Mental health problems in adolescence are increasingly prevalent and have tremendous impacts on life-long health and mortality. Although household poverty is a known risk factor for adolescent mental health, evidence of the timing hypothesis is scarce. We aimed to examine the longitudinal associations of poverty across childhood with mental health in adolescence, focusing on the timing of exposure.

We used the data of 5,671 children from a Japanese population-based longitudinal cohort, which recruited the first graders (aged 6–7 years) and followed biannually until eighth grade (aged 13–14 years) in Adachi, Tokyo. Household poverty was defined as households having any of the following experiences: annual income less than Japanese yen 3 million, payment difficulties and material deprivations, measured in first, second, fourth, sixth and eighth grades. Adolescent mental health included parent-report internalizing and externalizing problems (the Strengths and Difficulties Questionnaire), self-report depression (the Patient Health Questionnaire-9) and self-esteem (the Japanese version Children’s Perceived Competence Scale) in eighth grade. We applied g-estimation of structural nested mean modelling to account for time-varying confounders.

If adolescents were exposed to household poverty at any grade across childhood, on average, they would report more severe depressive symptoms (ψ = 0.32 [95% CI 0.13; 0.51]) and lower self-esteem (ψ = −0.41 [−0.62; −0.21]) in eighth grade. There were also average associations of household poverty at any grade with more internalizing (ψ = 0.19 [0.10; 0.29]) and externalizing problems (ψ = 0.10 [0.002; 0.19]). Although the associations between household poverty and mental health were stronger in younger ages (e.g., poverty in the second grade → depression: ψ = 0.54 [−0.12; 1.19] vs. poverty in the eighth grade → depression: ψ = −0.01 [−0.66; 0.64]), overlapping 95% CIs indicated no statistically significantly different associations by the timing of exposure.

We found the average effect of exposure to household poverty at any grade on mental health outcomes in eighth grade, failing to support the timing hypothesis. The findings indicate that the effects of household poverty accumulate over time in childhood and impact adolescent mental health (cumulative hypothesis) rather than the effects differ by the timing of exposure. While cumulative effects suggest a persistent intervention in poor households across childhood, we highlight intervention at any timing in childhood may be effective in alleviating adolescent mental health problems.

In India, women in rural areas have high rates of depression. They have poor access to mental healthcare resources and, hence, mental health symptoms remain largely unaddressed. Existing mobile telephone applications (apps) do not engage end-users, lack local language options, may not be socioculturally relevant and do not use audiovisual formats. We thus developed a mobile mental health app, Multiuser Interactive Health Response Application (MITHRA), to screen and provide brief behavioural intervention for mild to moderate depression among rural women attending self-help groups (SHGs) in India.

This qualitative study explores the process and findings of focus groups conducted with SHG administrators and women to inform the iterative development of the MITHRA app.

In total, 22 participants were interviewed (17 SHG participants and five administrators), and a thematic analysis of the data was conducted using the acceptability of interventions framework.

Frequent themes across the focus groups were affective attitude, burden, self-efficacy and perceived effectiveness. All women showed a positive attitude towards the app and depression interventions, while older women demonstrated less self-efficacy in using mobile mental health apps.

MITHRA is a promising app in the management of mild to moderate depression in women in SHG. With adequate training and education of family members, MITHRA has the potential to identify and treat women with mild to moderate depression.

People with non-communicable diseases (NCDs) have a higher prevalence of comorbid depression than the general population. While previous research has shown that behavioural activation is effective for general depression, its efficacy and safety in treating depression associated with NCDs remains unclear.

To compare the efficacy and safety of behavioural activation against comparators in reducing depression symptoms in people with NCDs.

We searched six databases from inception until 30 March 2023 (updated 23 September 2024) for randomised controlled trials (RCTs) comparing behavioural activation with comparators for depression in people with NCDs. Risk of bias was assessed using the Cochrane Collaboration’s ‘risk-of-bias 2 tool’. We calculated a random-effects, inverse-variance weighting meta-analysis.

Of the 21 386 initial studies, 12 RCTs (with 2144 patients) comparing behavioural activation with any comparator on treatment outcomes for depression with comorbid NCD met the inclusion criteria. Six studies rated as low risk of bias. For short-term follow-ups (up to 6 months), meta-analysis showed behavioural activation had little effect on depression symptom improvement in people with NCDs (Hedges’ g = −0.24; 95% CI, −0.62 to 0.15), compared to comparators, with high heterogeneity (I2 = 91.91%). Of the 12 included studies, three RCTs provided data on adverse events occurring during the trial.

Evidence from this systematic review is not sufficient to draw clear conclusions about the efficacy and safety of behavioural activation for reducing depression symptoms in people with NCDs. Future reviews need to include more high-quality, well-designed RCTs to better understand the potential benefits of behavioural activation for comorbid depression.

The cumulative effects of long-term exposure to pandemic-related stressors and the severity of social restrictions may have been important determinants of mental distress in the time of COVID-19.

This study aimed to investigate mental health among a cohort of Chinese university students over a 28-month period, focusing on the effects of lockdown type.

Depression, anxiety, stress and fear of COVID-19 infection were measured ten times among 188 Chinese students (females 77.7%, meanage = 19.8, s.d.age = 0.97), every 3 months: from prior to the emergence of COVID-19 in November 2019 (T1) to March 2022 (T10).

Initially depression, anxiety and stress dipped from T1 to T2, followed by a sudden increase at T3 and a slow upward rise over the remainder of the study period (T3 to T10). When locked down at university, participants showed greater mental distress compared with both home lockdown (d = 0.35–0.48) and a no-lockdown comparison period (d = 0.28–0.40). Conversely, home lockdown was associated with less anxiety and stress (d = 0.19 and 0.21, respectively), but not with depression (d = 0.13) compared with a no-lockdown period.

This study highlights the cumulative effects of exposure to COVID-19 stressors over time. It also suggests that the way in which a lockdown is carried out can impact the well-being of those involved. Some forms of lockdown appear to pose a greater threat to mental health than others.

Depression is a growing mental health concern among university students worldwide, including in Thailand. Studies show that between 17 and 40% of Thai university students experience depressive symptoms, although these studies often focus on specific groups and use different measures.

This study aimed to investigate the prevalence and associated factors of depressive disorders among university students across Thailand.

Data were collected with the HAPPINOMETER and the Patient Health Questionnaire-9 scale as part of a nationwide cross-sectional survey. A total of 14 621 students from 33 universities participated in the survey. A series of binary logistic regression analyses were performed to examine the effect of sociodemographic characteristics and health behaviours on the presence of depression.

The results revealed that 31.4% of students experienced depressive symptoms, with 14.2% having major depressive disorder. The students who identified as non-binary had the highest odds of having depression (adjusted odds ratio 2.10, 95% CI 1.7–2.6, P < 0.001). Other specific subgroups were also found to be particularly vulnerable, including women, fourth-year students and those studying in Bangkok, without part-time jobs, living alone and engaging in risky health behaviours like smoking, heavy drinking and poor diet.

The findings underscore the need for comprehensive mental health support and targeted interventions within Thai universities, especially for at-risk subpopulations. Leveraging the existing collaborative networks among Thai universities presents a unique opportunity to mount a coordinated effort in developing and implementing comprehensive mental health strategies tailored to the needs of this vulnerable population.

To develop effective mental health interventions for children and adolescents, it is essential to understand the intricate link between functional disability and mental well-being in this group.

To explore the network connections between various aspects of functional disability and mental well-being in young people with disabilities.

We analysed data from the Multiple Indicator Cluster Surveys in 47 low- and middle-income countries, tracking progress towards health-related sustainable development goals. Our focus was on children and adolescents aged 5–17 with functional disabilities. Mental well-being was gauged using carer-reported signs of depression, anxiety and disability on the Child Functioning Module. Network-analysis techniques were used to examine links between mental well-being and functional disability domains.

The study included 32 669 eligible children aged 5–17 with functional disabilities (14 826 females and 17 843 males). The core domains of disability with the strongest connections to poor mental well-being were difficulties in accepting change, making friends, behavioural control (controlling own behaviour) and remembering/concentrating. These associations remained largely consistent across different genders and developmental stages. However, there were notable gender differences and age-related shifts in the relationships between specific disabilities and mental well-being. In particular, signs of anxiety in males and depression in females were most associated with functional disability overall, while signs of depression had the closest links to disability in adolescents.

The network perspective may enable the design of tailored interventions and support services that consider age and gender differences. Further research should continue to explore these complex relationships, incorporating novel methodologies like network-analysis to enhance the understanding of these associations.

Data from an RCT of IAPT Norway (“Prompt Mental Health Care” [PMHC]) were linked to several administrative registers up to five years following the intervention. The aims were to (1) examine the effects of PMHC compared to treatment-as-usual (TAU) on work-related outcomes and health care use, (2) estimate the cost–benefit of PMHC, and (3) examine whether clinical outcomes at six-month follow-up explained the effects of PMHC on work−/cost–benefit-related outcomes.

RCTs with parallel assignment were conducted at two PMHC sites (N = 738) during 2016/2017. Eligible participants were considered for admission due to anxiety and/or depression. We used Bayesian estimation with 90% credibility intervals (CI) and posterior probabilities (PP) of effects in favor of PMHC. Primary outcome years were 2018–2022. The cost–benefit analysis estimated the overall economic gain expressed in terms of a benefit–cost ratio and the differences in overall public sector spending.

The PMHC group was more likely than the TAU group to be in regular work without receiving welfare benefits in 2019–2022 (1.27 ≤ OR ≤ 1.43). Some evidence was found that the PMHC group spent less on health care. The benefit–cost ratio in terms of economic gain relative to intervention costs was estimated at 5.26 (90%CI $ - $1.28, 11.8). The PP of PMHC being cost-beneficial for the economy as a whole was 85.9%. The estimated difference in public sector spending was small. PMHC effects on work participation and cost–benefit were largely explained by PMHC effects on mental health.

The results support the societal economic benefit of investing in IAPT-like services.

Sustained attention is integral to goal-directed tasks in everyday life. It is a demanding and effortful process prone to failure. Deficits are particularly prevalent in mood disorders. However, conventional methods of assessment, rooted in overall measures of performance, neglect the nuanced temporal dimensions inherent in sustained attention, necessitating alternative analytical approaches.

This study investigated sustained attention deficits and temporal patterns of attentional fluctuation in a large clinical cohort of patients with bipolar depression (BPd, n = 33), bipolar euthymia (BPe, n = 84), major depression (MDd, n = 38) and controls (HC, n = 138) using a continuous performance task (CPT). Longitudinal and spectral analyses were employed to examine trial-level reaction time (RT) data.

Longitudinal analysis revealed a significant worsening of performance over time (vigilance decrement) in BPd, whilst spectral analysis unveiled attentional fluctuations concentrated in the frequency range of 0.077 Hz (1/12.90 s)–0.049 Hz (1/20.24 s), with BPd and MDd demonstrating greater spectral power compared to BPe and controls.

Although speculative, the increased variability in this frequency range may have an association with the dysfunctional activity of the Default Mode Network, which has been shown to oscillate at a similar timescale. These findings underscore the importance of considering the temporal dimensions of sustained attention and show the potential of spectral analysis of RT in future clinical research.

Selective serotonin reuptake inhibitors (SSRIs) have been associated with increased risk of osteoporosis, and sertraline may be more potent than citalopram in this regard. Here, target trial emulation was used to investigate whether sertraline, citalopram and escitalopram (the S-enantiomer of citalopram) differentially affect the risk of osteoporosis. Subsequently, it was examined whether SSRIs increase the risk of osteoporosis in a dose-response-like manner.

Danish nationwide registers were used to identify all individuals that initiated treatment for depression with sertraline, citalopram, or escitalopram between January 1, 2007, and March 1, 2019. These individuals were followed until development of osteoporosis, death, or end of follow-up. Cox proportional hazards regression was used to adjust for relevant baseline covariates to emulate randomised treatment allocation to compare the rate of osteoporosis for individuals treated with sertraline, citalopram or escitalopram. Subsequently, the cumulative dose of sertraline, citalopram, and escitalopram was calculated, and Cox proportional hazards regression was used to assess dose-response-like relationships with osteoporosis.

We identified 27,280, 65,529, and 17,703 individuals initiating treatment with sertraline, citalopram, and escitalopram, respectively. There was no material or statistically significant differential risk of osteoporosis between these groups (adjusted hazard rate ratio, aHRR = 0.98 for citalopram versus sertraline and aHRR = 0.94 for escitalopram versus sertraline). The results were not indicative of the SSRIs having a dose-response-like effect on osteoporosis risk.

Sertraline, citalopram and escitalopram do not appear to differentially affect the risk of osteoporosis. The lack of clear dose-response-like relationships suggest that they do not have a causal effect on osteoporosis risk.

Evidence indicates that the COVID-19 pandemic has led to an increase in self-harm among adolescents; however, little is known about the trends in prevalence after the end of the pandemic.

This retrospective cross-sectional database study evaluates changes in the prevalence and clinical characteristics of self-harm among adolescents who sought attention from the emergency service of the largest children’s psychiatric hospital in Mexico before, during and after the COVID-19 pandemic.

After comparing the clinical characteristics of self-harm between the three periods, we calculated the monthly prevalence of self-harm among patients (n = 3520) visiting the hospital’s emergency psychiatric services over a period of 58 months. Using joinpoint regression, we evaluated temporal trends in self-harm prevalence.

Affective disorders and hitting as a method of self-harm were more frequent during and after the pandemic in comparison with the pre-pandemic period. The prevalence of self-harm diminished from March 2019 to March 2023, a trend followed by an increase coinciding with the end of the pandemic and the return to normal activities.

The significant increase in prevalence observed after the end of the pandemic suggests a long-term impact on mental health of adolescents. This underscores the need for monitoring this population during post-pandemic years to provide timely interventions.

Adolescents with psychiatric disorders are at increased risk of suicide, with insomnia, depression, and social-personal factors playing pivotal roles. This study investigates the interplay between these factors in a sample of adolescent psychiatric inpatients in Italy, with a particular focus on their association with suicide attempts.

We conducted a cross-sectional study on 95 adolescent inpatients (54 suicide attempters, 41 non-attempters) to explore their sociodemographic and clinical variables, including insomnia, depression, and social-personal factors as history of bullying. Logistic regression analyses and Pearson’s correlations were used to identify significant predictors of suicide attempts and their interrelations.

Suicide attempters were predominantly female (90% vs. 75%, p = 0.04) and more likely to have a family psychiatric history (83% vs. 63%, p = 0.04), a history of bullying (26% vs. 9%, p = 0.01), and insomnia (79% vs. 53%, p = 0.01). Depression was strongly associated with suicide attempts (96% vs. 70%, p = 0.01), while physically active adolescents were significantly less likely to attempt suicide (27% vs. 53%, p = 0.01). Insomnia and depression were highly correlated (r = 0.94, p = 0.02), emphasizing the critical role of the former in emotional dysregulation. Behavioral factors, such as physical inactivity and bullying, emerged as additional key contributors to suicidal behavior.

This study highlights the multifaceted nature of suicide risk in adolescent psychiatric inpatients, with sleep disturbances, depression, and behavioral factors playing central roles. These findings underscore the need for integrated interventions targeting sleep, emotional regulation, and behavioral vulnerabilities to mitigate suicide risk.

Depression has been linked to disruptions in resting-state networks (RSNs). However, inconsistent findings on RSN disruptions, with variations in reported connectivity within and between RSNs, complicate the understanding of the neurobiological mechanisms underlying depression.

A systematic literature search of PubMed and Web of Science identified studies that employed resting-state functional magnetic resonance imaging (fMRI) to explore RSN changes in depression. Studies using seed-based functional connectivity analysis or independent component analysis were included, and coordinate-based meta-analyses were performed to evaluate alterations in RSN connectivity both within and between networks.

A total of 58 studies were included, comprising 2321 patients with depression and 2197 healthy controls. The meta-analysis revealed significant alterations in RSN connectivity, both within and between networks, in patients with depression compared with healthy controls. Specifically, within-network changes included both increased and decreased connectivity in the default mode network (DMN) and increased connectivity in the frontoparietal network (FPN). Between-network findings showed increased DMN–FPN and limbic network (LN)–DMN connectivity, decreased DMN–somatomotor network and LN–FPN connectivity, and varied ventral attention network (VAN)–dorsal attentional network (DAN) connectivity. Additionally, a positive correlation was found between illness duration and increased connectivity between the VAN and DAN.

These findings not only provide a comprehensive characterization of RSN disruptions in depression but also enhance our understanding of the neurobiological mechanisms underlying depression.

Sleep problems are common in palliative care patients. In addition, psychological problems can affect sleep quality. The aim of this study was to investigate sleep quality, anxiety, and depression in palliative care patients.

The study was conducted between May 1, 2023 and October 31, 2023 in Turkey. The patient information form, the Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS) were used to collect data. The data were analyzed using the Pearson correlation and multiple linear regression test.

A total of 59.3% of patients were male, 76.7% were married, 89.3% had poor sleep quality, 61.3% had anxiety, and 86.7% were at risk of depression. A positive moderate correlation was found between HADS-anxiety, HADS-depression, and HADS total with subjective sleep quality. A positive moderate correlation was found between HADS-anxiety, HADS depression, and HADS total with the PSQI total. Sleep latency, sleep duration, sleep disturbances, use of sleep medication, and daytime dysfunction showed a weak positive correlation with HADS-depression and HADS total. In the regression analysis, anxiety proved to be a statistically significant predictor of sleep quality, while depression was not a significant predictor. These variables were found to explain 22% of the total variance in sleep quality.

The patients’ sleep quality was poor. Anxiety and the risk of depression were high. A positive moderate correlation was found between the total score of sleep quality and anxiety and depression. Anxiety was found to be a statistically significant predictor of sleep quality.