BACKGROUND:High rates of depression, anxiety, stress, and hazardous drinking are reported within the legal profession, yet large-scale data on current prevalence rates and occupational correlates remain limited or outdated. This study updates prevalence estimates, reports the first large, multi-jurisdictional estimate of work-related burnout among lawyers, and examines how distress, burnout, and drinking relate to practice environments and work demands. METHODS:We surveyed randomly invited lawyers recruited through twenty-eight participating jurisdictions (39,036 respondents; 36,925 eligible for weighting), calibrating responses to demographic benchmark margins by post-stratification raking. Survey-weighted models estimated associations between psychological distress (DASS-21), work-related burnout (Copenhagen Burnout Inventory), hazardous drinking (AUDIT-C), and work hours, practice setting, litigation, and work-family conflict. RESULTS:Moderate-or-higher symptoms were reported by 21.6% for depression, 20.4% for anxiety, and 18.9% for stress; 47.4% reported high or very high burnout. Hazardous drinking was 41.8% at the standard AUDIT-C threshold and 26.4% at the higher. Distress rose nonlinearly with burnout and was higher among lawyers reporting greater work-family conflict, with the largest absolute differences at high burnout. Confidentiality (53.3%) and career concerns (49.2%) were the most cited barriers to seeking help. CONCLUSIONS:Distress, burnout, and hazardous drinking were common in this sample and associated with practice demands, practice setting, and work-family conflict. Burnout is the more proximal correlate of distress, and tailored interventions addressing occupational exhaustion and work-life interference merit exploration and evaluation for the lawyer population.
Background Anxiety and depressive disorders are known risk factors for suicide. However, limited prospective research has tested whether mental disorders are associated with transitions from suicidal ideation (SI) to suicide attempt (SA). Our primary aim was to test the effects of mental disorder symptoms on SA over 18 months. Method Symptoms of major depression, generalized anxiety, social anxiety, obsessive-compulsive, and post-traumatic stress disorders, and psychological distress were assessed in a population-based sample of 923 Australian adults with SI (mean age 36.2 years, 65.2% women). SI severity and time to SA were then assessed every 6-months for 18-months, with 86% retention. All measures were self-reported. Results Suicide attempts were reported by 106 participants (11.5%) during the follow up period. Baseline depressive and post-traumatic stress symptoms were associated with increased hazard of SA at 18-months (HR = 1.064, 95%CI: 1.001–1.131 and HR = 1.264, 95%CI: 1.046–1.526 respectively), while baseline obsessive-compulsive symptoms had a small negative association with SA (HR = 0.960, 95%CI: 0.925–0.996). Greater depression or distress symptoms at baseline were associated with more severe SI at 18-months. Sensitivity analyses indicated that lifetime suicide attempt history attenuated symptom-level associations, such that only baseline PTSD associations remained significant for SA. Conclusion Depression and anxiety disorder symptoms were significantly associated with subsequent SI and SA over 18 months, although effects on SA were modest and attenuated by lifetime SA. Findings support potential moderation of mental health effects based on lifetime suicide attempts, and suggest that further examination of the role of suicide capability within specific mental disorders is needed.
Depressive symptoms are a major mental health concern among people with disabilities in South Korea, yet little is known about how depressive symptoms change before and after disability onset, or how their levels differ between people with and without disabilities. Thus, we examined (a) changes in depressive symptoms before and after disability onset within people with disabilities, (b) comparisons between pre-onset levels of depressive symptoms in people with disabilities and the level of depressive symptoms in people without disabilities, (c) comparisons between post-onset levels of depressive symptoms in people with disabilities and the level of depressive symptoms in people without disabilities, and (d) changes in depressive symptoms associated with disability duration. Using the Korea Welfare Panel Study, we analyzed 152,152 person-wave observations from 13,643 individuals. Disability onset was identified using retrospectively reported onset age. We used linear mixed-effects models approximating a hybrid specification, with participant-level random intercepts. The levels of depressive symptoms among people with disabilities were higher after disability onset than before onset (β = 0.06, p = .015). Pre-onset depressive symptoms among people with disabilities were elevated relative to those of people without disabilities (β = 0.12, p < .001), as were post-onset depressive symptoms (β = 0.18, p < .001). Depressive symptoms did not differ significantly across years since disability onset. We suggest integrating mental health screening into disability diagnosis processes, particularly at early stages for individuals with progressive health decline. The persistent gap in depressive symptoms between people with and without disabilities underscores the need for stronger systemic support.
BACKGROUND:Cardiorespiratory fitness (CRF) predicts cardiovascular and all-cause mortality and is reduced in severe mental illness. This systematic review with meta-analysis estimated the mean CRF of people with bipolar disorder (BD), the difference from controls without BD, and the effect of physical activity interventions on CRF in BD. METHODS:Five databases (PubMed, Embase, Web of Science, PsycINFO, SPORTDiscus) were searched from inception to November 24, 2025, and updated on August 25, 2026. Random-effects models pooled the mean CRF and the difference versus controls; subgroup and sensitivity analyses were post hoc. The review was not prospectively registered. RESULTS:Twenty studies were included; ten reported oxygen uptake, nine of which were pooled. In adults, mean CRF was 27.0 mL/kg/min (k = 8, n = 190; 95%CI 21.5 to 32.5; I2 = 97.0%); adding the adolescent sample gave 28.7 mL/kg/min (k = 9, n = 210; 95%CI 22.3 to 35.1; I2 = 98.1%). CRF was 7.4 mL/kg/min lower in BD than in controls (k = 7, n = 333; 95%CI -12.7 to -2.1; p = 0.006; I2 = 89.9%; standardized mean difference - 0.89, 95%CI -1.41 to -0.38). Only two uncontrolled pilot studies reported pre-post CRF, precluding meta-analysis. LIMITATIONS:The evidence base is small, cross-sectional and heterogeneous; the between-group estimate was not robust to excluding one study, and two indirect protocols applied to the same participants differed by 19.3 mL/kg/min. CONCLUSION:CRF was consistently lower in BD than in healthy controls, although heterogeneity means the pooled mean is a descriptive summary rather than a representative value. No conclusion about exercise efficacy can be drawn. Adequately powered controlled trials with standardized CRF assessment are required.
Cross-national examinations can clarify whether associations among theory-derived and social-cognitive factors related to suicidal ideation (SI) are shared or context-specific, yet evidence remains scarce. This study estimated an overall psychosocial network of SI and compared its structure across four countries. In a cross-sectional online survey conducted between June 2025 and January 2026, 2018 adults aged 18-60 years from Italy, Korea, the UK, and the US were recruited through online survey panels. Recruitment aimed for similar age and gender profiles across the countries. Participants completed measures of SI and related psychosocial factors, which were analysed using network and relative importance analyses. The overall cross-country network comprised 39 edges, with the strongest associations between ability- and opinion-based comparison, defeat and internal entrapment, and fear of social disapproval and moral objections. SI was directly associated with perceived burdensomeness, defeat, and internal entrapment, and negatively associated with survival and coping beliefs. Defeat showed the highest centrality, whereas perceived burdensomeness showed the highest relative importance, followed by defeat and internal entrapment. The model explained 25.1% of the variance in SI severity. Cross-national networks showed broadly similar structures, although direct associations with SI varied across countries, with higher explained variance in the UK and Italy than in the US and Korea. Defeat and internal entrapment may occupy central positions within the psychological network of SI, whereas perceived burdensomeness may represent a more proximal correlate of SI. Cross-national variation highlights the importance of considering both shared and context-dependent associations in understanding SI.
To identify latent classes of socio-contextual vulnerability among postpartum women and to examine whether these classes differed in postpartum depressive symptomatology and self-reported postpartum depression diagnosis. A total of 1308 women residing in Spain who had given birth within the previous 24 months participated in this cross-sectional online study. Latent class analysis (LCA) was conducted based on socio-demographic, caregiving, contextual, obstetric, and prior clinical-history indicators, including employment status, educational attainment, caregiving support, area of residence, age, partnership status, primiparity, postpartum time, and previous depression history. Differences between classes in EPDS screening positivity and self-reported postpartum depression diagnosis were subsequently explored. A 2-class model with better fit, parsimony, and interpretability was selected. The identified classes were characterized as Class 1: Higher socio-contextual vulnerability (27.5%) and Class 2: Lower socio-contextual vulnerability (72.5%). Relative to Class 2, Class 1 showed lower probabilities of employment (0.443 vs. 0.926) and higher education (0.482 vs. 0.833), together with higher probabilities of low caregiving support (0.392 vs. 0.132), unemployment (0.271 vs. 0.029), caregiving or home duties (0.248 vs. 0.038), younger age (0.666 vs. 0.443), and rural residence (0.288 vs. 0.122). Women in the higher socio-contextual vulnerability class showed a higher probability of EPDS screening positivity (0.632 vs. 0.551; OR = 1.401, 95% CI [1.163, 1.672]) and a somewhat higher probability of self-reported postpartum depression diagnosis (0.143 vs. 0.116). The findings suggest that postpartum depressive symptomatology is embedded within broader socio-contextual conditions and support the importance of incorporating socio-contextual indicators into postpartum mental health screening and prevention strategies.
BACKGROUND:Bipolar disorder (BD) and major depressive disorder (MDD) are frequently misdiagnosed, while most neuroimaging studies have focused on single illness stages rather than the entire disease course. This study applied Gaussian mixture model (GMM) clustering to resting-state functional magnetic resonance imaging (rs-fMRI) features across depressive episode, partial remission, and complete remission stages to model the stage related differences of differential patterns between the two affective disorders. METHODS:A total of 254 participants (109 BD and 145 MDD) aged 15-50 years underwent rs-fMRI scanning. Rs-fMRI data were preprocessed using DPABI, and dynamic fractional amplitude of low-frequency fluctuations (dfALFF) was calculated. Based on dfALFF features, Gaussian mixture model (GMM) unsupervised clustering was applied to cluster the two affective disorders across different illness stages, followed by clustering performance analysis of stage related differences, feature importance analysis, and construction of connection curves for the two affective disorders. RESULTS:Clustering accuracies during depressive episode, partial remission, and complete remission stages were 71.83%, 70.69%, and 53.42%, respectively. Discriminative brain regions during depressive episode and partial remission stages mainly involved frontal, temporal, parietal, limbic, cerebellar, subcortical, and occipital regions. No meaningful discriminative brain regions were identified during complete remission because BD and MDD could not be effectively distinguished. CONCLUSIONS:Brain functional patterns are distinguishable during depressive episodes and partial remission but become indistinguishable during complete remission. This study simulated differential diagnostic model patterns across disease course for two disorders, offering a novel perspective.
Suicidal ideation (SI) is common among patients presenting to psychiatric emergency departments (EDs), yet its association with longer-term clinical and functional outcomes remains insufficiently understood. This study examined trajectories of functional disability, depressive and anxiety symptoms, and alcohol misuse among patients with mood and anxiety disorders according to SI at ED presentation.Data were drawn from a prospective cohort of 261 adults with mood and anxiety disorders presenting to a psychiatric ED and followed for 12 months. Linear mixed-effects models examined longitudinal outcomes according to baseline SI, adjusting for sociodemographic, clinical, and psychosocial factors. A secondary analysis examined longitudinal associations between time-varying SI and depressive symptoms.Baseline SI was associated with greater functional disability and more severe depressive and anxiety symptoms throughout follow-up, but not with alcohol misuse. Time-by-SI interactions were nonsignificant for all outcomes, indicating similar trajectories regardless of baseline SI. Depressive and anxiety symptoms improved over follow-up, whereas functional disability increased at discharge before stabilizing, and alcohol misuse decreased only at 12 months. Poor sleep satisfaction, chronic physical illness, and higher impulsivity were associated with poorer outcomes. Male sex and religious or spiritual coping were associated with lower functional disability and/or fewer depressive and anxiety symptoms. Older age was associated with lower alcohol misuse. Time-varying SI was associated with depressive symptoms at both within- and between-person levels.SI at psychiatric ED presentation may identify patients with sustained clinical and functional burden despite similar patterns of change over time, supporting comprehensive assessment and post-discharge monitoring alongside suicide-risk assessment.
BACKGROUND:Inflammation is implicated in bipolar disorder and quantitative EEG (QEEG) measures cortical oscillatory activity, but the two have not been examined together in first-episode mania. METHODS:Sixty drug-naïve inpatients with a first manic episode (DSM-5) and sixty age- and sex-matched healthy controls were enrolled. Peripheral inflammatory measures, including the monocyte-to-lymphocyte ratio (MLR), C-reactive protein and albumin, were obtained from routine blood tests, and resting eyes-open EEG absolute spectral power was computed across five cortical regions and four bands. Groups were compared with Mann-Whitney U tests with Benjamini-Hochberg correction, and within-patient inflammation-QEEG associations examined by hierarchical regression adjusted for age, education and sex. RESULTS:Patients had higher monocyte counts (q = 0.004), higher MLR (q = 0.003) and lower albumin (q = 0.045) than controls. Absolute spectral power was higher in patients in 9 of 20 region × band cells, all surviving correction. Within patients, lower albumin was associated with higher frontal (β = -0.42, p = 0.006) and central (β = -0.44, p = 0.003) beta power, persisting after adjustment for smoking and log-transformation. Across all 20 cells with correction, these were the strongest associations but did not survive (minimum q = 0.17). CONCLUSIONS:First-episode drug-naïve mania is accompanied by an immune-metabolic shift and broad cortical oscillatory change. The albumin-beta association is exploratory and hypothesis-generating, and requires replication. Limitations include the single-centre cross-sectional design, modest sample size, and an inflammatory panel restricted to routine measures.
People with high social anxiety (HSA) experience self-disclosure difficulties that disrupt interpersonal interaction. Inter-brain synchrony (IBS) has been proposed as a neural index of interpersonal coupling during social interaction, yet how dyadic social anxiety composition shapes IBS remains unclear. Using fNIRS hyperscanning, this study examined IBS during a closeness-generation task in 21 low-low (LL), 23 high-high (HH), and 23 low-high (LH) social anxiety dyads. Participants reported state anxiety, perceived closeness, and post-event processing (PEP). HSA individuals reported higher state anxiety and greater PEP than individuals with low social anxiety. PEP was shaped by the interaction between participants' own and partners' social anxiety, with higher PEP after same-anxiety interactions. LH dyads showed reduced IBS in the right superior temporal gyrus (r-STG) and right frontopolar area compared with LL dyads, and reduced IBS in the r-STG and right dorsolateral prefrontal cortex compared with HH dyads. HH and LL dyads showed comparable IBS. Associations between IBS and subjective measures differed across dyad types: higher r-STG IBS was associated with greater closeness in HH dyads, whereas in LH dyads, higher r-STG IBS and greater closeness reported by HSA individuals were associated with higher PEP. Dynamic IBS analyses showed that LH dyads had a lower probability of transitioning from lower-efficiency state to a numerically intermediate-efficiency state than matched dyads. These findings suggest that social anxiety mismatch is associated with reduced IBS, altered neural coordination dynamics, and distinct links between neural and subjective measures, highlighting the value of dyadic, dynamic, and multi-level perspectives on social anxiety.
BACKGROUND:Acupuncture is effective for chronic insomnia disorder (CID), but the favorable treatment duration remains uncertain, and direct evidence comparing different treatment courses is limited. This study compared the effectiveness of 4-, 6-, and 8-week acupuncture courses to determine whether extending treatment provides additional clinical benefit. METHODS:In this three-arm randomized controlled trial, 201 patients with CID were randomly assigned (1:1:1) to receive 4, 6, or 8 weeks of acupuncture (n = 67 per group), administered three times weekly using the same acupoints. The primary outcome was the the Insomnia Severity Index (ISI) score at treatment completion. Secondary outcomes included clinical remission (ISI < 8), and a minimal clinically important difference (ISI-MCID reduction ≥6), as well as scores on the Pittsburgh Sleep Quality Index (PSQI), Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), and Fatigue Severity Scale (FSS), hypnotic medication use, and safety. Outcomes were assessed at baseline, treatment completion, and 1 and 3 months after treatment. Longitudinal continuous outcomes were analyzed using linear mixed-effects models under the intention-to-treat principle. RESULTS:A total of 201 patients (157 women [78.1%], 44 men [21.9%]) were included in the intention-to-treat analysis. ISI scores decreased from baseline to post-treatment in the 4-, 6-, and 8-week groups, with mean changes of -7.4 points (95% CI, -9.0 to -5.8; P < .001), -9.7 points (95% CI, -11.4 to -8.0; P < .001), and -10.0 points (95% CI, -11.7 to -8.3; P < .001), respectively. Compared with the 4-week group, the 6- and 8-week groups showed greater improvements in ISI scores, with adjusted mean differences of -2.7 points (95% CI, -4.8 to -0.6; P = .008) and -2.8 points (95% CI, -4.9 to -0.6; P = .006), respectively. The additional improvement with the 8-week course versus the 6-week course was limited, with an adjusted mean difference of 0.0 points (95% CI, -2.2 to 2.1; P > .99). Clinical remission and MCID were more frequent in the 6-week group than in the 4-week group (P = .003 and P = .010, respectively). Sleep quality also generally favored the 6-week course over the 4-week course, with an adjusted mean difference of -1.9 points (95% CI, -3.6 to -0.2; P = .02). Between-group differences in depressive and anxiety symptoms were observed mainly between the 8- and 4-week groups. However, these secondary findings should be interpreted cautiously. No significant between-group differences were observed in fatigue or hypnotic medication use. No serious adverse events were reported. CONCLUSION:Six- and 8-week acupuncture courses produced greater improvements in insomnia severity than a 4-week course in patients with CID. Extending treatment from 6 to 8 weeks provided limited additional benefit for core sleep outcomes. These findings may inform clinical decisions regarding acupuncture treatment duration for CID. TRIAL REGISTRATION:https://www.chictr.org.cn [ChiCTR2300073711].
OBJECTIVE:Obsessive-compulsive disorder (OCD) may be associated with elevated posttraumatic stress symptoms (PTSS) among trauma-exposed youth. However, it remains unclear to what extent this association varies based on resilience and trauma type (two factors reflecting protection and risk, respectively) over time. A prior study found that OCD was not significantly associated with longitudinal changes in PTSS among trauma-exposed youth. The present study represents a follow-up to that work by examining whether this association varies based on resilience and trauma type (interpersonal vs non-interpersonal) over time. METHOD:Participants were 1179 trauma-exposed youth ages 8-20 from the Texas Childhood Trauma Research Network who had complete PTSS data at baseline and the 1-, 6-, and 12-month assessments. Generalized estimating equations examined whether longitudinal changes in PTSS varied based on trauma type and resilience. RESULTS:At baseline, expected PTSS were highest among youth with OCD and interpersonal trauma and was approximately 2.4 times as severe as among youth without OCD who reported solely non-interpersonal trauma (MR = 2.42, p < .001). PTSS remained highest in the OCD × Interpersonal Trauma profile across all four assessments. However, resilience did not significantly moderate the association between OCD and PTSS (p = .509). CONCLUSIONS:Youth with co-occurring OCD and interpersonal trauma represent a clinically important subgroup with elevated PTSS. Resilience was associated with lower PTSS and slightly greater symptom improvement over time, but did not specifically buffer against the elevated PTSS associated with OCD.
BACKGROUND:Borderline personality disorder (BPD) is characterized by emotional dysregulation and high rates of suicidal and self-harming behavior, while effective treatments remain limited. This study evaluated short- and long-term effects of right dorsolateral prefrontal cortex (DLPFC) rTMS in a double-blind, sham-controlled design, accounting for concurrent treatment and trauma history. METHODS:Thirty women with BPD and recent nonsuicidal self-injury or suicidal behavior underwent 15 sessions of active or sham 10-Hz rTMS targeting the right DLPFC over three weeks. Outcomes were assessed at baseline, post-treatment, and three- and six-month follow-up. Primary analyses compared longitudinal trajectories between groups using linear mixed-effects models. RESULTS:No significant Group × Time interactions were observed for primary outcomes, indicating no evidence of differential longitudinal change between active and sham stimulation. Exploratory within-group analyses showed reduced self-reported depressive symptoms in the active group at post-treatment (β = -0.58), with borderline-significant reductions at three and six months; medication adjustment yielded a significant effect at three months (β = -0.78), but not six months (β = -0.62). Impulsivity decreased in the sham group at three (β = -0.58) and six months (β = -0.59). Self-harming and suicidal behavior decreased in both groups at three and six months. Dissociation decreased in the sham group at three months (β = -0.53). CONCLUSION:No evidence of superior longitudinal effects of active versus sham rTMS was observed. Exploratory within-group findings warrant further investigation but do not establish stimulation-specific efficacy. Larger sham-controlled trials are needed to determine the efficacy and durability of rTMS in BPD.
BACKGROUND:Mixed states in bipolar disorder (BD) remain a diagnostic and nosological challenge, with current classifications differing in their ability to capture the overlap between manic and depressive symptomatology. METHODS:We used baseline data from 1384 patients in a manic or mixed episode of BD according to DSM-IV criteria across five randomized clinical trials. We modelled mood symptom networks using the Young Mania Rating Scale (YMRS) and Montgomery-Åsberg Depression Rating Scale (MADRS). We identified mood symptom clusters and compared symptom networks between DSM-IV manic and mixed episodes, and between DSM-IV mixed episodes and DSM-5 manic episodes with mixed features. RESULTS:The joint YMRS-MADRS mood symptom network revealed strong within-domain coherence (i.e., strong connectivity among manic symptoms and among depressive symptoms). There were positive and negative associations between manic and depressive nodes, indicating that these domains both co-occur and inhibit each other. Depressive symptoms, especially sadness and anhedonia items, showed greater overall connectivity and centrality than manic symptoms. Cluster analyses identified three main domains - manic, depressive, and a mixed activation-dysphoria cluster -plus a smaller insomnia-related cluster. DSM-IV manic and mixed episodes differed significantly in structure and global connectivity, whereas DSM-5 distinctions were subtler and reflected increased depressive burden within manic presentations. CONCLUSIONS:Manic and depressive symptoms formed distinct yet interconnected clusters within a shared affective network. An activation-dysphoria cluster linked both domains, capturing core elements of mixed presentations. DSM-IV groups showed clearly differentiated network structures, whereas DSM-5 mixed features reflected variations within the manic spectrum rather than a distinct configuration.
BACKGROUND:Major depressive disorder exists along a continuum, from health through remission to active depression. Differentiating these states remains challenging, and suicide risk may not be fully captured by self-report. Objective markers, such as speech, which integrates affective, cognitive, and motor processes, offer a promising avenue for fine-grained state differentiation. METHODS:Ninety-nine participants (healthy controls, depressive remission, and depressive episode) completed word-reading, question-answering, and story-reading tasks with positive, neutral, and negative emotional content. Twenty-three acoustic features were extracted and modeled using Long Short-Term Memory networks for three-class depression classification and binary suicide risk identification. Five-fold cross-validation and Shapley Additive Explanations were used for performance evaluation and model interpretation. RESULTS:Speech-based modeling reliably distinguished depressive states, with remission occupying an intermediate acoustic profile. Question-answering tasks achieved the highest accuracy for depression (75.89%) and suicide risk (78.03%). Emotional materials enhanced group separation, with positive and negative valence outperforming neutral speech. Feature analysis highlighted Energy, Teager Energy, and Spectral Flatness for healthy/low-risk profiles, and PitchTrack, Zero-Crossing Rate, and specific MFCCs for depressive/high-risk profiles. CONCLUSIONS:Emotionally engaging speech tasks enable interpretable, fine-grained differentiation of depressive states and support suicide risk identification. Depressive remission presents as an acoustically distinct intermediate state rather than a full return to normative patterns, emphasizing the value of affective speech paradigms for scalable mental health assessment.
BACKGROUND:Major depressive disorder (MDD) involves both central neurotransmission and systemic metabolic disturbances. This study investigated how body mass index (BMI) modulates prefrontal neurometabolic profiles and their relationship with depressive severity in depression. METHODS:66 first-episode, drug-naïve Han Chinese patients with MDD and 79 Han Chinese healthy controls were recruited. Using multi-voxel proton magnetic resonance spectroscopy, we quantified tissue-corrected metabolite-to-creatine ratios in the anterior cingulate cortex (ACC) and bilateral dorsolateral prefrontal cortex (DLPFC). Serum lipid profiles and 17-item Hamilton Depression Rating Scale (HAMD) scores were collected. Patients were stratified into low-BMI and normal-BMI subgroups. RESULTS:Within the MDD cohort, the low-BMI subgroup showed lower HAMD-17 scores, triglyceride levels, and LDL-C levels and higher HDL-C levels than the normal-BMI subgroup. Nominally higher ACC GABA/Cr and DLPFC NAA/Cr ratios were observed in the low-BMI subgroup, although these differences did not survive FDR correction. In the additional comparison with low-BMI healthy controls, no neurometabolite difference survived false discovery rate correction. BMI subgroup significantly moderated the association between DLPFC Glu/Cr and HAMD-17 scores: the association was positive in the normal-BMI subgroup but negative in the low-BMI subgroup. CONCLUSIONS:These findings suggest a possible compensatory neurochemical pattern associated with low BMI in depression. However, the cross-sectional design cannot determine whether this pattern reflects compensatory adaptation or a pre-existing neurobiological subtype, and low BMI alone should not be interpreted as evidence of metabolic stress. TRIAL REGISTRATION:Chinese Clinical Trial Registry; URL: https://www.chictr.org.cn/; Registration number: ChiCTR2500109138.
BACKGROUND:Among teenagers and young adults, non-suicidal self-injury (NSSI) is highly prevalent and is closely related to suicide and mental disorders. However, existing assessment tools do not comprehensively cover the four stages of NSSI (idea-gesture-plan-behavior) and have limitations in cultural adaptability, assessment completeness, or clinical practicability. To date, few unified tools can simultaneously assess both suicide and NSSI within a single severity framework. METHODS:Of 2558 participants who completed the initial prescreening, those with a positive history were further assessed for data quality; 295 met the inclusion criteria and comprised the final analytic sample (mean age = 17.96 years; 56.61% female). Psychometric properties were assessed using internal consistency, confirmatory factor analysis (CFA), criterion-related validity, and expert-rated content validity. RESULTS:STBI24K demonstrated excellent internal consistency (α = 0.89) and content validity (S-CVI/Ave = 0.993). CFA supported the eight-factor structure of the STBI24K (χ2/df = 0.87, CFI = 1, TLI = 1.001, RMSEA = 0, SRMR = 0.08). Total score was significantly correlated with depression (r = 0.39, p < 0.001) and anxiety (r = 0.30, p < 0.001). DISCUSSION:The STBI24K is a new self-report tool developed in China that can quickly assess the stage and severity of suicide and NSSI, based on a unified four-stage continuum framework. With strong psychometric properties, it shows potential for use in clinical settings. Future research should validate its psychometric properties in diverse populations and examine predictive validity.
Depressive symptoms commonly increase during young adulthood and have been associated with disruptions in rest-activity rhythms (RAR), but prospective within-person associations between daily RAR characteristics and depressive symptoms remain unclear. This study examined reciprocal within-person associations between daily RAR parameters and depression among young adults. A total of 319 participants (mean age = 19.16 years; 78.1% female) contributed 3155 analytic person-days during a 14-day wrist-actigraphy and ecological momentary assessment protocol. RAR parameters included acrophase, circadian quotient, intradaily variability, interdaily stability, and relative amplitude. Daily depression mean and daily depression instability were derived from repeated assessments. Bayesian dynamic structural equation models adjusting for prior-day perceived stress and 24-h light exposure, as well as sex, age, and season were used to estimate the cross-lagged associations between depression and RAR. Late acrophase on day t - 1 predicted high depression mean on day t (posterior median = 0.051, 95% credible interval [CrI] [0.002, 0.100]). Great depression instability on day t - 1 predicted low interdaily stability on day t (posterior median = -0.039, 95% CrI [-0.069, -0.008]). No other cross-lagged associations were supported. Exploratory analysis did not provide credible evidence of sex differences. These findings advance our understanding of daily interplay between depression and behavioral rhythmicity and shed light on chrono-interventions for mood problems among young adults.
