Research on the significance of comorbid personality disorders (PD) on the outcome of depression treatment has shown inconsistent findings. In addition, it is still unclear whether treatment choice based on personality traits and coping can enhance the efficacy of depression treatment. Aiming to deliver clinically representative results, we use dimensional measures to examine avoidant personality and coping as moderators for the efficacy of cognitive-behavioral therapy (CBT) versus short-term psychodynamic psychotherapy (STPP) for depression. Furthermore, we explored whether these depression treatments reduced avoidant personality traits and coping. Included were 265 patients with major depressive disorder who received 16-week CBT or STPP in a randomized clinical trial. Depression, avoidant personality traits, and avoidant coping were measured with, respectively, the Hamilton Depression Rating Scale, NEO Five Factor Inventory (extraversion and neuroticism subscales), and Utrecht Coping List (avoidance subscale). Multilevel regression analyses estimated the moderating effects of avoidant personality traits and avoidant coping on the relationship between treatment type and depressive symptom change, as well as changes in avoidant personality traits and avoidant coping in CBT and STPP. Avoidant personality traits and avoidant coping did not moderate the efficacy of CBT and STPP. Both treatments resulted in significant reductions in avoidant personality traits, but not in coping. Both CBT and STPP can be offered to patients with avoidant personality traits and avoidant coping and can reduce avoidant personality traits. Trial Registration: ISRCTN31263312 (http://www.controlled-trials.com).

Although the mental health consequences of armed conflict, displacement, and climate-related disasters are well documented, the psychological effects of geopolitical rhetoric itself (independent of material events) remain insufficiently examined. This narrative review provides a conceptual and interdisciplinary synthesis of emerging and heterogeneous evidence on how threat-oriented political narratives may influence population mental health through indirect, mediated, and context-dependent pathways. The reviewed literature suggests convergent patterns across five thematic areas: symbolic threat and heightened vigilance; perceived uncertainty and loss of control; indirect effects of repeated media exposure; intersections with climate-related distress; and differential vulnerability across populations. Although empirical studies explicitly operationalising geopolitical rhetoric are limited, evidence from adjacent domains indicates that persistent exposure to such narratives may function as a chronic psychosocial stressor, extending beyond directly affected regions. Given the limited availability of direct empirical research, this review should be understood primarily as a theory-building synthesis rather than a consolidation of a well-established evidence base. These effects appear cumulative, are amplified by contemporary media environments, and are particularly salient in climate-sensitive and socially vulnerable contexts. Taken together, this review proposes a conceptual framework in which geopolitical rhetoric may act as an emerging contextual determinant of population mental health, with implications for preventive strategies, responsible public communication, and future research on socio-political determinants of psychological well-being.

As artificial intelligence becomes increasingly integrated into elderly healthcare systems, smart elderly health care (SEHC) has been promoted as a promising policy enhancing mental health and well-being among the elderly in China. This study examines the impact of SEHC on mental health and inequality among the elderly, with a particular focus on its unequal selection effect and the expansion of individual adaptability. Drawing on longitudinal data from China Health and Retirement Longitudinal Study, we adopt staggered difference-in-difference method to estimate the effects of SEHC policy implementation on elderly mental health and inequality, conduct robustness checks, heterogeneity tests, and mechanism analyses. SEHC significantly improves the mental health of the elderly (β = -1.391, P < 0.01) while simultaneously intensifying mental health inequality (β = 0.278, P < 0.01). However, these gains are disproportionately concentrated among individuals with higher income, lower hospitalization cost, higher educational attainment, and urban residency. Mechanism analysis reveals that SEHC improves mental health primarily by enhancing social participation and reducing hospitalization cost, with these adaptive benefits concentrated among higher-income individuals. While SEHC demonstrates significant potential to enhancing mental well-being among the elderly, it also generates disparities in mental health outcomes across different socioeconomic groups. To address this inequality, policymakers should implement inclusive intervention strategies that guarantee equitable and sustainable access to artificial intelligence-driven mental health benefits in elderly healthcare.

The use of antidepressant medications is increasing globally. Despite their obvious benefits, ongoing use of these medications is often not properly monitored or deprescribed when a person returns to better mental health; in addition, the proportion of prescriptions provided to those who do not suffer from clinical depression leads to a personal and societal cost burden.

This trial aims to assess the clinical and cost effectiveness of an online support tool to help patients with mild to no symptoms of depression and their general practitioners to manage the careful and appropriate tapering and cessation of antidepressants at 6 months compared to attention control.

This stratified, single-blind, parallel, two-arm, superiority randomised controlled trial in Australian primary care of individuals with mild to no symptoms of depression aged 18 to 75 years old and have been taking antidepressant medication for longer than 12 months After informed consent, 340 eligible patients will be randomised 1:1, stratified by general practice or state of residence if recruited via social media, into the active intervention arm, where they will be asked to reduce their antidepressant with the aid of a clinically guided online support tool, or the attention control arm, that will continue with usual care. Participants in both arms will be provided with information about antidepressants through the Beyond Blue website and followed up at 3, 6 ,12 and 18 months to record antidepressant use, depression and anxiety symptom severity, quality of life and health economics information. Intention to treat analysis will determine the clinical effectiveness of the online tool compared to attention control, where the primary outcome is between-arm difference in the proportion of participants with successful cessation of medication at 6 months with depression remaining mild or absent. Cost-consequence and cost-utility analyses will be used to determine the cost effectiveness of the intervention and its impact on quality of life, compared to control.

At submission of this manuscript in July 2025, 310 participants had been randomized and recruitment was ongoing. The target number of 340 randomized participants was achieved in January 2026.

The WiserAD online support tool assists patients and their GP with deprescribing and may lead to successful cessation of antidepressant medication, resulting in an enhanced quality of life and cost savings over the longer term.

ANZCTR ACTRN12622000567729, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=ACTRN12622000567729; ISRCTN 11562922, https://www.isrctn.com/ISRCTN11562922; ClinicalTrials.gov NCT05355025, https://clinicaltrials.gov/study/NCT05355025.

DERR1-10.2196/81858.

Adverse childhood experiences (ACEs) are traumatic events occurring before the age of 18 that may undermine a child's sense of safety, stability and attachment. ACEs can have lifelong consequences, including an elevated risk of developing psychological disorders and an increased likelihood of engaging in delinquent or violent behaviour later in life. Clinical practice suggests that many forensic psychiatric patients have a history of ACEs, but scientific research on ACEs within this population remains limited.

To study the prevalence of ACEs before the age of 18 within a large Dutch forensic psychiatric prison cohort and the relationship between repeated ACEs and psychopathology or violent criminal behaviour.

Data collected from 3421 adults (91% men) who had been admitted to one of the four penitentiary psychiatric centres (PPCs) in the Netherlands were used to examine the prevalence of ACEs and their association with different clusters of psychological disorders or violent criminal behaviour.

Over half of the men (1,633, 53%) and nearly two thirds of the women (198, 62%) had experienced repeated ACEs. The men with repeated ACEs had greater odds of having a neurobiological developmental disorder, having committed a violent offence and developing a substance use or addiction disorder, a personality disorder and/or a trauma- or stress-related disorder. The women with repeated ACEs had greater odds of developing a personality disorder.

Our findings underscore the importance of incorporating assessment of trauma histories and trauma-informed service for forensic psychiatric offenders. We also add evidence for the potential for early intervention, given that repeated ACEs were associated with certain mental disorders and with violent offending, in particular for men.

Depression is a common mental disorder and a leading cause of global disease burden. Emerging evidence supports diet as an adjunct treatment for depression. Previous studies are limited, meaning it is unclear whether improvements are directly due to dietary change. The OPTIMISM trial aims to address this gap through a sham-controlled randomised feeding trial design.The OPTIMISM trial is a 4-week double-blind, sham-controlled, randomised feeding trial. A total of 44 participants with MDD in a current major depressive episode of moderate to severe severity will be recruited and randomised to a Mediterranean or a sham control diet, designed to reflect typical dietary intake of the general population. All food will be provided for four weeks. Participants will complete assessments and have blood and stool collected at baseline and four weeks. The primary outcome is the differential change in clinician-rated depressive severity at four weeks. Exploratory outcomes include patient-rated depressive and anxiety symptoms, and quality of life. Potential mechanisms will be evaluated through analysis of biological samples. An additional group of 22 healthy individuals without depression will also be recruited and will receive a Mediterranean diet for four weeks; their data will determine whether clinical and biological responses to the intervention are unique to depression and whether the diet treatment modulates depression-related pathology.If the intervention diet leads to a greater reduction in depressive symptoms compared with a sham control diet, this trial will provide preliminary evidence supporting the use of a Mediterranean diet in the treatment of depression.

The extent and burden of post-acute cognitive dysfunctions following SARS-CoV-2 infection is uncertain.

25,485 SARS-CoV-2 test-positive and 25,032 test-negative individuals were repeatedly asked to score symptoms of subjective cognitive deficits 2 to 18 months after test using the "Cognitive complaints in bipolar disorder rating assessment" (COBRA) tool. Poisson mixed-effects models were used to estimate Score Ratios (SRs) by comparing scores between test-positive and test-negative individuals.

At each follow-up point, test-positive individuals have low but slightly higher mean COBRA scores compared with test-negatives. For the combined 2-18 months period, COBRA scores among test-positive individuals are 11% higher than corresponding scores among test-negatives (SR_2-18mth = 1.11 (95% CI; 1.09-1.13)). Of effect modifiers explored, being hospitalized with a positive SARS-CoV-2 test particularly elevates COBRA scores (SR_2-18mth = 1.38 (95% CI; 1.24-1.54)).

In the general population of SARS-CoV-2 infected individuals, self-reported post-acute scores of cognitive dysfunctions are low and only slightly higher than corresponding scores among test-negatives. Higher COBRA scores among hospitalized SARS-CoV-2 test positives corroborate with long-term cognitive impairment being most pronounced among those with severe SARS-CoV-2 infection.

Comorbid insomnia and sleep apnea (COMISA) is associated with poorer clinical outcomes than chronic insomnia disorder (CID) or obstructive sleep apnea (OSA) alone. However, the psychobehavioral characteristics that differentiate COMISA remain unclear. We aimed to examine the combined roles of dysfunctional beliefs and attitudes about sleep (DBAS) and excessive daytime sleepiness (EDS) in COMISA. We analyzed data from 283 patients (42 with CID alone, 166 with OSA alone, 75 with COMISA) from the National Center of Neurology and Psychiatry database, a component of a polysomnography databank for sleep disorders in Japan. DBAS was assessed using the 16-item DBAS scale (0-160 points), and EDS was measured using the Epworth Sleepiness Scale (ESS; 0-24 points). Participants were categorized into four groups based on median ESS and DBAS scale scores (medians: 90 and 9, respectively): low ESS/low DBAS, low ESS/high DBAS, high ESS/low DBAS, and high ESS/high DBAS. Logistic regression analyses, adjusting for multiple covariates, such as age, sex, and body mass index, were conducted. The high ESS/high DBAS phenotype was significantly associated with COMISA relative to the low ESS/low DBAS reference group in comparisons with both CID and OSA. The low ESS/high DBAS phenotype was also significantly associated with COMISA compared with OSA. Coexisting elevated DBAS and EDS appear to represent a distinct psychobehavioral phenotype distinguishing COMISA from CID or OSA alone. Assessing DBAS in patients with OSA and evaluating daytime sleepiness in those with CID may support earlier identification of COMISA and inform targeted management.

Medication use during adolescence provides important insight into current health and treatment patterns. However, these data are often difficult to analyze due to the complexity of medication labeling and classification. We present a reproducible framework that standardizes medication categorization in the Adolescent Brain Cognitive Development Study (ABCD Study), improving analytic consistency and enabling more reliable findings across the research community. Parent-reported data on youth prescription and over-the-counter medication use from baseline through Year 6 of the ABCD Study were reviewed and harmonized. Medications were categorized using a combination of the Anatomical Therapeutic Chemical (ATC) Classification System, artificial intelligence-assisted methods, and expert clinical input. A case study illustrated the utility of this tool by examining longitudinal associations between antidepressant use and youth-reported internalizing symptoms on the Brief Problem Monitor (BPM-Y). More than 6,300 unique medication entries were consolidated into 95 clinically meaningful categories, each coded across three recall periods (past 24 h, past 2 weeks, past year). The most common unique medication labels were for cold/flu/allergy (553) and acne treatments (355). In the case study, adolescents taking antidepressants showed a significantly greater reduction in BPM-Y internalizing scores over time compared to nonusers. This study introduces a standardized and reproducible classification of prescription and over-the-counter medication use in the ABCD Study. The resulting framework-accompanied by an interactive dashboard and publicly available code-facilitates new opportunities for researchers to examine how medication exposure relates to adolescent brain, neurocognitive behavior, and developmental outcomes.

Psychotic-like experiences (PLEs) are subthreshold psychotic phenomena that occur along the psychosis continuum and are frequently accompanied by distress. However, the factors underlying distress in individuals reporting PLEs-particularly within non-clinical populations-remain insufficiently understood. This systematic review aims to synthesise the evidence on factors directly or indirectly associated with distress in PLEs among non-clinical samples.

A systematic search of Medline, Web of Science, Embase, and Cochrane (January 2000-March 2025) using the terms psychotic-like experiences AND (distress OR resilience OR burden OR coping OR adaptive behaviour) identified 762 studies, of which 111 met inclusion criteria and were included in a narrative synthesis.

Distress related to PLEs can be differentiated into direct PLE-related distress and indirect psychological distress. Factors associated with distress clustered into three domains: (i) Symptomatology-greater frequency, intensity, persistence and specific subtypes predict higher distress, as do comorbid depression, anxiety and suicidality. (ii) Psychological factors-maladaptive metacognitive biases, poor emotion regulation and avoidant or emotion-focused coping contribute to distress, whereas self-compassion and problem-focused coping may be protective. (iii) Environmental and contextual factors-traumatic life events, discrimination, daily stressors and substance use amplify distress, often by interacting with internal vulnerabilities and emotion regulation capacities.

Distress in PLEs arises from the interaction between symptom features, internal psychological vulnerabilities and external environmental factors. Consistent with emotion regulation models, distress reflects disruptions in adaptive appraisal and coping processes that heighten emotional reactivity. Conceptualizing distress as a transdiagnostic vulnerability underscores its relevance for early identification and preventive interventions. Future research should harmonise definitions of distress, examine longitudinal pathways and evaluate resilience-building approaches to mitigate risk and improve mental health outcomes.