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

The current paper aimed to analyze quantitatively the trends of four major schools of thought in scientific Psychology (neuroscience, cognitivism, behaviorism, psychoanalysis) and their intersections, covering the period from 1979 to 2020. We utilized a rigorous methodology across three distinct sources: Mainstream Psychology (MP), Highly Influential Journal (HIJ), and non-English papers (NEP). Our findings align with previous research in two aspects: psychoanalysis and behaviorism have significantly declined, cognitivism remains a prominent trend. However, we deviate from prior studies by recognizing that neuroscience may be considered the most influential trend and that trends exhibit less linearity than previously assumed. We also acknowledge the significance of NEP, which manifest an independent pattern as compared to the other sources and that may reveal what happens in the “periphery” of Psychology. It is noteworthy that NEP demonstrated a still lively contribution from psychoanalysis. Our study also highlights the insularity and lack of cross-fertilization among psychological subdisciplines, despite the widespread claims to the contrary. It eventually supports the inference that scientific Psychology is a non-paradigmatic or pre-paradigmatic discipline, pointing out the dominance of applied psychology and confuting the notion of overarching “grand theories”.

History of the empirical analyses of trends in psychology

The study conducted by Friman et al. (1993) was one of the pioneering empirical investigations into the trends of subdisciplines within the field of Psychology. The authors specifically focused on psychoanalysis, behaviorism, and cognitivism during the years 1979–1988, utilizing data obtained from the Social Science Journal of Citation Reports (SSJCR). In their research, the authors selected four influential journals that represented each subdiscipline, taking into consideration various criteria, including a relatively high Impact Factor (IF)1 (for further details see Friman et al., 1993, pp. 659-660). For instance, Cognitive Psychology, Cognition, Journal of Experimental Psychology: Learning, Memory, and Cognition, and Memory & Cognition, aligned with the cognitive approach.

In the study conducted by Friman et al. (1993), the four selected journals representing each sub-discipline were examined using four different indexes: IF, Immediacy Index (II),2 citation number (the number of times the journal has been cited during a given year), and source items (the number of citable items the journal has produced during a given year). These indexes were calculated for each journal on an annual basis, and then averaged across the four journals to obtain single indexes for each sub-discipline. The three indexes were eventually plotted against each other. The main finding of the study indicated a significant increase in prominence for the cognitive school of thought. However, it was observed that the citation numbers and source items for behaviorism and psychoanalysis, although lower than those of cognitivism, were not substantially inferior. Despite the rise of the cognitive school, the study did not provide evidence for a clear-cut Kuhnian paradigmatic shift. Additionally, when considering the broader context of the social sciences, all three sub-disciplines (cognitive, behaviorism, and psychoanalysis) performed relatively well in comparison to other indexed journals in the SSJCR.

Conclusion

Taking a more speculative and substantial perspective on the history of Psychology, it can be inferred from the current data that over the past 40 years, the major scientific discourses have predominantly centered around the brain. Many recent studies (Bittermann & Fischer, 2018; Tracy et al., 2004; Yeung, Goto, & Leung, 2017; Wieczorek et al., 2021) suggest an increasing importance in neuroscience within Psychology and more widely across all natural sciences, and Benjafield (2020) highlights how the vocabulary of Psychology is more dependent on Biology than vice versa. These observations suggest an imbalance favoring biologically-based theories over emergentist/spiritualistic ones, although it does not necessarily imply a complete endorsement of materialism by neuroscientists. Rather, it might signify only an informal inclination towards biologically-based explanations. It is noteworthy that psychological researchers rarely adopt a clear ontological standpoint on “mind” and “behavior” and generally avoid extensive engagement with philosophical and theoretical issues (Henriques, 2011; Zagaria et al., 2020).

All things considered, the enduring and relatively stable patterns observed over a 40-year period are indicative of the robustness and vitality of Psychology as a discipline. These patterns demonstrate that the theoretical assumptions regarding the mind have exhibited relative stability over an extended duration.

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

This article addresses the critical issue of violence against children, defined as a violation of their rights across interpersonal, community, societal, and global settings, encompassing both physical and psychological actions targeting them or their parents. Globally, WHO estimates that an unacceptably large number of children aged 2–17 years, experience physical, sexual, or emotional violence or neglect yearly. War stands out as a major contributor to the infringement of children’s fundamental human rights. Those in conflict zones undergo traumatic experiences, including the loss of family members, disruptions to social networks, displacement, and the denial of basic needs. The severe deprivation of essential resources and opportunities, coupled with the stress of warfare, poses a grave threat to the emotional and cognitive development of children, increasing the risk of physical and mental illnesses, disabilities, social problems, and intergenerational consequences. The article aims to draw attention to this issue and advocates for the development of appropriate academic and post-academic educational courses and training programs. This will better equip pediatricians and healthcare professionals to effectively combat violence against children in any context.

Introduction

Violence against children, is a global critical issue, which is defined worldwide as a violation of their rights across interpersonal, community, societal, and global settings, encompassing both physical and psychological actions targeting them or their parents.1,2 Globally, WHO estimates that an unacceptably large number of children aged 2–17 years, experience physical, sexual, or emotional violence or neglect yearly.1., 2. War stands out as a major contributor to the infringement of children’s fundamental human rights. Those in conflict zones undergo traumatic experiences, including the loss of family members, disruptions to social networks, displacement, and the denial of basic needs.3 The severe deprivation of essential resources and opportunities, coupled with the stress of warfare, poses a grave threat to the emotional and cognitive development of children, increasing the risk of physical and mental illnesses, disabilities, social problems, and intergenerational consequences.2., 3., 4. The article aims to draw attention to this issue and advocates for the development of appropriate academic and post-academic educational courses and training programs. This will better equip pediatricians and healthcare professionals to effectively combat violence against children in any context.

Conclusion

In the current historic moment, it is crucial for pediatricians and families to provide support to children, mitigating the potential psychological repercussions mentioned earlier. Pediatricians can significantly contribute to ensuring that the children of the future enjoy better opportunities for a normal and enriched childhood. Their role is pivotal, especially in fostering psychological well-being and contributing to the personal growth of children within a community with its own set of rules. Children must cultivate love and respect for others, understanding that “other” does not signify a limitation but rather a treasure for their personal development. Consequently, the child of today can evolve into a better individual tomorrow.

Abstract

Language impairments often appear in patients with schizophrenia and are potential targets for rehabilitation. Clinical practice and research should be intimately connected. The aim was to perform a narrative review of the assessment and intervention tools that have been used for the rehabilitation of schizophrenia patients with language and communication impairments. Two types of tools, general and specific, were developed for both purposes. General tools include the Positive and Negative Syndrome Scale for assessment, and the Integrated Psychological Therapy for intervention. The specific tools used to evaluate language and communication impairments include the Scale for the Assessment of Thought, Language and Communication, the Formal Thought Disorder scales (for caregivers and patients), and the Thought and Language Disorder scale. The most recent language-specific intervention tools include the Cognitive Pragmatic Treatment, Conecta-2, Let’s talk! Multimodal Speech-Gesture training, Speech Therapy Intervention Group, and PragmaCom. These tools primarily involve psychopathology/psychiatry, psychology, linguistics, speech and language therapy, and nursing. In conclusion, a wide range of assessment and intervention tools are available for the rehabilitation of language and communication impairments associated with schizophrenia. An integrative and interdisciplinary approach should always be considered for rehabilitation of language and communication in patients with schizophrenia throughout their lifetime.

Introduction

Language is a basic skill in humans that facilitates communication with their environment, mainly with other humans. Communication has also been recognized by the International Communication Project as a human right which is embedded within Article 19 of the Universal Declaration of Human Rights [1]. This project highlights the importance of human communication and the significant impact of communication disabilities on every aspect of life, including positive social relationships, literacy, and employment, and the need to enable those with communication disability to fully access and participate in society [2].

1.1. Heterogeneity of language and communication impairments in schizophreniaAccording to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders [3], a key feature of the schizophrenia spectrum as well as of other psychotic disorders is disorganized speech. However, the term ‘disorganized speech’ remains ambiguous and is often used as a replacement of the formerly used term ‘formal thought disorder’ (FTD), clinically considered as ‘impairments in the production of language and subjective alterations in the thought process’ [4]. In fact, the term FTD was replaced by ‘disorganized speech’ as the latter can be object to direct observation and assessment, whereas the former can only be deduced from other deviations in overt behaviour.

Conclusions

We conclude that: i) there is currently a wide range of assessment and intervention tools that cover various language and communication impairments in schizophrenia; ii) the rehabilitation of language and communication requires an integrative and interdisciplinary approach, and should always be considered in patients with schizophrenia throughout their lifetime; and iii) further research on the assessment and intervention tools for the rehabilitation of language and communication in patients with schizophrenia is needed.

Abstract

Bipolar disorder (BD) is worldwide a prevalent mental illness and a leading risk factor for suicide. Over the past three decades, it has been discovered that sex differences exist throughout the entire panorama of BD, but the etiologic regions and mechanisms that generate such differences remain poorly characterized. Available evidence indicates that the dorsolateral prefrontal cortex (DLPFC), a critical region that controls higher-order cognitive processing and mood, exhibits biological disparities between male and female patients with psychiatric disorders, which are highly correlated with the co-occurrence of psychotic symptoms. This review addresses the sex differences in BD concerning epidemiology, cognitive impairments, clinical manifestations, neuroimaging, and laboratory abnormalities. It also provides strong evidence linking DLPFC to the etiopathogenesis of these sex differences. We emphasize the importance of identifying gene signatures using human brain transcriptomics, which can depict sexually different variations, explain sex-biased symptomatic features, and provide novel targets for sex-specific therapeutics.

Introduction

Bipolar disorder (BD) is a severe mood disorder that is categorized by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). According to the intensity of mood elevation, two major forms of BD are distinguished: bipolar I disorder (with mania) and bipolar II disorder (with hypomania). In 2019, more than 40 million people experienced BD worldwide (Kakhramonovich, 2022). Approximately half to 70% of BD patients develop psychotic features during their lifetime (Van Bergen et al., 2019). A history of psychotic features has been associated with earlier onset of BD, more frequent hospitalizations, severer cognitive impairments, lower response to lithium, and worse psychosocial prognosis, particularly for manic episodes (Van Bergen et al., 2019, Maj, 2003, Glahn et al., 2007, Maj et al., 2002). As a major hazard of psychiatric illnesses, life expectancy in patients with BD has been reported to be decreased by 10–20 years, with suicide serving as the primary culprit (Kessing et al., 2015). Suicidal behaviors are prevalent among patients with BD, as 20–60% of them attempt suicide at least once in their lifetime (Dome et al., 2019). The incidence of suicide death among patients with BD can be more than 20 times higher than in the general population, particularly when untreated (Grande et al., 2016). In addition, the lethal index, a parameter defined as the ratio of suicidal attempts to suicide completion, is more than 10 times lower for BD patients (3:1) than for the general population (35:1) (Dome et al., 2019).

A distinct feature that underpins the high suicidality in BD is its sex difference. Among bipolar patients, suicide attempters were 35% more frequent in females than in males, regardless of the diagnostic subtypes (Tondo et al., 2016). When patients had manic episodes, females were 2.4 times more likely to die by suicide than males (Bhattacharya et al., 2011). This sex-related suicide rate was up to 3 times higher in female patients with a first-episode psychosis than in male counterparts, but suicidality can be better remitted by therapeutic interventions in female than in males (Chang et al., 2011, Tseliou et al., 2017). These data suggest that the manic episodes and psychotic features are major risk factors for suicide. The higher prevalence of suicide rate in females with BD, and the observation that suicidality increased with the development of psychotic symptoms and was reduced after medical care, have led to the idea that unraveling the neurobiological basis of sex differences in BD, particularly in patients with comorbid psychosis (bipolar psychosis), may provide novel therapeutic targets for extending the lifespan of BD populations.

Conclusions

Due to the asymmetry in research intensity between the clinical and biological literature that has controlled for sex, at present, we could merely provide our speculative explanation for the origin of sex disparities in clinical symptoms and cognitive impairments in BD. While there are highly promising preliminary findings, research on the pathophysiology of BD has yet to fully analyze the confounding factors, particularly psychotic features, and suicide in relation to sex. Transcriptomic approaches to study the neurobiology of BD in both sexes have been discussed. These techniques place a strong emphasis on discovering the key cells and molecules across psychiatric diagnoses as well as comorbidities based on diverse clusters of symptoms.

Despite the fact that the effect of female sex hormones and neurosteroids on BD is beginning to be understood, studies should evaluate treatments in terms of female hormonal fluctuations, such as entering puberty, menstrual cycle stage, menopausal stage, or use of hormonal contraception. There should be clinical and laboratorial consensus that, in BD research at multi-dimensional levels, data are analyzed including sex as a confounder.

Abstract

Schizophrenia (SCZ) and obsessive–compulsive disorder (OCD) typically have distinct diagnostic criteria and treatment approaches. SCZ is characterized by delusions, hallucinations, disorganized speech, and cognitive impairments, while OCD involves persistent, intrusive thoughts (obsessions) and repetitive behaviors (compulsions). The co-occurrence of these disorders increases clinical complexity and poses significant challenges for diagnosis and treatment. Epidemiological studies indicate a significant overlap, with prevalence rates of comorbid OCD in SCZ patients ranging from 12% to 25%, which is higher than in the general population. Etiological hypotheses suggest shared genetic, neurobiological, and environmental factors, with genetic studies identifying common loci and pathways, such as glutamatergic and dopaminergic systems. Neuroimaging studies reveal both overlapping and distinct neural abnormalities, indicating shared and unique neurobiological substrates. Environmental factors, like early life stressors and urbanicity, also contribute to the comorbidity. The overlapping clinical features of both disorders complicate diagnosis. Treatment approaches include combining SSRIs with antipsychotics and cognitive behavioral therapy (CBT). The complexity of SCZ and OCD comorbidity underscores the need for a dimensional, spectrum-based perspective on psychiatric disorders, alongside traditional categorical approaches, to improve diagnosis and treatment outcomes.

Introduction

Schizophrenia (SCZ) and obsessive–compulsive disorder (OCD) are both debilitating psychiatric conditions, each with distinct diagnostic criteria and treatment approaches. SCZ, as defined in the DSM-5 [1], is a chronic mental disorder characterized by a range of symptoms, including delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and cognitive impairments [2,3]. These symptoms must be present for a significant portion of time during a one-month period, with continuous signs of disturbance persisting for at least six months, significantly impacting various areas of functioning, such as work, interpersonal relations, and self-care [1]. SCZ’s influence on everyday life can be profound, often leading to significant disabilities and incomplete recovery for many individuals [4]. Those with relatively positive outcomes still contend with social isolation, the stigma associated with the disorder, and fewer opportunities to build close relationships. Unemployment rates are exceptionally high among those with SCZ [5,6]. Common issues, such as unhealthy diet, weight gain, smoking, and substance abuse, contribute to a decreased life expectancy, shortening it by about 13 to 15 years [5,6]. Moreover, the risk of suicide over a lifetime for individuals with SCZ is estimated to be between 5% and 10% [7].

OCD, on the other hand, involves persistent, intrusive thoughts (obsessions) and repetitive behaviors (compulsions) aimed at reducing the anxiety generated by these thoughts [8,9]. Obsessions are defined as recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, causing marked anxiety or distress. Compulsions are defined as repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rigid rules and as being time-consuming or causing significant distress or impairment in important areas of functioning [1]. OCD profoundly affects daily life, causing significant distress and impairment. Individuals with OCD often devote excessive time to their obsessions and compulsions, disrupting work, education, and personal relationships [10]. The disorder severely limits social and occupational functioning, with studies indicating that up to 60% of those with OCD experience moderate to severe daily impairment [10,11]. The quality of life for these individuals is considerably lower than that of the general population, with high comorbidity rates for depression and anxiety [9,10]. Regarding mortality, OCD is linked to a heightened risk of suicide; the lifetime prevalence of suicidal thoughts among individuals with OCD ranges from 36% to 63%, and the risk of suicide attempts is between 10% and 27% [12].

Discussion

The literature shows various overlapping factors between SCZ and OCD. Both disorders are fundamental pathological entities in psychiatry, due to their prevalence and the burden they impose [11,15,16,17,18]. They share a complex etiological and pathophysiological component, comprising genetic, environmental, and neurostructural elements [23,38,54,82]. Our review highlights how some of these elements demonstrate the following commonalities: shared genetic factors, environmental circumstances that may underlie both disorders, and shared neurostructural alterations. It is important, therefore, to consider studies that demonstrate common etiological and clinical characteristics. For example, a recent study using integrated bioinformatic analysis has highlighted shared genetic and molecular mechanisms between SCZ and OCD [119].

Due to the shared features and differing elements between the two disorders, treatment remains challenging. The pharmacological profiles of treatments for SCZ and OCD differ significantly, with SGAs potentially inducing obsessive symptoms by antagonizing the 5HT2A receptor [90]. Hence, further studies are necessary to determine the best treatment for OCSs in patients with schizophrenia. Preliminary recommendations include combining an antipsychotic with an SSRI, such as escitalopram [95].

Summary

The public health approach to suicide prevention requires us to move away from thinking about suicide as a purely clinical problem and to pay heed to the array of social determinants (such as financial hardship or domestic violence and abuse) that might lead people to consider suicide as an option. Clinical factors are important, and, indeed, clinical or indicated interventions are entirely appropriate for people who have reached a point of crisis and should be a mainstay of national suicide prevention strategies. However, our Series stresses the need for selective and universal interventions that tackle the pervasive problem of suicide in a more upstream way, preventing people reaching a crisis point. Many social determinants can best be addressed by sectors outside health, so we are calling for a whole-of-government commitment to suicide prevention. We make recommendations for actions in the areas of policy, practice, research, and advocacy. People with lived experience of suicide should have genuine involvement in all of these actions.

Introduction

The Comprehensive Mental Health Action Plan, initially released by WHO in 2013 and updated in 2021, sets a target of a 30% reduction in the suicide rate internationally by 2030.1 Figure 1 indicates how the annual figures are tracking against that target.2 In 2013, the age-adjusted global suicide rate was 10·0 per 100 000 population, and by 2019, the year for which the most recent international data are available, the figure was 9·0 per 100 000 (a 10% decrease), which seems promising. However, the trend line suggests that the reduction might be levelling off. In addition, the aggregate figures mask between-country and between-region inequalities. Low-income and-middle-income countries (LMICs), which account for 77% of the world’s suicides,3 have not fared as well as high-income countries (HICs) in reducing suicide, with factors such as access to means,4 poverty,5 alcohol use,6 and domestic violence and abuse7 being implicated. Suicide rates have also varied over time according to region, with a notable outlier being the Americas. The suicide rate in that region has not reduced, potentially due—at least in part—to a failure to address gun ownership in the USA.8 In this Series, we have argued that the only way we will make substantial inroads into the major problem of suicide is by reorienting suicide prevention activities through a public health approach.

Conclusion

Widespread adoption of a public health approach to suicide prevention is crucial for ensuring that the overall decreases in suicide rates that are being seen globally continue on a downward trajectory and occur across countries and regions. Suicide is a societal issue that requires a societal response; preventing suicide is everybody’s business. Garnering cross-sectoral commitment from all levels of government and meaningfully involving all stakeholders at every step on the journey will be transformative.