To evaluate the efficacy of digital cognitive behavioral therapy for insomnia (dCBT-I) as a behavioral intervention in older adults, with focus on insomnia severity and the sustainability of treatment effects. Systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating dCBT-I in adults aged ≥ 60 years. Databases searched included PubMed, Web of Science, Cochrane Library, and EBSCOhost. Mean differences (MDs) in insomnia severity were pooled using random-effects models. Subgroup analyses examined therapist guidance and control type. Nine RCTs involving 760 participants were included. Compared with control conditions, dCBT-I significantly reduced insomnia severity at post-intervention (MD = − 3.96, 95
Familial hypercholesterolemia (FH) is a common genetic condition associated with lifelong hypercholesterolemia and increased risk of premature cardiovascular disease. Genetic cascade testing, the systematic identification and testing of at-risk blood relatives of a diagnosed index case, enables early detection and intervention but remains underutilized in primary care. This study explored the experiences of patients and general practitioners (GPs) involved in FH genetic cascade testing to identify barriers and facilitators to implementation. A mixed-methods study was conducted using semi-structured interviews with adults diagnosed with FH and parents of children with FH, alongside open-ended questionnaires completed by GPs. Data were collected following delivery of the Enhanced Detection of FH in General Practice (EDIFICE) program and analyzed using reflexive thematic analysis. Twenty patients and 12 GPs participated. Themes included knowledge and understanding of FH, communication and testing challenges, emotional impacts, professional confidence, and system-level barriers. Patients reported variable understanding of FH, distress associated with diagnosis, and difficulties navigating healthcare pathways. GPs recognized the value of cascade testing but identified knowledge gaps, limited communication with specialists, and uncertainty regarding pediatric case management. Both groups highlighted the need for improved educational resources and streamlined referral processes. FH genetic cascade testing in primary care is a valuable but underused strategy for early cardiovascular risk reduction. Improving practitioner training, patient education, and healthcare system integration may enhance implementation and uptake.
We aimed to characterize dynamic, individualized relationships among glucose, physical symptoms, emotions, and functioning (e.g., experiential variables) in adults with type 1 diabetes (T1D) using person-centered temporal network models, and assess whether network features relate to retrospective well-being and functioning. We analyzed data from 158 adults with T1D who completed 14 days of blinded continuous glucose monitoring (CGM) and ecological momentary assessments of experiential variables. For each participant, we estimated a temporal network using the Group Iterative Multiple Model Estimation (GIMME) algorithm, which quantifies dynamic interconnections of variables within individuals. We assessed the variability of models across participants, and examined whether interconnections among variables (network density) were associated with retrospective measures of well-being and functioning. GIMME models converged for 96.3
Research on the impact of vaccine rollout and vaccination on the relationship between perceived importance of and adherence to preventive behaviors in Canada remains limited. This study assessed adherence to preventive behaviors (mask wearing, hand washing, social distancing, self-isolating when sick, refraining from visiting hospitality venues, and refraining from gathering with others) as a function of vaccination status after vaccines became available in Canada as of December 2020. As part of the iCARE study, five cross-sectional age, sex, and province-weighted population-based samples totaling 14,771 Canadians aged 18+ years completed an online survey between May 2021 and June 2022. Vaccination status (categorized as unvaccinated or vaccinated (includes partial or fully vaccinated)), perceived importance of, and adherence to, preventive behaviors were assessed across the five survey periods. Logistic regressions showed that a greater proportion of vaccinated individuals considered preventive behaviors to be “very important” for reducing the spread of the virus, with higher odds of endorsing prevention behaviors (OR = 5.0, 95
This in memoriam honours Professor Jules Angst, MD, and reflects on his major contributions to mood disorder research, psychiatric classification, longitudinal clinical studies, and lithium prophylaxis. It also commemorates his enduring influence on IGSLi, clinical psychiatry, and generations of researchers and clinicians.
Abstract Background With limited evidence-based options, treatment of depressive episodes in bipolar disorder (BD-DE) remains challenging. This study examines the trajectories of psychotropic drug use and polypsychopharmacy in psychiatric inpatients with acute BD-DE. Methods Using data from the German pharmacovigilance program “Arzneimittelsicherheit in der Psychiatrie” (AMSP), the pharmacological treatment of 1,902 psychiatric inpatients with BD-DE between 2007–2024 was analyzed. Temporal changes in drug use between early (T1: 2007–2010) and late (T2: 2021–2024) periods were calculated using prevalence ratios (PR) with 95% confidence intervals (CI) and Welch’s t-test. Results Overall, 98.5% of inpatients with acute BD-DE were treated with psychotropic drugs. Antipsychotic drugs (APD) were the most used psychotropic drug group (76.2%), followed by antidepressant (ADD; 70.3%) and antiepileptic drugs (AED; 44.3%) during the entire study period. Over time, APD use increased from 70.1% in T1 to 80.7% in T2 (PR 1.15, CI 1.06–1.25), attributable to the increased use of second-generation APD (PR 1.19, CI 1.07–1.32), especially quetiapine and aripiprazole. ADD (T1: 78.1% vs T2: 67.6%; PR 0.87, CI 0.79–0.95) and AED (T1: 56.7% vs T2: 34.6%; PR 0.61, CI 0.51–0.73) use significantly declined, while lithium use remained stable (31.7% from 2007–2024). Although the mean number of psychotropic drugs per patient decreased (T1: 3.85 vs T2: 3.34, p < 0.001, d =−0.30), complex polypsychopharmacy consisting of ≥3 psychotropic drugs remained prevalent (66.1% of patients during the entire study period). Combination strategies involving APD, especially use of two APD, significantly increased (T1: 15.6% vs T2: 31.5%; PR 2.01, CI 1.51–2.69). Conclusion Pharmacological treatment of BD-DE has shifted towards an increased use of second-generation APD while AED are less utilized. ADD use and complex polypsychopharmacy continue to be prevalent, indicating a persistent gap between guideline recommendations and real-world practice.
Regular physical activity (PA) improves health across various domains, reducing the risk of cardiovascular disease and certain forms of cancer while improving mental health. Despite cultural and family-oriented strengths that can support healthy lifestyle behaviors, Latinas have high rates of inactivity and are disproportionately burdened by health conditions associated with regular PA. Thus, research is needed to elucidate determinants of success in PA interventions in this population. Sleep is a health behavior that has an established bidirectional relationship to PA, yet it remains unclear how sleep may moderate PA intervention efficacy. This study examines time in bed, as a proxy for nighttime sleep duration, as a moderator of the intervention effect on PA outcomes in two randomized controlled trials among sedentary Latinas. We ran a series of generalized mixed effects models with subject-specific intercepts. Analyses were run separately on data from two randomized controlled trials to help establish consistency of findings across two similar participant populations. Results indicated that time in bed (whether operationalized continuously or dichotomously based on sleep duration guidelines) was a significant moderator of intervention effects on PA outcomes over time, p’s < 0.05. Across studies, women who reported more time in bed showed greater benefits from intervention vs. control (in study 1) and enhanced vs. original intervention (in study 2). To our knowledge, this is the first study to examine a sleep-related measure as an effect modifier of PA intervention success. Findings suggest that sufficient sleep may allow Latinas to benefit more from PA interventions.
Social support is an important correlate of quality of life in patients living with chronic illness. Little work has examined this association in a longitudinal manner among patients with chronic kidney disease (CKD). The current work utilized ancillary data from the Chronic Renal Insufficiency Cohort (CRIC) study, focusing on the Hispanic sub-cohort (n = 250). The Medical Outcomes Study (MOS) social support survey and Kidney Disease Quality of Life (KDQOL-36) were analyzed over a 12-year period. Only participants who progressed to end-stage renal disease (ESRD; n = 140) during the study were included in analyses. Piecewise multivariate growth models assessed change in KDQOL subscales with the MOS before and after patients entered ESRD. Average MOS and KDQOL scores declined both before and after ESRD. Before ESRD, there were significant correlations between change in the MOS and KDQOL Burden (r = 0.38, p < 0.001) and Effects (r = 0.59, p < 0.001), indicating that less decline on the MOS was associated with less decline in quality of life. After entering ESRD, associations were found between change in MOS Overall Support and change in all KDQOL subscales: Burden (r = 0.34, p < 0.001), Effects (r = 0.85, p < 0.001), and Symptoms (r = 0.98, p < 0.001). These results reveal that after entering ESRD, patients with less decline in support showed less decline in KDQOL across all CKD-specific domains. Results suggest social support can have a protective effect on QoL before and after ESRD diagnosis.
BACKGROUND:This study examined temporal trajectories of anxiety and career adaptability in unemployed adults receiving a structured biweekly counseling intervention delivered either through an AI-delivered system or through human counselors. METHOD:In this 6-month randomized longitudinal study, 400 participants were assessed across 13 waves (T0-T12). Linear mixed-effects modeling was used to evaluate onset timing, rate of change, and stabilization patterns across delivery conditions. RESULTS:Anxiety decreased and career adaptability increased significantly over time in both groups. However, the AI-delivered condition showed steeper reductions in anxiety and faster gains in career adaptability than the human-delivered condition. Differences between conditions were reflected in rate of change rather than onset timing. CONCLUSION:Both delivery formats were associated with improvement, but AI-delivered support was associated with faster longitudinal change within the structured intervention protocol. These findings suggest that delivery modality may shape the temporal dynamics of psychological change in structured behavioral interventions for unemployed adults.
Persistent physical symptoms (PPS) can significantly impair health-related quality of life (HRQoL). Psychological flexibility (PF), characterized by the ability to adapt functionally and congruently to diverse situations based on personal values, may moderate the impairment of HRQoL. This study examined whether the intervention based on internet-delivered acceptance and commitment therapy (iACT) combined with individual case formulation and treatment as usual (TAU) (n = 50) was effective in improving HRQoL compared to TAU alone (n = 53) in adults with PPS associated with indoor environment and/or chronic fatigue syndrome. Then, the mediating role of PF was explored. In this trial (ClinicalTrials.gov NCT04532827), self-report questionnaires were administered to evaluate HRQoL, and PF, including general PF, cognitive fusion, and thought suppression. The primary outcome was HRQoL. Outcomes were assessed at baseline, at post-intervention (3 months from baseline), and at 3- and 9-month follow-ups from post-intervention. Significant interaction effects for HRQoL were found in the iACT + TAU group from baseline to the 9-month follow-up (p = 0.003), indicating the HRQoL increased more in the iACT + TAU group, compared to the TAU alone (p = 0.164). PF did not mediate the change of HRQoL during the follow-up. The iACT + TAU combined with individual case formulation significantly increased HRQoL compared to TAU alone. However, no mediation effects were observed, suggesting that PF did not mediate the change in HRQoL. Further research on mechanisms of change is warranted to enhance understanding of both conditions and lead to more effective treatments.
Sleep disturbances persist during euthymia in bipolar disorder (BD) and may contribute to cognitive impairment. While subjective sleep complaints have been linked to cognition, associations between objective sleep parameters and objective cognitive performance are under-explored. In this exploratory cross-sectional study, 40 euthymic individuals with BD underwent 21 days of actigraphy to assess objective sleep parameters, including sleep duration, sleep onset latency, sleep efficiency, wake time after sleep onset (WASO), and fragmentation index. Cognitive performance was assessed using the Screen for Cognitive Impairment in Psychiatry (SCIP). Associations between sleep parameters and cognitive outcomes were examined using Spearman correlations, then using multivariable linear regression models, including a stepwise selection of potential confounding factors and a false discovery rate correction for multiple testing. Assumed sleep duration was negatively associated with the SCIP total score (β = −0.38, p = 0.011), with age retained as a covariate (p = 0.011). Total sleep time was negatively associated with delayed verbal learning (β = −0.48, p = 0.003), with no covariate retained. Sleep onset latency was negatively associated with working memory (β = −0.41, p = 0.014), with no covariate retained. Sleep onset latency was negatively associated with processing speed (β = −0.38, p = 0.002), with age (p < 0.001) and sex (p = 0.022) retained as covariates. WASO was negatively associated with verbal fluency (β = −0.39, p = 0.016), with no covariate retained. In euthymic individuals with BD, objective measures of sleep duration, sleep initiation, and sleep continuity were associated with distinct cognitive domains. These findings highlight the relevance of sleep continuity and sleep initiation, beyond sleep duration alone, as correlates of cognitive functioning in BD. Due to methodological limitations, these results should be considered hypothesis-generating and require replication in larger, longitudinal cohorts. This study was conducted as part of a larger research protocol entitled GAN (Genetics, Actimetry, and Neuropsychology in Bipolar Disorders). The protocol has been registered on ClinicalTrials.gov on November 13, 2015 (NCT02627404).
Peer advocacy has been shown to influence HIV protective behaviors, but few studies have examined whether advocacy within social networks is diffused—a process whereby the recipient of advocacy engages in further advocacy with others. Advocacy diffusion is critical for wide dissemination of knowledge and behavioral change throughout a network. In a randomized controlled trial of a peer advocacy training intervention for people living with HIV (PLWH) in urban Uganda, 210 PLWH were enrolled as index participants along with 599 of their social network members (alter participants), all of whom were assessed at baseline and months 6, 12 and 18. Prevention advocacy engagement was assessed with a 10-item scale of frequency of discussion of various HIV prevention topics with others in the past 3 months. Repeated-measures linear regression models examined predictors of change in HIV prevention advocacy engagement among 596 alters who completed at least one follow-up assessment. Alter engagement in HIV prevention advocacy increased significantly across follow-up (from 2.08 at baseline to 3.53 at month 18; possible range: 1–5), and this increase was predicted by general increased engagement in advocacy reported by the index participant who recruited them, receipt of any behavior-specific advocacy from this index, older age, and greater HIV disclosure (if the alter was living with HIV). These findings provide evidence of an initial step of HIV prevention advocacy diffusion from index to first-degree alter, thereby highlighting the possibility of diffusion throughout the wider network and the potential for scaled-up dissemination of knowledge and behavior change for HIV prevention.
Psychosocial well-being relates to lower cardiovascular risk, and a healthy lifestyle may contribute to this association. Prior research has focused on aging adults, although health behaviors are usually consolidated in early adulthood. This longitudinal study assessed the association between two psychosocial well-being indicators and subsequent healthy lifestyles in young adults. Participants (n = 799; agemean = 30.6 years) in the Nicotine Dependence in Teens Study completed items to derive the emotional vitality score, a flourishing scale, and covariates in 2017–2020. Data on selected outcomes (i.e., smoking, sleep, physical activity, alcohol intake, diet quality), collected in 2017–2020 and 2020–2021, were combined into a lifestyle score used categorically (≥ 4 healthy behaviors) and continuously (0–5 scores). Associations between psychosocial well-being indicators and lifestyle up to 4 years later were modeled using logistic and linear regressions. In model 3 adjusting for sociodemographic, health-related, and depression covariates, higher likelihood of a healthy lifestyle (≥ 4 healthy behaviors) was observed with flourishing (OR = 1.56, 95
Emerging evidence shows that infectious diseases, such as COVID-19, can lead to chronic health conditions. Long COVID symptoms such as fatigue, cognitive impairment, and psychological distress can significantly hinder return-to-work, complicating recovery and rehabilitation. This study explores how these persistent symptoms affect work outcomes to inform clinical and policy interventions supporting affected individuals. We conducted a single-site study of patients following acute SARS-CoV-2 infection (N = 206, 128 employed prior to infection). Participants reported symptoms that occurred anytime between COVID-19 infection and survey completion and their work status. A classification decision tree was generated with return-to-work status as an outcome. Among 128 participants, 65
Spanish-speaking individuals in the U.S. face a number of barriers to quality pain care and limited access to culturally adapted treatments. While mindfulness-based interventions are effective for chronic pain, few have been translated for Spanish-speaking populations. This pilot study tested a brief, Spanish-language adaptation of Mindfulness-Oriented Recovery Enhancement (Spanish B-MORE) for Spanish-speaking adults with chronic pain. A single-site, waitlist-controlled randomized clinical trial was conducted to assess the feasibility, acceptability, and preliminary efficacy of Spanish B-MORE. Spanish-speaking adults with chronic pain (N = 20) were randomized 1:1 to receive the Spanish B-MORE intervention or a waitlist control. Outcomes were assessed at baseline, 2-week, and 6-week follow-up. Primary outcome was chronic pain symptoms (PEG-3); secondary and tertiary outcomes included participant-rated intervention acceptability, depression, anxiety, well-being, pain catastrophizing, and proposed therapeutic mechanisms (self-transcendence, mindful reappraisal of pain). Acute effects were also assessed immediately before and after the intervention sessions. All participants completed both sessions and all follow-ups. Participants rated the intervention as highly acceptable (M = 9.4/10) and would recommend it to others (M = 9.67/10). Immediately following the intervention, B-MORE significantly reduced pain intensity, pain unpleasantness, and anxiety, all with large Cohen’s d effect sizes (d = 1.32–1.48). At six weeks, relative to those in the waitlist-controlled condition, B-MORE participants showed greater improvements on all clinical outcomes. Spanish B-MORE may represent a brief, scalable, and culturally responsive intervention for chronic pain in Spanish-speaking populations. These promising findings support further evaluation in larger trials. NCT06316713.
Cardiovascular health is increasingly recognized as a key determinant of cognitive aging. The American Heart Association recently introduced Life's Essential 8 (LE8), integrating both behavioral and clinical components of cardiovascular health. However, the relative contributions of behavioral versus clinical factors to cognitive outcomes remain unclear, particularly in Chinese older adults. This study included 2,527 participants aged ≥ 65 years from the Ma'anshan Healthy Aging Cohort. Weighted linear and logistic regression models were used to examine the associations of LE8 scores with cognitive function and mild cognitive impairment (MCI). Restricted cubic spline (RCS) models were applied to assess dose–response relationships. Subgroup and sensitivity analyses were conducted. Higher LE8 scores were significantly associated with better cognitive function and lower risk of MCI. Each 10-point increase in LE8 score was associated with a 0.532-point higher MMSE score (95
Bipolar disorder (BD) is a severe, chronic psychiatric illness defined by profound and recurrent fluctuations in mood, energy, and function. Treatment is generally limited by both the efficacy and safety of available agents. Thyroid augmentation has been found to be useful to treat depression and rapid cycling in BD. Herein, we provide a narrative review of adjunctive use of thyroid hormone in BD with a specific focus on its potential mechanism of action. Ion dysregulation with mood-state-related reduced sodium pump activity and increased intracellular sodium and calcium are among the most reproduced biologic findings in manic and depressed bipolar patients. Thyroid hormone directly increases sodium pump expression and activity, and indirectly improves energy utilization in bipolar patients. Across the reviewed literature, approximately 300–350 patients received supraphysiologic doses of thyroid hormone (T3 or T4), with the majority comprising individuals with BD and yielding generally very positive outcomes and minimal harm. Thyroid hormone augmentation can improve depression and reduce rapid cycling, and while never studied to treat mania, it does not increase the risk of manic episodes in all of the studies. Inconsistencies in data are related to different dosing regimens in different studies. Thyroid hormone appears to directly correct known pathophysiologic abnormalities in patients with bipolar disorder. While additional studies are needed to confirm these findings, sufficient data are available to warrant the use of supertherapeutic thyroid hormone augmentation in selected patients.
Given the global burden of type 2 diabetes mellitus (T2DM), the present study aims to compare the effectiveness of the family-centered empowerment model, collaborative care model, and motivational interviewing on blood glucose control and nutritional behaviors based on the BASNEF model. A single-blind randomized clinical trial was conducted among patients with T2DM referred to the Rural Health Centers in Gorgan city, Iran. A total of 120 patients were allocated into one of four groups: family-centered empowerment model (n = 30), collaborative care model (n = 30), motivational interviewing (n = 30), and control group (n = 30) using a computer-generated randomization sequence. Participants were blinded to group assignment, while outcome assessors (laboratory technicians) and the data analyst were blinded to the group codes. The primary outcome was the change in HbA1c and FBS levels from baseline to 12 months. Blood glucose control, nutritional behaviors, and constructs of the model were measured pre-intervention and at 2, 6, and 12 months’ follow-up. Regarding the primary behavioral and nutritional outcomes, the Collaborative Care Model (CCM) demonstrated superior effectiveness. It produced the highest scores in patient attitude (40.17, p < 0.01) and enabling factors (12.07, p < 0.01), and led to the most substantial reduction in saturated fat intake (65
