INTRODUCTION:Social functioning is a key component of recovery in depression, yet most research on first-line treatments focuses on symptom reduction, and comparative evidence on social functioning is limited. We aimed to evaluate the comparative effects of psychotherapy, antidepressant medication, and their combination on social functioning in adults with major depression. METHODS:We conducted a systematic review and network meta-analysis of randomized controlled trials up to May 1, 2025. Eligible trials compared psychotherapy, antidepressant medication, combined treatment, and control conditions (placebo, care as usual, waitlist, or no/minimal treatment) in adults with major depression. Effects were calculated as standardized mean differences (SMDs) in social functioning instruments (e.g., Sheehan Disability Scale) at posttreatment (mean 12 weeks) and follow-up (mean 32 weeks). Random effects models were used. We assessed risk of bias and conducted sensitivity analyses. Certainty of evidence was evaluated using CINeMA. RESULTS:Of 490 identified trials, 94 (19%; 23,874 participants) reported social functioning and were included. All active treatments outperformed control conditions. Effects varied substantially by control condition type, with waitlist comparisons yielding the largest estimates and comparisons against placebo or care as usual yielding more conservative effects. Combined psychotherapy and pharmacotherapy showed the largest effects versus placebo at posttreatment (SMD 0.75, 95% CI: 0.57-0.94) and follow-up (1.08, 0.62-1.54). Psychotherapy and pharmacotherapy did not differ at posttreatment (SMD 0.10, 95% CI: -0.05 to 0.25) or follow-up (0.27, 95% CI: 0.00-0.54). Certainty of the evidence ranged from moderate to low. CONCLUSION:First-line depression treatments support not only symptom reduction but also meaningful participation in daily life. However, only one-fifth of trials assessed this outcome, highlighting the need to better integrate patient-valued outcomes into future trials.

OBJECTIVES:Dysfunctional attitudes (DA) constitute a vulnerability factor for depression that might be most effectively targeted with cognitive-behavioral therapy (CBT), but evidence is inconclusive. This individual participant data meta-analysis examined DA change during CBT and antidepressant medication, potential pathways of change by exploring how DA were related to depressive symptoms at posttreatment, and whether baseline DA moderated CBT versus antidepressants' efficacy on depression outcomes. METHOD:We conducted systematic literature searches up to May 1, 2024. We included randomized comparisons of CBT and antidepressants in the acute-phase treatment of adult depression, assessing the Dysfunctional Attitude Scale at baseline and posttreatment. Individual participant data were requested and analyzed with mixed-effects models and network estimation techniques. RESULTS:Five studies totaling 734 participants met inclusion criteria. DA decreased significantly after CBT and antidepressants, with no significant difference between treatments. Regardless of treatment, posttreatment DA were positively associated with posttreatment depressive symptomatology, particularly with guilt and suicidal thoughts. Baseline DA moderated the efficacy of CBT versus antidepressants on observer-rated outcomes, with CBT more effective for participants with higher DA and antidepressants more effective for those with lower DA, but this was not replicated across individual studies nor with self-reported outcomes. CONCLUSIONS:Change in DA and its associations with changes in depressive symptomatology do not appear specific to CBT. We found inconsistent evidence for the notion that CBT is more efficacious than antidepressants for individuals with high levels of DA. Repeated DA assessment during treatment would allow for more nuanced analysis in future studies. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Importance:Suicidal ideation and suicide attempts are debilitating mental health problems that are often treated with indirect psychotherapy (ie, psychotherapy that focuses on other mental health problems, such as depression or personality disorders). The effects of direct and indirect psychotherapy on suicidal ideation have not yet been examined in a meta-analysis, and several trials have been published since a previous meta-analysis examined the effect size of direct and indirect psychotherapy on suicide attempts. Objective:To investigate the effect sizes of direct and indirect psychotherapy on suicidal ideation and the incidence of suicide attempts. Data Sources:PubMed, Embase, PsycInfo, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials were searched for articles published up until April 1, 2023. Study Selection:Randomized clinical trials of psychotherapy for any mental health problem, delivered in any setting, compared with any control group, and reporting suicidal ideation or suicide attempts were included. Studies measuring suicidal ideation with 1 item were excluded. Data Extraction and Synthesis:PRISMA guidelines were followed. Summary data were extracted by 2 independent researchers and pooled using 3-level meta-analyses. Main Outcomes and Measures:Hedges g was pooled for suicidal ideation and relative risk (RR) was pooled for suicide attempts. Results:Of 15 006 studies identified, 147 comprising 193 comparisons and 11 001 participants were included. Direct and indirect psychotherapy conditions were associated with reduced suicidal ideation (direct: g, -0.39; 95% CI, -0.53 to -0.24; I2, 83.2; indirect: g, -0.30; 95% CI, -0.42 to -0.18; I2, 52.2). Direct and indirect psychotherapy conditions were also associated with reduced suicide attempts (direct: RR, 0.72; 95% CI, 0.62 to 0.84; I2, 40.5; indirect: RR, 0.68; 95% CI, 0.48 to 0.95; I2, 0). Sensitivity analyses largely confirmed these results. Conclusions and Relevance:Direct and indirect interventions had similar effect sizes for reducing suicidal ideation and suicide attempts. Suicide prevention strategies could make greater use of indirect treatments to provide effective interventions for people who would not likely seek treatment for suicidal ideation or self-harm.

Background: The increase in tracheostomies among infants and children, driven by medical advances and evolving family preferences, underscores the need for standardized, evidence-based guidelines. This guideline outlines management recommendations for these medically complex and resource-intensive children with tracheostomies, incorporating best evidence on diagnostic tools and streamlined care protocols. Methods: This Clinical Practice Guideline adheres to American Thoracic Society policies and procedures, using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to form clinical questions, summarize evidence, and develop recommendations with a health equity perspective. A multidisciplinary panel with expertise in pediatric tracheostomy care contributed to recommendations for ethical considerations, discharge processes, in-home caregiver requirements, and diagnostic tools (tracheal aspirate cultures, bronchoscopy, and polysomnography). Results: The panel recommends applying ethical principles to guide shared decision-making about tracheostomy placement (strong recommendation). We also recommend a standardized discharge process involving comprehensive family caregiver training for safe transitions from hospital to home (conditional recommendation). A continuously awake, trained caregiver to manage emergencies is also recommended for high-risk patients (strong recommendation). The panel recommends tracheal aspirate cultures during acute respiratory episodes to guide antibiotic therapy, but not for routine surveillance (conditional recommendation); bronchoscopy for thorough airway examination before tracheostomy decannulation (strong recommendation); and polysomnography before decannulation to ensure respiratory stability (conditional recommendation). Conclusions: These guidelines aim to standardize and improve the management of pediatric patients with tracheostomies by providing evidence-based recommendations for ethical considerations, discharge planning, and diagnostic assessments. Implementing these guidelines aims to enhance patient safety and quality of life through a structured and patient-centered approach.

AIMS:The comparability between self-reports and clinician-rated scales for measuring depression following treatment has been a long-standing debate, with studies finding mixed results. While the use of self-reports in psychotherapy trials is very common, it has been widely assumed that these tools pose a validity threat when masking of participants is not possible. We conducted a meta-analysis across randomized controlled trials (RCTs) of psychotherapy for depression to examine if treatment effect estimates obtained via self-reports differ from clinician-rated outcomes. METHODS:We identified studies from a living database of psychotherapies for depression (updated to 1 January 2023). We included RCTs measuring depression at post-treatment with both a self-report and a clinician-rated scale. As our main model, we ran a multilevel hierarchical meta-analysis, resulting in a pooled differential effect size (Δg) between self-reports and clinician ratings. Moderators of this difference were explored through multimodel inference analyses. RESULTS:A total of 91 trials (283 effect sizes) were included. In our main model, we found that self-reports produced smaller effect size estimates compared to clinician-rated instruments (Δg= 0.12; 95% CI: 0.03-0.21). This difference was very similar when only including trials with masked clinicians (Δg= 0.10; 95% CI: 0.00-0.20). However, it was more pronounced for unmasked clinical ratings (Δg= 0.20; 95% CI: -0.03 to 0.43) and when trials targeted specific population groups (e.g., perinatal depression) (Δg= 0.20; 95% CI: 0.08-0.32). Effect sizes between self-reports and clinicians were identical in trials targeting general adults (Δg= 0.00; 95% CI: -0.14 to 0.14). CONCLUSIONS:Self-report instruments did not overestimate the effects of psychotherapy for depression and were generally more conservative than clinician assessments. Patients' perception of improvement should not be considered less valid by default, despite the inherent challenge of masking in psychotherapy.

In 2019, the FDA and EMA approved intranasal esketamine for treatment-resistant depression (TRD). The current study re-evaluated its efficacy and safety. This registered report presents a systematic review and individual patient data (IPD) meta-analysis of double-blind, randomised, placebo-controlled trials (RCTs) assessing intranasal esketamine for TRD. Two reviewers independently screened studies from multiple databases and obtained IPD via the Yale Open Data Access Project. Two independent researchers selected studies and assessed risk of bias. The primary outcome was the Montgomery-Åsberg Depression Rating Scale (MADRS) score at ≥ 4 weeks in initiation trials, benchmarked against the 6.5-point clinical significance threshold used in the design of pivotal trials. Evidence certainty was rated using GRADE. Secondary outcomes included additional efficacy and safety endpoints. A two-step IPD meta-analysis was conducted, with separate analyses by trial phase (initiation vs. continuation) and treatment type (combination vs. monotherapy). A one-stage meta-analysis explored moderators (e.g. age and resistance level). We re-analysed IPD from 7 RCTs including 1505 patients. In five initiation trials of esketamine plus an antidepressant, esketamine reduced MADRS scores at 4 weeks (mean difference (MD) = − 2.94, 95

The scientific output generated in psychology has surged in recent decades, including the number of studies investigating psychological treatments. To keep track of all this evidence, we developed the "Metapsy" meta-analytic research domain: a comprehensive system of open databases and tailored software that allows for rapid evidence generation. We leverage this novel infrastructure to summarize the effect of psychological treatment across 12 mental health problems and trace back the global expansion of psychotherapy research over the past 50 years. Including 1,029 studies with 85,952 patients, our results indicate small to moderate average benefits in treating psychosis (g = 0.32), suicidal ideation (g = 0.34), borderline personality disorder (g = 0.46), and prolonged grief (g = 0.49). In contrast, psychological interventions have large average effects on depression (g = 0.73), problem gambling (g = 0.80), panic (g = 0.83), generalized anxiety (g = 0.86), social anxiety (g = 0.95), obsessive-compulsive (g = 1.18), posttraumatic stress disorder (g = 1.18), and phobias (g = 1.25). Most available evidence (83.4%-86.1%) comes from high-income and Western countries, but their dominance is declining. We found no indication that psychotherapy is less effective in low- and middle-income countries (g = 0.38-2.41) or non-Western cultures (g = 0.74-2.20). We discuss ways to further enhance psychotherapy's public health impact, as well as how the meta-analytic research domain concept may be extended to other types of psychological research in the future. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Death anxiety (DA), apprehension when thinking about death, has long been associated with distress. Studies have suggested that DA may transdiagnostically contribute to mental disorders. We conducted a systematic review and meta-analysis, aiming to estimate the relationship between DA and distress or symptoms of mental disorders. The included studies reported the correlation between DA and distress or symptoms of mental disorders, across general population and clinical samples, using previously validated measures for all outcomes. PsychInfo and the Psychology and Behavioral Sciences Collection (via EBSCO), Embase, and Medline (via PubMed) were systematically searched up to 30 October 2023. Study quality was evaluated with the Study Quality Assessment Tools (National Heart, Lung, and Blood Institute). A total of 129 studies were included, reporting on 158 independent samples, for a total of 34,147 participants. Most studies were rated as poor quality. The findings indicated consistently positive associations between DA and distress outcomes (general anxiety: r = 0.42, P < 0.001; depression: r = 0.41, P < 0.001; distress: r = 0.36, P < 0.001). Heterogeneity was substantial, and prediction intervals crossed zero for all outcomes, except for anxiety and distress. We found no moderation by DA measure, sample type or the proportion of women in the sample. However, the association was stronger (t(35.37) = -2.055, P = 0.047) when medical conditions were present (r = 0.48, P < 0.001) than when they were absent (r = 0.37, P < 0.001). There was evidence of small-study effects, indicating possible publication bias. DA should be investigated in longitudinal studies across diverse samples of patients to clarify its contribution to psychopathology.

This paper reviews the scientific evidence on new anti-amyloid monoclonal antibodies for treating Alzheimer's disease as a case study for improving scientific evidence communication. We introduce five guidelines condensed from the biomedical evidence literature but adapted to the short format of science communication in e.g. journal opinion pieces and newspaper articles. Given the major importance and recent confusion regarding the discussed drugs, with certain disagreements seen e.g. between FDA and EMA, the suggested guidelines may be useful to clinicians discussing with their patients and to scientists communicating the evidence in balance. More generally, we hope that the guidelines may help us to improve communication of scientific evidence on complex topics in opinion pieces in the scientific literature, in advocacy, and in media appearances.

Rationale: Bronchopulmonary dysplasia (BPD) affects over 10,000 premature infants yearly in the US (PMID34078747). While 9% of these infants have severe BPD, 77% of infants with severe BPD experience death or serious respiratory morbidity (PMID30995069). Significant tracheobronchomalacia (TBM) likely affects 30-50% of infants with severe BPD, with increased morbidity compared to infants without TBM (PMID30518799, PMID33780653). Bronchoscopy is the gold standard for diagnosis, but this procedure is invasive, inconsistently performed across institutions, and findings are subject to interpretation. Prediction of TBM using simple clinical variables would be a valuable tool in the management of BPD. Methods: We aimed to create a prediction model for moderate/severe TBM using positive end-expiratory pressure (PEEP) and oxygen saturation index (OSI) as predictors. Bronchoscopy video recordings from infants with BPD were independently assessed by 2 blinded bronchoscopists (SB, IC) and evaluated for TBM severity (0-25% collapse = no malacia, 25-50% collapse = mild malacia, >50% collapse = moderate/severe TBM) (PMID31862439) in each of 3 regions: trachea, left mainstem bronchus, right mainstem bronchus. If there was disagreement in severity score, the video was reviewed by a third bronchoscopist (GM). All respiratory data including PEEP and OSI were collected from the electronic medical record for 7 days following time of bronchoscopy. OSI was separated into 3 categories (<8, 8 to <12, and ≥12). Multiple logistic regression was used to calculate probability of moderate/severe TBM using average PEEP and OSI as predictors. Results: Bronchoscopy videos (N=48) recorded between July 2023 and October 2024 were evaluated. Bronchoscopies were excluded if PEEP and OSI data were not available in the week following the bronchoscopy (i.e. patients on non-invasive support). Of the 48 bronchoscopy videos evaluated, moderate/severe TBM was present on 54% (N=26) of bronchoscopies. The resulting model (Figure 1) has 75% positive predictive power when using a classification cutoff of 0.5 (area under the Receiver Operator Curve was 0.7557, p = 0.0026). The odds ratio of TBM with a 1 point increase in PEEP was 1.4, while the odds ratio for increasing OSI category was 0.26. Conclusion: The proposed model uses PEEP and OSI as a simple predictor of moderate/severe TBM. This is the first ever proposed clinical prediction model for TBM. While this is a single center study and PEEP/vent management are influenced by center-specific ventilator strategies, these initial data suggest the possible utility of a prediction model for TBM when bronchoscopy is not available.

OBJECTIVES:During the COVID-19 pandemic, BMJ, a leading journal on evidence-based medicine worldwide, published many views by advocates of specific COVID-19 policies. We aimed to evaluate the presence and potential bias of this advocacy. DESIGN AND METHODS:Scopus was searched for items published until 13 April 2024 on 'COVID-19 OR SARS-CoV-2'. BMJ publication numbers and types before (2016-2019) and during (2020-2023) the pandemic were compared for a group of advocates favouring aggressive measures (leaders of both indieSAGE and the Vaccines-Plus initiative) and four control groups: leading members of the governmental SAGE, UK-based key signatories of the Great Barrington Declaration (GBD) (favouring more restricted measures), highly cited UK scientists and UK scientists who published the highest number of COVID-19-related papers across science (n=16 in each group). RESULTS:122 authors published >5 COVID-19-related items each in BMJ: 18 were leading members/signatories of aggressive measures advocacy groups publishing 231 COVID-19-related BMJ documents, 53 were editors, journalists or regular columnists and 51 scientists were not identified as associated with any advocacy. Of 41 authors with >10 publications in BMJ, 8 were scientists advocating for aggressive measures, 7 were editors, 23 were journalists or regular columnists and only 3 were non-advocate scientists. Some aggressive measures advocates already had strong BMJ presence prepandemic. During pandemic years, the studied indieSAGE/Vaccines-Plus advocates outperformed in BMJ presence leading SAGE members by 16.0-fold, UK-based GBD advocates by 64.2-fold, the most-cited scientists by 16.0-fold and the authors who published most COVID-19 papers overall by 10.7-fold. The difference was driven mainly by short opinion pieces and analyses. CONCLUSIONS:BMJ had a strong bias in favour of authors advocating an aggressive approach to COVID-19 mitigation. Advocacy bias may influence public opinion and policy decisions and should be mitigated in future health crises in favour of open and balanced debate of different policy options.

The brain disease model of addiction has dominated public and scientific discourse on addiction (termed substance use disorder [SUD] in the DSM-5) over the past 3 decades. The model framed addiction as a chronic and relapsing brain disease caused by structural and functional brain alterations. The purpose of this model was purportedly dual, as both an aetiological theory and a tool to reduce stigma. Weak empirical support and concerns about the model downplaying fundamental psychosocial causes of SUDs have led to stark disagreement as to whether addiction should be conceptualised as a brain disease. In this Personal View, we argue that the absence of an agreed, clear, and consistent definition of a brain disease-coupled with frequent recourse to concepts with divergent or shifting meaning-have obstructed productive debate and a coherent advance in knowledge and understanding of addiction. Borrowing from the philosophy of psychiatry, we show that both narrow and broad views of brain disease coexist and inform addiction research, though often implicitly and inconsistently. The narrow view of brain disease posits that a mental condition qualifies as a brain disease only if it manifests similarly to a paradigmatic brain disease, resulting from either known or unknown structural and functional damage. The broad view of brain disease suggests that brain disease status should be granted automatically to mental disorders, as all mental activity resides in the brain. We examine theoretical assumptions, empirical evidence, and treatment implications for each view and propose ways of moving beyond them.

Scientific institutions, including universities and research centers, occasionally engage in advocacy to gain financial support. However, this can be problematic if they selectively present scientific evidence. We describe a case involving a French semi-public foundation dedicated to clinical research on four adult psychiatric disorders: autism without intellectual disability, treatment-resistant depression, schizophrenia, and bipolar disorder. The foundation has claimed that an initial assessment at any of its Expert Centers led to a 50 % reduction in hospitalization days. We analyzed communication directed at the public in the French press, advocacy efforts towards members of the French Parliament (MFPs), evidence supporting this claim within those activities, and MFPs' initiatives that addressed the foundation's request. However, the reduction in hospitalization originated from a single study of bipolar disorder patients, which lacked a control group and had other methodological flaws. No scientific publications supported similar claims for the other three disorders. On May 2, 2024, 70 members of the French Parliament introduced a bill aimed at integrating these Expert Centers into the healthcare system. Justifications for the bill explicitly cited the 50 % reduction in hospitalization for all four conditions. This case highlights the need for policy makers and journalists to verify the robustness of scientific claims before these become policy. It also emphasizes the responsibility of scientists and journal editors to recognize and mitigate spin in research studies and opinion articles and to develop tools that help evaluate advocacy and lobbying claims in scientific contexts.

ImportanceSuicidal ideation and suicide attempts are debilitating mental health problems that are often treated with indirect psychotherapy (ie, psychotherapy that focuses on other mental health problems, such as depression or personality disorders). The effects of direct and indirect psychotherapy on suicidal ideation have not yet been examined in a meta-analysis, and several trials have been published since a previous meta-analysis examined the effect size of direct and indirect psychotherapy on suicide attempts.ObjectiveTo investigate the effect sizes of direct and indirect psychotherapy on suicidal ideation and the incidence of suicide attempts.Data SourcesPubMed, Embase, PsycInfo, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials were searched for articles published up until April 1, 2023.Study SelectionRandomized clinical trials of psychotherapy for any mental health problem, delivered in any setting, compared with any control group, and reporting suicidal ideation or suicide attempts were included. Studies measuring suicidal ideation with 1 item were excluded.Data Extraction and SynthesisPRISMA guidelines were followed. Summary data were extracted by 2 independent researchers and pooled using 3-level meta-analyses.Main Outcomes and MeasuresHedges g was pooled for suicidal ideation and relative risk (RR) was pooled for suicide attempts.ResultsOf 15 006 studies identified, 147 comprising 193 comparisons and 11 001 participants were included. Direct and indirect psychotherapy conditions were associated with reduced suicidal ideation (direct: g, −0.39; 95% CI, −0.53 to −0.24; I2, 83.2; indirect: g, −0.30; 95% CI, −0.42 to −0.18; I2, 52.2). Direct and indirect psychotherapy conditions were also associated with reduced suicide attempts (direct: RR, 0.72; 95% CI, 0.62 to 0.84; I2, 40.5; indirect: RR, 0.68; 95% CI, 0.48 to 0.95; I2, 0). Sensitivity analyses largely confirmed these results.Conclusions and RelevanceDirect and indirect interventions had similar effect sizes for reducing suicidal ideation and suicide attempts. Suicide prevention strategies could make greater use of indirect treatments to provide effective interventions for people who would not likely seek treatment for suicidal ideation or self-harm.

Systematic reviews and meta-analyses are often considered the highest level in evidence hierarchies, and therefore are often drawn upon when considering changes in policy. Despite journals implementing measures aiming to enhance the quality of systematic reviews they publish, the authorship raise concerns about the quality of existing and ongoing systematic reviews, particularly relating to transparency and bias minimisation. Building on the current guidelines, standards and tools, we suggest a ‘meta checklist’ which aims to maximise methodologically sound, unbiased and reproducible reviews of the best scientific quality while considering feasibility throughout the process.

BACKGROUND:A history of atopy is associated with respiratory morbidities in term-born children; however, little is known about how allergies/atopy affect respiratory outcomes in children with bronchopulmonary dysplasia (BPD). This study aims to describe the prevalence of reported allergies/atopy in young children with BPD and assess whether allergies/atopy are associated with outpatient outcomes. METHODS:A retrospective longitudinal cohort study of children between 0 and 36 months of age followed at outpatient BPD clinics was performed using data from questionnaires administered during routine clinical encounters. The presence of allergy/atopy was defined by caregiver questionnaires. Generalized estimating equations were used to adjust associations between allergy/atopy and respiratory outcomes. RESULTS:Rates of reported allergy/atopy in a cohort of infants and children with BPD (21.6%) were similar to previously published rates in healthy children. Children with atopy/allergy were more likely to be born at earlier gestational ages, have pulmonary hypertension, and be non-white and non-Hispanic compared to their non-atopic peers and to experience trouble breathing, nighttime symptoms, activity limitations, and rescue medication use during the first three years of life. CONCLUSIONS:In children with BPD, allergy/atopy was more common among those born at earlier gestational ages and was significantly associated with increased respiratory symptoms during the first 3 years of life. Further studies are needed to assess whether the association between allergy/atopy and increased respiratory morbidity persists throughout childhood and affects later lung function and whether potential interventions, including inhaled steroids, may modify this risk. IMPACT:There is limited data on the prevalence of atopy/allergy in children with bronchopulmonary dysplasia (BPD) and the association between allergy/atopy and respiratory outcomes in this population. Our findings demonstrate that in children with BPD, allergy/atopy was more common among those born at earlier gestational ages and was associated with increased respiratory symptoms and rescue medication use during the first 3 years of life. Further studies are needed to determine whether this association persists throughout childhood and affects later lung function and whether potential interventions may modify this risk.