Background Adverse childhood experiences(ACEs)are strong predictors of psychopathology across the lifespan,exerting extensive adverse effects on physical and mental health during early development.While ACEs increase the risk of childhood psychopathology,sleep quality and impair cognitive function,the early neurobiological mechanisms mediating ACE-induced cognitive impairment remain unclear.Objective To explore the association between ACEs exposure and the risk of psychopathology,sleep disorders,and cognitive function,and to examine the mediating role of the putamen volume in the relationship between ACEs and cognitive function from a neurodevelopment perspective.Methods Data were obtained from the Adolescent Brain Cognitive Development(ABCD)study,comprising 10 572 children aged 9 to 10.Participants were categorized into five groups based on the cumulative score of ACEs reported by their parents and the children themselves:no-exposure group(0 types of ACEs),the one-exposure group,the two-exposure group,the three-exposure group,and the high-risk exposure group(≥4 types of ACEs).Logistic regression analysis was employed to evaluate the association between ACEs and psychopathological symptoms[T score of the Child Behavior Checklist(CBCL)≥65].Multiple linear regression analysis was ultilized to analyze the correlations between ACEs and the scores of the Sleep Disturbance Scale for Children(SDSC),the NIH Toolbox Cognition Battery(NIHTB-CB),as well as the multiple structures in the cerebral cortex and subcortex.The Bootstrap method was applied to test the mediating effect of the putamen volume between ACEs and neurocognitive function.Results After adjusting for confounders,ACEs cumulative score was correlated with children's psychopathological symptoms in a dose-response manner.Compared with the no-exposed group,the high-risk exposure group had a 2.08-fold(OR=2.080,95%CI:1.401-3.088)increased risk of internalizing problems and a 3.13-fold(OR=3.132,95%CI:1.703-5.760)increased risk of externalizing problems,and the risk of conduct problems was 4.68 times that of the no-exposed group(OR=4.681,95%CI:2.528-8.669).ACEs cumulative score positively predicted the total score of SDSC(β=0.080,95%CI:0.059-0.102),with relatively stronger predictive effects on sleep-wake transition disorder(β=0.086,95%CI:0.063-0.109)and sleep onset and maintenance disorder(β=0.066,95%CI:0.043-0.089).In terms of neurocognition and brain structure,ACEs cumulative score negatively predicted the overall cognitive composite score(β=-0.025,95%CI:-0.050--0.001),the crystallized cognitive composite score(β=-0.035,95%CI:-0.060--0.010),the volume of the left putamen nucleus(β=-0.025,95%CI:-0.046-0.003),and the volume of the right putamen nucleus(β=-0.023,95%CI:-0.044-0.003).The total putamen volume played a partial mediating role between ACEs and the overall cognitive composite score,the effect value was-0.002(95%CI:-0.004--0.001),accounting for 7.49%of the total effect.Conclusion ACEs exposure may increase the risk of psychopathological and sleep disturbances in children and may impair neurocognitive function.Reduced putamen volume may serve a potential neurobiological pathway underlying the impact of ACEs on childhood cognition.
Background Current studies on the relationship between depressive symptoms and the risks of stroke and all-cause mortality mostly focus on the elderly population or high-risk groups with chronic diseases.The long-term impact of depressive symptoms in young and middle-aged people on the risks of stroke and all-cause mortality still lacks systematic assessment,and the relevant evidence is insufficient.Objective To explore the association between depressive symptoms and the risks of stroke and all-cause mortality in young and middle-aged adults,thereby expanding the risk evidence in this age group and providing epidemiological basis for early identification of high-risk individuals and the development of targeted intervention strategies.Methods Based on data from the National Health and Nutrition Examination Survey(NHANES)database(2009-2018),a total of 14 947 young and middle-aged respondents aged 18 to 64 were included as the research subjects.Logistic regression and restricted cubic spline(RCS)models were employed to examine the association between depressive symptoms and stroke.Cox proportional hazards model,RCS model,and Kaplan-Meier(K-M)survival curves were used to clarify the relationship between depressive symptoms and all-cause mortality risk.To verify the robustness of main findings,sensitivity analysis was conducted stratified by gender,hypertension,diabetes,hyperlipid-emia,body mass index(BMI),and age.Results Logistic regression analysis revealed that compared with the non-depressed group,the risk of stroke in the mild depression group increased by 53.50%(OR=1.535,95%CI:1.147-2.053),while the moderate-to-severe depression group showed the highest risk with a 132.90%increase(OR=2.329,95%CI:1.733-3.129).RCS analysis indicated an approximately linear dose-response relationship between PHQ-9 score and the risk of stroke(Pfor non-linearity=0.089),with stroke risk increasing as PHQ-9 scores rose.As the PHQ-9 score increased,the risk of stroke also showed an upward trend.Cox regression analysis demonstrated that compared with the non-depressed group,the risk of all-cause mortality in the mild depression group increased by 48.80%(HR=1.488,95%CI:1.164-1.902),and the moderate-to-severe depression group had a 70.60%increased risk(HR=1.706,95%CI:1.310-2.221).RCS analysis showed a linear dose-response relationship between PHQ-9 scores and all-cause mortality risk(Pfor non-linearity=0.440).K-M curves indicated that as the severity of depressive symptoms increases,the risk of all-cause mortality gradually rises(P<0.05).Sensitivity analysis confirmed that the associations between depression symptoms and risks of stroke and all-cause mortality were not modified by gender,hypertension,diabetes,hyperlipid-emia,BMI,or age,demonstrating robust findings.Conclusion Among the young and middle-aged population,both mild and moderate-to-severe depression were associated with increased risks of stroke and all-cause mortality,with the moderate-to-severe depression group showed more pronounced risk elevations.A positive dose-response relationship was observed between depressive symptoms and these risks.
Background The global prevalence of depressive disorders is high,with a significant treatment gap remaining.Escitalopram oxalate,as a commonly used antidepressant in clinical practice,has a single target and is prone to cause adverse reactions such as gastrointestinal discomfort.The traditional Mongolian medicine Zadi-5 pills has a multi-target anti-depression mechanism and unique advantages such as improving the intestinal flora.However,there is currently a lack of randomized controlled trial evidence for the combined treatment of first-episode depression,along with insufficient research on its metabolic safety and potential drug interactions.Objective To explore the efficacy and safety of Zadi-5 pills combined with escitalopram oxalate in the treatment of the first-episode depression,so as to provide references for Mongolian medicine in depression management.Methods A randomized controlled trial was conducted.A total of 103 patients with first-episode depression who were treated in the outpatient or inpatient departments of the Inner Mongolia Autonomous Region Mental Health Center from January 2023 to December 2024 and met the diagnostic criteria for depressive episode as defined in International Classification of Diseases,tenth edition(ICD-10)were included.Random numbers were generated using the RAND function in Excel software,and the patients were divided into the study group(n=52)and the control group(n=51).Both groups received escitalopram oxalate treatment,starting from 5 mg/d and gradually increasing to 20 mg/d.The study group additionally received Zadi-5 pills,13 pills per day.The treatment duration for both groups was 6 weeks.Before treatment and at the 2nd,4th,and 6th weeks of treatment,the severity of depressive symptoms was evaluated using the Hamilton Depression Scale-24 item(HAMD-24).At these time points,blood was collected on an empty stomach at 7∶00 for the detection of liver function(aspartate aminotransferase,alanine aminotransferase),triglycerides,and the blood concentration of escitalopram oxalate.Results A total of 100 patients completed the study,with 50 cases in the study group and the control group.The results of the repeated measures ANOVA showed that the interaction effect between group and time in the HAMD-24 score was statistically significant(F interaction=18.070,P<0.01).At the end of the 4th and 6th weeks of treatment,the HAMD-24 score of the study group was lower than those of the control group(P<0.05).At each time point after treatment,the reduction rate of the HAMD-24 score in the study group was higher than those of the control group,and the differences were all statistically significant(P<0.05).The interaction effect between the triglyceride level groups and time was statistically significant(Finteraction=3.381,P<0.05).After treatment,the triglyceride levels in the study group showed a downward trend,while those in the control group showed an upward trend.There was no statistically significant interaction effect between the groups and time for liver function(aspartate aminotransferase and alanine aminotransferase)and the blood concentration of escitalopram oxalate(P>0.05).Conclusion Compared with escitalopram oxalate treatment alone,the combination of Zadi-5 pills and escitalopram oxalate is more effective in treating the first-episode depression,without increasing the risk of liver damage.The combined medication may have a potential beneficial effect on lipid metabolism.
Background Non-suicidal self-injury(NSSI)behavior has become a global public health concern affecting the physical and mental health of adolescents.The experiential avoidance model posits that childhood trauma contributes to NSSI behavior through the mediating pathway of emotional dysregulation.However,existing research has predominantly focused on isolated psychological or social factors,with limited attention to their interactive effects of emotional dysregulation and social anxiety,both of which fall within the psychosocial domain.Objective To examine the relationship between childhood trauma and NSSI among adolescents,and to analyze the mediating role of emotional dysregulation and the moderating role of social anxiety,so as to provide evidence for targeted interventions for NSSI behavior of adolescents.Methods A total of 282 adolescent inpatients who consecutively admitted to the Department of Psychiatry of Guangdong Provincial People's Hospital from March to December 2025 and met the Diagnostic and Statistical Manual of Mental Disorders,fifth edition(DSM-5)criteria for NSSI were enrolled as study participants.Participants were assessed using the general information questionnaire,the Adolescent Self-Harm Questionnaire,the Childhood Trauma Questionnaire(CTQ),the Difficulties in Emotion Regulation Scale(DERS),and the Social Anxiety Scale for Adolescents(SAS-A).Pearson correlation analysis was used to examine correlations among scale scores.model 4 and model 58 of the Process 4.1 were used to test the mediating effect of emotional dysregulation and the moderating effect of social anxiety,respectively.Results CTQ score was positively associated with score of the Adolescent Self-Injury Questionnaire(r=0.279,P<0.01).Emotional dysregulation significantly partially mediated the relationship between childhood trauma and NSSI behavior,with a mediating effect of 0.112(95%CI:0.043-0.208),accounting for 40.14%of the total effect.Social anxiety moderated the association between childhood trauma and emotional dysregulation,the effect value was 0.102(95%CI:0.008-0.196),as well as the relationship between emotional dysregulation and NSSI behavior,the effect value was 0.130(95%CI:0.033-0.226).Conclusion Emotional dysregulation may mediate the relationship between childhood trauma and NSSI behavior among hospitalized adolescents,while social anxiety moderates both the first and second paths of this mediating process.
Background Negative emotions are core predictors of adolescent mental health.While existing research has predominantly focused on the impact of risk factors such as negative life events and rumination on adolescents'emotions,the protective role of the family,particularly parental involvement,has received less attention.Consequently,the integrated mechanism connecting negative life events,rumination,parental involvement and negative emotions remains insufficiently clarified.Objective To elucidate the mechanisms linking negative life events to negative emotions in adolescents,and to verify the mediating role of rumination and the moderating role of parental involvement,so as to provide a theoretical basis for relevant prevention and intervention.Methods A cross-sectional study was conducted in June 2025.A total of 600 adolescents from a middle school in Liangshan Yi Autonomous Prefecture,Sichuan Province,were recruited through cluster random sampling.Participants completed the Adolescent Self-rating Life Events Checklist(ASLEC),the Rumination Response Scale(RRS),parental involvement subscale of the Perception of Parents Scales(POPS),and the Chinese short version of Depression Anxiety and Stress Scale(DASS-21).Pearson correlation analysis was performed to examine the correlations among all variables.Model 4 and model 7 embedded in Process macro 4.1 were employed to separately test the mediating effect of rumination between negative life events and negative emotions of adolescents,as well as the moderating effect of parental involvement.Results Ultimately,534 valid questionnaires were obtained,yielding a valid response rate of 89.00%.ASLEC score and RRS score were positively correlated with DASS-21 scores(r=0.580,0.706,P<0.01),and ASLEC score was also positively correlated with RRS score(r=0.583,P<0.01).Rumination acted as a partial mediator between negative life events and negative emotions,with an indirect effect of 0.531(95%CI:0.438-0.630),accounting for 55.60%of the total effect.Parental involvement significantly moderated the first stage of the mediating pathway(β=-0.109,P<0.05).Conclusion In adolescents,rumination serves as a partial mediator in the relationship between negative life events and negative emotions,and parental involvement further moderates the predictive relationship from negative life events to rumination.
