Objectives Socioeconomic status (SES) is generally considered to exert a positive influence on subjective well-being (SWB). However, under the current economic downturn context, this relationship has become increasingly complex. Psychosomatic symptoms, as important factors affecting SWB, may play a crucial role. This study aimed to systematically examine their interrelationships. Methods A nationwide cross-sectional online survey was conducted, collecting data on objective SES (oSES), subjective SES (SSS), psychosomatic symptoms, and SWB. A total of 27,876 valid participants (female, 65.9%) were included. Structural equation modeling, subgroup stratification, and mediation analyses were employed to evaluate the associations among these variables. Results In the overall sample, oSES was significantly and positively associated with SSS, but negatively associated with SWB. Psychosomatic symptoms showed strong negative associations with SWB and significantly mediated the relationship between oSES and SWB, accounting for 40.9% of the total effect. Fatigue, irritability or suicidal ideation, and pain emerged as the most influential mediators. Subgroup analyses indicated notable heterogeneity across age and SES groups. Conclusions In today's socioeconomic context, the association between SES and SWB has shifted, with psychosomatic symptoms serving as a key mediating mechanism. Efforts to enhance SWB should focus not only on socioeconomic resource distribution but also on the early detection and management of psychosomatic symptoms.

Objectives: While post-COVID symptoms are well-documented, symptoms following non-SARS-CoV-2 recent respiratory tract infections (RRIs) remain understudied. This study aimed to investigate the prevalence, associated factors of symptoms following RRIs. Methods: A nationwide cross-sectional survey of 61,012 adults was conducted between December 2023 and January 2024. Self-reported RRIs within one month, SARS-CoV-2 infections, infection times and severity of COVID-19 were documented. Psychosomatic symptoms, subjective cognitive and well-being were measured using brief psychosomatic symptom scale (BPSS), brief brain fog scale (BBFS) and 5-item World Health Organization well-being index (WHO-5). Logistic and linear regressions and pathway analyses were used to examine associated factors. Results: Among 15,715 participants reporting RRIs, 40.8% exhibited psychosomatic symptoms (vs. 25.6% in non-RRI group, FDR-adjusted P < 0.05) and 17.5% reported cognitive symptoms (vs. 9.0%, FDR-adjusted P < 0.05). The most prevalent symptoms included sleep difficulty (18.2%), depression (16.7%), and pain (15.2%). RRIs was more strongly associated with most symptoms than SARS-CoV-2 (OR: 1.41-2.02 vs. 0.88-1.37). Socioeconomic status (OR < 1, FDR-adjusted P < 0.05) and comorbidities (OR > 1, FDR-adjusted P <0.05) were associated with these symptoms. Participants with both RRIs and previous SARS-CoV-2 infections exhibited increased symptom burdens (psychosomatic: 41.6%; cognitive: 18.0%). Psychosomatic and cognitive symptoms accounted for 71.7% (95% CI: 68.2%-75.4%) and 56.3% (95% CI: 53.1%-59.7%) effects of RRIs on well-being. Conclusion: RRIs were associated with higher symptom reporting than COVID-19 exacerbated by socioeconomic disparities and comorbidities. Our preliminary findings call for integrated frameworks in practice that managing psychosomatic and cognitive symptoms and socioeconomic factors.

Insight impairment is a core clinical feature of schizophrenia that predicts poor treatment adherence and unfavorable prognosis. Genetic factors have been increasingly recognized as a likely basis for inter-individual variability in insight; however, direct evidence for a complete mechanistic chain—from specific genetic variants through insight impairment to clinical outcomes—remains to be established. We enrolled 233 antipsychotic-free patients with first-episode schizophrenia. Five SNPs previously implicated in insight (SOX2-OT rs1479165 and DISC1 rs821616, rs821597, rs821633, rs6675281) were genotyped. Insight was assessed using the Birchwood Insight Scale (BIS) and treatment response was measured as PANSS reduction rate at 8 weeks. Mediation analysis, brain expression quantitative trait locus (eQTL) (GTEx v8), and STRING protein–protein interaction network were integrated to explore the pathway from genotype to clinical outcome. The SOX2-OT rs1479165 C allele was significantly associated with better insight (β = 2.03, p < 0.001). Baseline BIS score significantly predicted PANSS reduction rate (β = 3.175, p < 0.001). Mediation analysis demonstrated that the effect of SOX2-OT on treatment response was predominantly mediated by baseline insight (ACME = 6.11, 95

Major Depressive Disorder (MDD) is characterized by abnormal metabolic profiles along the microbiome-gut-brain axis. Bile acids (BAs), a class of steroid compounds regulated by the host and microbes, are increasingly shown to become dysregulated in models of depression. However, the identity of key regulatory BA metabolite in patients with MDD and associated mechanism remain to be clarified. Here, a prospective observational study in patients with depression (n = 235) and control subjects (n = 232) for identifying functional BA metabolites regulating depressive behavior and brain functional connectivity is performed. Using comparative metabolomics assay, an increased level of taurocholic acid (TCA) in the serum of patients with MDD is observed, which is reversed by anti-depressant treatments. Transferring fecal microbiome from patients with MDD induced TCA accumulation to the hippocampus of recipient mice exhibiting depression-like behavior. TCA supplementation suppressed hippocampal neurogenesis, triggered microglial activation, and elicited depression-like behavior in mice, which are alleviated by a sphingosine-1-phosphate receptor 2 (S1PR2) antagonist. In patients with MDD, functional neuroimaging and spearman correlation analysis revealed that circulating TCA is strongly correlated with functional connectivity in the subregions of hippocampus. The results highlight the potential of harnessing TCA as a prognostic marker and therapeutic target for depression.

BackgroundThe investigation of personality alterations in temporal lobe epilepsy (TLE) constitutes a complex and demanding field of research. These alterations may be intricately linked to neuroinflammation, imaging changes, and electrophysiological irregularities.ObjectiveThis study aims to explore the potential value of the peripheral inflammatory indices, video electroencephalogram (VEEG), hippocampal magnetic resonance imaging (MRI) as biomarkers for personality changes in patients with TLE.MethodsA total of 110 individuals with TLE were categorized into two groups: 55 patients exhibiting personality alterations and 55 patients without personality abnormalities. A supplementary cohort of 150 healthy individuals was enlisted as a control group. Demographic information, clinical attributes, inflammatory biomarkers, hippocampus MRI, and video EEG data were gathered and subjected to statistical analysis utilizing SPSS software.ResultsIn comparison to the healthy control group, patients with TLE demonstrated markedly reduced counts of neutrophils, lymphocytes, and platelets, although the monocyte-to-lymphocyte ratio (MLR) was considerably elevated (all P<0.05). The cohort exhibiting personality alterations demonstrated an extended disease duration, an elevated incidence of hippocampal sclerosis or atrophy on MRI, and a reduced rate of monotherapy relative to the cohort without personality alterations (P<0.05). Binary logistic regression research indicated no significant correlation between personality alterations in patients with TLE and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), MLR, systemic immune-inflammation index (SII), or pan-immune-inflammation value (PIV).ConclusionsMLR was markedly elevated in patients with TLE relative to healthy controls. Hippocampal sclerosis or atrophy constituted an independent risk factor for personality alterations in TLE, although monotherapy seemed to serve as a protective factor.

Objectives Growing attention has been directed toward the structural and functional alterations among individuals infected with COVID-19. However, data on its impact on patients with Major Depressive Disorder (MDD) remain limited. Methods This study investigates the effects of COVID-19 on patients with MDD and healthy controls (HCs) using MRI scans. Participants were categorized into four groups: MDD patients before (n=165) and after COVID-19 infection (n=70), HCs before (n=108) and after COVID-19 infection (n=57). All participants underwent T1-weighted imaging, diffusion tensor imaging (DTI), and resting-state functional MRI from January 2022 to August 2023. Results Structural alterations associated with COVID-19 were predominantly observed in the white matter (WM) rather than the gray matter (GM), with specific involvement noted in the superior longitudinal fasciculus tract, Forceps minor tract, and cingulum-cingulate gyrus tract among patients with MDD. Functional changes were spread from GM to WM. The bilateral supplementary motor area, the left angular gyrus, the left subcortical regions (amygdala and parahippocampal gyrus), and various WM tracts showed significant infection-related changes across groups. Conclusion COVID-19 infection induces significant microstructural damage of WM in healthy individuals and exacerbates white matter microstructural injury of MDD. These findings suggest that WM might be more susceptible to COVID-19 effects than GM in both MDD patients and HCs.

Background Traditional studies on brain functional connectivity in major depressive disorder (MDD) predominantly focused on gray matter (GM), often overlooking the critical role of white matter (WM). The integrative gray-white-gray (G-W-G) communication connectivity framework highlighted WM as a key bridge influencing whole-brain communication. Methods G-W-G communication framework was constructed using signals of GM and WM from resting-state functional magnetic resonance imaging data of 325 MDD patients and 177 healthy controls, then applied to explore its clinical relevance in symptomatology and treatment response. Results The results revealed that G-W-G communication connectivity in MDD was disrupted, primarily mediated by functional disruptions in WM, including the anterior limb of the internal capsule, sagittal stratum, cingulum, splenium of the corpus callosum, fornix, and superior longitudinal fasciculus. Notably, the left anterior limb of the internal capsule potentially bridged disrupted connectivity and suicidal symptoms, while several G-W-G connections showed potential for predicting antidepressant efficacy. Limitations Future investigations with larger, multi-center cohorts are warranted to validate the present findings. Additionally, longitudinal and multimodal approaches are needed to clarify the causal role of the G-W-G framework in the pathophysiology and treatment of MDD. Conclusions By treating GM and WM as an integrated functional network, the G-W-G neural circuits provide novel insights into the pathophysiology of MDD, highlight its potential as a target for clinical intervention.

Psychosomatic refers to an illness in which stress causes or exacerbates physical symptoms, and it may occur in transient or along with more acute mood disorders. The current study aimed to enhance understanding of the prevalence and cultural factors affecting psychosomatic symptoms, depression, and anxiety in China and Pakistan. A comparative cross-cultural study was conducted using a non-probability sampling technique. A total of 1633 samples were collected, including 598 healthy controls (300 from China and 298 from Pakistan) and 1035 patients (521 from China and 514 from Pakistan). Three assessment tools were utilized: Psychosomatic symptom scale (PSSS), patient health questionnaire-9, and generalized anxiety disorder-7. There were significant differences in the symptoms of patients and control groups with psychosomatic symptoms, depression, and anxiety in both countries. Post hoc testing revealed that Pakistani patients with mood disorders reported more psychosomatic symptoms than Chinese patients (p<0.001), whereas the Chinese control group had more psychosomatic symptoms than the Pakistani control group (p=0.001). Analysis of PSSS ratings in Chinese patients demonstrated a strong correlation between “depressed mood” and “loss of interest.” Pakistani PSSS displayed strong correlations on the somatic subscale and psychological subscale. In the present study, Pakistani patients exhibited higher levels of psychosomatic complaints, depression, and anxiety compared to Chinese patients. Notably, network analysis reveals that Pakistani patients displayed more physical symptoms, whereas Chinese patients experienced more psychological symptoms.

Abstract Background Type 2 diabetes patients display complex psychosomatic symptoms, but the key variables and their interactions remain poorly understood. Aims & Objectives We aimed to explore the networks and predictivities among psychosomatic symptoms, demographics, and clinical characteristics of type 2 diabetes. Method 412 type 2 diabetes patients and 422 healthy controls were recruited. The demographics, the Diagnostic Criteria for Psychosomatic Research-Revised Semi-Structured Interview (DCPR-R SSI), and the Psychosomatic Symptom Scale (PSSS) were used. Clinical characteristics, including glycated hemoglobin (HbA1c) and high-density lipoprotein (HDL), were tested. Flow network analyses were applied to psychosomatic symptoms. Then, a predictability network of psychosomatic symptoms, demographics, and clinical characteristics was constructed. Results Compared to healthy controls, the type 2 diabetes networks showed significantly stronger edge connections (global strength type 2 diabetes/healthy controls = 3.56/2.23, p <0.001), especially between PSSS somatic factor and persistent somatization (edge weight difference = 0.29, p <0.001), allostatic overload, and demoralization (edge weight difference = 0.32, p <0.001). The comprehensive network showed high predictability in work (62.5%), sex (43.8%), age (37.8%), diabetes duration (13%), HDL (11.4%), and HbA1c (7.6%), in addition to psychosomatic manifestations. Discussion and Conclusion This study not only provides a novel framework for understanding the psychosomatic symptoms specific to type 2 diabetes but also offers robust evidence for targeted interventions for these complex symptoms.

Abstract Background Coronavirus disease-2019(COVID-19) infection has been reported to be associated with multiple neuropsychiatric complications including depression, insomnia, cognitive impairment, and anosmia. However, information on brain alterations in individuals affected by COVID-19 is limited. Consistently, Major Depressive Disorder(MDD) patients also have specific structural and functional brain abnormalities. Aims & Objectives We aimed to identify the existence of potential brain changes related to COVID-19 in healthy populations and MDD, comparing individuals with COVID-19 and without COVID-19. Method We enrolled 2 populations (healthy population and MDD), four cohorts: 57 healthy controls (HC) with COVID-19, 108 age- and gender-matched HC without COVID-19; 79 MDD with COVID-19, 165 MDD without COVID-19. For all subjects, we acquired T1-weighted MRI, fMRI, and diffusion tensor imaging(DTI), calculated regional cortical thickness, surface area, subcortical volume, Amplitude of Low- Frequency Fluctuations(ALFF), regional homogeneity(ReHo), functional connectivity(FC), fractional anisotropy (FA), and mean diffusivity(MD) to quantify Gray and white matter structural and functional abnormalities. Group comparisons were analyzed with ANCOVA, and bonferroni correction was applied for multiple comparisons. Results We found widespread decreased FA values(PBonferroni<0.05) in HC with COVID-19 compared to HC without COVID-19 in 20 white matter tracts, ALFF and ReHo values in white matter tracts between HC with and without COVID-19 had no significant differences after Bonferroni correction. In gray matter, there were no significant differences in cortical thickness, surface area, subcortical volume, ALFF, ReHo, and FC between the two groups. Our study also found FA values were decreased in bilateral Superior longitudinal fasciculus, left Anterior thalamic radiation, left Cingulum (cingulate gyrus), and Forceps minor in MDD with COVID-19 compared to MDD without COVID-19(PBonferroni<0.05). Likewise in healthy populations, ALFF and ReHo values in white matter tracts had no significant differences after Bonferroni correction between the two groups in MDD. In gray matter, we found ALFF values were increased in left Amygdala, left Parahippocampal gyrus, and bilateral Supplementary motor area, and decreased in left Angular gyrus in MDD with COVID-19 compared to MDD without COVID-19. Other gray matter indicator (cortical thickness, surface area, subcortical volume, ReHo, FC) had no significant differences among two MDD groups. Discussion & Conclusion COVID-19 significantly impairs the microstructure of white matter fibers in healthy individuals, and exacerbated white matter fibers’ microstructural injury of MDD. Of note, the appearance of COVID-19 induced functional impairment precedes structure impairment of grey matter in MDD. Our study results highlighted that the potential influence of COVID-19 in future neuroimaging studies should be fully considered, especially in white matter studies.

BACKGROUND:Gut microbial disturbance has been widely confirmed in mood disorders. However, little is known about whether gut microbial characteristics can distinguish major depressive disorder (MDD), bipolar depression (BP-D), and bipolar mania (BP-M). METHODS:This was a prospective case-control study. The composition of gut microbiota was profiled using 16S ribosomal RNA (rRNA) gene sequencing of fecal samples and compared between healthy controls (HC; n = 46), MDD (n = 51), BP-D (n = 44), and patients with BP-M (n = 45). RESULTS:Gut microbial compositions were remarkably changed in the patients with MDD, BP-D, and BP-M. Compared to HC, distinct gut microbiome signatures were found in MDD, BP-D, and BP-M, and some gut microbial changes were overlapping between the three mood disorders. Furthermore, we identified a signature of 7 operational taxonomic units (OUT; Prevotellaceae-related OUT22, Prevotellaceae-related OUT31, Prevotellaceae-related OTU770, Ruminococcaceae-related OUT70, Bacteroidaceae-related OTU1536, Propionibacteriaceae-related OTU97, Acidaminococcaceae-related OTU34) that can distinguish patients with MDD from those with BP-D, BP-M, or HC, with area under the curve (AUC) values ranging from 0.910 to 0.996. CONCLUSION:Our results provide the clinical rationale for the discriminative diagnosis of MDD, BP-D, and BP-M by characteristic gut microbial features.

ObjectivesConvulsive status epilepticus (CSE) is a major subtype of status epilepticus that is known to be closely associated with systemic inflammation. Some important inflammatory biomarkers of this disorder include the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune inflammation index (SII), and pan-immune inflammation value (PIV). This study aimed to determine the NLR, PLR, MLR, SII, and PIV levels before and after treatment in adult patients with CSE and investigated the relationship of these parameters with disease severity.MethodsThis retrospective study analyzed data from 103 adult patients with CSE and 103 healthy controls. The neutrophil, monocyte, platelet, and lymphocyte counts, as well as the NLR, PLR, MLR, SII, and PIV, were compared in adult patients with CSE during acute seizures (within 2 h of admission) and after treatment relief (1–2 weeks of complete seizure control). Furthermore, multivariate linear regression analysis investigated the relationship between NLR, PLR, MLR, SII, and PIV with the Status Epilepticus Severity Score (STESS).ResultsThe data revealed significant differences (p < 0.05) in neutrophils, monocytes, lymphocytes, NLR, PLR, MLR, SII, and PIV between adult patients with CSE during acute seizures and after treatment relief. The average neutrophil count was high during acute seizures in the patient group and decreased after remission. In contrast, the average lymphocyte count was lower after remission (p < 0.05). Furthermore, significant differences (p < 0.05) were observed in monocytes, lymphocytes, platelets, NLR, PLR, MLR, and PIV levels between adult patients with CSE after remission and the healthy control group. Multivariate linear regression analysis showed no significant correlation between NLR, PLR, MLR, SII, and PIV with STESS.ConclusionThe results of this study indicated that adult patients with CSE experienced a transient systemic inflammatory response during acute seizures, which gradually returned to baseline levels after remission. However, there was a lack of robust clinical evidence correlating the severity of adult CSE and systemic inflammatory response.

Objective: Panic disorder (PD) is a common disabling condition characterized by recurrent panic attacks. Emotional and behavioral impairments are associated with functional connectivity (FC) and network abnormalities. We used whole-brain FC, modular networks, and graph-theory analysis to investigate extensive network profiles in PD. Methods: Functional magnetic resonance imaging (fMRI) data from 82 subjects with PD and 97 healthy controls were included. Intrinsic FC between each pair of 160 regions, six intra-network, and 15 inter-network FCs were analyzed. Topological properties were explored. Results: PD patients showed altered FCs within the right insula, between frontal cortex-posterior cingulate cortex (PCC), frontal cortex-cerebellum, and PCC-occipital cortex (corrected p < 0.001). Lower connections within the sensorimotor network (SMN) and SMN-occipital network (OCN) were detected (p < 0.05). Various decreased global and local network features were found in PD (p < 0.05). In addition, significant correlations were found between PD symptoms and nodal efficiency (Ne) in the insula (r = -0.273, p = 0.016) and intra-insula FC (r = -0.226, p = 0.041). Conclusion: PD patients present with abnormal functional brain networks, especially decreased FC and Ne within the insula, suggesting that dysfunction of information integration plays an important role in PD.

BackgroundDue to the high heterogeneity of schizophrenia, the factors influencing social cognitive impairment are controversial. The purpose of this study was to investigate the social cognitive dysfunction of deficit schizophrenia (DS), and to explore its clinical impact on the clinical characteristics and neurocognitive function assessment results.MethodsThis study involved 100 DS patients, 100 non-deficit schizophrenia (NDS) patients, and 100 healthy controls (HC). Social cognitive functions were assessed using the Eye Complex Emotion Discrimination Task (ECEDT), Game of Dice Task (GDT), and Iowa Gambling Task (IGT), while neurocognitive functions were examined using the Clock Drawing Task (CDT), the Verbal Fluency Task (VFT), Digit Span Test (DST), Stroop Color-word Test (SCWT), and Trail Making Test (TMT). We analyzed the differences in cognitive function among the three groups of patients and the correlation between cognitive function assessment results and Positive and Negative Syndrome Scale (PANSS) scores.ResultsComparison of neurocognitive functions among the three groups through CDT, VFT, DST, SCWT, and TMT revealed that in the values of these tests in the DS group differed significantly from those of the NDS and HC groups. However, the DSB of the NDS group was lower and the TMT results were significantly higher than those of the HC group. In the DS group, ECEDT emotion recognition was positively correlated with stroop colors and stroop interference; the score of gender recognition was positively correlated with VFT, DSF, and SCWT, and TMT-B; the total time spent was positively correlated with TMT; The GDT risky option was negatively correlated with VFT, DST, stroop word, and stroop interference; the negative feedback utilization was negatively correlated with PANSS-Negative; TMT was positively correlated with VFT; IGT was positively correlated with CDT, VFT, DST, and SCWT, but it was negatively correlated with PANSS-Negative and TMT, with statistically significant.ConclusionThere are significant social cognitive impairments in the perception of social information, judgment and resolution of social problems in deficit schizophrenia, which are closely related to negative symptoms and multidimensional neurocognitive dysfunction such as attention, learning, memory, brain information processing speed, cognitive flexibility, and functional executive power.

Gene-environment interactions shape behavior and susceptibility to depression. However, little is known about the signaling pathways integrating genetic and environmental inputs to impact neurobehavioral outcomes. We report that gut G-protein-coupled receptor, Gpr35, engages a microbe-to-brain metabolic pathway to modulate neuronal plasticity and depressive behavior in mice. Psychological stress decreases intestinal epithelial Gpr35, genetic deletion of which induces depressive-like behavior in a microbiome-dependent manner. Gpr35-/- mice and individuals with depression have increased Parabacteroides distasonis, and its colonization to wild-type mice induces depression. Gpr35-/- and Parabacteroides distasonis-colonized mice show reduced indole-3-carboxaldehyde (IAld) and increased indole-3-lactate (ILA), which are produced from opposing branches along the bacterial catabolic pathway of tryptophan. IAld and ILA counteractively modulate neuroplasticity in the nucleus accumbens, a brain region linked to depression. IAld supplementation produces anti-depressant effects in mice with stress or gut epithelial Gpr35 deficiency. Together, these findings elucidate a gut microbe-brain signaling mechanism that underlies susceptibility to depression.

Background: Depression is a heritable brain disorder. Laminin genes were recently identified to affect the brain's overall thickness through neurogenesis, differentiation, and migration in depression. This study aims to explore the effects of the LAMA2's single nucleotide polymorphisms (SNP), a subunit gene of laminin, on the detected brain regions of patients with major depressive disorder (MDD). Methods: The study included 89 patients with MDD and 60 healthy controls with T1-weighted structural magnetic resonance imaging and blood samples for genotyping. The interactions between LAMA2 gene SNPs and diagnosis as well as duration of illness (DOI) were explored on brain measures controlled for age, gender, and site.Results: The right transverse temporal gyrus and right parahippocampal gyrus showed reduced thickness in MDD. Almost all seven LAMA2 SNPs showed significant interactions with diagnosis on both gyrus (corrected p < 0.05 or trending). In MDD, rs6569604, rs2229848, rs2229849, rs2229850, and rs2784895 interacted with DOI on the right transverse temporal gyrus (correctedp < 0.05), not the right parahippocampal gyrus.Conclusion: The thickness of the right transverse temporal gyrus in patients with MDD may be affected by LAMA2 gene and

An unseen wave of vast infection was detected in China in December 2022, and healthcare workers faced inevitable challenges and heavy stress. We aimed to present a dynamic mental health map and, most importantly, provide a timely report of the current situation in healthcare workers. The current study conducted four national cross-sectional online surveys from February and March 2020, Apr 2022, and Jan 2023. The Psychosomatic Symptom Scale (PSSS) and Perceived Stress Scale-10 (PSS-10) were used to assess psychosomatic symptoms and perceived stress. Fourteen thousand nine hundred forty-five participants (8578 healthcare workers and 6367 others) participated in the surveys. The prevalence of psychosomatic syndrome, reflected by PSSS, was 19.3% (Wave1), 22.9% (Wave2), 36.4% (Wave3), and 60.7% (Wave4) among healthcare workers, compared to 24.0% (Wave1), 35.7% (Wave2), 34.2% (Wave3) and 50.5% (Wave4) among the others. In addition, healthcare workers exhibited lower PSSS total scores at the beginning but higher in later waves. Despite their infection status, they now suffer from more severe psychosomatic symptoms than the rest of society. Our findings suggest that healthcare workers in China have now experienced severe psychosomatic symptoms and tremendous stress. Therefore, there is an urgent need to utilize social support for them.

Background: Childhood trauma, low social support, and alexithymia are recognized as risk factors for major depressive disorder (MDD). However, the mechanisms of risk factors, symptoms, and corresponding structural brain abnormalities in MDD are not fully understood. Structural equation modeling (SEM) has advantages in studying multivariate interrelationships. We aim to illustrate their relationships using SEM.Methods: 313 MDD patients (213 female; mean age 42.49 years) underwent magnetic resonance imaging and completed assessments. We integrated childhood trauma, alexithymia, social support, anhedonia, depression, anxiety, suicidal ideation and cortical thickness into a multivariate SEM.Results: We first established the risk factors-clinical phenotype SEM with an adequate fit. Cortical thickness results show a negative correlation of childhood trauma with the left middle temporal gyrus (MTG) (p = 0.012), and social support was negatively correlated with the left posterior cingulate cortex (PCC) (p < 0.001). The final good fit SEM (?(2) = 32.92, df = 21, ?(2)/df = 1.57, CFI = 0.962, GFI = 0.978, RMSEA = 0.043) suggested two pathways, with left PCC thickness mediating the relationship between social support and suicidal ideation, and left MTG thickness mediating between childhood trauma and anhedonia/anxiety.Conclusion: Our findings provide evidence for the impact of risk factor variables on the brain structure and clinical phenotype of MDD patients. Insufficient social support and childhood trauma might lead to corresponding cortical abnormalities in PCC and MTG, affecting the patient's mood and suicidal ideation. Future interventions should aim at these nodes.

目的 利用心肺耦合(cardiopulmonary coupling,CPC)技术检测惊恐障碍患者的睡眠特征.方法 纳入2019年9月至2020年6月淮安市第三人民医院门诊或住院的未治疗惊恐障碍(panic disorder,PD)患者31例为患者组,选择年龄、性别匹配的健康对照29名为对照组,利用CPC设备检测睡眠指标.结果 与对照组相比,患者组的睡眠总时间[(7.84±1.41)h vs.(6.06±1.30)h]、浅睡时间[2.70(2.30,3.90)h vs.1.90(1.40,2.55)h]、快速眼动睡眠时间[(1.77±0.64)h vs.(1.13±0.44)h]、觉醒时间[0.90(0.60,1.20)h vs.0.40(0.35,0.60)h]增加,睡眠效率降低[89.20％(86.30％,93.00％)vs.92.70％(91.65％,94.25％)],差异有统计学意义(P<0.05).logistic回归分析显示睡眠总时间(OR=0.32,95％CI:0.17～0.60)、睡眠效率(OR=1.31,95％CI:1.09～1.59)与惊恐障碍相关联.结论 CPC检测显示PD患者的睡眠与健康对照存在显著差异,主要表现在睡眠总时间增加,睡眠效率降低.

Mental health is one of the major causes of disability worldwide, and mental health problems such as depression and anxiety are ranked among the top 25 leading causes of disease burden in the world. This burden is considerable over the lifetime of both men and women and in various settings and ages. This study aims to compare the mental health status of people in China and Pakistan and to highlight the mental health laws and policies during COVID-19 and afterwards. According to the literature on mental health, before the COVID-19 pandemic, mental health problems increased gradually, but during and after the COVID-19 pandemic, an abrupt surge occurred in mental health problems. To overcome mental health disorders, most (but not all) countries have mental health laws, but some countries ignore mental health disorders. China is one such country that has mental health laws and policies and, during the COVID-19 pandemic, China made beneficial and robust policies and laws, thereby succeeding in defeating the COVID-19 pandemic. The mortality rate and financial loss were also lower than in other countries. While Pakistan has mental health laws and general health policies, the law is only limited to paperwork and books. When it came to COVID-19, Pakistan did not make any specific laws to overcome the virus. Mental health problems are greater in Pakistan than in China, and China's mental health laws and policies are more robust and more widely implemented than those in Pakistan. We conclude that there are fewer mental health issues in China than in Pakistan both before and since the COVID-19 pandemic. China has strong mental health laws and these are robustly implemented, while the mental health law in Pakistan is not applied in practice.