symptoms (Ormel et al., 2019). Moreover, these current pharmacotherapy and physical therapy have limited efficacy in improving prognosis and social function, as well as reducing relapse rates (Cieślik et al., 2020). The cognitive behavioral therapy has been shown to be highly effective in treating depression but has limited impact on generational deficits and trauma-related emotional responses in the symptomatic components of depressive symptoms (Johnsen, T. J., & Friborg, O. 2015). The eye movement desensitization and reprocessing therapy has shown some positive outcomes in helping individuals to reprocess traumatic memories of some emotional traumas, but it is not appropriate for traumatized populations of all backgrounds and can exacerbate symptoms in some populations. Therefore, its limitations and side effects need to be considered (Shapiro, F. 2014). Thus, exploration of new mechanisms and subsequent development of new treatments is an urgent need for patients with depression.

Results

3.1. Non-biological transgenerational transmission of depression
Intergenerational transmission of pathological psychology refers to the phenomenon that psychological disorders or problems presented in the previous generation can reappear in the next generation, or that the behavior or psychological trauma of the previous generation causes mental and psychological problems in the next generation. These problems may span generations and manifest in different ways and degrees (Cooke et al., 2019). In recent years, evidence on the intergenerational transmission of depression has been accumulated. In the biomedical field, family and twin studies have repeatedly validated that the intergenerational transmission of depression is often a result of gene-mediated genetic disorders or epigenetic inheritance (Goodman, 2020, Park et al., 2019). However, the non-biological transgenerational mechanisms of depression have also attracted attention recently (Gotlib et al., 2020).

More and more non-biological transmissions have been observed, while the intergenerational phenomenon of depression and its transmission ways have different explanations (Hentges et al., 2021). For example, parental depression may be transmitted to the next generation through multiple pathways: intergenerational transmission of trauma (Hankerson et al., 2022); intergenerational damage to emotions, self-esteem, and cognition; family culture; parenting style; and behavioral consequences etc. (Kang et al., 2021, Risi et al., 2021, Kujawa et al., 2020, Johnco et al., 2021). These transgenerational mechanisms may indirectly influence the biological changes that evolve into the symptoms of depression (Allison et al., 2023). In the intergenerational transmission of depression, offspring may not inherit the symptoms of depression, but instead display a variety of psychological dysfunctions a variety of psychological dysfunctions, including a tendency to react negatively to emotions (Israel & Gibb, 2024), a state of self-esteem hypersensitivity, cognitive biases, and excessive self-focus (Woody et al., 2022). In addition, offspring may also display relationships with alienation, control, and unclear boundaries (Wei et al., 2023), and even the characteristics of illness that appear in early adulthood or suicidal tendencies (Gijzen et al., 2021).

Abstract

Background
Evidence on the association between single nucleotide polymorphisms (SNPs) in the vitamin D receptor (VDR) and depressive symptoms is inconclusive.

Objectives
The primary aim of the study was to investigate the association between SNPs in the VDR gene and depressive symptoms.

Methods
In a sample of older adults from the Longitudinal Ageing Study Amsterdam (n = 922), depressive symptoms were assessed using the Centre for Epidemiological Studies Depression scale (CES-D scale) at baseline and after 3, 6, and 10 y of follow-up. Blood samples for SNP and serum 25-hydroxyvitamin D3 (25(OH)D3) determination were obtained at baseline. The association between 13 SNPs in the VDR gene and the course of depressive symptoms were evaluated using linear mixed models. The interaction between SNPs and serum 25(OH)D3 in relation to depressive symptoms was evaluated using multiple linear regression.

Results
No SNPs were associated with the course of depressive symptoms. Significant interactions between serum 25(OH)D3 and SNPs in the VDR gene were found. Stratified analysis revealed that within the GG genotype strata, 10 nmol/L higher serum 25(OH)D3 was associated with 0.27 (95% CI: −0.50, −0.04) and 0.23 (95% CI: −0.48, 0.02) lower scores on the CES-D scale for Cdx-2 and 1b-G-886A, respectively. This association was not found in persons having the GA or AA genotype.

Conclusions
No SNPs is associated with the course of depressive symptoms. Stratified analysis shows that the effect of serum 25(OH)D3 concentrations on depressive symptoms is different among genotypes of Cdx-2 and 1b-G-886A. Future research should elucidate on the function of Cdx-2 and 1b-G-886A to describe their effect.

Introduction

Depressive symptoms follow a U-shaped relationship with age, increasing again after the age of 60–65 y [1]. This is, however, not solely due to aging and varies widely between people [2]. A higher medical burden [3], aging-related anxiety [4], and nonhealth-related events [5] have been associated with depressive symptoms in older adults. The prevalence of depressive symptoms in older adults is estimated at 17% [6], but they are often overlooked [7] due to the overlap with symptoms, among others [6,8]. The burden will continue to rise due to the aging population and increasing life expectancy [9], thereby increasing years lived with disease [10] and societal costs [11].

Different factors (e.g., biological, social, and psychological) play a role in the onset and course of depressive symptoms [[12], [13], [14], [15]]. Vitamin D – a modifiable risk factor of which the status decreases with age [16] – has been associated with the course of depressive symptoms. In a previous study of the Longitudinal Ageing Study Amsterdam (LASA), an association between low vitamin D status and an increase in depressive symptoms among women was observed [17]. Two recent meta-analyses found a similar association in both men and women [18,19]. Genetic factors, such as single nucleotide polymorphisms (SNPs) in vitamin D-related genes may influence the response to, and therefore the requirement of, vitamin D [20]. The vitamin D receptor (VDR) gene encodes the VDR, the transporter of active vitamin D (1,25(OH)2D), and thereby influences the availability of 1,25(OH)2D [21].

Results

The study sample consisted of 922 participants who were on average 75.6 (SD 6.6) y old, were 51% women, and had a median CES-D score of 13.6 (IQR: 11.6–15.6). The prevalence of depressive symptoms [40] and antidepressant use at baseline was 24% and 2.5%, respectively. Mean serum 25(OH)D3 concentration was 46.6 nmol/L (SD 17.7), mean BMI was 26.6 kg/m2 (SD 5.2), and median physical activity in minutes per week was 128.6 (IQR: 67.7–189.7). The basic characteristics are summarized in Table 1 [35,36,40]. Compared with nonresponders, participants in the study sample were older and more often women, never smokers, moderate-to-excessive alcohol users, and more often had 2 or more comorbidities (all P < 0.05; Supplemental Table 2). The minor allele frequency was smallest for 282 W (n = 63/919; 3%), and no SNPs departed from Hardy–Weinberg equilibrium (Supplemental Table 1).