Suicidal ideation (SI) is a public health concern that remains poorly characterized during the perinatal period. It is most often assessed by the final items in two depression screening instruments, the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire-9 (PHQ-9). We sought to examine and compare SI trajectories identified by these measures and their changes from pregnancy to postpartum.This study reports on data from a supplemental study to the Understanding and Preventing Women’s Relapse of Depression (UPWARD) study on perinatal depression (NIMH, NCT03623620; supplement entitled UPWARD-S). Participants were ineligible for UPWARD if they endorsed SI at baseline; but eligible for UPWARD-S if they were pregnant and had a history of major depressive disorder. Participants in UPWARD-S (N=38) completed phone interviews and surveys from pregnancy through six months postpartum. Group-based trajectory modeling was conducted during pregnancy and postpartum using item 10 of the EPDS and item 9 of the PHQ-9.Trajectory analyses resulted in three group models. For both time periods, there were two groups showing relatively stable trajectories in the frequency of SI endorsement, one high and one low. During pregnancy, a third group began high and declined, and, during postpartum, a third group began low and increased. Trajectory patterns were broadly similar across items; however, the proportion of participants classified within each group differed by measure. Our findings demonstrated distinct and relatively stable trajectories and modest agreement between items. Findings from this study could inform larger studies to advise perinatal screening and intervention strategies.
Background Transcranial Magnetic Stimulation (TMS) is a non-invasive intervention for treatment-resistant depression (TRD). Comorbid anxiety is common in TRD patients. We examined the effect of single-dose versus high-dose bilateral TMS on depression and anxiety. Methods: Seventy-eight patients received 1Hz right dorsolateral prefrontal cortex (DLPFC) stimulation combined with left single-dose or high-dose iTBS to the left DLPFC at a nonprofit clinic. Depression and anxiety symptoms were measured at baseline, after 10 and 20 sessions, and final (30-36) TMS sessions. Results: Bilateral TMS resulted in a significant decrease in depression (F(3,70)=9.670, p<.001; 74.4% response, 47.7% remission) and anxiety (F(3,70)=4.916, p=0.004, 52.6% response, 39.7% remission). The high-dose group showed a faster reduction in depression (F(3,70)=2.875, p=0.042), but not anxiety symptoms. There was no dose difference at the final session. Conclusion: Bilateral TMS improved depression and anxiety symptoms with a quicker reduction in depression symptoms with higher dosing, which highlights an important clinical consideration to reduce visits.
Executive function (EF) is a cognitive construct supporting activities of daily living. Trait anxiety (TA) is a stable predisposition to experiencing anxiety that some work has linked to an EF deficit. In turn, a single bout of aerobic exercise elicits a postexercise EF benefit and therefore may serve as an intervention to ameliorate TA-related EF deficits. Here, we examined whether postexercise EF benefits differ across individuals along the continuum of TA. Participants (N = 31) completed a single 25-min bout of moderate-intensity aerobic exercise (via cycle ergometer) and an equivalent duration non-exercise control condition. TA was assessed via the State-Trait Anxiety Inventory (STAI) and pre- and post-condition EF was assessed via the antisaccade task. STAI values ranged from 23 to 60 and produced an average of 42 (SD=10), and a linear mixed model employing STAI as a covariate showed that the variable was positively correlated with reaction time (RT) across all experimental conditions. Moreover, a higher-order interaction showed that the exercise condition – but not the control condition – produced a pre- to post-condition reduction in antisaccade RTs and was a result that did not vary across the continuum of participant-specific STAI values. Thus, although increased TA was associated with reduced information processing efficiency, TA status did not impact the extent to which exercise provided an EF “boost”. Accordingly, single bout and prospective chronic exercise programs may serve to ameliorate TA-based EF changes.
Observational fear learning preceding a first-hand learning experience is assumed to potentially sensitize individuals, resulting in greater fear acquisition. In a laboratory setting, we therefore investigated how different demonstrator responses to temporary dyspnea influence consecutive direct fear acquisition. 74 participants were randomly assigned to three experimental groups. In the two observational learning groups, participants observed a demonstrator completing an interoceptive differential fear conditioning paradigm, during which one of two visual cues (conditioned stimuli, CS) was paired with temporary dyspnea for the demonstrator, displaying either a calm, non-fearful or a fearful response to the unconditioned stimulus (US). Participants of the control condition saw the similar setup with no demonstrator being present. Then, the three groups completed a differential direct fear conditioning paradigm with first-hand temporary dyspnea as the US. During observational learning, observers of any demonstrator, but not the control condition, acquired significant contingency knowledge, indicated by greater US-expectancy in response to CS + vs. CS -. During direct acquisition, participants of all groups showed significant fear learning, indicated by greater US-expectancy, skin conductance responses and startle response magnitudes to CS + vs. CS -. Although fear responses decreased in these measures, significant CS + /CS - differences were maintained upon the end of extinction. Evaluating the effect of the different demonstrators, exploratory analyses revealed that startle response potentiation to CS + vs. CS - was only present in the fearful demonstrator group during acquisition. Although preliminary in nature, this suggests that the acquisition of fear of interoceptive threat may be facilitated by preceding observational learning from a fearful demonstrator.
Advances in statistical techniques for analyzing biological data have driven the need for larger sample sizes, which are ultimately made possible through team science efforts. Findings from these efforts have led to a significant shift in approaches to biological data collection over the past decade, from traditional approaches relying on single measures or assays collected by individual investigators in small lab-based studies to high-dimensional methodologies embedded within large cohorts or multi-site studies. These recent large scale consortium efforts necessitate careful consideration across the full data pipeline, from pre-data generation and sample collection to processing and statistical analysis, while addressing challenges such as cost, standardization of laboratory procedures, and harmonization across sites. Selecting an appropriate methodological approach to measure a biomarker involves complex decisions and tradeoffs to determine the most suitable biological modality (e.g., blood vs. saliva) and assay type (e.g., plasma vs. serum) for the research question and target population. These decisions must account for contextual factors such as cost, study population characteristics, storage space, and analytic capabilities, and carry important implications for data quality, feasibility, and interpretability. Standardization of data collection, storage, quality control, and analytical practices (e.g., accounting for technical confounders), is critical, especially when analyzing biological data across multiple cohorts and time points. This review synthesizes recommended best practices for standardizing collection of peripheral biomarkers (blood, saliva, and urine) in psychiatric research, which we hope will enhance data quality, facilitate cross-study comparisons, and advance individual and team biomarker research now and in the future.
Background:Bipolar disorder confers elevated cancer morbidity and mortality compared to the general population, yet bipolar disorder remains under-studied in oncology settings. Aims:This narrative review aimed to synthesize key considerations for psychiatrists and oncologists treating people with co-occurring bipolar disorder and cancer. Methods:A narrative review was performed to examine literature related to bipolar disorder in oncological care, focusing on outcomes, treatment-emergent mood symptoms, psychopharmacological interactions, and supportive interventions. Results:Bipolar disorder may adversely affect cancer care through reduced treatment engagement, diagnostic delays, and lower receipt of guideline-concordant oncologic therapy. Bipolar disorder is associated with increased risks of self-harm and suicide, as is receiving a cancer diagnosis. Cancer-related neurological conditions and treatments, including corticosteroids, antineoplastics, and interferon-alpha, may precipitate or worsen mood episodes. Mood stabilizers and antipsychotics carry clinically relevant risks including organ toxicity, electrolyte disturbances, cardiac effects, and immunosuppression. Nonpharmacologic strategies, particularly psychotherapy and maintenance of sleep stability, are essential care components. Discussion:Bipolar disorder has important implications for cancer treatment, while cancer and its therapies can destabilize mood and complicate psychiatric care. Early psychiatric care, close collaboration between oncology and psychiatry, careful medication selection and monitoring, attention to suicide risk and sleep, and psychosocial support are essential to improving care outcomes in this high-risk population. Future research addressing bipolar disorder as a distinct category within psycho-oncology rather than categorized under broader severe mental illness classifications will help further elucidate disorder-specific best practices.
Psychiatric disorders are biologically complex conditions arising from interactions across genomic, epigenomic, transcriptomic, proteomic, metabolomic, and metagenomic layers. Single-omics approaches rarely capture more than a fraction of the variance in complex conditions, underscoring the importance of integrative multi-omics frameworks. This mini-review summarizes key methodologies and their application in psychiatric research, with a focus on systems-level integration of genomic risk scores, transcriptomic networks, and neuroimaging data to advance biological understanding of disorders such as depression, schizophrenia, and Alzheimer's disease. We also outline the infrastructural requirements for effective multi-omics research, including standardized biobanking, Laboratory Information Management Systems, adherence to FAIR data principles, and federated learning approaches for privacy-preserving analysis. Importantly, we highlight the need for greater global inclusivity in psychiatric genomics. Current datasets are heavily biased toward relatively high-resourced and predominantly White, non-Hispanic populations, limiting generalizability. Initiatives such as the Psychiatric Genomics Consortium-Africa and H3ABioNet demonstrate how locally led efforts can strengthen capacity, promote data sovereignty, and support equitable research practices. Advancing multi-omics psychiatry will require coordinated investment in infrastructure, training, and inclusive international collaboration. This mini-review serves primarily as a conceptual roadmap, highlighting what integrative approaches have demonstrated so far and future directions for the field.
Augmenting cognitive behavioral therapy (CBT) with attention bias modification training (ABMT) has shown promising yet inconsistent results. Thus, research is needed to identify potential moderators of treatment outcomes. Self-efficacy beliefs have been linked to CBT treatment response and potentially to the cognitive mechanisms which influence engagement with ABMT. This study examined the relation between self-efficacy and treatment response among pediatric patients (N = 111) undergoing CBT for pediatric anxiety supplemented with either an active or sham ABMT. Moderated-mediation analyses revealed a significant interaction between child-reported self-efficacy and ABMT condition in predicting early treatment changes in parent-reported depressive symptoms (a3 = -0.18, SE = 0.05, p < .01), indicating that the association between active ABMT and early depressive symptom change was conditional on self-efficacy. This greater early treatment change related to better overall treatment outcomes (b = 0.09, SE = 0.02, t = 4.33, p < .001). No associations emerged for clinician, parent, or child-reported anxiety (ps > 0.4). Findings that self-efficacy prior to CBT exposures influences ABMT responsiveness highlights high self-efficacy as a potential correlate of change in mood symptoms. Current findings elucidate the complex, yet significant role of self-efficacy in mood-related treatment response and the need for further investigation into the relations between self-efficacy, attentional biases, and treatment outcomes among multiple reporters.
Certain childbirth-related events-including preterm delivery and emergency cesareans-can involve threat to life of woman and child. Limited research has considered maternal mental health following these experiences. Women veterans in a national survey study reported information about prior pregnancies, including gestational age at delivery (coded to represent preterm birth), infant birthweight (categorized to indicate low birthweight), and whether delivery involved an emergency cesarean. Generalized linear mixed-effects models sampling 1780 pregnancies across 903 women tested associations between a composite of these adverse perinatal events and postpartum depression and/or anxiety. Such events were not uncommon, endorsed by nearly one-half of women (49.8%). Pregnancies involving adverse events were linked with elevated odds of postpartum depression and/or anxiety (OR = 1.27, 95% confidence interval 1.18-2.50), even when controlling for risk factors. Findings support childbirth as a potentially traumatic stressor and highlight the importance of attending to mental health following adverse perinatal experiences.
Previous research has provided conflicting answers about whether the active use of social media, rather than just passive use, is linked to poor mental health. In addition, few studies have examined associations between social media use and mental health in international samples. Among adolescents aged 15-16 from 47 countries around the world (N = 143,203), both active and passive social media use were associated with higher levels of anxious affect, though most associations with active use reversed or became non-significant when passive use was included in a multilevel model. Among girls across all regions, heavy passive social media users (7 + hours a day) were 88% more likely than light passive users (less than an hour a day) to strongly agree they got nervous easily; heavy active users were 64% more likely than light active users to strongly agree. Among boys, heavy passive social media users were 73% more likely than light passive users to strongly agree they worry about many things; heavy active users were 60% more likely than light active users to strongly agree. The associations appeared across all world regions, with effect sizes especially large in Central/Eastern Europe. Mean differences were larger among girls than boys, but relative risk elevations were larger among boys, likely due to lower base rates. Multilevel models identified significant interactions by gender. Thus, passive SMU (and sometimes active SMU) is associated with anxious affect, especially for girls.
Nightmares are common after sexual assault and may play an important role in the development of posttraumatic stress disorder (PTSD). However, little research has examined daily temporal associations between nightmares and PTSD symptoms in the acute aftermath of sexual assault. Ecological momentary assessment (EMA) was used to test within- and between-person associations between nightmares and PTSD symptoms during the six weeks following assault. Participants were 54 women sexual assault survivors presenting for emergency care (Mage=24.64, 51.9% White, 29.6% Hispanic/Latina), followed with daily EMA surveys. Dynamic structural equation modeling (DSEM) was used to estimate lagged bidirectional associations between nightmares and PTSD symptoms. Most participants had clinically significant PTSD symptoms according to traditional self-report (97.9% at week one; 85.4% at week seven) and frequent nightmares measured by EMA (42.8% of days). At the within-person level, nightmares significantly predicted next-survey PTSD symptoms (the full model accounted for 18.4% of the within-level variance in PTSD), and PTSD symptoms significantly predicted subsequent nightmares (the full model accounted for 11.7% of the within-level variance in nightmares). However, these effects were no longer significant after adjusting for autoregressive effects. At the between-person level, individuals with frequent nightmares had higher PTSD symptoms and vice versa, with models accounting for 43.2-43.9% of the between-level variance. While nightmares are common in early recovery, short-term fluctuations in nightmare symptoms may not meaningfully drive PTSD symptoms changes once stability is considered. Nightmares may function as an indicator of overall PTSD severity, underscoring their importance in identifying survivors at risk for more severe PTSD symptoms.
Background:People who identify as LGBTQ+ report significantly higher rates of mental illness compared to cisgender, heterosexual populations. Transgender and non-binary (TNB) individuals show substantial mental health challenges when compared to non-LGBTQ+ people. However, few studies have explored TNB mental health compared to cisgender sexual minority individuals within a clinical LGBTQ+ sample. Method:This observational study examined differences in anxiety, depression, general health and well-being, and psychiatric diagnoses in a sample of adults who identified as LGBTQ+ according to their self-reported gender identity (TNB vs. cisgender). The sample consisted of 100 TNB and 139 cisgender sexual minority adults (n = 239 total). Participants were in their early to mid-30s, mostly identified as non-Hispanic/Latino White, and were employed. Self-report measures of anxiety, depression, general health/well-being, and interviewer-administered measures of anxiety, depression, and psychiatric diagnoses were used. Results:After adjusting for age, ethnicity, and race in an analysis of covariance (ANCOVA) model, compared to cisgender sexual minority individuals, participants who identified as TNB demonstrated significantly worse anxiety (self-report: d=0.33; interview: d=0.56), depression (self-report: d=0.27; interview: d=0.25), and general health/well-being (d=-0.34). TNB individuals were also significantly more likely to meet criteria for depressive or anxiety disorders (OR=2.19, 95%CI: 1.17, 4.08, p = .014). Conclusions:This is among the first studies to compare mental health and well-being within a LGBTQ+ adult sample according to individuals' gender identity. Results indicate that people who identify as TNB have a particularly high mental health burden, underscoring the importance of careful screening and tailored interventions for this subgroup.
Background:Understanding the heterogeneity of suicide attempts (SA), and non-suicidal self-injury (NSSI) - e.g., impulsiveness of these behaviors, as in the length of time between participants' thought of engaging in the relevant self-injurious behavior and acting on the thought - is an important step towards personalized intervention. Although impulsivity has been extensively studied in relation to SA and NSSI, much less work has evaluated impulsivity in relation to impulsiveness of these behaviors. This study assessed whether trait and state-sensitive impulsivity were associated with impulsiveness of SA and NSSI, respectively, in an adolescent inpatient sample. Methods:Adolescents (N = 146) were recruited from a psychiatric inpatient facility. Multiple regression models examined whether trait impulsivity via self-report (i.e., lack of premeditation, lack of perseverance, sensation-seeking, and negative urgency) and state-sensitive impulsivity via the stop-signal task (SST) were associated with impulsiveness of SA and NSSI, respectively. Results:Lack of premeditation was positively associated with impulsiveness of SA. Greater impulsivity, as reflected by worse impulse inhibition on the SST, was also positively related to impulsiveness of SA. Lack of premeditation and low sensation-seeking were associated with the impulsiveness of NSSI. Conclusion:These findings suggest that aspects of trait and state-sensitive impulsivity are differentially associated with impulsiveness of SA and NSSI. Collectively, these findings support the view that despite phenotypic overlap between these forms of self-injurious behaviors, important distinctions exist in their underlying correlates. They also support impulsiveness of these behaviors as a meaningfully manifestation of their heterogeneity.
Purpose:Prenatal mental health problems often impair maternal functioning and offspring development. Maternal childhood maltreatment is a well-established risk factor for prenatal mental health problems; however, growing evidence supports the health-promoting role of positive childhood experiences (PCEs) for better prenatal mental health. Yet joint effects of childhood maltreatment and PCEs on prenatal mental illness diagnoses, in addition to symptoms, are not understood. Methods:This study examined associations between childhood maltreatment and PCEs on prenatal mental health symptoms and clinical diagnoses in 234 pregnant individuals (M gestational age: 16.7 weeks). Childhood maltreatment, PCEs, and prenatal depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms were assessed with standardized self-report measures. Prenatal Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) during adulthood were assessed during pregnancy via structured clinical interviews. Results:Higher levels of childhood maltreatment predicted greater symptom levels of depression, anxiety, and PTSD during pregnancy (effect sizes: 0.17-0.23) and elevated of prenatal MDD and adult GAD (ORs: 1.31, 1.32). In contrast, higher levels of PCEs predicted less symptom severity across all domains (effect sizes: -0.31 to -0.38) and lower MDD and GAD rates (ORs: 0.68, 0.70). When maltreatment and PCEs were modeled simultaneously, PCEs were the only significant predictor of fewer symptoms and diagnoses across all domains (effect sizes: -0.29 to -0.35; ORs: 0.68, 0.70), whereas effects of childhood maltreatment dropped to non-significance. Conclusion:Positive childhood experiences have enduring effects, predicting both dimensional and categorical prenatal mental health above and beyond childhood maltreatment.
Objective:SAINT®, a functional connectivity-guided, accelerated form of intermittent theta-burst stimulation, has shown high efficacy in depression in open-label and randomized controlled trials. To evaluate real-world effectiveness across diverse clinical practice settings, an open-label, multicenter study was conducted. Methods:Adult patients with major depressive disorder who failed to achieve satisfactory improvement from prior antidepressant medication in the current episode were enrolled across 7 private psychiatric clinics in the U.S. All participants received a 5-day course of SAINT. The primary outcome was the Clinical Global Impressions Scale of Improvement (CGI-I) score following the final treatment session with CGI-S (measure of severity) collected as a secondary measure. Results:A per protocol analysis of the acute outcomes data included 101 participants. All patients who initiated SAINT treatment completed the full 5-day protocol, with no treatment discontinuations due to adverse events or tolerability concerns. At the primary endpoint, treatment day 5, 68.3% of participants achieved CGI-I ≤ 2 ("much improved") with a mean CGI-I of 2.32. Meaningful clinical benefit (≥1 point reduction in CGI-S from baseline through 5 days following treatment) was observed in 89.1% of participants. Improvement rates did not significantly differ by baseline severity or across clinical sites. Conclusions:This analysis of the primary outcome includes the largest cohort of patients treated with SAINT to date. The results support previously reported rapid and significant improvements in depressive symptoms and extend these findings to a more clinically representative population.
Objective:To optimize treatment outcome and promote recovery, it is necessary to understand how clinical indicators of improvement translate into meaningful differences in the lives of individuals with posttraumatic stress disorder (PTSD). Prior research has suggested that treatment response alone is insufficient and that more substantial improvement is needed, but data are limited. This study addressed the gap through secondary analysis of a pragmatic comparative effectiveness trial of Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) in veterans. Methods:Participants were 597 male and female US military veterans who were randomized to receive CPT or PE. PTSD symptom change from pre- to posttreatment was categorized into four mutually exclusive categories: No Response, Response, Loss of Diagnosis, and Remission. Analyses compared each category to the prior one to identify the effect of attaining a higher benchmark on experiencing clinically meaningful improvements and good endpoints (no/little impairment in functioning or ≥70% on a QoL scale) on clinician-rated and self-reported measures. Results:Response was associated with improvement on most outcomes, but with a good endpoint on only one. Loss of Diagnosis added little benefit beyond response. Remission was associated with increased likelihood of meaningful improvement (OR=2.31-23.65, lowest p < .001) and a good endpoint (OR=3.37-13.50, lowest p < .001) on all measures. Conclusions:Response without more substantial improvement following PTSD treatment is insufficient for helping patients achieve good QoL. Findings support the position that focusing on more than symptom change and response alone is necessary when setting treatment goals for individual patients and for evaluating treatments.
Obsessive-compulsive (OC) symptoms frequently co-occur with depressive and anxiety symptoms, yet the covariation of these symptoms over time is understudied. In this study, 2364 young adults (18-30 years) from a public university in Singapore were followed across five waves over 2.5 years. Latent growth curve models were estimated for OC, depressive, and anxiety symptoms, and parallel-process models examined cross-domain coupling, with regression models testing the unique influence of growth factors on OC symptom change. Results showed significant longitudinal coupling, primarily as co-improvement with steeper declines in depressive/anxiety symptoms associated with steeper declines in OC symptoms. A small subset of the sample (n = 21) showed co-worsening of OC and depressive symptoms. Higher baseline depressive and anxiety symptoms predicted slower OC improvement, highlighting the adverse impact of co-occurring internalizing symptoms. Only depressive trajectory uniquely predicted OC change beyond anxiety symptoms, suggesting that depressive symptoms may be a key influence in OC symptom progression. OC symptoms showed the greatest stability over time relative to depressive and anxiety symptoms. Overall, linked changes support shared etiological processes and underscore the role of comorbidity in maintaining OC symptoms, while also suggesting potential benefits of targeting transdiagnostic mechanisms or depressive symptoms in interventions. Longitudinal research tracking subclinical OC symptoms in community samples can further inform early identification and intervention strategies for OCD.
Social anxiety disorder (SAD) is defined by negative valence symptoms, such as fear and anxiety related to perceived social threats, however, a growing literature has also identified positive valence system (PVS) impairments. PVS deficits in approach motivation, positive affect, and reward sensitivity may contribute to limitations in efficacy of existing treatments that primarily target negative valence system features. This scoping review describes the literature assessing PVS-targeted treatments of SAD and associations of PVS measures with social anxiety (SA) or SAD across units of analysis, from self-report to neuroimaging. Following screening, 192 peer-reviewed articles were included. Findings were most robust for association of SA and SAD with lower self-reported positive affect and reward sensitivity. Studies utilizing reward tasks reported some divergence of outcomes, with SA and SAD being associated with greater behavioral and striatal reactivity to social and monetary rewards in youth, but decreased reactivity specific to social rewards in adults. Some studies of reward learning found an association of SAD and SA with deficits in learning from and recalling social rewards, though neural outcomes were mixed. Most studies of novel PVS-focused treatments have used nonsocial rewards to motivate behavioral change, with fewer studies exploring direct enhancement of PVS functions. Inconsistencies in findings may relate to small sample sizes and heterogeneous methods. Further clarification of behavioral and neural mechanisms of PVS deficits is needed, but existing evidence supports increased development and testing of treatments to leverage and enhance PVS function in SAD.
Low positive affect (PA) and high negative affect (NA) are common features of depressive and anxiety disorders that have been linked to social disconnection. Prior research, however, has examined PA, NA, and social connectedness as global dimensions rather than as systems of interacting discrete emotions and connectedness indicators. This study used network analysis to: (a) examine interrelationships among discrete emotions to identify potentially influential emotions within and across positive and negative emotion communities, and (b) determine which emotions are most strongly linked to indicators of perceived social connection or disconnection. Data were derived from 359 adults with clinically elevated anxiety or depression who completed measures of discrete emotions and social connectedness. We estimated three networks: Model 1 examined associations among positive and negative emotions; Model 2 examined associations among discrete emotions and indicators of social connection; and Model 3 examined associations among discrete emotions and indicators of social disconnection. Model 1 revealed that hope, joy, and guilt/shame were the most central nodes within their respective communities while sadness emerged as a key node linking positive and negative emotions. In Model 2, cross-community links were observed between love and feeling understood, and between embarrassment and comfort around strangers. In Model 3, the node guilt/shame shared a positive association with poor belonging while love was negatively associated with lacking brother/sisterhood among friends. These findings inform how discrete emotions and social experiences relate in anxiety and depressive disorders, pointing to specific emotions and connectedness indicators that may represent promising treatment targets.
