Depression is commonly treated with either psychotherapy or antidepressants, but patients differ widely in their comparative responses. Identifying the most effective treatment for each individual is crucial to optimizing scarce resources, particularly in low-resource settings. This study evaluated the feasibility and acceptability of a precision treatment trial comparing psychotherapy based on behavioral activation (the Healthy Activity Program) with antidepressant medication (fluoxetine) in adults with depression in primary care settings in India. A single-blind, two-arm randomized controlled pilot was conducted with adults aged ≥18 years with moderate to severe depression (PHQ-9 score≥10) from eight primary healthcare centers in Bhopal, India. Primary outcomes were feasibility and acceptability, assessed using indicators of study implementation (recruitment, randomization, treatment fidelity, completeness of assessments, biologic sample collection, and safety) and participant engagement (retention and treatment adherence). Secondary outcomes included changes in depressive symptoms, remission, and patients’ subjective sense of improvement at the 3-month endpoint. Of 578 individuals screened, 180 were eligible and 76 (42%) enrolled. Retention was 82% at 3 months. Psychotherapy participants attended 5.6/6-8 sessions, while medication participants consumed 57.9% of prescribed doses. Completion rates of study assessments were high (72–100%), and missing data were minimal, although some baseline measures were burdensome and were subsequently shortened for the main trial. Biologic sample collection was feasible, with 67% of participants consenting to blood draws. Depressive symptoms improved across both arms, with 45.2% achieving remission. However, treatment responses varied substantially within each arm (psychotherapy: –9.1 [SD=6.5]; medication: –7.6 [SD=6.9]), indicating marked individual heterogeneity. This pilot demonstrated the feasibility and acceptability of implementing a precision treatment trial for depression in Indian primary care, identified refinements to optimize procedures for the main trial, and supported the potential to identify the optimal treatment for each patient.

Several meta-analyses and meta-reviews have yielded inconclusive results on the efficacy of digital mental health interventions for anxiety disorders. To address this discrepancy, we conducted an umbrella review and multiverse meta-analysis of randomized controlled trials with no restrictions on intervention type, target group, format, control condition, or diagnosis. Studies focusing on comorbid anxiety were excluded. We screened 10.942 records and retrieved 1.263 full texts, identifying 10 meta-analyses and 81 randomized controlled trials meeting inclusion criteria. Unfortunately, the majority of included meta-analyses and primary investigations were of suboptimal quality, with possible conflicts of interest. Only two meta-analyses provided suggestive evidence, and the majority yielded weak evidence. Digital interventions demonstrated stronger evidence for the treatment of generalized anxiety disorder than other anxiety disorders. The multiverse meta-analysis calculated 2.220 additional meta-analyses, with an average effect size of Hedges’ g = 0.65 with 79% of the meta-analyses reaching at least a small effect size. Results suggest the overall robustness of digital interventions, with larger effect sizes observed for guided interventions, internet-based interventions, and comparisons with waitlist control groups. Nonetheless, we caution against overinterpreting findings given the overall low quality of evidence.

INTRODUCTION:Psychotherapies for depression are effective. To generalize to the diverse U.S. population, clinical trials must adequately represent racial/ethnic minority groups. Prior reviews of diversity of clinical trial participants are limited by incomplete reporting of race/ethnicity, use of national rather than state-level comparators, and pooling practices where a few diverse trials skew estimates. METHODS:We evaluated racial/ethnic representation in U.S. randomized trials comparing psychotherapy with an inactive control in depressed adults using meta-analysis with state-specific population benchmarks. We assessed reporting of race/ethnicity and, using meta-analysis, evaluated minority representation relative to state population benchmarks. Analyses included sensitivity and subgroup tests (through 2001 and 2002 onward) and meta-regressions assessing links between minority representation and treatment effectiveness. Seventy-six trials (98 comparisons; 8819 participants) were included. RESULTS:Race/ethnicity was not reported in 29.1% of studies. The "total minority" estimate suggested slight overrepresentation (+2%) but was inconsistent across sensitivity analyses and obscured subgroup differences in representation and temporal patterns. Subgroup analyses showed uneven representation, with Black participants overrepresented and Hispanic/Latino, Asian, and multiracial participants persistently underrepresented. Psychotherapy showed a moderate effect (g = 0.62). The apparent association between greater minority representation and lower treatment effectiveness was no longer significant after adjustment for trial characteristics or exclusion of high-risk-of-bias trials. DISCUSSION:Incomplete reporting limits evaluation of representativeness. Aggregate "total minority" estimates obscures important subgroup differences, including persistent underrepresentation of some racial/ethnic groups. More complete reporting and subgroup-specific analyses are needed to evaluate racial/ethnic representation in depression treatment clinical trials.

Posttraumatic stress disorder (PTSD) is a chronic and disabling condition and identifying beneficial therapies is timely and important. We aimed to estimate the efficacy of 3,4-methylenedioxymethamphetamine-assisted therapy (MDMA-AT) compared with control on clinical and functional outcomes in PTSD. A PRISMA-compliant search (PROSPEROCRD42022353261) up to August 14, 2025, covered nine databases and manual searches to identify randomised controlled trials (RCTs). Methodological quality was assessed using the Cochrane Risk of Bias tool (RoB2), and the certainty of the evidence for each outcome was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Of 1035 records identified, 14 studies met inclusion criteria for qualitative synthesis; eight trials provided sufficient data for quantitative synthesis (k = 24). Random-effects meta-analyses indicated that MDMA-AT was associated with reductions in PTSD symptom severity (n = 298, k = 9, SMD = -1.19, 95 % CI [-1.95, -0.42]; I² = 68.8 %, τ2 = 1.02), dissociative symptoms (n = 148, k = 5, SMD = -0.37, 95 % CI [-0.70, -0.04]; I² = 0.0 %, τ2 = 0), and may improve functioning (n = 227, k = 4, SMD = -0.83, 95 % CI [-1.47, -0.19]; I² = 61.2 %, τ2 = 0.27). No clear evidence of benefit was observed for depressive symptoms. Most studies showed a high risk of bias in the measurement of the outcome, and some concerns due to deviations from the intended intervention; the overall certainty of the evidence was very low. The number of trials remains limited, with considerable heterogeneity in certain outcomes, small sample sizes, and the absence of active controls in most studies, which likely compromised blinding integrity. Current findings suggest that MDMA-AT may warrant further investigation as a potential treatment for PTSD; however, larger, higher-quality RCTs with active controls and long-term follow-up are needed to determine its efficacy.

INTRODUCTION:The global burden of depression continues to rise despite evidence that prevention is feasible and cost-effective. Building on the Resilience Enhancement with Smartphone in Living ENvironmenTs (RESiLIENT) randomised controlled trial, the Best, Efficient and Affordable Training in Resilience in Constant Evolution (BEATRICE) platform trial evaluates and optimises smartphone-delivered cognitive-behavioural therapy (CBT) for adults with no to subthreshold depression. The primary objective is to minimise the Total Burden of Depression, measured by the integral of weekly to monthly Patient Health Questionnaire-8 (PHQ-8) scores over 12 months, through a living, adaptive platform trial that sequentially tests multiple clinical questions and personalised algorithms. METHODS AND ANALYSIS:BEATRICE is a nationwide, digitally centralised, multi-arm platform trial conducted via the 'Resilience Training App'. Eligible participants are adults (aged ≥18 years) with PHQ-8 ≤14, fluent in Japanese, owning a smartphone and not currently receiving mental health treatment. Recruitment takes place through health-insurance associations, companies, municipalities and online outreach. Participants are randomised centrally to CBT skill modules-behavioural activation, assertion training, behaviour therapy for insomnia, cognitive restructuringor problem-solving-delivered alone or in combination. Assessments are open-label and completed digitally by self-reports.The initial list of clinical questions to be examined in this platform trial includes: external validity of the personalised and optimised algorithm for first-line interventions, strategies to help individuals not on track during initial weeks, second-line interventions at 6 months, development of super-personalised and optimised therapy algorithm, that is, longitudinally personalised and optimised in response to individuals' responses after the first-line assignment. The primary outcomes, sample sizes and statistical analyses differ depending on the clinical question addressed within the platform trial. ETHICS AND DISSEMINATION:Approved by the Ethics Committee of Kyoto University Graduate School of Medicine (C1733). Results will be disseminated via peer-reviewed publications, conferences and public reports. TRIAL REGISTRATION NUMBER:UMIN000058696.

Introduction Despite evidence supporting child and adolescent cognitive behavioural therapy (CBT) globally, interventions remain largely unavailable within public systems. This gap requires implementation models integrating development, training, and scalability research within real-world settings and changes in management structures. Here we developed and implemented manualised psychotherapeutic protocols through a national capacity-building initiative in Greece. Methods We designed a structured implementation pathway conducted through the Child and Adolescent Mental Health Initiative (CAMHI), a public-private partnership involving clinical and academic institutions across Greece: (1) pre-implementation research through national reviews and national surveys of health professionals; (2) co-development and iterative pilot implementation of evidence-based interventions through supervised practice within the National Health System; and (3) dissemination research supporting scalability and institutionalisation within public structures. Results Pre-implementation research identified gaps in the availability of clinical protocols in Greek services; a survey of 120 psychologists and psychiatrists indicated the need for psychotherapeutic training. Three evidence-based protocols were co-developed: CBT for anxiety (6 to 12 years), CBT for depression (12 to 17 years), and behavioural parent training (BPT) for disruptive behaviour (4 to 14 years). During a three-stage pilot, 45 clinicians delivered interventions to 140 cases (anxiety n=52; depression n=25; BPT n=63); 117 (83.5%) completed treatment. Significant symptom reductions were observed for anxiety (d=-2.92; RCADS25), depression (d=-1.79, RCADS25), and disruptive behaviour (d=-2.3, SNAPIV), with 63%, 38% and 44% showing reliable improvement at the treatment endpoint. A train-the-trainer model is under implementation for national scale-up. Institutionalisation includes integration into child and adolescent psychiatry curricula. Sustainability safeguards were established through Law 5015.2023, with the Ministry of Health assuming operations by 2027. Discussion Pilot results demonstrate the feasibility of evidence-based psychotherapeutic interventions embedded within real-world child and adolescent services in Greece. Integrated implementation approaches provide a viable pathway for developing, refining, and scaling clinical manuals within public health provision. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by the Stavros-Niarchos Foundation (SNF) as part of the Child and Adolescent Mental Health Initiative (CAMHI) in Greece ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Each regional hub secured ethical approval from its respective local ethics board, with amendments approved as necessary to accommodate additional trainers. In Athens, approvals were granted by the 1st Health District of Attica via the Scientific Council of "Agia Sofia" Children's General Hospital (27761/04.12.2023; 20381/12.08.2024). In Thessaloniki, approval was obtained from the 3rd Health District of Macedonia through the Scientific Councils of Hippokrateio Hospital (52297/17.11.2023) and Papanikolaou Hospital (925/28.11.2023; 1218/10.09.2024). Approval for the Ioannina hub was provided by the Administrative Board of the University General Hospital of Ioannina (36/19.12.2023). In Crete, the 7th Health District granted approval through the Scientific Council of the University General Hospital of Heraklion (36515/31.10.2023). Finally, in Alexandroupolis, approvals were issued by the Administrative Board of the University General Hospital of Alexandroupolis (54805/09.11.2023; 55388/04.11.2024). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors

OBJECTIVE:To estimate the minimal detectable change (MDC) for the Patient Health Questionnaire-9 (PHQ-9) and its eight item (PHQ-8) and two item (PHQ-2) versions including differences by participant and study characteristics. DESIGN:Individual participant data meta-analysis. DATA SOURCES:Medline, Medline In-Process and other non-indexed citations, PsycInfo, and Web of Science, 1 January 2000 to 9 May 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES:Datasets from articles in any language if participants were aged ≥18 years, were recruited from any non-psychiatric setting, and were not recruited because they were seeking mental healthcare. Eligible datasets had a classification for major depressive disorder or major depressive episode based on a validated semi-structured or fully structured interview conducted within two weeks of administering the PHQ-9, PHQ-8, or PHQ-2. RESULTS:Pooled MDCs across studies were estimated for the PHQ-9, PHQ-8, and PHQ-2 with random effects meta-analysis for 95% (MDC95), 90% (MDC90), and 67% (MDC67) confidence that change beyond measurement error occurred. PHQ-9, PHQ-8, and PHQ-2 analyses included 42 548 participants (94 studies), 42 592 participants (94 studies), and 44 085 participants (98 studies), respectively. Mean participant age was 49 years (standard deviation 17), and 60% of participants were women. Overall, 10% of participants had major depression (range 1-57% across studies). MDC95 was 5.72 points (95% confidence interval (CI) 5.54 to 5.90, 95% prediction interval (PI) 4.00 to 7.44) for the PHQ-9, 5.51 points (95% CI 5.33 to 5.68, 95% PI 3.87 to 7.15) for the PHQ-8, and 2.26 points (95% CI 2.15 to 2.37, 95% PI 1.20 to 3.32) for the PHQ-2. For the PHQ-9, MDC95 was highest in inpatient healthcare settings at 6.48 (95% CI 6.05 to 6.92) points. MDC95 for the PHQ-9 increased by 0.40 (95% CI 0.25 to 0.55) points for each 10% increase in the proportion of participants with major depression. Sex and age had minimal or no association. Subgroup and meta-regression findings were similar for the PHQ-8 and PHQ-2. CONCLUSIONS:Based on the pooled estimate, a six point difference on the PHQ-9, the PHQ version most used in clinical practice, could be an appropriate MDC threshold in general practice. A higher threshold may be preferred in specialty mental healthcare. MDC67 or MDC90 thresholds would provide less certainty that change has occurred. Alternative strategies, such as using the upper end of a prediction interval, would provide more certainty but a greater likelihood of not recognising change. STUDY REGISTRATION:PROSPERO CRD42014010673.

Depression is a major cause of disability worldwide, motivating interest in psilocybin as a potential treatment. Here we present a living systematic review and open-data meta-analytic resource on psilocybin treatment for depressive symptoms. In this initial release, 15 randomized controlled trials comprising 801 participants are included in the database, with 12 of those studies included in our primary model (n = 585) using inverse-variance random-effects modeling of standardized mean differences on primary outcomes. Compared with control conditions, psilocybin showed a greater reduction in depression scores (Hedges' g = -0.90). This systematic review and meta-analysis suggests that psilocybin-assisted therapy results in substantial decreases in depressive symptoms across studies to date. However, many studies have small sample sizes or risk of bias. This living systematic review, meta-analysis, database and online dashboard (sypres.io) will continue to be updated as evidence emerges, providing a valuable resource for researchers in a rapidly evolving field.

OBJECTIVES:Psychological outcome measures guide research and clinical decision-making, yet many widely used tools were developed with limited psychometric rigour. Although advanced methods (e.g., item response theory, structural equation modelling) are now widely available, their added value in applied research remains uncertain and applied researcher perspective regarding such are unexplored. We aimed to address this gap in knowledge by examining key stakeholder perspective. METHOD:To explore how these methods are perceived, we conducted semi-structured interviews with 21 stakeholders spanning psychometrics, clinical practice, applied research, statistics and academia. Data were analysed using reflexive thematic analysis. RESULTS:Analysis identified three overarching themes: (1) growing recognition that heterogeneity in latent traits challenges assumptions underlying many measures, (2) the enduring use of entrenched but psychometrically weak tools and (3) nuanced views on when advanced methods meaningfully influence research findings. Participants acknowledged gaps in psychometric literacy and emphasised the need for more training and collaboration with psychometricians. CONCLUSION:These findings highlighted persistent limitations in measurement practice, clarify contexts where psychometric methods add genuine value, and point to opportunities for strengthening outcome measurement in psychology and psychiatry research.

3,4-methylenedioxymethamphetamine (MDMA) has emerged as a potential treatment for post-traumatic stress disorder (PTSD), generating considerable enthusiasm in the field. However, rapidly changing evidence in a fast-moving field can be challenging to integrate. Here, we present a living systematic review and open-data meta-analytic resource on MDMA treatment for PTSD. In this initial release, six randomized controlled trials comprising 286 participants are included in the database. Our primary model uses inverse-variance random-effects meta-analysis of standardized mean differences on primary outcomes of PTSD. Compared to control conditions, MDMA showed a greater reduction in PTSD symptoms (Hedges' g = -0.71). Meta-regression on both the number of dosing sessions and cumulative dose showed that a higher number of dosing sessions and a higher cumulative dose was related to larger effects of MDMA. Treatment with MDMA as compared to placebo also resulted in higher response (risk ratio (RR) = 1.35) and remission (RR = 2.25) rates. Most studies included in the database had a low risk of bias according to Cochrane guidelines, though these fail to capture pertinent challenges in the field such as expectancy, functional unblinding, potential issues with study conduct, and safety. The current findings were assigned an overall low certainty rating using the GRADE approach. Together, this systematic review and meta-analysis suggests that MDMA-assisted therapy results in short-term decreases in PTSD symptoms across studies to date, though more trials are needed. This living systematic review, meta-analysis, database, and online dashboard (sypres.io) will continue to be updated as evidence emerges, providing a valuable, open, and transparent resource for researchers in a rapidly evolving field. ### Competing Interest Statement Over the last three years, ECS has had grant funding to his institution from NIH; editing payments from: Wolters-Kluwer; compensation for serving on boards or consulting from: Eli Lilly and Company, Boehringer Ingelheim, Dimerx; medical devices supplied to his institution for his research: Masimo; and he has conducted medical-legal consultations. He also has served on the board of directors (unpaid) for a treatment program: Ashley Addiction Treatment. SMN is a co-investigator on a Usona Institute sponsored trial of psilocybin for Major Depressive Disorder. DBY has received research support from the NIH, the Gracias Family Foundation, the Heffter Research Institute, and philanthropic donors to the Johns Hopkins Center for Psychedelic and Consciousness Research. He co-directs the Hub at Oxford for Psychedelic Ethics (HOPE), which has received a small anonymous donation to support travel for underrepresented workshop participants; DBY does not personally receive financial support for this role. DBY has received a consulting fee from Soneira and educational speaking fees from the Integrative Psychiatry Institute. RHD, since 1 January 2021, has received research grants and contracts from the US FDA and the US NIH, and compensation for serving on advisory boards or consulting on clinical trial methods from Acadia, Akigai, Allay, AM-Pharma, Analgesic Solutions, Beckley, Biogen, Biosplice, Bsense, Cardialen, Chiesi, Clexio, Collegium, CombiGene, Confo, Contineum, Eccogene, Editas, Eli Lilly, Emmes, Endo, Epizon, Ethismos (equity), Exicure, GlaxoSmithKline, Glenmark, Gloriana, JucaBio, Kriya, Mainstay, Merck, Mind Medicine (also equity), NeuroBo, Noema, OliPass, Orion, Oxford Cannabinoid Technologies, Pfizer, Q-State, Regenacy (also equity), Rho, Salvia, Sangamo, Semnur, SIMR Biotech, Sinfonia, SK Biopharmaceuticals, Sparian, SPM Therapeutics, SPRIM Health, Tiefenbacher, Validae, Vertex, Viscera and WCG. All other authors have no conflicts to declare. ### Funding Statement This effort is supported by the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks and Pediatric Anesthesia Safety Initiative (ACTTION/PASI) public-private partnership with the US FDA. The views expressed in this article are those of the authors, and no endorsement by the FDA should be inferred. RHD is director and chair of the ACTTION management committee, and TDS obtained funding for this study via ACTTION. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The living database used for this analysis can be accessed through Metapsy (docs.metapsy.org/databases/ptsd-mdmactr/) or downloaded from our website, where code for all analyses is also openly available (sypres.io).

BACKGROUND:Work-family conflict, defined as a type of inter-role conflict where demands from work and family roles are incompatible, is a global public health concern. Cross-sectional studies consistently demonstrate associations between work-family conflict and adverse mental health outcomes. However, longitudinal evidence remains mixed, highlighting the need for a comprehensive synthesis of available data to better understand its long-term impacts. METHODS AND FINDINGS:We performed a systematic review and meta-analysis of longitudinal studies of associations between work-family conflict and mental health outcomes, involving 112,714 participants and 52 studies in the meta-analysis. The review was prospectively registered in PROSPERO (CRD42022325540). We searched PubMed, Web of Science, Scopus, and PsycINFO for English-language articles and SinoMed for Chinese-language articles in February-March 2026. We further performed backward citation searches by screening the reference lists of previously published reviews to ensure the comprehensive inclusion of all eligible studies. Eligible studies were original longitudinal research focusing on adult workers, examining work-to-family and/or family-to-work conflict as exposures related to mental health outcomes. Risk of bias was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analyses were conducted for outcomes with three or more comparable studies, converting effect sizes to standardised regression coefficients (β), indicating standard deviation (SD) differences in mental health per 1-SD increase in work-family conflict. We synthesised effect sizes with the most comprehensive confounding adjustments when possible, including sociodemographic, work/family-related factors, and baseline mental health. Work-to-family conflict was associated with depressive symptoms (β = 0.10, 95% confidence interval [0.06, 0.15]; p < 0.001), burnout (β = 0.11, 95% CI [0.01, 0.21]; p = 0.040), and general mental distress (β = 0.13, 95% CI [0.03, 0.24]; p = 0.005), independent of baseline mental health and other confounders. Significant associations were also found for family-to-work conflict with depressive symptoms (β = 0.09, 95% CI [0.04, 0.15]; p = 0.006) and burnout (β = 0.08, 95% CI [0.03, 0.13]; p = 0.013) in studies with similar adjustments. No significant differences emerged based on gender, follow-up length, and geographical location. While evidence of publication bias was identified, sensitivity analyses employing a trim-and-fill method to adjust for this bias yielded broadly similar pooled estimates. A causal relationship cannot be fully established as all identified studies were observational. CONCLUSIONS:These findings provide evidence of the longitudinal association between work-family conflicts and mental health outcomes, underscoring the need for context-specific policies in promoting work-family balance and mental health.

Introduction:Despite the clinical relevance and high prevalence of AjD, there is limited research on psychological treatments for this disorder. The scientific literature suggests that low-intensity interventions, such as blended treatments, could be a promising option given how well they would fit with the characteristics of the disorder. The aim of this study was to analyze the feasibility and potential efficacy of a blended intervention for AjD. Method:An open-label, single-group feasibility trial was conducted. After completing the eligibility assessment, 41 participants with an AjD diagnosis received the blended intervention. This combined a 7-module internet-based CBT intervention with videoconference sessions with a therapist every 12 days. Patients were assessed at four time points: pre-treatment, post-treatment, and at 3- and 12-month follow-ups. Feasibility was assessed both quantitatively and qualitatively, including measures of adherence, satisfaction and expectations, participants' opinions, preferences, therapeutic alliance, and usability. In addition, different clinical measures were included. Results:The treatment proved to be well accepted and valued by the participants, showing high adherence rates, a preference for the blended format, and high expectations, satisfaction, usability, and therapeutic alliance scores. Overall, the participants reported positive opinions, both quantitatively and qualitatively, emphasizing the importance of the therapist's support. The dropout rate was 14.6%. The intervention was effective in improving both primary and secondary measures. Discussion:This blended intervention for AjD appears to be a viable and effective option for addressing the symptomatology of the disorder. The results of this study will aid in the design of future randomized controlled trials. Trial registration:Protocol registration: ClinicalTrials.gov Identifier: NCT05464121. Registered 19 July 2022, https://clinicaltrials.gov/ct2/show/NCT05464121.Protocol publication: https://doi.org/10.1016/j.invent.2024.100715.

OBJECTIVES:Several psychological treatments for depression in older adults have been found to be effective compared to control conditions. It is less clear, however, if these treatments have comparable effects. We aimed to examine the relative effects of these treatments. DESIGN:Systematic review and network meta-analysis. SETTING:Any outpatient setting. PARTICIPANTS, INTERVENTIONS, MEASUREMENTS:We included randomized controlled trials examining the effects of psychological treatments in older adults with depression, and comparing a treatment with another treatment or a control condition (care-as-usual and waitlist). Only treatments with at least five trials were included. RESULTS:We included 86 randomized trials (10,165 participants) examining five types of treatment: cognitive behavior therapy (CBT), behavioral activation therapy (BAT), problem-solving therapy (PST), supportive therapy (SUP) and life review therapy (LRT). The network was relatively well connected. CBT, BAT, PST and LRT were more effective than CAU (SMD range: 0.52-0.99) and WL (SMD range: (0.62-1.10). SUP was not more effective than WL or CAU. All therapies were more effective than SUP (SMD range: 0.43-0.80), except for BAT. LRT was more effective than CBT and BAT. However, we found a significant difference between direct and indirect evidence. After excluding outliers, the general conclusions were similar, except that LRT was no longer superior to other therapies. CONCLUSIONS:CBT, LRT, BAT and PST are effective interventions in the treatment of depression in older adults, and they probably have comparable effects. LRT and CBT have lower drop-out and may be preferrable as first treatment.

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.

INTRODUCTION:It is not yet clear whether baseline severity is associated with the effects of psychotherapies. We examined baseline severity at the study level in a large sample of randomized controlled trials comparing psychotherapies against a control condition for the treatment of depression. METHODS:We used an existing large database of randomized trials comparing psychotherapies for depression with control groups (www.metapsy.org). We converted baseline severity scores across different depression measures into a common metric. We ran bivariable and multivariable meta-regression analyses to examine the association of effect sizes with baseline severity. We also examined response rates in treatment and control conditions. RESULTS:We included 387 randomized trials (463 comparisons; 47,315 patients). The pooled effect size of the psychotherapies was g = 0.77 (95 % CI, 0.70; 0.84). In the main analyses, we found a highly significant association between the effect size and baseline severity (bivariable coefficient: 0.024 (SE = 0.006; p < 0.0001), multivariable coefficient: 0.022 (SE = 0.007; p = 0.002)). This was confirmed in some but not all sensitivity analyses. Absolute response rates in the control conditions remained stable across different levels of baseline severity (bivariable metaregression analyses: p = 0.545), or showed a negative association (multivariable analyses: p = 0.002). In the therapy conditions the response rates were significantly larger with increasing levels of baseline severity (bivariable: p ≤0.0001; multivariable: p = 0.006). CONCLUSION:The effects of psychotherapies are probably associated with baseline severity. Response rates in control conditions remained relatively stable across different levels of baseline severity, while in the treatment conditions the response rates increased with increasing levels of baseline severity.

BACKGROUND:Latent factor scoring may provide more precise score estimates than sum scores, but this has not been evaluated for the Hospital Anxiety and Depression Scale (HADS). We investigated whether latent factor scores could improve HADS depression screening accuracy. METHODS:We used a HADS screening accuracy individual participant data meta-analysis (IPDMA) database. We included 42 studies (7982 participants; 12 to 1143 per study) with a semi-structured interview reference standard. We randomly split the database into calibration and validation datasets. In calibration, we estimated latent scores using one-factor models (14-item HADS total scale [HADS-T], 7-item depression subscale [HADS-D]) plus HADS-T two-factor and bi-factor (general factor and two specific factors) models. We estimated cut-offs that maximized combined sensitivity and specificity for each method. In validation, we compared screening accuracy between latent variable approaches and the HADS-D sum score. The process was repeated 1000 times to estimate 95% confidence intervals for parameters. RESULTS:After removing iterations with failed models in confirmatory factor analysis (N = 304) or IPDMA (N = 31), aggregated results showed that confidence intervals for sensitivity, specificity, and combined sensitivity and specificity included 0 for all comparisons between factor scores and sum scores. Statistically significant but minimal advantages appeared in the receiver operating characteristic curve for the two-factor and bi-factor models (0.01, 95% CI [0.01, 0.02]; 0.02, 95% CI [0.01, 0.02]). Sensitivity analysis confirmed findings. CONCLUSIONS:Latent factor scoring did not meaningfully improve HADS screening accuracy compared with sum scores. Sum scores may be preferred in applied settings for their simplicity and feasibility.

Introduction Up to 30% of individuals with depression develop persistent depressive disorder (PDD), an often disabling and difficult to treat condition. The Cognitive Behavioural Analysis System of Psychotherapy (CBASP) is the only psychotherapy developed specifically for treating individuals with PDD. While several randomised controlled trials (RCTs) have demonstrated its efficacy in outpatient settings, evidence for its use in inpatient settings remains limited. Pilot studies of CBASP inpatient programmes in Germany have shown promising feasibility and effectiveness; however, no RCTs to date have systematically evaluated their outcomes. This study represents the first RCT to compare the short- and long-term efficacy and safety of CBASP with Behavioural Activation (BA), a first-line psychotherapy for depression, within an intensive multimodal inpatient setting.Methods and analysis In this prospective, multicentre, rater-blinded RCT with an active control group, we aim to recruit 396 adults (aged 18–70 years) with treatment-resistant PDD at eight German university hospitals. Participants will be randomly assigned to receive either (1) CBASP or (2) BA within an intensive treatment programme consisting of 10 weeks acute treatment in an inpatient and/or day clinic setting, followed by 6 weeks of outpatient continuation treatment. Primary and secondary outcome assessments will be conducted at multiple time points: baseline (T0), treatment onset (T1), after 5 and 10 weeks of acute treatment (T2, T3), at the end of continuation treatment (T4, week 16) and every 2 months up to week 64 (T5, naturalistic follow-up).The primary outcome measure will be the change in depression severity, as assessed by the Hamilton Depression Rating Scale (24-item version), after 16 weeks of treatment (from T0 to T4). Secondary outcomes will include response, remission, deterioration and relapse rates, self-reported depression and anxiety symptoms and additional psychological variables. A cost-benefit analysis will evaluate the health-economic benefits of both interventions. Additionally, this RCT will explore personalised treatment selection and mechanisms of change, including potential moderators and mediators of treatment effects. The findings from this trial are expected to provide clinicians with evidence-based guidance on choosing CBASP versus BA for inpatients with treatment-resistant PDD.Ethics and dissemination This study has received ethical approval from the ethics committees of all participating university hospitals. All participants will provide written informed consent before enrolment. Study findings will be published in peer-reviewed journals and presented at national and international conferences. We have involved people with lived experience from the earliest pilots onward, using their feedback to refine our study design. Ongoing consultation at conferences and public events has further ensured that our research remains grounded in patient perspectives.Trial registration number NCT04996433.

This study aimed to examine the differences in specialized mental health care utilization among young conflict-affected migrants in the Netherlands, compared to their Dutch-born and non-conflict-affected peers, and to assess the role of benefit receipt and duration of stay. This register-based study included 1,219,051 individuals aged 18–25 residing in the Netherlands on 1 January 2015. Participants were followed until 31 December 2018 for specialized mental health care contact. Adjusted hazard ratios (aHR) with 95