Background Although millions of adults seriously consider suicide each year, clinical trials often exclude individuals experiencing suicidal ideation (SI). This analysis sought to describe the use of a range of psychiatric treatment modalities in individuals with mood disorders with and without a history of suicide attempt or SI. Methods Individuals with mood disorders (n=211; M=93/F=118) who had previously participated in psychiatric research at the National Institutes of Health Clinical Center completed a follow-up clinical assessment (range=1-20 years since study participation). In addition to clinical outcomes, participants were asked about psychiatric treatment use since discharge, treatment indication, and perceived helpfulness of the intervention. Differences between participants who did and did not report SI and/or history of suicide attempt at index visit were analyzed using general linear models. Results Individuals with SI on index visit had generally similar clinical outcomes as those who did not report SI on index visit, but they were more likely to report use of psychiatric medications or ketamine at follow-up. Few group differences were noted with regard to perceived helpfulness or use of treatments for suicide-related indications. Individuals with a history of suicide attempt on index visit were more likely to report suicide attempts and psychiatric hospitalization at follow-up. Conclusion Individuals with SI or with a history of suicide attempts frequently use psychiatric services, particularly psychiatric medications and hospitalizations. The results underscore the need for effective, suicide-focused treatments for individuals with suicidal thoughts and behaviors. Clinical Trials Identifier www.clinicaltrials.gov (NCT02543983)
Persistent anxiety may be better understood as a dynamic system in which symptoms reinforce one another over time rather than as a collection of independent manifestations. Building on Hoogerwerf et al.’s network perspective, this Letter proposes extending symptom based models by incorporating physical activity as a time varying behavioral node. Their findings highlight the temporal persistence of worrying and nervousness, alongside a prospective association between worrying and tiredness, suggesting potential pathways through which anxiety may sustain itself. We propose that momentary physical activity could interact with these pathways by reducing the persistence of worry and nervousness, attenuating tiredness, and facilitating positive affect and enthusiasm. Importantly, this proposition does not assume that exercise universally reduces anxiety. Instead, it reframes the research question toward identifying when, for whom, and through which temporal mechanisms physical activity may modify anxiety networks. Integrating experience sampling methodology with objective physical activity monitoring and longitudinal network analysis could test whether movement at one moment predicts weaker symptom reinforcement at subsequent moments. This process based extension may advance anxiety research from identifying symptom connectivity toward identifying modifiable everyday behaviors capable of influencing network dynamics and strengthening anxiety resilience.
Background Major depressive disorder is characterized by substantial heterogeneity in symptom presentation and functional impairment, which are not fully captured by existing clinician- and patient-reported outcome measures. The Patient-Reported Depression Checklist (PRDC) may address limitations of commonly used symptom assessments. Methods Post hoc analyses from the ENLIGHTEN-randomized, placebo-controlled trial of liafensine (1 or2 mg/day) were performed in 188 patients with treatment resistant depression. Baseline convergent validity was assessed between PRDC Frequency, Impact, and Overall Impact scores against established clinical assessments, including the Montgomery-Asberg Depression Rating Scale (MADRS), the Clinical Global Impression-Severity (CGI-S), Clinical Global Impression-Improvement (CGI-I) and the Sheehan Disability Scale (SDS). Longitudinal convergent responsiveness was evaluated using correlations between change from baseline in PRDC scores and comparator measures. Results At baseline, PRDC Frequency, Impact and Overall Impact scores demonstrated moderate correlations with CGI-S and MADRS scores across treatment groups (r = 0.33–0.6; all p ≤ 0.006). By Day 7, PRDC scores showed moderate-to-strong longitudinal responsiveness (r = 0.26–0.65; all p < 0.001), with consistent patterns across treatment groups. In comparison, PRDC Frequency and Impact scores demonstrated consistent treatment effect sizes (d = 0.47 and 0.48, respectively), numerically greater than MADRS (d = 0.39), CGI-I (d = 0.35), and CGI-S (d = 0.28), all comparisons p ≤ 0.002. Limitations The PRDC was evaluated as a secondary/post hoc analysis within a single clinical trial, and not through a dedicated prospective psychometric validation study. Conclusions The PRDC demonstrated convergent validity with established clinician-rated measures and was responsive to both early and sustained treatment-related change. The PRDC captured valuable patient-reported effects on symptom frequency and functional impact which are increasingly sought by clinicians and regulators.
Problematic behaviors during childhood are associated with an increased risk of later mental health difficulties. Emerging evidence suggests that the gut microbiota may contribute to behavioral problems by influencing the development of executive function (EF), particularly explicit emotion regulation (EER). This longitudinal study investigated whether gut microbiota composition was associated with the risk of problematic behaviors. We analyzed data from 68 typically developing children assessed at both 3 and 5 years of age. Gut microbiota composition and EF, including EER, were assessed at ages 3 and 5 using 16S rRNA gene sequencing and the Behavior Rating Inventory of Executive Function–Preschool Version, respectively. The risk of problematic behaviors was assessed at age 5 using the Child Behavior Checklist. A higher relative abundance of Coprobacillus at age 3 was associated with poorer EER at age 3, which was prospectively associated with an increased risk of both externalizing (indirect effect = 0.29, 95% CI [0.01, 1.04]) and internalizing behavioral problems (indirect effect = 0.28, 95% CI [0.01, 0.87]) at age 5. In addition, a lower relative abundance of Granulicatella at age 5 was associated with poorer EER at age 5, which mediated the association with internalizing behavioral problems at age 5 (indirect effects = −0.35 and −0.36; 95% CIs [−1.32, −0.07] and [−1.18, −0.05], respectively). These findings provide evidence that gut microbiota composition may represent an early indicator of subsequent mental health risk. However, given the sample size and the number of taxa examined, these findings should be regarded as exploratory.
Importance : To be aware of central serous chorioretinopathy among patients with mental health co-morbidities and improve diagnosis and timely referral. Objective : To describe the association of selected mental health conditions with central serous chorioretinopathy. Design : A cross-sectional study from the All of Us Research Program with data collected from 2014 to 2025 and analyzed in 2025. Cases were identified using ICD-9/10 and SNOMED codes and compared to propensity score-matched controls. Setting A population-based study from All of Us, a national, multicenter initiative designed to reflect the diversity of the U.S. population. Participants 568 adult patients with central serous chorioretinopathy were identified. 1,704 controls were selected using 1:3 propensity score matching on age, gender, race, ethnicity, annual household income, and education level. Exposure(s) (for observational studies) Depression, anxiety, obsessive-compulsive disorders, and trauma-related disorders were identified using ICD-9/10 and SNOMED codes. Main Outcome(s) and Measure(s) We used multiple logistic regression models to assess the association between central serous chorioretinopathy and each mental health condition, adjusting for covariates including demographic factors, corticosteroid use, and obstructive sleep apnea. Results : In comprehensive models adjusting for sociodemographic factors, clinical comorbidities, and all other selected mental health conditions, depression (OR = 1.68, 95% CI: 1.26–2.23, p < 0.001) and trauma-related disorders (OR = 1.45, 95% CI: 1.07–1.97, p = 0.016) remained significant predictors of central serous chorioretinopathy. In independent models, depression, anxiety, and trauma-related disorders were individually significant (depression OR = 2.02; 95% CI: 1.57–2.59; p < 0.001, anxiety OR = 1.78; 95% CI: 1.28–2.46; p = 0.003, and trauma-related disorders OR = 1.88; 95% CI: 1.42–2.48; p < 0.001). Conclusions and Relevance Adults with depression, anxiety, and trauma-related disorders were more likely to have central serous chorioretinopathy compared to controls. Psychiatrists need to be aware of the mental health conditions commonly associated with central serous chorioretinopathy to support timely identification and proper referral to an ophthalmologist.
Background : The role of Positive Youth Development (PYD) and prosocial involvement in buffering the impact of racial-ethnic discrimination among Latine adolescents remains understudied. Objective : To examine whether PYD and community-level opportunities and rewards for prosocial involvement moderate the association between discrimination and depressive symptoms and suicidality in Latine adolescents through a mixed methods approach. Methods : A cross-sectional survey was conducted among Latine adolescents (N =110), assessing racial-ethnic discrimination (Everyday Discrimination Scale [EDS]), depressive symptoms and suicidality (Mood and Feelings Questionnaire [MFQ]), PYD (PYD Short Form), and community-level opportunities and rewards for prosocial involvement (Communities That Care scales). Linear and logistic regression models examined predictors of depressive symptoms and suicidality. Moderation was tested with interaction terms. Semi-structured interviews were completed with a nested sample of adolescents and caregivers (N= 18 dyads). A thematic analysis of interviews with a focus on the role of PYD was conducted. Results : EDS scores were associated with higher MFQ scores and suicidality. PYD factors and community-level opportunities and rewards for prosocial involvement were associated with lower MFQ scores and suicidality. These trends were generally consistent in adjusted regressions. None of the PYD factors, nor community-level opportunities and rewards for prosocial involvement, moderated these relationships. Qualitative findings identified youth-described processes consistent with the 5Cs that appeared to support coping in the context of discrimination. Conclusions : PYD factors and community-level opportunities and rewards for prosocial involvement are associated with improved mental health among Latine adolescents but may not be sufficient to buffer the harmful effects of racial-ethnic discrimination.
Information on child irritability varies by informant, yet little is known about how ratings differ between male and female parent respondents, and psychometric evidence for father-reported irritability is scarce. This study evaluated the psychometric properties and measurement invariance of the Japanese Affective Reactivity Index Parent-Report Form (ARI-p) across parent respondent gender groups, then examined group differences and their interactions with sociodemographic variables. In a two-wave community-based online panel survey, 4,800 parents (2,633 male and 2,167 female parent respondents) of children aged 6–18 years completed the ARI-p, the Strengths and Difficulties Questionnaire (SDQ), and demographic questions; 3,847 (80.1%) completed a follow-up after two months. The ARI-p showed good internal consistency (α = 0.885, 95% CI [0.880, 0.890]) and moderate test-retest reliability (ICC = 0.570, 95% CI [0.548, 0.591]). Approximate configural, metric, and scalar measurement invariance was supported, with qualifications including an elevated RMSEA. The ARI-p correlated positively with SDQ Emotional Symptoms (ρ = .46) and modified Conduct Problems (ρ = .50), and each one-point increase was associated with higher odds of a parent-reported disruptive mood dysregulation disorder classification (OR = 1.53, 95% CI [1.41, 1.65]). Score distributions were similar between the two respondent groups (p = .211); after adjusting for sociodemographic variables, male parent respondents reported slightly higher scores (B = 0.32, 95% CI [0.15, 0.48], p < .001), with no statistically detectable gender-by-sociodemographic interactions (p = .541). The Japanese ARI-p is reliable and valid for community samples, and the gender of parental respondents merits consideration when interpreting irritability ratings.
Depression prevalence varies substantially across Latin American countries (4.3–21.4%), yet evidence on measurement equivalence of depression screening instruments remains limited. This study evaluated the factorial structure and measurement invariance of the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) across eleven Latin American countries using data from 10,207 adults aged 25–64 years participating in the Development Bank of Latin America (CAF) 2019 survey. Sequential multigroup confirmatory factor analysis was conducted using robust weighted least squares estimation with mean and variance adjustment (WLSMV) for ordinal indicators in urban samples from Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Mexico, Panama, Paraguay, Peru, and Uruguay. Competing factorial models were tested. Both a correlated two-factor model (depressive affect and positive affect) and a unidimensional model with correlated residuals between positively worded items demonstrated excellent and comparable fit, as indicated by the Comparative Fit Index (CFI = 0.976). Measurement invariance testing supported configural (CFI = 0.972), metric, and scalar invariance according to established criteria (change in Comparative Fit Index [ΔCFI] ≤ 0.010; change in Root Mean Square Error of Approximation [ΔRMSEA] ≤ 0.015), whereas strict invariance was not achieved. These findings indicate that the CES-D-10 captures a comparable latent construct of depressive symptomatology and maintains equivalent item–factor relationships across Latin American countries. The attainment of scalar invariance supports meaningful cross-national comparisons of latent mean differences, reinforcing the suitability of the CES-D-10 for regional epidemiological surveillance and comparative research.
Background Major Depressive Disorder (MDD) remains one leading cause of global health burden. Human proteome represents a major source of therapeutic targets. We aimed to explore novel therapeutic targets for MDD via integration of plasma and cerebrospinal fluid proteomes with the brain transcriptome. Methods Using a statistical framework incorporating Mendelian randomization (MR), Bayesian colocalization, summary-data-based MR (SMR) and heterogeneity in dependent instruments (HEIDI) tests, we identified candidate proteins. Steiger filtering and reverse MR analyses were conducted to validate causal directionality, and findings were validated by replacing the exposure or outcome datasets. Then, we mapped candidate proteins to the transcriptomic profiles of 13 brain regions to identify potential targets. The Bonferroni correction was applied to control the family-wise error rate due to multiple testing. Lastly, protein-protein interaction (PPI) networks and druggability evaluation were employed to further prioritize potential antidepressant targets. Additionally, we conducted Spearman correlation analysis to examine the consistency of the shared proteins’ effects on MDD across CSF and plasma. Results We identified four potential antidepressant targets (ACAA1, ITIH4, IGLON5 and POR). The drug-gene interaction analysis suggested that ACAA1 may have antidepressant effects. ITIH4 maintained a robust causal association with MDD throughout various tests. The PPI analysis indicated ITIH4 and IGLON5 interacted with the current antidepressant targets. Notably, ITIH4 and POR were novel targets. Besides, Spearman correlation analysis showed that the effects of most overlapping proteins on MDD in CSF exhibited a positive correlation with those in plasma. Conclusions Our findings provide insights into the potential of CSF proteomics for the genetic prediction of antidepressant targets.
Depressive symptoms are common among college students, yet scalable screening tools that adequately capture nonlinear risk patterns remain limited. This study developed and validated a Probability-Strength Stacking (PSS) ensemble framework for depression risk prediction using a publicly available, anonymized college student mental health dataset from Kaggle (n = 27,901). Thirteen sociodemographic, psychological, behavioral, and economic predictors were analyzed. Data were split 80:20 into training and held-out test sets. XGBoost, LightGBM, Random Forest, SVM, CatBoost, hard-label stacking, and PSS Stacking-v2 were compared. PSS Stacking-v2 used continuous probability outputs from four base learners as meta-features for a logistic regression meta-learner, preserving inter-model confidence information discarded by conventional hard-label stacking. Performance was assessed by AUC, accuracy, sensitivity, specificity, F1, and Brier score, with 5-fold cross-validation, 1000-iteration bootstrap resampling, SHAP analysis, and decision curve analysis. On the held-out test set (n = 5581), PSS Stacking-v2 achieved AUC=0.9193 (95% CI: 0.9125–0.9266), accuracy=0.8461, sensitivity=0.8843, specificity=0.7920, F1=0.8706, and Brier score=0.1112, comparable to standalone CatBoost (AUC=0.9197, Brier=0.1098) and substantially outperforming hard-label stacking (AUC=0.8605; Brier=0.1251). SHAP identified suicidal ideation, academic pressure, and financial stress as the strongest predictors. The model showed positive net benefit across decision thresholds from 0.04 to 0.96, indicating good potential for practical risk stratification and early identification of depression among college students.
Background Post-stroke neuropsychiatric symptoms are common but frequently overlooked in clinical practice. General practitioners (GPs) who maintain long-term patient relationships are well placed to identify these symptoms. Aims To assess GPs’ knowledge, beliefs, and confidence in diagnosing and managing post-stroke neuropsychiatric symptoms, and to explore their management strategies as well as perceived barriers. Methods A survey was distributed to GPs practising in the Republic of Ireland in July 2024. Quantitative data was analysed descriptively and inferentially, and free-text responses underwent conventional content analysis. Results Of the 292 respondents, the majority (85%) viewed that post-stroke neuropsychiatric symptoms are underdiagnosed. Nearly two-thirds viewed themselves as the healthcare professionals most responsible for diagnosing and managing these symptoms. Despite this, the proportions who were very/extremely confident in diagnosing and managing these symptoms were low: depression (27%), anxiety (26%), apathy (15%), and fatigue (15%). The proportion who often/always screened for these conditions was low, with post-stroke depression (45%), and anxiety (34%) being screened for more often than fatigue (23%) and apathy (17%) Some of the strongest perceived barriers to effective diagnosis and management included other post-stroke complications being higher priority, insufficient time during consultations, insufficient hospital discharge information, and post-stroke cognitive impairment. Conclusions GPs perceive post-stroke neuropsychiatric symptoms as frequently missed, highlighting a critical opportunity for earlier recognition in primary care. Enhanced support and resources are required to improve assessment and management. These findings can guide targeted resource allocation to address barriers in providing mental health care to stroke survivors.
Dysregulation of the Behavioral Approach System (BAS), a neurobiological and psychological system that regulates approach motivation and goal-directed behavior, has been linked to forms of psychopathology, particularly mood disorders. Frontal EEG alpha asymmetry, defined as greater left-than-right frontal alpha band (8-12 Hertz) activity (rLFA), has been used as a neurophysiological marker of the BAS. Although the BAS has been independently linked to both behavioral and emotional dysregulation, examining the interplay of BAS related behaviors and emotions remains less clear, particularly in adolescents. Reduced distress tolerance (DT), a transdiagnostic behavioral marker associated with lower persistence toward goals, may be associated with neurophysiological changes in the BAS. The current study examined the associations among task-induced increase in rLFA, mood instability, and DT in adolescents to examine whether DT is associated with the relationship between BAS-related neural activity and mood instability. Methods Adolescents presenting to a mood disorders clinic (N=57; M age= 14.77, SD=1.83) completed eyes open resting and a frustrating mirror-tracing task, an indicator of behavioral DT, while EEG data were collected. Results Stable or decreasing rLFA from rest to task was associated with greater DT and less mood instability, whereas resting rLFA alone was not associated with either outcome. An indirect-effect model suggested, at a marginal level, (ps = .055-.064 when entered simultaneously), that DT was associated with attenuation of the cross-sectional association between rLFA increase and mood instability. Conclusion The study suggests that smaller increase in rLFA during a distress‑producing task is associated with greater behavioral persistence and lower mood instability and highlights DT as an important treatment target in adolescents with behavioral and emotional dysregulation.
This correspondence raises several methodological and interpretative concerns regarding a recently published study on the global burden of adolescent depressive disorders. We identify issues related to the interpretation of incidence trends, risk factor attribution, projection model validation, citation accuracy, and data reproducibility. We request that the original authors provide clarifications or corrections to maintain the scientific integrity of the published record.
Background Scientific literature continues to indicate significant levels of negative mental health among university students. Thus, mental health remains a concerning dynamic problem evolving with the fast pace of society, variety/novelty of challenging events, and the generational differences in coping strategies. In this cross-sectional study we simultaneously compared mental health and potential stressors in two samples (Germany and United States) of university students. Methods : Utilizing convenience sampling, university students (18+ years; Germany, n=1497; United States (U.S), n= 507) meeting inclusion criteria were administered an anonymous survey consisting of questions assessing demographics, mental health (specifically depression, anxiety and stress), and potential stressors experienced within the university environment. Results : Our sample comprised of a significantly higher percentage of females overall. Age-range was not different between countries. However, median age was significantly higher in the German sample. Significant differences were also present between the two samples in relation to various demographics. Sex differences, within each country, were present in relation to anxiety and stress but not depression, with females scoring higher. The top five sources of stress reported for the two samples where the same. Consideration is necessary, however, of comparability constraints. Conclusion : Despite the limitations, including, but not limited to, in sampling strategy, that limit direct comparisons most especially in relation to the mental health measures, the results highlight the prevalence of negative mental health and similarity in underlying factors/predictors influencing the psychological wellbeing of students, emphasizing the necessity for greater in-depth consideration of common underlying issues that transcend countries and cultures.
Background: Compared to heterosexual adults, sexual minority or queer adults are at an elevated risk for depression and suicidal ideation. Studies have established relationships between minority stress, such as internalized sexual orientation stigma (ISOS), depression, and suicidality. However, no known research has explored relationships between implicit ISOS, explicit ISOS, depression, and suicidality. Methods: The present study uses data from a large national two-wave quantitative panel survey study using a diverse sample of sexual minority adults from the United States (N = 500). Implicit ISOS was measured using a newly developed instrument, the Implicit Internalized Sexual Orientation Stigma Affect Misattribution Procedure (Internal-SOS-AMP). Confirmatory factor analysis was used to evaluate a one-factor model. General structural equation modeling was used to explore pathways and relationships between implicit ISOS, explicit ISOS, depression, and suicidal ideation. Results: Based on prior theory and research, our model is presented depicting relationships between implicit ISOS as a first order factor, explicit ISOS, depressive symptoms, and suicidal ideation. The presented model indicates a statistically significant positive relationship between implicit ISOS and explicit ISOS (β = 0.14, p < .01). As explicit ISOS increased, individuals also reported greater depressive symptoms (β = 0.29, p < .001). Individuals with higher depression levels were about 2.38 times more likely to endorse suicidal ideation in the last month compared to those reporting less depressive symptoms. Age was significantly, inversely related to suicidal ideation endorsement. For each 1-year increase in age, the odds of endorsing suicidal ideation within the last month decreased by approximately 1.5%. Conclusions: Suicide prevention efforts with sexual minority individuals should pay particular attention to developmental considerations for young adult subgroups and be responsive to the distinct forms of implicit and explicit ISOS, and mechanisms that drive the health disparities. Future research suggestions and implications related to sexual minority suicide prevention are discussed.
Olorunlambe et al. provide important evidence linking childhood maltreatment profiles with premenstrual symptom burden among female adolescents using latent class analysis. While the study addresses an underexplored area of adolescent mental and reproductive health, several methodological considerations warrant a more cautious interpretation of the findings. We highlight three issues that may influence the validity and reproducibility of the reported associations. First, the Premenstrual Symptoms Screening Tool for Adolescents (PSST-A) is a screening instrument, and the applied diagnostic threshold appears to differ from the validated scoring algorithm required for provisional PMDD, while confirmed PMDD additionally requires prospective daily symptom ratings across at least two menstrual cycles. Second, clarification is needed regarding the latent class analysis, including inconsistencies in reported fit statistics, indicator coding, and the robustness of the selected three-class solution. Third, although classification error was addressed in distal outcome analyses, potential confounding by depressive symptoms, anxiety, alcohol use, and food insecurity remains insufficiently accounted for. We recommend transparent reporting of the PSST-A scoring algorithm and latent class modeling procedures, together with sensitivity analyses using alternative indicator specifications and covariate-adjusted models. Prospective validation with daily symptom ratings would further distinguish PMDD from premenstrual exacerbation and strengthen the clinical interpretation of the reported associations. Until these issues are addressed, the findings are best interpreted as demonstrating co-occurrence between childhood maltreatment profiles and self-reported premenstrual symptoms rather than confirmed PMDD.
Background: Personal recovery - the subjective experience of living a meaningful life, even despite psychiatric symptoms - is increasingly recognized as a central outcome in mental health care. Reliable assessment is essential to capture changes in patients beyond symptom reduction. However, the 14-item short form of the Recovery Assessment Scale (RAS) lacks comprehensive validation in individuals with depression and anxiety, limiting its interpretability in clinical and research settings. Methods: This study evaluated the psychometric properties of the 14-item German version (RAS-G), following COSMIN(COnsensus-based Standards for the selection of health Measurement Instruments)-guidelines. We conducted a secondary analysis of data from a large randomized controlled trial on mental health video consultations (PROVIDE-C), including 281 adult patients with depression and/or anxiety recruited from 29 primary care practices in Germany. Results: Results supported alignment with the theoretical CHIME recovery framework. Confirmatory factor analysis indicated a five-factor structure. Scalar measurement invariance was demonstrated across gender and age groups, and strict longitudinal invariance was confirmed when accounting for trial group, supporting its use for group comparisons and monitoring change over time. Internal consistency was acceptable to good, six-month test-retest reliability moderate and convergent validity satisfactory. Conclusions: Overall, the RAS-G appears suitable for assessing personal recovery in individuals with depression and anxiety. Its use may complement symptom-based outcomes in clinical trials and routine care. Refinement of specific subscales and evaluation of shorter test-retest intervals are recommended to consolidate these findings. Trial registration: ClinicalTrials.gov NCT04316572
Background The Patient Health Questionnaire-9 (PHQ-9) is widely used to assess depressive symptom severity in clinical practice and research and is recommended in several guidelines. However, most psychometric evaluations have been conducted in general population or mixed clinical samples and have relied predominantly on classical test theory (CTT). Given that CTT assumes equal item weighting and treats ordinal responses as interval-level data, it may obscure variation in item performance and limit the interpretability of summed scores, particularly in diagnostically homogeneous populations. Methods We evaluated the measurement properties of the PHQ-9 in a clinical sample of 628 patients from two outpatient clinics with a major depressive disorder (MDD), using both non-parametric and parametric item response theory (IRT) methods. Results The PHQ-9 demonstrated weak capacity to credibly rank individuals based on summed scores, especially in the presence of psychiatric comorbidity. Exclusion of weaker items resulted in only modest improvements. Additional sources of misfit, including age-related effects and non-uniform item weight, remained. Limitations The findings are based on a clinical outpatient sample and may not generalize to other settings or populations. Conclusions The PHQ-9 may have important limitations as a measure of symptom severity in clinically diagnosed MDD populations. By applying IRT methods in a diagnosis-restricted sample, this study provides a more rigorous evaluation of the scale in its primary target group. The results have implications for the interpretation of PHQ-9 scores in both clinical and research contexts.
Prior research indicates a causal effect of smoking on depression liability, yet the shape of this association remains unexplored. Distinguishing linear from non-linear effects is useful, as each suggests different intervention recommendations. A recent development is non-linear Mendelian Randomization (MR), where analyses are performed in strata with different average exposure levels. However, non-linear MR methods have produced biased estimates under different scenarios. We explore the causal effect of pack years of smoking on depression by performing linear MR and doubly-ranked non-linear MR in a sample of UK Biobank participants. We use two genetic instruments (for cigarettes per day and lifetime smoking) and incorporate sensitivity analyses and positive and negative control outcomes to evaluate potential bias. We found significant associations of genetically predicted packyears with sex and age across both linear and non-linear analyses for some strata, potentially reflecting participation bias. Only for the lifetime smoking instrument, stratified analyses revealed significant causal effects on depression in ‘smoking-exposed strata’. However, no single analysis was ideal, as there were associations with negative control outcomes in some strata. We emphasize the necessity of multiple sensitivity checks and control analyses when interpreting non-linear MR results. A particular concern results from smoothing methods (fractional polynomials) when estimates are much more precise in some strata than others, dominating the shape of the estimate. Overall, our findings provide some evidence supporting smoking as a risk factor for depression, but no strong evidence for deviation from linearity.
Introduction: Workplace mobbing has been increasingly recognized as a relevant psychosocial risk factor associated with adverse mental health outcomes. Persistent exposure to hostile behaviors at work may contribute to emotional distress, psychological disorders, and impaired well-being, yet evidence from Latin American populations remains limited. Understanding the associations of workplace mobbing on multiple mental health indicators is essential for informing prevention and public health strategies. Objective: To analyze the association between workplace mobbing and suicidal ideation, depressive symptoms, generalized anxiety, and sleep quality in adults from the general population. Methods: A associative strategy and quantitative approach were employed. A total of 345 Peruvian adults (51.3% women) residing in Metropolitan Lima participated and completed a sociodemographic survey and psychological instruments. Statistical analyses were conducted using structural equation modelling with latent and observed variables. Results: The model demonstrated an adequate fit, with CFI = 0.98, RMSEA = 0.03 [90% CI: 0.025, 0.045], and SRMR = 0.04. Workplace mobbing was positively and significantly associated with generalized anxiety (β = 0.38, p = 0.001), depressive symptoms (β = 0.37, p = 0.001), sleep quality (β = 0.32, p = 0.001), and suicidal ideation (β = 0.27, p = 0.011). Conclusions: The findings highlight workplace mobbing as a significant association of multiple adverse mental health outcomes in adults. These results underscore the importance of addressing psychosocial risks in occupational settings and support the need for preventive interventions and mental health promotion strategies within a public health framework.
