BACKGROUND:Antidepressants are recommended for moderate-to-severe depression and anxiety, but concerns exist around overprescribing, long-term use, and paucity of evidence-based deprescribing strategies. We aimed to compare the effectiveness of different deprescribing approaches in individuals with clinically remitted depression or anxiety. METHODS:For this systematic review and network meta-analysis, we searched PubMed, PsycINFO, Web of Science, CENTRAL, CINAHL, and online trial registries from inception to April 6, 2025, for randomised controlled trials comparing abrupt discontinuation, fast tapering (≤4 weeks), slow tapering (>4 weeks), dose reduction (≤50% of the minimal effective dose), or continuation, with or without psychological support in adults with fully or partially remitted depressive or anxiety disorders on antidepressant treatment. The primary outcome was relapse rate by trial end. For each study, we extracted summary-level data on study characteristics, participant demographics, intervention details, and outcome measures. We did random-effects pairwise meta-analysis, and random-effects frequentist network meta-analysis to obtain relative risks (RRs) and standardised mean differences with 95% CIs. We assessed risk of bias using the Cochrane Risk-of-Bias-2 tool and the certainty of pooled estimates using the Confidence in Network Meta-Analysis approach. Individuals with lived experiences contributed to the interpretation of results. The study was registered with Open Science Framework, https://osf.io/9bsxz/. FINDINGS:Of 13 011 records, we included 76 trials comprising 17 379 participants. The mean age of individuals was 45·2 years (SD 15·2, IQR 34·9-55·5); 11 731 (67·5%) were female and 5648 (32·5%) male; the mean follow-up was 45·9 weeks (SD 29·7). Individuals were predominantly White (mean 87·9% [SD 8·1]). 60 (79%) of 76 studies investigated depression and 16 (21%) investigated anxiety. Separate analyses by diagnosis showed consistent baseline characteristics or treatment effects, although most comparisons were informed primarily by studies of participants with depression. After pooling data across conditions, the following strategies outperformed abrupt discontinuation for relapse prevention: continuation at standard dose plus psychological support (RR 0·40, 95% CI 0·26-0·61; number needed to treat [NNT] 4·3; moderate certainty), continuation at standard dose (0·51, 0·46-0·58; NNT 5·3; moderate certainty), slow tapering plus psychological support (0·52, 0·38-0·72; NNT 5·4; moderate certainty), and continuation at reduced dose (0·62, 0·42-0·92; NNT 6·8; low certainty). These strategies also outperformed fast tapering (point estimates ranging from 0·39 to 0·52; the first three supported by moderate certainty, the last by low certainty). Compared with abrupt discontinuation, the following strategies made no difference in relapse prevention: fast tapering plus psychological support (0·52, 0·27-1·01; low certainty), abrupt stopping plus psychological support (0·73, 0·30-1·78; very low certainty), and slow tapering alone (0·81, 0·56-1·18; low certainty). Moderate heterogeneity emerged (τ2=0·07), without evidence of inconsistency. Sensitivity, subgroup, and secondary outcomes provided consistent results. Tolerability was comparable across strategies. INTERPRETATION:In remitted depression, slow tapering plus psychological support is as effective as antidepressant continuation in preventing relapse and superior to abrupt or rapid discontinuation. In remitted anxiety, despite consistent population characteristics and effect estimates, limited evidence warrants cautious generalisation. Guidelines should promote individualised deprescribing with gradual tapering and structured psychological support. FUNDING:None.

QUESTION:Psychological distress is increasingly prevalent among university students, raising concerns about their mental health. This review aimed to assess the strength and credibility of evidence on the efficacy of psychosocial interventions for improving mental health in this population. STUDY SELECTION AND ANALYSIS:We conducted an umbrella review of systematic reviews (SRs) with meta-analyses of randomised controlled trials assessing psychosocial interventions among university students. Searches were performed in Medline, PubMed, Cochrane Central, PsycINFO, CINAHL, Epistemonikos and Campbell Collaboration from 1 January 2014 to 1 February 2026. Data on intervention type, comparator, outcome and study-level effect sizes were analysed using inverse-variance random-effects models with restricted maximum likelihood estimation of between-study heterogeneity (τ²). Strength of associations was evaluated according to umbrella review criteria, reporting quality using A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR-2) and certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE). FINDINGS:A total of 34 SRs were identified. After excluding overlapping syntheses, 28 unique meta-analyses from 12 SRs were included. Mindfulness-based interventions versus inactive controls for distress (standardised mean difference (SMD) -0.40; 95% CI -0.53 to -0.28) showed highly suggestive evidence (class II; GRADE: low; AMSTAR: high). Seven associations provided suggestive evidence (Class III): mindfulness-based interventions versus inactive controls for anxiety (SMD -0.54; 95% CI -0.81 to -0.27) and depression (SMD -0.52; 95% CI -0.65 to -0.39); cognitive-based interventions versus inactive controls for anxiety (SMD -0.48; 95% CI -0.62 to -0.34) and depression (SMD -0.60; 95% CI -0.75 to -0.45); cognitive-based interventions versus active controls for well-being (SMD -0.30; 95% CI -0.42 to -0.18); positive psychology interventions versus inactive controls for distress (SMD -0.22; 95% CI -0.35 to -0.10); and multimodal interventions versus inactive controls for distress (SMD -0.85; 95% CI -1.32 to -0.87). The remaining associations were weak or non-significant, generally supported by low or very low certainty and mostly low or very low reporting quality. CONCLUSIONS:The most robust evidence emerged for mindfulness and cognitive-based interventions, with some support also for positive psychology approaches. These interventions appear to improve depression, anxiety, distress and well-being among university students, though further rigorous research is needed. PROSPERO REGISTRATION NUMBER:CRD42023493618.

INTRODUCTION:Antidepressant overprescribing and unnecessary long-term use are common and can increase the risk of adverse effects and withdrawal symptoms on discontinuation. Although gradual tapering strategies have been proposed, empirical evidence from randomised trials is lacking. This study will compare the efficacy of two antidepressant discontinuation strategies-linear and hyperbolic tapering-in adults with remitted depressive disorders. METHODS AND ANALYSIS:This pragmatic, multicentre, open-label, parallel-group superiority randomised controlled trial will recruit adults (≥18 years) with remitted depressive disorders who have been taking an antidepressant for at least 6 months. During an 8-month recruitment period, participants in outpatient psychiatric and primary care settings will be randomised (1:1) to (a) linear tapering (dose reduced by 50% of the minimum effective dose every 2 weeks until cessation) or (b) hyperbolic tapering (dose reduced by 20-25% every 2 weeks until cessation). The primary outcome is the proportion of participants who fail to discontinue the antidepressant by the end of the predefined tapering schedule or who re-initiate antidepressant therapy within 16 weeks of discontinuation. Secondary outcomes include safety, tolerability (including withdrawal symptoms), acceptability, clinical effectiveness, social functioning, quality of life and cost-effectiveness. Recruiters and participants will be aware of their treatment allocation; however, outcome assessors and the biostatistician will remain blinded throughout follow-up. Validated rating scales measuring depression, anxiety, withdrawal symptoms and social functioning will be administered at baseline and at scheduled follow-up visits up to 36 weeks. Based on observational data, we aim to recruit 150 participants (75 per arm). ETHICS AND DISSEMINATION:The study was approved by institutional Ethics Committees and regulatory authorities. Written informed consent will be obtained from all participants and data processed in accordance with General Data Protection Regulation. Study insurance and pharmacovigilance procedures are in place. Findings will be published in open-access journals, presented at scientific meetings and communicated to policy and regulatory stakeholders. TRIAL REGISTRATION:NCT07393919.

Abstract Aims Populations affected by humanitarian crises, including conflict, disasters and displacement, are frequently exposed to elevated psychological distress, while access to mental health services remains scarce. Problem Management Plus (PM+), a low-intensity psychological intervention developed by the World Health Organization, has shown clinical efficacy. However, evidence on its implementation in humanitarian contexts remains limited. This systematic review aimed to synthesize available evidence on the implementation outcomes of PM+ and its delivery formats (individual, group and digital) in such settings. The review included individual PM+, group PM+ and Step-by-Step. Methods Following PRISMA 2020 guidelines, we systematically searched four databases (PubMed, Scopus, Web of Science and CENTRAL) for studies published up to June 2025. Eligible studies included populations in humanitarian settings receiving PM+ in any format and reported at least one implementation outcome based on Proctor’s framework (acceptability, adoption, appropriateness, feasibility, fidelity, cost, penetration and sustainability). Data extraction and quality appraisal were conducted independently by two reviewers. The protocol for this systematic review was prospectively registered in PROSPERO (Registration No. CRD42024551943). Results Of 2093 records screened, 23 studies met inclusion criteria, representing 5377 participants across diverse humanitarian contexts. Feasibility (70% of studies) and acceptability (65%) were the most frequently assessed outcomes, with consistently positive findings, including adequate recruitment, retention and cultural adaptability of PM+. Evidence was strongest for participant and provider acceptability and feasibility of delivery, whereas system-level outcomes such as sustainability, adoption, penetration and cost were rarely reported. Delivery by trained non-specialist providers was common and supported by supervision structures. Fidelity assessments (43%) demonstrated high adherence to intervention manuals. In contrast, sustainability (9%) and cost evaluations (17%) were infrequently reported. Barriers to implementation included stigma, population mobility and resource constraints, while facilitators included contextual adaptation, community engagement and ongoing supervision. Conclusions PM+ demonstrates strong feasibility and acceptability when delivered by trained non-specialist providers in humanitarian contexts. However, gaps remain in evidence on long-term sustainability, cost-effectiveness and policy integration. The limited availability of system-level implementation data constrains conclusions regarding large-scale integration of PM+ in humanitarian settings. Future research should employ standardized implementation science metrics and focus on strategies to enhance scalability and embed PM+ within existing health systems.

Following safety failures and gaps in oversight, acute in-patient mental health services face increasing scrutiny. This article examines accountability, conceptualised as answerability, responsibility and responsiveness, and reviews key strategies. Evidence varies in strength, with strongest support for reducing coercion and measurement systems. Structural and cultural alignment is essential for sustained improvement.

BACKGROUND:People with intellectual disabilities experience higher rates of mental disorders, contributing to restrictive practices and premature mortality. Prevalence data are essential to understanding the patterns of disease, and for the development of tailored interventions. AIMS:To systematically examine the burden and pattern of mental disorders in people with intellectual disabilities across the lifespan. METHOD:We searched six databases (inception to 17 October 2024), and conducted a manual search up to 15 December 2024, for systematic reviews on the prevalence of mental disorders in people with intellectual disabilities with or without neurodevelopmental conditions. We conducted a narrative synthesis of prevalence rates, including those stratified by intellectual disability level, sex, age and autism, where available, and compared these with published prevalence rates in people without intellectual disabilities (International Prospective Register of Systematic Reviews, no. CRD42024610611). RESULTS:We included 26 systematic reviews: 7 meta-analyses and 19 narrative reviews. Compared with the general population, the prevalence of schizophrenia (3.55-4.80%), anxiety (5.4-5.5%) and obsessive-compulsive disorders (2.4%) appeared higher, whereas that of mood (6-7%), personality and post-traumatic stress disorders appeared lower. Study quality was moderate to critically low. For syndromic intellectual disabilities we noted high anxiety rates in fragile-X, Williams and 22q11.2 deletion syndromes, and in those with co-occurring autism. We found gaps on dementia, bipolar, substance use and eating disorders, and limited data stratified by intellectual disability level, sex and age. CONCLUSIONS:This umbrella review confirms the high prevalence of mental disorders among people with intellectual disabilities, and highlights limited evidence for several conditions and population subgroups, including for minoritised ethnic groups. Standardised, high-quality epidemiological research is needed to shape clinical care and public mental health policy.

Serotonin syndrome (SS) is a concern for prescribers of serotonergic acting agents and mainly antidepressants, yet the implicated drug combinations and associated outcomes across clinical settings remain incompletely characterized. We performed a systematic review in PubMed/Embase, searching for SS cases in adults from the database’s inception until June 2024, and conducted a patient-level and network analysis of drug co-occurrence. The quality of SS diagnoses was assessed using the Hunter Serotonin Toxicity and the Sternbach Criteria. A total of 764 cases were included; 653 (85.6

Over the past decades research into psychotherapy has disproportionately focused on treatment outcomes while largely neglecting the underlying processes. Consequently, the understanding of how, for whom, and under what conditions psychotherapies are effective remains limited. Our aim was to identify, define, and classify the individual, treatment-specific elements embedded in psychological and social interventions delivered by non-specialist providers (NSPs) for people with common mental disorders such as depression and anxiety.We developed a taxonomy by systematically reviewing 11 evidence-based intervention manuals and coding their treatment-specific elements. The resulting three-tiered taxonomy comprises 39 techniques, organized into nine components, and further grouped into five overarching families. Each element was assigned an intensity score to distinguish between core and peripheral elements.All manuals (100%) included “psychoeducation” and some form of “cognitive reframing”, particularly strategies that assist clients in linking thoughts, emotions, and behaviors. “Problem management” and “relaxation” were also widely represented, as were techniques to “strengthen social support” (73%). “Interpersonal focus” (64%) and “behavioral activation” (45%) were moderately present, while “acceptance and mindfulness” and “emotion regulation” appeared less frequently (27%).Taxonomies, particularly those based on transdiagnostic frameworks, help move beyond one-size-fits-all approaches in psychotherapy research and practice. Taxonomies are foundational to predicting how individuals with specific characteristics will respond to the active elements embedded within therapy protocols.

Despite important research efforts devoted to testing the effectiveness of psychological interventions for the treatment of common mental disorders in low- and middle- income countries (LMICs), a gap remains in the field of prevention. We searched multiple databases up to May 7, 2026 for randomized controlled trials (RCTs) testing task-sharing psychological interventions for preventing common mental disorders in adults living in LMICs. Prevention interventions were classified into indicated, selective and universal. Primary outcomes were the diagnosis and symptom decrease of depression, PTSD, and anxiety at post-intervention. We estimated risk ratios (RRs) and standardized mean differences (SMDs) using random effects pairways and network meta-analyses (NMA). Protocol registration: CRD42023402399. We included 81 RCTs with 10,747 participants. 41 RCTs tested indicated, 34 selective and 7 universal prevention interventions. For preventing depression, wellbeing promotion, parental psychoeducation, yoga/mindfulness, and multi-component interventions were more effective than enhanced treatment as usual (ETAU/TAU) (RR 0.25 to 0.66). In head-to-head comparisons, wellbeing promotion and psychoeducation ranked highest (Surface Under the Cumulative Ranking, SUCRA>90%). In reducing depressive symptoms, parental psychoeducation, social support, wellbeing promotion, yoga-mindfulness, cognitive behavioral therapy, multicomponent interventions were more effective than ETAU/TAU (SMDs -0.94 to -0.36). For PTSD prevention, yoga-mindfulness, parental psychoeducation, CBT, and multicomponent interventions reduced symptoms. For anxiety diagnosis and symptoms, wellbeing promotion, social support, yoga-mindfulness, multicomponent interventions, and active waiting list were the most effective interventions. Extensive evidence supports the effectiveness of task-sharing psychosocial interventions in preventing mental disorders in LMICs, with stronger evidence for indicated and selective prevention.

Affiliate stigma—the internalization of public stigma by family caregivers of people with mental disorders—has been associated with emotional distress, burden, and reduced well-being. However, evidence from European contexts remains limited, and no national studies have been conducted in Italy. This study aimed to (1) assess levels of affiliate stigma among Italian family caregivers and (2) identify sociodemographic, relational, and psychological determinants of stigma. A cross-sectional online survey was conducted in Italy among 508 caregivers of people with mental disorders recruited through national and regional family associations. Measures included the Affiliate Stigma Scale (ASS), the Involvement Evaluation Questionnaire (IEQ), the Manchester Short Assessment of Quality of Life (MANSA), and the Three-Item Loneliness Scale (TILS). Multivariate linear regression was used to identify determinants of affiliate stigma. Caregivers reported moderate levels of affiliate stigma, with the affective dimension scoring highest. The multivariate model explained 27.2

Background Haiti is experiencing a severe humanitarian crisis characterised by political instability and economic and security hardship. These adversities contribute to significant mental health challenges, which are also exacerbated by poor access to psychological support due to a shortage of specialised professionals. Problem Management Plus (PM+), a scalable and low-intensity intervention developed by the World Health Organization, is based on a task-sharing approach to address the treatment gap by training non-specialist helpers to provide psychosocial support. Aims This study aimed to explore the implementation process of PM+ in Haiti, focusing on the barriers and facilitators that influenced its delivery. Specifically, the study focused on understanding the contextual factors affecting intervention accessibility, participant experiences and potential adaptations to enhance its effect. Method A qualitative study was conducted across three Haitian cities, where trained helpers delivered PM+. Data were collected through the PSYCHLOPS tool with end-users and via cognitive interviews with stakeholders. Thematic analysis was conducted incorporating Lund’s social determinants of mental health model and Bronfenbrenner’s ecological systems theory to interpret findings. Results Sixteen end-users and five stakeholders participated in the study. Key barriers to implementation and its success mainly included economic constraints and safety concerns. Facilitating factors included strong community engagement, adaptive implementation strategies (such as flexible scheduling, remote supervision and culturally responsive adjustments), alongside strong organisational support. End-users described substantial difficulties in managing everyday problems and emotional distress, as reported during pre-intervention qualitative assessments. Conclusions PM+ appeared feasible in the Haitian context from an implementation perspective; however, its implementability depends on cultural adaptations, economic considerations and sustained support for facilitators. Addressing systemic barriers and integrating task-sharing interventions within existing health structures could enhance the long-term impact.

Antipsychotic-associated sexual adverse drug reactions (ADRs) are well known in clinical practice, although efforts to understand differences between antipsychotics and distinct types of sexual ADRs are limited. The aim of this study was to assess and prioritize the profile of each antipsychotic regarding sexual ADRs reporting, and to account for potential confounders. We used VigiBase® to conduct a case/non-case study using a customized clinically guided search strategy of antipsychotic-related sexual ADRs. The reporting odds ratio (ROR) and Bayesian information component (IC) with relevant 95 https://osf.io/96eq7 .

Background:Self Help Plus (SH+) is a WHO intervention that provides strategies for managing distress arising from adversity. In the Palestinian context, SH+ holds promise in supporting psychological well-being and mitigating the impact of trauma, with the critical challenge in adapting and scaling the intervention for feasible and sustainable delivery. Methods:This is the piloting phase of a prospective hybrid type-1 non-randomised follow-up study investigating the implementability and effectiveness of SH+ in early 2023 in the Gaza Strip. Participants were recruited by the Gaza Community Mental Health Programme, which also facilitated the intervention. Assessments were conducted immediately before and one week after the intervention. Exposure to traumatic events was measured by the Gaza Trauma Checklist (GTC). Implementability was evaluated using the Feasibility of Intervention Measure, the Acceptability of Intervention Measure, and the Intervention Appropriateness Measure. Effectiveness was assessed using the Depression, Anxiety, and Stress Scale-21 items (DASS-21), the WHO-5 Well-being Index, and the WHO Disability Assessment Schedule (WHODAS 2·0)-12 items. After each session, the facilitators completed an online fidelity test for the intervention. Findings:Of 177 eligible participants, 162 completed the pre-assessment, and 157 the post-assessment. Results indicated that 151 participants (96·16%) found SH+ acceptable, 131 (83·44%) appropriate, and 139 (88·45%) feasible. In terms of effectiveness measures, the estimated average psychological well-being score increased from 10·78 (SE = 0·42) to 17·69 (SE = 0·41), indicating a substantial enhancement in well-being. The disability scores were estimated to decrease, on average, from 22·70 (SE = 0·63) to 18·35 (SE = 0·53), and significant improvements were also observed across all DASS subscales, and in the global DASS score, with fitted model values declining from 58·97 (SE = 1·85) to 33·02 (SE = 1·71). Interpretation:The pilot phase of the study shows that SH+ is a scalable psychological intervention for individuals exposed to trauma in the Gaza Strip. Conducting the implementation phase is needed to confirm the findings. Funding:None.

BACKGROUND:Although psychosocial interventions delivered by non-specialist providers effectively treat common mental disorders such as depression and anxiety, the treatment-specific elements driving their efficacy remain largely unknown. Our aim was to compare and rank the efficacy of the individual active components of task-shared psychosocial interventions and to predict efficacy using individual participant characteristics. METHODS:We performed a systematic review and Bayesian individual participant data component network meta-analysis of RCTs comparing different task-shared psychosocial interventions with control conditions for the treatment of adults with common mental disorders. We searched MEDLINE, Embase, PsycINFO, and CENTRAL from database inception to March 15, 2023. We included additional datasets published up to May 29, 2026 and unpublished RCTs. We sought individual participant data from the trial authors. A purpose-built taxonomy of treatment-specific elements was used to dismantle interventions into their constituent components. The primary outcome was efficacy in reducing symptoms of common mental disorders, as measured at study endpoint. We used incremental mean difference to indicate the added benefit (or detrimental effect) of adding a component to a treatment. We assessed the risk of bias of the included studies with the revised Cochrane Risk of Bias tool. The protocol was published in a peer-reviewed journal. FINDINGS:We included 34 RCTs, from which 30 trials (89%) contributed individual participant data from 10 612 participants. Of these participants, 7662 were women (72·2%) and 2950 were men (27·8%). The mean age of participants was 36·7 years (SD 5·5). Findings identified strengthening social support (incremental mean difference -9·48; 95% credible interval [CrI] -13·29 to -6·60), behavioural activation (-4·15; -7·48 to -0·05), and problem management (-4·08; -5·37 to -2·83) as the most beneficial components. Relaxation (7·97; 3·35 to 12·11) and, less clearly, cognitive reframing (5·17; 0·78 to 9·15) were identified as detrimental components. Interaction analyses revealed that component effects vary systematically by baseline severity and other sociodemographic characteristics. Ethnicity data were not available. Individuals with lived experience contributed to the interpretation of results. Personalised effect estimates can be computed via a freely accessible web application. INTERPRETATION:Strengthening social support, problem management, and behavioural activation were associated with the greatest incremental benefit within task-shared psychosocial interventions for adults with depression or anxiety. FUNDING:European Commission.

BACKGROUND:Many international migrant workers (IMWs) in the Netherlands experience symptoms of anxiety and depression, often linked to adverse work and living conditions, yet underutilise mental healthcare. Stepped-care approaches may improve access by offering low-intensity support, followed by more intensive treatment if needed. We evaluated the effectiveness of a culturally adapted, remotely delivered, scalable stepped-care intervention combining guided online self-help (Doing What Matters in Times of Stress; DWM; step 1) and individual psychological support via videoconferencing (Problem Management Plus; PM+; step 2) both delivered by non-professional helpers, among Polish migrant workers living in the Netherlands. METHODS AND FINDINGS:In this parallel-group, two-arm, superiority randomised controlled trial, conducted in the Netherlands, Polish-speaking migrant workers aged 18 years or older with elevated psychological distress (Kessler Psychological Distress Scale; K10 ≥ 16) were recruited between May 2022 and January 2024 via social media and Polish community spaces. All participants received Psychological First Aid (PFA) before being informed about their allocation. Participants were randomly assigned 1:1 to care-as-usual or stepped-care (DWM, followed by PM+ if distress persisted; K10 ≥ 16) using computer-generated randomisation with permuted blocks in Castor Electronic Data Capture (Castor EDC). Participants and the main researcher were not blinded after allocation; outcomes were self-reported, and research assistants handling later incidental follow-up contact remained blinded. Assessments occurred at four timepoints: baseline (week 1), post-DWM (week 7), post-PM+ (week 13), and 2-month follow-up (week 21). The primary outcome was a composite measure of anxiety and depression (Patient Health Questionnaire-Anxiety and Depression Scale; PHQ-ADS), measured at all timepoints, with the primary endpoint at follow-up. Primary analyses followed the intention-to-treat (ITT) principle using linear mixed models adjusted for baseline PHQ-ADS values. In total, 218 participants were randomised and included in the ITT analysis (109 in each group); PHQ-ADS data at the primary endpoint were available for 94 participants in the intervention group and 101 in the control group. At follow-up, adjusted mean PHQ-ADS scores were lower in the intervention group than in the control group (14.8 versus 21.3), with a between-group mean difference adjusted for baseline PHQ-ADS score of -6.52 (95% confidence interval [CI] [-8.73, -4.31]; p < 0.001; Cohen's d = -0.57), reflecting a moderate effect. Significant between-group differences adjusted for baseline PHQ-ADS were also observed post-DWM (-5.90; 95% CI [-8.12, -3.69]; p < 0.001; d = -0.56) and post-PM+ (-4.87; 95% CI [-7.18, -2.56]; p < 0.001; d = -0.44). Most participants in the intervention group who completed the post-DWM assessment still met criteria for PM+ (85/95, 89.5%). Eight serious adverse events occurred (intervention: n = 2; control: n = 6), and none were considered related to the intervention. The main limitations were limited generalisability, as most participants were women and had lived in the Netherlands for several years, and limited conclusions about longer-term effects due to the short follow-up period. CONCLUSION:The DWM/PM+ stepped-care intervention significantly reduced symptoms of anxiety and depression among Polish migrant workers in the Netherlands. These findings support the use of a remotely delivered stepped-care model combining scalable psychological interventions for migrant workers with elevated psychological distress.

BACKGROUND:Emotional difficulties are common among individuals with Eating Disorders (EDs). Following Panksepp's theoretical model, which conceptualises primary emotional systems as the evolutionary foundation of personality, this study aimed to identify distinct profiles of primary emotional systems within a clinical eating disorder (ED) sample. It further examined differences in sociodemographic, clinical, and psychopathological characteristics across profiles, as well as associations between clinical features and profile membership. METHODS:In this cross-sectional study, data were obtained from the Regional Centre for ED registry at the University Hospital of Verona. Measures included the Affective Neuroscience Personality scales, the Eating Disorder Examination, the Symptom CheckList-90-Revised, the Life Stressor Checklist-Revised, and the Impact of Event Scale-Revised. A Latent Profile Analysis was conducted, followed by inferential analyses. RESULTS:Among 122 patients, three profiles emerged: (1) high FEAR and SADNESS, and low SEEKING and PLAY; (2) low negative primary emotional systems and CARE; (3) high positive primary emotional systems and high SADNESS and ANGER. Profiles differed by age, sex, illness duration, trauma burden, depressive-anxiety symptoms, and ED severity. DISCUSSION:Findings revealed emotional heterogeneity among ED patients, underscoring the importance of considering individual emotional differences in treatment planning. Study limitations and directions for future research are discussed.

OBJECTIVE:To assess the association between postpartum depression (PPD) and miscarriage history and the role of moderators. METHODS:We identified observational studies of PPD rates in women with vs. without miscarriage history in Embase and Medline in July 2023 and updated in October 2024. Study quality was evaluated using the Newcastle-Ottawa Scale. The primary outcome was the odds ratio (OR, 95 % confidence intervals [95 %CI]) of PPD in women with vs. without miscarriage history. Meta-regression analyses included the effects of age, marital status, history of depression/anxiety and parity; subgroup analyses were based on PPD assessment methods and timepoint, cohorts from low-/middle-vs. high-income countries and cohorts with single vs. multiple miscarriages. We performed sensitivity analyses excluding poor-quality, cross-sectional studies and sequentially each study. RESULTS:Seventeen and two studies were rated as poor- and fair-quality, respectively. In 19 studies (n = 111,772), women with miscarriage history were at higher PPD risk compared to women without miscarriage (OR = 1.62, 95 % CI = 1.26 to 2.07, p < 0.001), with substantial heterogeneity (I2 = 99.8 %). We detected some asymmetry in the funnel plot. The Egger's test was positive (p = 0.04). The OR using the trim-and-fill method was 0.98 (95 %CI = 0.70 to 1.37, p = 0.91). Higher miscarriage-related PPD ORs were estimated in low-/middle-vs. high-income countries (OR = 2.09, 95 %CI = 1.47 to 2.95, k = 10, n = 5,665, vs. 1.23, 95 %CI = 0.96 to 1.58, k = 9, n = 106,107, p = 0.02). After excluding low-quality studies the PPD OR dropped (1.15, 95 %CI = 0.50 to 2.64, k = 2, n = 2,911, p = 0.75). CONCLUSIONS:Women with miscarriage history had higher PPD risk, although small study effects and low study quality may have led to an overestimation.