This study explored the culturally specific manifestations of interpersonal psychotherapy's (IPT's) four problem areas within the Chinese cultural context. Synthesizing qualitative feedback from IPT training and clinical supervision involving approximately 500 Chinese mental health professionals (2018-2025), the analysis aimed to highlight how traditional values-such as collectivism, filial piety (xiao), and face (mianzi, or social reputation and dignity)-profoundly shape interpersonal distress. The specific cultural nuances examined included how complicated grief is often masked by male stoicism or compounded by the shidu (loss of only child) stigma; how role transitions are intensified by rapid urbanization, affecting both migrants and left-behind elders; how role disputes are navigated through indirect communication; and how interpersonal deficits are linked to systemic pressures from exam-oriented education. The authors argue that successful implementation of IPT necessitates cultural contextualization rather than structural alteration. Therapists are encouraged to act as cultural navigators, cultivating sensitivity to these internal social norms. By validating somatic expressions and reconstructing culturally resonant support systems, IPT can achieve clinical efficacy and social relevance to foster interpersonal recovery in China.

Adolescents in middle school face rising socio-emotional and academic pressures. Understanding the convergent and grade-specific needs of students, parents, and teachers is essential to designing effective, developmentally appropriate school mental-health curricula in China. A mixed-methods design was used. Semi-structured interviews with students, parents, and teachers (n = 18) from diverse school types informed item generation. A self-developed questionnaire (student/parent/teacher versions) was administered in eight middle schools (students n = 1,510; parents n = 1,337; teachers n = 200). Multiple-response items were summarized using penetration rate and per-respondent normalized share. Grade differences in student penetration rates were tested with R × C chi-square and Bonferroni-adjusted pairwise proportion tests (α = 0.05). Across stakeholders, priorities clustered around study-methods guidance, interpersonal communication skills, life education, and emotion management. Clear grade patterns emerged: Grade 1 emphasized transition/adaptation, whereas Grades 2–3 increasingly prioritized stress and emotion regulation as academic pressure rose. Respondents favored interactive delivery (e.g., role-play, scenario work) and qualified instructors. Findings support a developmentally sequenced, school-based mental-health curriculum aligned with HPS principles, combining universal and grade-differentiated modules, interactive pedagogy, trained staff, and school–family–community collaboration with referral pathways. Limitations (single-province sample, self-developed instrument, self-report, potential selection bias) temper generalizability; future cross-regional, prospective evaluations should test impacts on wellbeing, help-seeking, academic engagement, and implementation outcomes.

Introduction:Transcutaneous auricular vagus nerve stimulation (taVNS) is a promising neuromodulation therapy for major depressive disorder (MDD), but reliable predictors of treatment response are lacking. Second-order morphometric similarity networks (MSN-II), which capture higher-order structural covariance patterns, may provide novel predictive biomarkers. Methods:A total of 122 antidepressant-free MDD patients from two centers (Site A, n = 92; Site B, n = 30) underwent structural MRI before and after 8 weeks of taVNS. Baseline MSN-II nodal strength within 26 limbic regions was extracted from T1-weighted images. A LASSO logistic regression model was trained in Site A and externally validated in Site B. Treatment response was defined as ≥60% HAMD-17 reduction. Results:MSN-II showed significant training performance (AUC = 0.792 ± 0.158; permutation P < 0.001) and generalized to external validation (AUC = 0.856, 95% CI: 0.693-0.978). MSN-I showed comparable performance (external AUC = 0.804). MSN-II also showed higher external validation performance than ReHo, ALFF, subcortical volumes, and baseline HAMD-17. The left orbitofrontal cortex area 13 (L_OFC_A13; β = -0.649) was the strongest predictor among four retained features. Non-responders showed higher baseline MSN-II in L_OFC_A13 (P = 0.021) and significant post-treatment decreases (P < 0.001), whereas responders remained stable (Time × Group interaction, P = 0.005). Discussion:MSN-II features from limbic regions provide promising cross-site prediction of taVNS response in MDD, with L_OFC_A13 emerging as a key biomarker. These findings support the potential of MSN-based approaches for individualized neuromodulation treatment planning.

OBJECTIVE:This study focused on the preferences for psychological assistance and associated factors among Chinese healthcare workers (HCWs) during the COVID-19 pandemic. DESIGN:Cross-sectional analysis of survey data collected from Chinese HCWs during the COVID-19 pandemic. SETTING:Nationwide psychological service platforms in China that facilitated participation of HCWs. PARTICIPANTS:A total of 901 HCWs aged 19-84 years, including doctors, nurses and other medical staff. PRIMARY AND SECONDARY OUTCOME MEASURES:Preference for psychological assistance was assessed through survey options, including psychological materials, stress management skills, telephone hotline, online non-video psychological counselling, online video psychological counselling and no need or others. Prevalence of mental health symptoms was evaluated using validated scales: Patient Health Questionnaire-2 (PHQ-2) for depression, Generalised Anxiety Disorder-7 (GAD-7) and Primary Care Post-Traumatic Stress Disorder (PTSD) Screen for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (PC-PTSD-5) for stress. Additional measures included sleep disturbance, suicidal ideation and demographic characteristics such as age, education level and occupation. RESULTS:Among 901 HCWs surveyed, the prevalence of depression, anxiety and stress was 12.32% (PHQ-2 score ≥3), 42.18% (GAD-7 score ≥5) and 28.75% (PC-PTSD-5 score ≥3), respectively. Sleep disturbance and suicidal ideation were reported by 29.41% (cut-off value=2) and 9.32% (cut-off value=1) of participants. Among the 602 respondents who preferred psychological assistance, the most preferred options were stress management skills, psychological materials and online non-video counselling. HCWs with severe suicidal ideation (item 9 of PHQ-9=3) preferred online video counselling (80%). Logistic regression indicated that age was negatively correlated with the preference for psychological materials (β=-0.86, p=0.034) but positively associated with the preference of telephone hotlines (26-35 years: β=1.69, p=0.035; ≥45 years: β=1.90, p=0.031). Higher educational attainment was associated with greater preference for psychological materials (undergraduates: β=0.71, p=0.014; masters: β=1.13, p=0.007) and online counselling (masters: β=1.743, p=0.002). Nurses were more likely to prefer stress management skills (β=0.71, p=0.014), while HCWs with suicidal ideation showed a stronger preference for online video counselling (β=0.66, p<0.05). Linear regression further showed that participants with a bachelor's or master's degree and those with severe anxiety were more likely to use multiple forms of psychological assistance. CONCLUSION:The high prevalence of mental health problems among HCWs highlights an urgent need for targeted psychological support. Distinct characteristics of HCWs were associated with different preferences for psychological assistance, highlighting the importance of tailoring interventions to the specific needs of HCWs.

This study’s aim was to assess the efficacy of different physiotherapy modalities for the treatment of post-traumatic stress disorder using an umbrella review. As of June 2024, we have published evidence in PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, China National Knowledge Infrastructure (CNKI), Wanfang and Sinomed for meta-analyses of randomized controlled trials. This article compared all eligible meta-analyses to gain a comprehensive understanding of the current state of research. Reporting quality was assessed using the AMSTAR 2 tool and certainty of evidence was assessed using the GRADE tool. A total of seven meta-analyses of different physiotherapy treatments were included. This study’s evidence suggests that non-invasive brain stimulation and acupuncture may be associated with improvements in PTSD, depressive, and anxiety symptoms. However, the certainty of the evidence is predominantly low or very low according to GRADE, due to small sample sizes, substantial methodological limitations, and considerable heterogeneity across trials and meta-analyses. At present, these modalities should be regarded as adjunctive or experimental options, rather than established first-line treatments, and their use in clinical practice should be limited to carefully selected patients and experienced centers until more robust evidence becomes available. Future large-scale trials with greater diversity and improved quality of efficacy meta-analyses are necessary for the treatment of PTSD.

BACKGROUND:Many patients with coronavirus disease 2019 (COVID-19) may experience emotional issues and cognitive impairment. However, it remains unclear whether the brain mediates the impact of COVID-19 on the emergence of psychopathological symptoms. It remains unclear whether anxiety and depression are caused by stressors or viral infection. AIM:To use functional near-infrared spectroscopy (fNIRS) to detect cortical hemodynamic changes in patients with COVID-19 and their relationship with mental symptoms (mainly depression and anxiety), to investigate whether COVID-19 causes these changes by affecting brain function. METHODS:A total of 58 subjects, comprising 29 patients with first acute COVID-19 infection and 29 healthy controls without COVID-19 infection and without anxiety or depression were recruited. Then cortical activation during the performance of the verbal fluency test (VFT) and brain connectivity during the resting state (rs) were evaluated by 53-channel fNIRS. For the COVID-19-infected group, Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) were used to assess the emotional state before fNIRS measures. RESULTS:For the rs, compared to the uninfected group, the infected group exhibited lower rs functional connectivity (FC) in the dorsolateral prefrontal cortex (DLPFC), which was correlated with both the PHQ score and GAD score. During the VFT, the infected group exhibited significantly lower cortical activation than the uninfected group in both Broca-left and Broca-right. Besides, the integral value in the DLPFC-L showed a significant negative correlation with the PHQ-9 score during the VFT in the infected group. CONCLUSION:There were significant differences in the bilateral Broca area and DLPFC between the COVID-19-infected and uninfected groups, which may be the reason why COVID-19 infection impairs cognitive function and language function and leads to psychiatric symptoms. In addition, the rsFC in patients with COVID-19 was positively correlated with the severity of depression and anxiety, which may be related to the fact that the mental symptoms of patients with COVID-19 are characterized by depression and anxiety, rather than depression or anxiety alone. Our study provides evidence that the psychological and emotional issues caused by COVID-19 are not only due to external social factors but also involve more direct brain neural mechanisms and abnormal neural circuits, which also provide insights into the future treatment and prognosis of individuals with COVID-19.

In this comprehensive study, we sought to unravel the risk factors for recurrence in Major Depressive Disorder (MDD), uniquely focusing on patients undergoing mono-antidepressant treatment. By considering psychiatric readmission as a direct indicator of MDD recurrence, we meticulously analyzed the records of 1,456 inpatients from a Chinese mental health center from 2012 to 2020. Our follow-up periods, spanning 90, 180, and 365 days post-discharge, allowed for a nuanced understanding of the recurrence dynamics. We identified four critical risk factors: thyroid function (FT3 and TSH), high-density lipoprotein (HDL) levels, and region of residence. Notably, the study revealed an increasing risk of readmission associated with decreased FT3 and HDL over time, while elevated TSH and residing in another province 's impact diminished. The antidepressant type did not significantly alter readmission risks, providing a unique perspective on MDD management. This research contributes to the field by offering a deeper understanding of how demographic and biochemical factors influence the likelihood of MDD recurrence, guiding more effective treatment approaches.

Abstract This chapter explores the rapidly growing practice of interpersonal psychotherapy in mainland China. The most recent major change in China's mental health care is the recognition of psychotherapy as a scientific and effective method of treatment. IPT suits China particularly well due to the importance of interpersonal relationships and Confucianism in the country. The chapter looks into case examples that demonstrate the applicability of IPT to the challenges of a typical Chinese family and highlights the importance of adapting IPT to meet the cultural needs of patients in China. It mentions that IPT China has several plans to promote the growth of this modality in the country.

Abstract This chapter looks into interpersonal psychotherapy (IPT) training in mainland China. It starts with how psychiatrist Wanhong Zheng attempted to disseminate IPT knowledge to practitioners in China. One of the critical steps for making IPT training more available in China was the translation of IPT training manuals into the native language. Additionally, as part of the strategic plan for the dissemination of knowledge about IPT in China, the International Society of Interpersonal Psychotherapy (ISIPT) Chinese chapter (IPT China) was established in 2021. The chapter then highlights that the limited resources made it difficult to meet the need for case supervision.

This study aimed to identify different symptom trajectories based on the severity of depression symptoms within a 2-month follow-up, and to explore predictive factors for different symptom trajectories. Three hundred and ninety-two adults diagnosed with major depressive disorder (MDD) were recruited from two longitudinal cohorts. Patients received antidepressant treatment as usual, and the depression symptoms were evaluated by the 17-item Hamilton depression rating scale (HAMD-17) at baseline, two weeks, and eight weeks. Based on the HAMD-17 scores, different trajectories of symptom change were distinguished by applying Growth Mixture Modeling (GMM). Furthermore, the baseline sociodemographic, clinical, and cognitive characteristics were compared to identify potential predictors for different trajectories. Through GMM, three unique depressive symptom trajectories of MDD patients were identified: (1) mild-severity class with significant improvement (Mild, n = 255); (2) high-severity class with significant improvement (High, n = 39); (3) moderate-severity class with limited improvement (Limited, n = 98). Among the three trajectories, the Mild class had a relatively low level of anxiety symptoms at baseline, whereas the High class had the lowest education level and the worst cognitive performance. Additionally, participants in the Limited class exhibited an early age of onset and experienced a higher level of emotional abuse. MDD patients could be categorised into three distinct latent subtypes through different symptom trajectories in this study, and the characteristics of these subtype patients may inform identifications for trajectory-specific intervention targets.

Background Although both psychological resilience and social support are widely believed to be effective in alleviating post-traumatic psychiatric symptoms in individuals with traumatic events, there has been a lack of comparative analysis of their intervention effects on different post-traumatic psychiatric symptoms. Furthermore, previous studies have mostly failed to control for potential confounding effects caused by different traumatic events. Aims We used the novel network analysis approach to examine the differential moderating effects of psychological resilience and social support on post-traumatic psychiatric symptoms, controlling for the confounding effects of traumatic events. Method We recruited 264 front-line rescuers who experienced the same traumatic event. Quantified edge weights and bridge expected influence (BEI) were applied to compare the alleviating effects of psychological resilience and social support. Results Our study revealed distinct correlations in a sample of front-line rescuers: social support negatively correlates more with psychosomatic symptoms, notably fatigue in depressive networks and sleep disturbance in post-traumatic stress disorder (PTSD) networks, whereas psychological resilience shows fewer such correlations. Quantitative analysis using BEI indicated that psychological resilience more effectively suppresses depressive and anxiety symptom networks, whereas social support more significantly inhibits PTSD symptom networks. Conclusions The current study represents the first attempt to examine the differential effects of psychological resilience and social support on post-traumatic outcomes in real-world emergency rescuers, controlling for the confounding effect of traumatic events. Our results can act as the theoretical reference for future precise and efficient post-trauma psychological interventions.

BackgroundPrevious research has largely lacked studies that explore the trajectories of Posttraumatic stress symptoms (PTSS) and the structure of comorbid psychiatric symptom networks following traumatic event, while controlling for the severity of traumatic exposure. The present study aims to explore the characteristic trajectories of PTSS, in the context of ensuring controlled levels of traumatic exposure. Furthermore, the PTSS, depressive, and anxiety comorbid symptom networks of different PTSS trajectory subgroups are also investigated.MethodsA total of 296 frontline rescue personnel were enrolled into our study. In an effort to control for variations in traumatic exposure severity, this study ensured that all participants had same responsibilities and cumulative operational duration at the post-disaster rescue circumstance. Growth mixture models (GMMs) were employed to scrutinize the trajectories of PTSS. Additionally, network analysis was used to examine the comorbid symptom network of PTSS, depression, and anxiety.ResultsFour distinct PTSS trajectories were identified, namely Persisting Symptom, Gradual Recovery, Gradual Aggravation, and Asymptomatic. Although both the Persisting Symptom and Gradual Aggravation groups belong to the high-risk subgroups for persistent PTSS, they exhibit differences in core symptoms within their respective networks. The core symptom for the Persisting Symptom Network is flashbacks, while for the Gradual Aggravation Network, it is sleep disturbances.ConclusionTo the best of our knowledge, the present study represents the first research endeavor to integrate longitudinal trajectory analysis of PTSS with longitudinal symptom network analysis, clarifying the evolving features of PTSS but also offering valuable insights for early screening and intervention strategies.

BACKGROUND Symptoms of depression and comorbid anxiety are known risk factors for cognitive impairment in major depressive disorder (MDD). Understanding their relationships is crucial for developing targeted interventions to mitigate cognitive impairments in MDD patients. We expect that the severity of sleep disturbances and other depressive symptoms will be positively correlated with the degree of cognitive impairments. We also hypothesize that anxiety symptoms, especially psychic anxiety, is a key factor in predicting cognitive performance in MDD patients and may indirectly contribute to cognitive impairment by affecting sleep disturbances and other potential factors. AIM To determine which dimension of the depressive and anxiety symptoms predicts cognitive impairment during a depressive episode. METHODS A comprehensive neurocognitive test battery assessed executive function, attention, processing speed, and memory in 162 medication-free MDD patients and 142 matched healthy controls. The 24-item Hamilton Depression Rating Scale was used to assess depressive symptoms, and the 14-item Hamilton Anxiety Scale was used to assess anxiety symptoms. Linear regression analyses and mediation analyses were conducted to evaluate the impact of depressive and anxiety symptoms, as well as their interactions, on cognitive impairments. RESULTS Among the depressive symptoms, sleep disturbances were associated with poorer executive function (P = 0.004), lower processing speed (P = 0.047), and memory impairments (P < 0.001), and psychomotor retardation (PR) was associated with lower processing speed in patients with MDD (P = 0.019). Notably, PR was found to mediate the impact of sleep disturbances on the processing speed. Regarding anxiety symptoms, psychic anxiety, rather than somatic anxiety, was associated with cognitive impairments in all aspects. Sleep disturbances mediated the effect of psychic anxiety on executive function [β = -0.013, BC CI (-0.027, -0.001)] and memory [β = -0.149, BC CI (-0.237, -0.063)], while PR mediated its effect on processing speed (β = -0.023, BC CI (-0.045, -0.004)]. CONCLUSION Sleep disturbances may be a key predictor of poorer executive function, lower processing speed, and memory loss, while PR is crucial for lower processing speed during a depressive episode. Psychic anxiety contributes to all aspects of cognitive impairments, mediated by sleep disturbances and PR.

Background: Studying the role of psychological resilience in self-perceived stress and mental disorders among family members of medical workers can help us understand its importance in mental health care and guide us to develop psychological intervention strategies for family members of medical workers. Methods: A total of 671 family members of medical workers were enrolled. Self-perceived stress, resilience, depression symptoms, anxiety symptoms, and post-traumatic stress disorder (PTSD) symptoms were measured in our research. Results: The prevalence of anxiety, depression, and PTSD symptoms among relatives of medical workers were 49.0 %, 12.2 %, and 20.3 % respectively during the COVID-19 epidemic. According to the Multivariate regression model, compared with family members of doctor, family members of nurse and medical technologists were more likely to report anxiety symptoms. Female members of medical staff were more likely to have PTSD symptoms than male counterparts; and family members of medical technologist appeared to less likely have PTSD symptoms than family members of either doctor or nurse. The mediation analysis confirmed that mental resilience mediated the relationship between self-perceived stress and anxiety symptoms. Limitations: Single cross-sectional study design without the follow-up comparative analysis, only self-reported measurements were adopted, and inadequate pre-set demographic variables. Conclusions: To the best of our knowledge, our study firstly demonstrated the risk of psychological distress present in the family members of medical providers during the COVID-19 epidemic. Meanwhile, our findings highlighted the importance of mental resilience in family members of frontline medical workers as it mediated the relationship between self-perceived stress and anxiety symptoms.

Background:Firefighters, as first responders with a high risk of occupational exposure to traumatic events and heavy working stress, have a high prevalence of PTSD symptoms and depressive symptoms. But no previous studies analyzed the relationships and hierarchies of PTSD and depressive symptoms among firefighters. Network analysis is a novel and effective method for investigating the complex interactions of mental disorders at the symptom level and providing a new understanding of psychopathology. The current study was designed to characterize the PTSD and depressive symptoms network structure in the Chinese firefighters.Method:The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) and the Self-Rating Depression Scale (SDS) were applied to assess PTSD and depressive symptoms, respectively. The network structure of PTSD and depressive symptoms was characterized using "expected influence (EI)" and "bridge EI" as centrality indices. The Walktrap algorithm was conducted to identify communities in the PTSD and depressive symptoms network. Finally, Network accuracy and stability were examined using the Bootstrapped test and the case-dropping procedure.Results:A total of 1,768 firefighters were enrolled in our research. Network analysis revealed that the relationship between PTSD symptoms, "Flashback" and "Avoidance," was the strongest. "Life emptiness" was the most central symptom with the highest EI in the PTSD and depression network model. Followed by "Fatigue" and "Interest loss." Bridge symptoms connecting PTSD and depressive symptoms in our study were "Numb," "High alertness," "Sad mood," and "Compunction and blame," successively. The data-driven community detection suggested the differences in PTSD symptoms in the clustering process. The reliability of the network was approved by both stability and accuracy tests.Conclusion:To the best of our knowledge, the current study first demonstrated the network structure of PTSD and depressive symptoms among Chinese firefighters, identifying the central and bridge symptoms. Targeting interventions to the symptoms mentioned above may effectively treat firefighters suffering from PTSD and depressive symptoms.

目的 探讨采用低频振幅(ALFF)法分析伴消极完美主义首发抑郁症患者特征性脑功能改变及其与临床症状的相关性.方法 纳入2020—2022年招募的44例首发抑郁症患者,其中男11例,女33例,年龄(24.64±5.31)岁,根据中文Frost多维度完美主义量表(CFMPS)中消极完美主义总分将患者分为抑郁伴消极完美主义(DANP)组24例和抑郁不伴消极完美主义(DWNP)组20例.分析比较两组ALFF值的差异,将差异有统计学意义的脑区提取ALFF值与CFMPS量表中消极完美主义总分、17项汉密尔顿抑郁量表(HAMD-17)总分进行Pearson相关性分析.结果 与DWNP组相比,DANP组右侧额中回、右侧顶下缘角回、右侧脑岛、左侧颞下回、左侧颞中回ALFF值显著升高,左侧中央旁小叶、左侧额中回、左侧缘上回、左侧三角部额下回、左侧岛盖部额下回ALFF值显著降低.右侧额中回ALFF值与消极完美主义总分和HAMD-17总分呈负相关(r=-0.531,P=0.008;r=-0.477,P=0.018).结论 DANP患者较DWNP患者的脑功能存在异常,这些异常主要表现在与情绪、认知等有关的额叶、颞叶、顶叶,且右侧额中回代偿功能越强,消极完美主义及抑郁严重程度越弱.

OBJECTIVES:Shelter hospital was an alternative way to provide large-scale medical isolation and treatment for people with mild coronavirus disease 2019 (COVID-19). Due to various reasons, patients admitted to the large shelter hospital was reported high level of psychological distress, so did the healthcare workers. This study aims to introduce a comprehensive and multifaceted psychosocial crisis intervention model.METHODS:The psychosocial crisis intervention model was provided to 200 patients and 240 healthcare workers in Wuhan Wuchang shelter hospital. Patient volunteers and organized peer support, client-centered culturally sensitive supportive care, timely delivery of scientific information about COVID-19 and its complications, mental health knowledge acquisition of non-psychiatric healthcare workers, group activities, counseling and education, virtualization of psychological intervention, consultation and liaison were exhibited respectively in the model. Pre-service survey was done in 38 patients and 49 healthcare workers using the Generalized Anxiety Disorder 7-item (GAD-7) scale, the Patient Health Questionnaire 2-item (PHQ-2) scale, and the Primary Care PTSD screen for the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (PC-PTSD-5). Forty-eight healthcare workers gave feedback after the intervention.RESULTS:The psychosocial crisis intervention model was successfully implemented by 10 mental health professionals and was well-accepted by both patients and healthcare workers in the shelter hospital. In pre-service survey, 15.8% of 38 patients were with anxiety, 55.3% were with stress, and 15.8% were with depression; 16.3% of 49 healthcare workers were with anxiety, 26.5% were with stress, and 22.4% were with depression. In post-service survey, 62.5% of 48 healthcare workers thought it was very practical, 37.5% thought more practical; 37.5% of them thought it was very helpful to relief anxiety and insomnia, and 27.1% thought much helpful; 37.5% of them thought it was very helpful to recognize patients with anxiety and insomnia, and 29.2% thought much helpful; 35.4% of them thought it was very helpful to deal with patients' anxiety and insomnia, and 37.5% thought much helpful.CONCLUSIONS:Psychological crisis intervention is feasible, acceptable, and associated with positive outcomes. Future tastings of this model in larger population and different settings are warranted.

This study aimed to investigate whether there are different cognitive subtypes in patients with major depressive disorder (MDD) and the change pattern of cognitive clusters across the course of MDD. A battery of comprehensive cognitive tests was used to assess the executive function, processing speed, attention, and memory of 153 medication-free patients and 142 healthy controls (HCs). After 6 months of treatment with antidepressants, 87 patients completed cognitive tests again. K-means cluster analysis was performed to determine the cognitive subtypes. A preserved cognition cluster and an impaired cognition cluster were identified in the acute episode phase and the 6-month follow-up phase. 80.5% of the patients remained in their original subgroup after 6 months of treatment. The impaired cognition cluster during the 6-month follow-up period could be predicted by impaired cognition during the episode phase, disease state (remission or non-remission), current illness duration, and education level. This study supporting the heterogeneity of cognitive performance across the course of disease in patients with MDD using cluster analysis. It was found that cognitive impairment during depressive episodes was predictive of poorer cognitive performance even after treatment with antidepressants. Therefore, interventions targeting cognitive function from the early stages of MDD is essential.

Background: Cognitive impairments (CI) are prevalent and persistent in patients with major depressive disorder (MDD). There is a lack of longitudinal studies exploring the changes of the percentage of CI among MDD patients before and after a long-term antidepressant treatment and the risk factors that predict the residual CI.Methods: A neurocognitive battery was performed to assess four domains of cognitive function, including ex-ecutive function, processing speed, attention, and memory. CI was set as cognitive performance scoring 1.5 SDs lower than the mean scores of healthy controls (HCs). Logistic regression models were conducted to examine the risk factors for the after-treatment residual CI.Results: Over 50 % of patients showed at least one kind of CI. After the antidepressant treatment, the overall cognitive performance among remitted MDD patients was identical to HCs, however, there were still 24 % of the remitted MDD patients had at least one type of CI, especially in executive function and attention. Additionally, the percentage of CI among non-remitted MDD patients was still significantly different from HCs. Our regression analysis further identified that except for the non-remission of MDD, CI at baseline could also predict the residual CI in MDD patients.Limitations: A relatively high drop-out rate at follow-ups.Conclusions: Cognitive impairment in executive function and attention is persistent even in remitted patients with MDD, and baseline cognitive performance can predict the post-treatment cognitive performance. Our findings emphasize the integral role of early cognitive intervention in MDD treatment.