The physical and social exposome affects human aging, and brain clocks may track its effects. However, most studies neglect multidomain exposures (physical, social and political) across diverse settings globally and their associations with brain aging. In this study, we characterized the associations between 73 country-level physical and social exposomal factors and multimodal brain age in 18,701 participants from 34 countries (healthy individuals and those with Alzheimer's disease, frontotemporal lobar degeneration or mild cognitive impairment). Exposome effects were assessed using generalized additive models and meta-analytic frameworks. Aggregated exposome models explained up to 15.5-fold more variance than individual exposures (delta Akaike information criterion (ΔAIC): 2,034-3,127). Physical exposome was primarily associated with accelerated structural brain aging (limbic, subcortical and cerebellar regions), whereas social exposome was more strongly associated with functional brain aging (frontotemporal and limbic networks). Exposome burden accounted for 3.3-9.1-fold higher risk of accelerated aging, exceeding effects of clinical diagnoses. Findings were out-of-sample validated in cross-sectional and longitudinal designs, remained consistent across clinical subgroups and persisted after adjustment for demographics, age correction bias, cognition, scanner type and data quality. The exposome accelerates brain aging in health and disease, underscoring the need to address physical, social and political inequities.

BACKGROUND:Childhood maltreatment (CM), encompassing abuse and neglect, is highly prevalent and associated with elevated risk for major depressive disorder (MDD), posttraumatic stress disorder (PTSD), and other related conditions. However, the extent to which neuroanatomical alterations in MDD and PTSD are attributable to CM is uncertain. METHODS:Here, we analyzed CM and whole-brain magnetic resonance imaging (MRI) data from 3711 participants in the ENIGMA (Enhancing Neuro Imaging Genetics through Meta Analysis) MDD and PTSD Working Groups (25 sites; mean age = 33.3 ± 13.0 years; 59.9% female). Normative modeling estimated deviation z scores for 14 subcortical volume, 68 cortical thickness (CT), and 68 surface area (SA) measures. To identify transdiagnostic effects, associations between CM and brain deviation scores were evaluated across all participants (patients and healthy control participants) stratified by sex and 3 age bins (pediatric, young adult, older adult). RESULTS:In young adults (ages 18-35), abuse was associated with larger volumes in the thalamus and pallidum, thinner isthmus cingulate and middle frontal regions, and thicker medial orbitofrontal cortex; there were no significant effects in pediatric (≤18 years) participants. The strongest effects were observed in young female adults (|β| = 0.07-0.22, q < .05): Greater abuse and neglect were correlated with smaller hippocampus and putamen volumes, thinner entorhinal cortex, and smaller SA in fusiform/inferior parietal regions and with larger SA in the orbitofrontal and occipital cortices. In males, abuse had widespread effects on CT and SA (|β| = 0.1-0.18, q < .05); effects for neglect were minimal. CONCLUSIONS:Our findings of age- and sex-specific instantiations of CM on brain morphometry highlight the importance of developmental context in understanding how adverse experiences shape neurobiological vulnerability to MDD and PTSD.

BACKGROUND:Prenatal exposure to alcohol (PAE) and/or tobacco (PTE) may impact neurobiological and cognitive development years after such exposures have occurred. While such effects on cortical gray matter and cognition are widely researched, there is less research on the effects of PAE and PTE on white-matter development and cognition, particularly in non-clinical, community samples. METHODS:We analyzed white-matter microstructure and its cognitive correlates in four hundred and sixty five 8-12-year-olds in the urban Cape Town region of South Africa: 192 were prenatally exposed to alcohol and tobacco (PAE + PTE), 73 to tobacco only (PTE), 102 to alcohol only (PAE), and 98 to neither tobacco nor alcohol (CON). White-matter microstructure was quantified via neurite orientation and dendrite dispersion imaging (NODDI). The outcome variables were fractional anisotropy (FA), the neurite density index (NDI), and neurite orientation dispersion index (ODI) for 52 white-matter tracts. Cognition was measured using the Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V). RESULTS:PAE (but not PTE) was associated with NDI in 35 of 52 white-matter tracts analyzed. There were no false-discovery-rate (FDR) corrected main effects of PAE or PTE on FA or ODI. For 17 of the 35 tracts affected by PAE, the corresponding NDIs were positively associated with scores on the WISC-V Processing Speed Index. CONCLUSIONS:Our previous research of neuroanatomical structure in this cohort suggested that there are stronger effects of PTE on cortical gray matter. In contrast, the present data suggest that PAE may have stronger associations with white-matter microstructure, with such effects potentially manifesting as downstream deficits in processing speed.

This work presents a policy analysis regarding Problematic Usage of the Internet (PUI) across seven countries (Netherlands, Spain, Hungary, Lithuania, Portugal, Estonia, and Switzerland) belonging to or associated with the European Union (EU). I It examines legislative instruments addressing PUI and its multifaceted impacts on society, including social, economic, and political dimensions. Despite the growing prevalence of PUI, particularly among adolescents, and its association with various mental health concerns, the study reveals a notable gap in direct policy interventions targeting PUI within these countries. Existing regulations largely focus on broader digital governance issues like data protection, cybersecurity, and market regulation, offering only indirect approaches to mitigating PUI's adverse effects. Our findings highlight a pressing need for innovative policy frameworks that incorporate mental health considerations into digital governance, promoting a balanced approach that fosters market innovation while ensuring robust public health protections. Building on the policy discourse examined in this study, future research should focus on developing targeted, multidimensional strategies to mitigate the risks associated with problematic internet use (PUI), with particular emphasis on safeguarding the well-being of vulnerable populations.

Abstract Brain disorders are increasingly understood as disorders of distributed brain circuits, yet functional connectivity (FC), the dominant framework for mapping them, treats the brain as a collection of pairwise relationships between regions and cannot represent pathology distributed across coordinated sets of connections. We introduce a Hodge-Laplacian topological framework that localizes higher-order “loop” (1-cycle) organization within functional connectome, maps each loop to specific edges and networks, and yields a subject-level measure of loop expression. Applied to resting-state fMRI from the ENIGMA-OCD consortium (1,024 patients and 1,028 controls across 28 sites), the framework identified 93 loop-level abnormalities in obsessive–compulsive disorder (OCD), concentrated in frontoparietal and somatomotor systems. The edges forming these loops largely showed no significant differences between groups, indicating that the abnormalities were invisible to conventional FC analysis. The frontoparietal and somatomotor loop clusters recurred across the clinical subgroups, suggesting convergence on a shared higher-order phenotype. Robustness analyses showed the loop signal reflected higher-order organization rather than an artifact of individual edges, the network backbone, or any single site. These results indicate that coordinated, multi-edge pathology exists and can be localized even when pairwise analyses fail to detect it, positioning higher-order topology as a generalizable axis for mapping circuit pathology across psychiatric and neurological disorders.

Background The hospitalization of patients with obsessive-compulsive disorder (OCD) is less common in comparison to other mental disorders, and often a significant and distressing event. Objectives This paper presents a position statement, developed by the International College of Obsessive-Compulsive Spectrum Disorders, on the indications for hospital admission for people with OCD, the treatment that is offered within hospital, the complications that may occur in this setting, and principles for best practice. Methods Current literature was critically reviewed and narratively synthesized by a group of international experts in the field of OCD. Results An inpatient hospital admission may be required for people with severe OCD who are unable to accept or tolerate pharmacological or psychological treatment as an outpatient or where there would be significant risks to the individual or those around them. Admissions have been associated with significant reductions in OCD severity. Inpatient treatment often involves psychoeducation of staff, patients and family members, pharmacotherapy, exposure and response prevention psychological work, addressing comorbidity as well as psychosocial issues such as family-relational issues, homelessness, grief or loss. Admissions can be distressing, and intensive inpatient-based therapy programs require the comprehensive assessment of risk. Conclusions The inpatient treatment of people with OCD is an important management option that needs to be well considered and managed. Admissions often require close monitoring of risks, additional support to staff who may be unfamiliar with OCD, addressing comorbidity, pharmacotherapy and exposure and response prevention therapy.

This study aims to prospectively collect harmonized, quantitative, and dimensional psychiatric phenotypes (suicidality, anhedonia, and obsessive-compulsive symptoms) and information on discrimination, stigma, and unfair treatment in up to 27,500 individuals across diverse ancestries and clinical populations for genetic analysis within the NIMH Ancestral Population Network (APN). Five APN projects are participating in the current study (PUMAS-Paisa, PUMAS-NeuroGAP, KOMOGEN-D, LATINO, and SAX-II), spanning recruitment over 15 countries across the Americas, Africa, and Asia. Participants are being enrolled via the recruitment protocols specific to each participating project. The harmonized clinical battery includes the Columbia-Suicide Severity Scale, Snaith-Hamilton Pleasure Scale, and Florida Obsessive-Compulsive Inventory-II to assess suicidality, anhedonia, and obsessive-compulsive symptoms, respectively. Additionally, we use the Discrimination and Stigma Scale-Ultra Short to evaluate discrimination and stigma across cultures. This project is a pioneering effort to prospectively assess transdiagnostic phenotypes in large-scale, diverse ancestral and clinical populations (across different diagnoses) using a harmonized clinical battery, advancing genetic research in mental health in underrepresented populations.

Background and Aims:Problematic usage of the internet (PUI) is a growing global concern, emerging among more than 5.3 billion people who use the internet worldwide. While specific forms such as online gaming and gambling are recognized as disorders or conditions for further study in diagnostic manuals, global data on prevalence, treatment, and health responses to PUI remain limited. This study aimed to obtain perspectives from representatives of addiction medicine/psychiatry societies regarding the scope, treatment, and health responses to PUI and identify gaps. Methods:A global survey was conducted through the International Society of Addiction Medicine's Global Expert Network (ISAM-GEN), involving addiction societies from 38 countries across Europe, Asia/Oceania, the Americas, and Africa. The survey assessed responses to non-specific PUI and five subtypes: online gaming, gambling, pornography, social media, and online shopping. It included case scenarios and questions on the significance and severity of PUI, and country-level health responses. Results:Online gambling (94.8%) and gaming (86.9%) were the most frequently reported PUI forms, followed by social media (84.2%), pornography (68.3%), and online shopping (52.6%). Psychotherapeutic approaches, particularly cognitive behavioral therapy, were the most widely available treatments, reported as accessible by over 70% of country respondents. Despite growing awareness-reflected in the formation of PUI interest groups in 44.7% of societies-gaps were reported, including lack of professional certification (78.9%), insufficient practitioner education (68.4%), and inadequate expert training (63.2%). Notably, 65.8% rated the 10-year severity of PUI as extremely or very important. Discussion & Conclusion:Global attention to PUI is increasing, but more robust healthcare responses are needed. Addressing existing gaps requires enhanced training and sustainable international efforts.

Major depressive disorder (MDD) is common and disabling, yet reported brain structural differences vary across studies. Here we performed a large vertex-wise (point-by-point) meta-analysis of cortical thickness and surface area using harmonized magnetic resonance imaging processing across 64 cohorts from the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) MDD and Depression Imaging Research Consortium (DIRECT) consortia (5,736 patients; 6,538 controls). We show significantly lower cortical thickness in patients with MDD in multiple brain regions, including the inferior parietal, lateral occipital, superior parietal, medial and lateral orbitofrontal, anterior and posterior cingulate, and precentral gyri, with cortical surface area showing no significant differences. Effects were most pronounced in adults with acute depression, whereas adolescents showed no significant case-control differences. Antidepressant medication use at scanning was associated with more extensive thinning, although effect sizes remained modest (mostly |Cohen's d| < 0.20). This high-resolution, globally generalizable map can support studies of mechanisms and help evaluate structural markers of the clinical course and treatment response.

Posttraumatic stress disorder (PTSD) is a psychiatric condition that may develop after trauma exposure. PTSD is characterized by considerable clinical heterogeneity. The amygdala's key role in fear conditioning makes it an important focus for investigating the neurobiology of PTSD. However, associations between amygdala volume and PTSD have been inconsistent. The amygdala consists of functionally distinct nuclei. Specific associations between amygdala nuclei volumes and PTSD may account for previous discrepancies between PTSD and whole amygdala volume. This study investigates the associations between amygdala nuclei volumes, PTSD diagnosis, severity, symptom cluster scores, age of onset and childhood trauma. Individuals with a PTSD diagnosis (n = 771) and controls (n = 1 081, 72% trauma-exposed) were sourced from the Enhancing Neuro-Imaging Genetics through Meta-Analysis and Psychiatric Genomics Consortium (mean age = 32.4 years, (SD = 13 years), 60% male). Nine amygdala nuclei volumes were compared to PTSD diagnosis, age of onset, overall severity, symptom cluster scores (re-experiencing, arousal, and avoidance/emotional numbing), and childhood trauma subscales. Analyses were performed using ordinary least-squares regression, corrected for age, sex, intracranial volume, and whole amygdala volume. PTSD diagnosis was not significantly associated with amygdala nuclei volumes. PTSD severity scores were associated with smaller right lateral nucleus volume (β = -0.26, pBON = 0.01). Smaller right lateral nucleus volume was also associated with re-experiencing (β = -1.01, pBON = 0.04) and arousal (β = -0.9, pBON = 0.04), smaller left paralaminar nucleus volume was associated with re-experiencing (β = -0.1, pBON = 0.04), smaller left corticoamygdaloid transition area volume was associated with avoidance (β = -0.31, pBON = 0.02). Larger left and right central nucleus volumes were significantly associated with childhood physical abuse (β = 0.24, pBON = 9 × 10-3) and neglect (β = 0.29, pBON = 0.04), respectively. Differences in select amygdala nuclei volumes among adults are associated with PTSD severity, symptom cluster scores, and childhood physical abuse and neglect. These findings demonstrate nuclei-specific patterns consistent with their functional roles in fear learning and expression.

Objective:There is little longitudinal research investigating links between violence exposure and mental disorders among children in low- and middle-income countries (LMICs), despite high rates of violence. We examined cross-sectional and longitudinal violence-mental health associations among children in a large South African birth cohort, the Drakenstein Child Health Study, including direct clinical interviews capturing children's mental disorders. Method:In this birth cohort (N=974), we assessed lifetime violence exposure and four subtypes (witnessed community, community victimization, witnessed domestic, domestic victimization) at ages 4.5 and 8-years via caregiver reports. At 8-years, caregivers completed the Child Behaviour Checklist; and psychiatric disorders were assessed using the Mini-International Neuropsychiatric Interview for Children and Adolescents, a self-report measure. We tested for associations using linear/logistic regressions, adjusted for confounders. Results:Most children (91%) had experienced violence by 8-years. Cross-sectionally, total violence exposure was associated with total (B =0.49 [95% CI 0.32, 0.66]), internalizing (0.32 [0.17, 0.47]), and externalizing problems (0.46 [0.31, 0.61]), and with increased odds of disorder at 8 years (aOR=1.09 [1.05, 1.13]). Longitudinally, total violence exposure up to 4.5-years was associated with total (B=0.27 [0.03, 0.52]), internalizing (0.24 [0.04. 0.44]), and externalizing scores (0.23 [0.008, 0.45]) at 8-years, but not with increased risk of psychiatric disorders. The strongest and most consistent associations were observed for domestic versus community violence subtypes. Conclusion:Our strong cross-sectional but weaker longitudinal findings suggest that recent violence exposures may be more critical than early exposures for children's mental health. Longitudinal exploration of other violence-affected LMIC populations is urgently needed.

ABSTRACT Importance Problematic use of the internet (PUI) behaviors, including problematic gaming, social media use, smartphone use, and general internet use, have been increasingly studied worldwide. So far it is unclear what the global prevalence of PUI is. Objective To critically appraise existing systematic reviews and meta-analyses on the prevalence of PUI behaviors and generate aggregated global prevalence estimates across different manifestations and definitions. Data Sources MEDLINE (Ovid), Embase (Ovid), Scopus, Web of Science, CINAHL, and the Cochrane Review Library were searched for relevant articles from database inception to the most recent available search prior to manuscript preparation. Searches targeted systematic reviews and meta-analyses reporting prevalence for PUI-related behaviors. Study Selection Systematic reviews and meta-analyses of observational studies reporting prevalence estimates for problematic gaming, problematic internet use, problematic smartphone use, problematic social media use, or sexting were included. Scoping reviews were retained for descriptive synthesis only. Data Extraction and Synthesis An umbrella review methodology was used. Data extraction and methodological appraisal were conducted using AMSTAR-2 to assess the quality of included systematic reviews up to February 2026. Primary studies included in each review were extracted and pooled using random-effects meta-analysis. Analyses were conducted to estimate pooled prevalence with 95% confidence intervals (CIs) and heterogeneity across non-overlapping primary studies. Small-study effects were examined. Main Outcomes and Measures Global pooled prevalence estimates for PUI behaviors, including problematic gaming, problematic internet use, problematic smartphone use, problematic social media use, and sexting. Results Eleven reviews (10 systematic reviews and 1 scoping review) met inclusion criteria, representing data from 3 145 428 individuals, of whom 3 030 023 were included in pooled prevalence analyses. Across regions, pooled prevalence estimates were 6% (95% CI, 5%–7%) for problematic gaming, 16% (95% CI, 15%–17%) for problematic internet use, 32% (95% CI, 28%–35%) for problematic smartphone use, and 23% (95% CI, 19%–28%) for problematic social media use. Substantial heterogeneity (I 2 > 99%) was observed across primary studies, reflecting variation in study methodologies, sampled populations, and definitions of PUI behaviors. Conclusions and Relevance PUI behaviors appear to affect a substantial proportion of the global population. However, methodological concerns were common, with 9 of 10 systematic reviews rated as having low or critically low confidence according to AMSTAR-2. Evidence remains concentrated in East Asia and Europe, and many reviews combine heterogeneous populations and sampling strategies. Additional high-quality epidemiological research, including underrepresented regions is needed to refine prevalence estimates, clarify risk factors, and support the development of standardized criteria for PUI behaviors. Key Points Question What is the global prevalence of problematic use of the internet (PUI) behaviors across major subtypes, based on an umbrella review of existing reviews and a meta-analysis of nonoverlapping primary studies? Findings In this umbrella review of 11 reviews and random-effects meta-analysis of 753 nonoverlapping primary studies including 3 030 023 individuals, pooled prevalence estimates were 6% for problematic gaming, 16% for problematic internet use, 32% for problematic smartphone use, and 23% for problematic social media use. Findings indicated substantial between-study heterogeneity, and most included systematic reviews were rated low or critically low in methodological quality. Meaning These findings suggest that PUI behaviors affect a substantial proportion of the global population, but more methodologically rigorous and geographically representative epidemiological research is needed to generate more precise and comparable prevalence estimates across clinical and population samples.

BACKGROUND:Approximately 1.3 million individuals in sub-Saharan Africa, as well as millions of others worldwide, live with psychotic disorders. However, there is limited mental health research based on these populations and even less of a focus on neuropsychiatric genetics research within these settings. METHODS:To address this gap, the Neuropsychiatric Genetics of African Populations-Psychosis (NeuroGAP-Psychosis), a case-control study, collected data identifying genetic and environmental risk factors associated with psychotic disorders in Ethiopia, Kenya, South Africa, and Uganda. This paper describes baseline demographic and clinical characteristics of the 42,953 participants recruited between 2018-2023 and compares these characteristics by country and case status. RESULTS:Overall, 57.3% of participants were male (ranging from 65.8% in Ethiopia to 46.6% in Uganda). Among cases, the clinical diagnosis of schizophrenia or psychotic disorder not otherwise specified (NOS) ranged from 75.5% in Ethiopia to 44.4% in Uganda. Specific to bipolar disorder or mania NOS, the highest proportion was 53.9% in Uganda, and the lowest was 24.0% in Ethiopia. There were country-level and case-status differences across all demographic and clinical (e.g., physical comorbidities, substance use) variables. CONCLUSION:Many factors, including language of consent, recruitment catchment areas, diagnostic practices across countries, and translation and/or cultural interpretation of the measures used in this study may account for the differences observed across countries. These findings suggest the importance of ongoing evaluation of cross-national differences to explore clinical implications and patterns of symptoms amongst geographically and culturally diverse populations. Future analyses should evaluate within-country differences to better explore these variations.

This work analyses policies related to the Problematic Usage of the Internet (PUI) and its relationships to adolescent mental health across the United Kingdom, France, Germany, Italy, Australia, Canada, the United States, and New Zealand. Using a policy path dependency framework, national legislation was examined to assess relationships with PUI. The study maps policy by reviewing governmental legislation and databases, analysing them on macro (societal), meso (market/intermediary organisations), and micro (citizen rights, duties, and protection) levels. It explores legal instruments related to PUI, including data protection, cybersecurity, content regulation, and harassment, offering both historical and comparative analyses across the eight countries. Findings indicate that while several countries have policies indirectly regulating PUI, significant legislative gaps persist relating to adolescent mental health. Most policies address broader internet concerns without specifically targeting PUI or its effects on mental health. Overall, the analysis highlights the need for more targeted public health policies to address the root causes of PUI, advocating for tailored interventions focused on adolescent well-being.

Early temperament, such as socio-emotional development and activity level, varies widely, yet its underlying biological associations are not understood. We identified genetic variation associated with infant and toddler temperament using genome-wide association meta-analyses. We studied parent-rated emotionality, activity, shyness and sociability (n = 43,963-72,663) in the second and third postnatal years and a cross-age average. Cross-age single nucleotide polymorphism heritabilities for emotionality, activity, shyness and sociability were 6.79% (95% confidence interval (CI), (4.71%, 8.87%)), 9.55% (95% CI, (7.04%, 12.06%)), 15.26% (95% CI, (12.24%, 18.28%)) and 3.42% (95% CI, (1.30%, 5.54%)), respectively. Ten genome-wide significant loci were discovered. Two loci colocalized with expression quantitative trait loci in the adult cortex: RHEBL1 (posterior probability, 0.93; associated with activity) and MR1 (posterior probability, 0.99; with emotionality). Genetic correlations were observed between early temperament and later outcomes, such as emotionality and adult neuroticism, activity and attention deficit/hyperactivity disorder (ADHD), sociability and autism, and shyness and adult extraversion. Multi-ancestry (n = 56,083-78,894) and European-ancestry analyses gave similar results. Infant and toddler temperament is associated with genetic variation and shows genetic continuity with later outcomes.

Maternal antenatal psychological distress can negatively affect child development, particularly in low- and middle-income countries (LMICs) where women are at heightened risk for distress. This study examined the association between maternal antenatal distress and child amygdala-prefrontal cortex functional connectivity in a South African birth cohort using resting-state fMRI. Children aged 2-3 years who were either exposed to maternal distress in utero (n=27) or unexposed (n=85) were analyzed using region-of-interest analysis. Multivariate analysis of covariance assessed group differences, adjusting for confounders, and Pearson correlations examined associations with externalizing behaviors 6-18 months later across the whole sample (n=111). Exposed children showed weaker amygdala-medial PFC and amygdala-lateral PFC connectivity than unexposed peers (medial PFC: mean=0.099 vs 0.164, p=0.034; lateral PFC: mean=0.095 vs 0.132, p=0.025). These differences were significant in boys only (medial PFC: p=0.016; lateral PFC: p=0.019). Additionally, hippocampus-PFC connectivity at ages 2-3 was negatively associated with later externalizing behaviors. Findings suggest exposure to maternal psychological distress in utero impacts amygdala-PFC connectivity in early childhood, while exploratory associations between hippocampus-PFC and externalizing behavior point to potential links with later behavioral outcomes. Understanding these neural correlates may inform early interventions to disrupt intergenerational transmission of psychological risk.

Background and aims:Studies regarding whether compulsive sexual behavior (CSB) shows a persistent or transient longitudinal course have been scarce and generated mixed findings, complicating its conceptualization. A model that includes both trait-like/stable and state-like/occasion-specific factors may clarify the course and nature of CSB. The authors aimed to determine the proportion of variance in CSB scores attributable to trait-like/stable and state-like/occasion-specific factors and examine the strength of autoregressive effects between successive state-like/occasion-specific factors. Methods:Data from young adults (N = 782; women: 39.60% [N = 310]; age at wave 1: M = 27.06 [SD = 4.69]) showing continuous sexual activity from waves 1-4 of the representative Budapest Longitudinal Study were analyzed. CSB was measured with the eight-item Hypersexual Behavior Inventory. Results:Latent growth modeling showed decreases in CSB over waves 1-4 across three years, following a non-linear (quadratic) trajectory (M [SE] = -0.26 [0.08]). A latent state-trait model with one CSB trait-like/stable factor and four state-like/occasion-specific residual factors (capturing time-specific fluctuations) had optimal fit (χ2 [df] = 653.667 [550], p = 0.002; CFI = 0.996; TLI = 0.997; RMSEA [90% CI] = 0.016 [0.011; 0.021]; SRMR = 0.075). High proportions of CSB score variance were attributable to state-like/occasion-specific factors (69-93%), while lower proportions of CSB scores were attributable to the trait-like/stable factor (7-31%). Additionally, positive, moderate-to-strong autoregressive effects were observed between successive state-like/occasion-specific factors, indicating short-term stability and carry-over across assessments (β [SE] = 0.36-0.65 [0.06-0.08]). Discussion and conclusions:Overall, CSB is more likely to be a state-like phenomenon in young adults from the general population. Situational influences may explain the longitudinally fluctuating and transient course of CSB. Significant state-like/occasion-specific effects may have important implications for screening for and diagnosis of CSB disorder.