National Veterans Affairs electronic health records were used to examine the association between traumatic brain injury (TBI) severity and four dementia phenotypes ranging from narrow (strict AD) to broad (all-cause dementia).

Veterans with TBI (n = 91,753) and a propensity score-matched comparison group of veterans without TBI (n = 183,506) were included. Four validated dementia phenotypes defined using International Classification of Diseases (ICD) codes were evaluated. The association between TBI severity and each dementia phenotype was examined using adjusted logistic regression.

TBI severity was significantly associated with increased odds of developing dementia across the three broader dementia phenotypes in a dose-response manner (moderate/severe/penetrating TBI > mild TBI). Those with unclassified TBI had disease risk falling in between mild and more severe TBI. In contrast, TBI was associated with decreased risk of strict AD across all severity levels.

Findings support a dose-response relationship between TBI severity and broader dementia risk but raise questions regarding the TBI-AD link.

With the intensification of global population aging, the incidence of depressive symptoms among older women has increased year by year, affecting their quality of life and physical and mental health. Therefore, investigating the impact of daytime napping behavior on depressive symptoms in older women, particularly the regulatory effects of napping on frailty status and inflammatory response, is of important clinical and public health significance. This study aims to explore the relationship between daytime napping behavior and depressive symptoms in older women, with a focus on the chain mediating roles of frailty status and C-reactive protein (CRP) between napping and depressive symptoms.

This study used 5 waves of data from the China Health and Retirement Longitudinal Study (CHARLS), including 3755 female participants aged ≥45 years. First, descriptive statistics and difference analyses were used to summarize baseline characteristics of the participants. Second, Cox proportional hazards regression models were used to analyze the effects of napping habits and nap duration on depressive symptoms. To explore the biological mechanisms linking napping and depressive symptoms, path analysis was further conducted to examine the chain mediating roles of frailty status and CRP in the effect of napping on depressive symptoms. To control for potential confounding factors, all analyses were adjusted for multiple covariates, including age, education level, marital status, smoking, drinking, social participation, and physical exercise. Finally, subgroup analyses were conducted to further verify the moderating effects of different lifestyles on the impact of napping.

Napping behavior was significantly associated with a lower risk of depressive symptoms, particularly among women with nap durations of 5 to 30 minutes, who had the lowest risk of depressive symptoms. Specifically, individuals with nap durations of 5 to 30 minutes had a lower risk of depressive symptoms (HR=0.750, 95% CI 0.637 to 0.883, P<0.001), whereas those with naps longer than 60 minutes did not show a significant reduction in depressive symptom risk (HR=0.934, 95% CI 0.811 to 1.076, P=0.347). Further path analysis showed that there is a total indirect effect between napping and depressive symptoms (β=-0.0219, P<0.05), and there is an overall effect between the two (β=-0.081, P<0.05), indicating that napping could indirectly alleviate depressive symptoms by slowing frailty progression and reducing CRP levels. Subgroup analysis showed that the protective effect of napping on depressive symptoms was more pronounced among women who did not smoke or drink, exercised regularly, and participated in social activities, suggesting that the psychological protective effect of napping depends on an individual's overall health behavior pattern.

Daytime napping exerts a chain mediating effect on depressive symptoms in older women through frailty status and CRP levels. Moderate napping, especially short naps of 5 to 30 minutes, can effectively reduce the risk of depressive symptoms, and this effect may be achieved by improving physical function and alleviating frailty and inflammatory responses.

Antenatal depression is an important public health issue affecting the physical and mental health of pregnant women and maternal-infant outcomes, with a global prevalence of 10% to 20%. Psychological capital, as a positive psychological resource of pregnant women, includes 4 core dimensions: Self-efficacy, hope, optimism, and resilience, and plays a critical role in coping with pregnancy-related stress and maintaining mental health. However, current research on antenatal depression and psychological capital remains insufficient, particularly with regard to exploration of their latent heterogeneous patterns. This study aims to identify latent joint profile types of psychological capital and antenatal depression among pregnant women using latent profile analysis (LPA), and to quantify the effects of social support, sleep quality, and exercise behavior on different types, so as to provide empirical evidence for the precision of psychological interventions during pregnancy.

A cross-sectional survey design was adopted. From July to December 2023, an online survey platform was used to conduct investigations in tertiary hospitals in Hubei Province, Liaoning Province, and Guangdong Province (one hospital per province, 3 hospitals in total). A total of 772 valid questionnaires were obtained. Data were collected using the Chinese version of the Edinburgh Postnatal Depression Scale (EPDS), the 12-item short version of the Psychological Capital Questionnaire (PCQ-12), the Multidimensional Scale of Perceived Social Support (MSPSS) for perceived social support, the Pittsburgh Sleep Quality Index (PSQI), and a self-designed questionnaire. LPA was used to identify latent profile types of psychological capital and antenatal depression. The optimal fitting model was determined based on the Bayesian Information Criterion (BIC), entropy, and the Lo-Mendell-Rubin (LMR) adjusted likelihood ratio test results. Multinomial logistic regression was applied to evaluate the effects of various factors on different latent types.

The three-class model was the optimal fitting model. The comprehensive deprivation group (3.50%) showed the lowest levels of psychological capital and the most severe depressive symptoms; the functionally restricted group (33.94%) showed moderate psychological capital and relatively high depressive symptoms; and the positive adjustment group (62.56%) showed high psychological capital and low depressive symptoms. Univariate analysis showed statistically significant differences among the 3 latent classes in occupation, educational level, monthly income, frequency of alcohol consumption during pregnancy, frequency of exercise during and before pregnancy, relationship with husband, perceived social support, and sleep quality (all P<0.05). After controlling for covariates, each 1-point increase in perceived social support increased the probability of pregnant women entering the positive adjustment group rather than the comprehensive deprivation group by 13.0% [odds ratio (OR)=1.130, 95% confidence interval (CI) 1.091 to 1.171, P<0.001]. Pregnant women who rarely exercised during pregnancy were more likely to enter the comprehensive deprivation group rather than the positive adjustment group (OR=0.107, 95% CI 0.012 to 0.962, P=0.046). Pregnant women with higher perceived social support scores were more likely to enter the positive adjustment group rather than the functionally limited group (OR=1.075, 95% CI 1.058 to 1.091, P<0.001), while pregnant women with poor sleep quality were more likely to enter the functionally limited group rather than the positive adjustment group (OR=0.902, 95% CI 0.848 to 0.959, P<0.001). Pregnant women with higher perceived social support scores were more likely to enter the functionally limited group rather than the comprehensive deprivation group (OR=1.052, 95% CI 1.017 to 1.087, P=0.003).

Significant heterogeneity exists in psychological capital and antenatal depression among pregnant women, and 3 latent classes with clinical and intervention significance can be identified. Social support is a key protective factor in promoting psychological resilience and preventing antenatal depression, while regular physical activity and good sleep also have independent predictive value. It is recommended that positive psychological resources be incorporated into pregnancy mental health screening systems, promoting a shift in service models from "disease-oriented" to "resource-oriented" and implementing stratified intervention strategies based on class characteristics. For the positive adjustment group, participation in community peer support networks can be encouraged, and they can be cultivated as key opinion leaders for mental health promotion. For the functionally limited group, priority should be given to improving sleep disorders, increasing physical activity, and strengthening social connections to prevent progression to high-risk states. For the comprehensive deprivation group, inclusion in high-risk case management pathways in prenatal care clinics is required, with early identification and multidisciplinary collaborative interventions to effectively reduce the risk of adverse psychological and pregnancy outcomes and improve overall maternal and infant health.

Depression is a complex mental disorder whose disease burden has become a major global public health issue. Sex is an important factor influencing susceptibility to depression, but the underlying mechanisms remain unclear. Previous studies have demonstrated a significant association between depression and acylcarnitine metabolism; however, systematic comparisons of acylcarnitine metabolic profiles between male and female patients with depression remain limited. This study aims to investigate sex differences in plasma acylcarnitine metabolic characteristics in first-episode, drug-naïve patients with depression, analyze the relationships between specific acylcarnitines and depression susceptibility and severity in different sexes, and explore the potential biological mechanisms underlying sex differences in depression from a metabolomics perspective.

Plasma samples from first-episode, drug-naïve patients with depression and healthy controls collected in a clinical trial conducted between 2017 and 2020 were analyzed for carnitine levels. A total of 100 patients with first-episode, drug-naïve depression and 50 healthy controls were included. A two-step analytical strategy combining qualitative identification using ultrahigh-performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UHPLC-Q-TOF MS) and targeted quantification using liquid chromatography-tandem mass spectrometry (LC-MS/MS) was applied to systematically detect plasma acylcarnitine metabolic profiles. Two-way analysis of variance (ANOVA) or the Scheirer-Ray-Hare test was used to examine the effects of depression diagnosis and sex differences on acylcarnitine levels. Multivariate linear regression analysis was further conducted to determine the associations between acylcarnitines, sex, depression susceptibility, and severity.

A total of 33 acylcarnitines and free carnitine were detected in plasma. After preliminary analysis and screening, 8 acylcarnitines showed significant sex differences. Further multivariate linear regression analysis incorporating baseline characteristics revealed that acetylcarnitine C2:0 (β=0.910, P=0.023), valerylcarnitine C5:0 (β=-0.020, P=0.012), and undecylenoylcarnitine C11:1 (β=-3.322, P=0.008) were significantly associated with sex. When baseline characteristics and sex-differentiated acylcarnitines were included as independent variables and scale scores were used as dependent variables in multivariate linear regression models, C11:1 showed a significant positive correlation with Beck Depression Inventory (BDI) scores (β=0.817, P=0.036). C12:1-OH (β=0.774, P=0.034) was positively correlated with Hamilton Anxiety Scale (HAMA) scores, whereas C4:0 (β=-44.616, P=0.028) and C13:1 (β=-1.344, P=0.022) were negatively correlated with HAMA scores (P<0.05).

This study demonstrated significant sex differences in acylcarnitine metabolism in patients with first-episode depression. Among them, C2:0, C5:0, and C11:1 were key metabolites independently regulated by sex. C4:0, C11:1, C12:1-OH, and C13:1 were closely associated with depression susceptibility and anxiety severity. These findings suggest that dysregulation of mitochondrial fatty acid β-oxidation pathways may represent an important biological basis for sex differences in depression and provide new directions for precision classification and sex-specific diagnostic and therapeutic strategies for depression.

Postpartum depression (PPD) is a common and serious mental disorder after childbirth, imposing a heavy burden on mothers, infants, and families. Abnormalities in the tryptophan-kynurenine (TRP-KYN) metabolic pathway are considered to be involved in its pathogenesis, but the role of quinolinic acid phosphoribosyltransferase (QPRT), a key downstream enzyme in this pathway, remains unclear. This study aims to explore the association between PPD in women undergoing cesarean section and QPRT gene polymorphisms, as well as other risk factors for PPD.

A candidate gene association study design was adopted. From January 2024 to June 2025, full-term singleton pregnant women scheduled to undergo elective cesarean section under spinal anesthesia were recruited at the Third Xiangya Hospital of Central South University and Hunan Provincial Maternal and Child Health Hospital. At 42 days postpartum, postpartum depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS). Peripheral blood samples were collected and genomic DNA was extracted. Four QPRT single nucleotide polymorphism loci (rs1134700, rs2303255, rs9922666, and rs9933310) were selected for genotyping to analyze the association between these loci and PPD. Bioinformatics analysis and dual-luciferase reporter gene assays were performed to investigate the possible mechanism by which significant loci influence disease occurrence.

A total of 362 women were ultimately included in the analysis, among whom 29 were diagnosed with PPD, with an incidence of 8.01%. Analysis of general data showed that comorbid hypertension or thyroid disease, inconsistency between neonatal sex and expectation, prenatal depression, prenatal self-harm ideation, domestic violence, poor marital and mother-in-law/daughter-in-law relationships, stressful life events, dissatisfaction with current life status, poor mood during pregnancy, and high stress during pregnancy were all risk factors for PPD in women undergoing cesarean section (all P<0.05). Genetic association analysis revealed that the QPRT rs9933310 A>G polymorphism was associated with PPD. Women carrying the rs9933310 GG or AG genotype had a 2.92-fold higher risk of PPD compared with women with the AA genotype (OR=2.92, 95% CI 1.18 to 6.99). Expression quantitative trait loci (eQTL) analysis suggested that the G allele at this locus was associated with downregulation of QPRT expression (AA>AG>GG). Multi-database queries indicated that the rs9933310 locus may have promoter and/or enhancer activity. In addition, JASPAR database prediction and experimental validation showed that the mutant (G) allele at the QPRT rs9933310 locus was more likely than the wild-type (A) allele to weaken promoter-enhancer activity at this locus, and resulted in loss of transcription factors Gata1, GATA2, GATA3, Gata4, Sox17, Sox2, Sox3, Sox6, and SRY, thereby regulating QPRT expression.

Comorbid hypertension or thyroid disease, inconsistency between neonatal sex and expectation, prenatal depression, prenatal self-harm ideation, domestic violence, poor marital and mother-in-law/daughter-in-law relationships, stressful life events, dissatisfaction with current life status, poor mood during pregnancy, high stress during pregnancy, and mutation at the QPRT rs9933310 locus are all risk factors for PPD. The QPRT rs9933310 G allele is an independent risk factor for PPD in women undergoing cesarean section, and its pathogenic mechanism may involve downregulation of QPRT expression and disruption of TRP-KYN pathway homeostasis. QPRT has a potential role in the pathogenesis of PPD and may become a novel antidepressant target acting on the TRP-KYN pathway.

Impaired insight into illness affects up to 95% of individuals with schizophrenia, depending on the stage of illness, and is a predictor of antipsychotic nonadherence and poor clinical outcomes. Despite its importance, no effective treatment exists. Interhemispheric imbalance in frontoparietal regions may serve as a biomarker of impaired insight into illness and target for transcranial direct current stimulation (tDCS). Meta-analyses suggest that sham-controlled multisession tDCS applied to frontotemporoparietal areas improves insight in schizophrenia. However, no randomized controlled tDCS trial has targeted the posterior parietal areas to improve insight into illness. We hypothesized that multisession biparietal tDCS would lead to both immediate (ie, following 2-weeks of tDCS) and sustained (ie, up to 4-weeks) improvement in insight in schizophrenia.

Thirty-four participants with schizophrenia/schizoaffective disorder and impaired insight into illness were randomized to receive either active (n = 18) or sham (n = 16) biparietal tDCS (anodal/cathodal:P4/P3), administered twice daily over 10 days. Insight was assessed using the VAGUS Insight into Psychosis scale at baseline pre-treatment, post-treatment, and weekly for 4 weeks. Linear mixed-effects models compared estimated marginal mean VAGUS scores between conditions, with and without adjusting for Intelligence Quotient (IQ), illness severity, and clozapine use.

Active tDCS significantly improved average VAGUS scores immediately following and up to 4 weeks post-treatment.

Biparietal tDCS appears to be a promising intervention for improving insight in schizophrenia. Future research should explore its adjunctive use with medication to enhance treatment adherence.

Internet addiction and depressive symptoms are common comorbid mental health problems among adolescents. This study aims to employ a cross-lagged panel network (CLPN) model to examine the longitudinal dynamic interactions between adolescent internet addiction and depressive symptoms at the symptom level, and to explore gender-specific patterns.

A total of 1 138 adolescents from a middle school in a northern city were followed for 5 months with two waves of assessment. Internet addiction and depressive symptoms were measured using the Internet Addiction Test (IAT) and the Patient Health Questionnaire-9 (PHQ-9), respectively. CLPN was conducted using R software version 4.4.0 to estimate out-expected influence (out-EI) and in-expected influence (in-EI).

The cross-lagged effects of depressive symptoms on internet addiction were stronger than the reverse effects. In the overall sample, feelings of worthlessness showed the highest out-EI. Gender-specific CLPN results indicated that, in males, suicidal ideation had significant negative cross-lagged effects on salience, neglect of work, and anticipation in internet addiction. In females, excessive internet use and lack of control showed significant positive cross-lagged effects.

Depressive symptoms are key drivers of internet addiction in adolescents, with notable gender differences in symptom pathways. Future research and interventions should consider gender sensitivity and target specific symptom pathways to develop precise prevention and intervention strategies.

In recent years, the phenomenon of "hollow heart syndrome" has become increasingly prevalent among college students, characterized by persistent inner emptiness, lack of motivation, and a diminished sense of meaning. Even when external achievements are attained, individuals often fail to experience a sense of fulfillment and satisfaction. Such students may appear successful outwardly but remain trapped in confusion and meaninglessness, and may even frequently experience suicidal ideation. As a critical stage of psychological development, the college period involves the transition from identity diffusion to identity formation. Establishing a stable and clear self-identity during this stage is essential for developing a sustained sense of meaning in life. Therefore, this study aims to examine the relationship between self-concept clarity and meaning in life among college students using a longitudinal design, and to further investigate the moderating role of depressive symptoms in this relationship, thereby providing theoretical support for promoting meaning in life and empirical evidence for improving psychological crisis prevention and intervention systems.

A longitudinal design was employed. A total of 387 college students from a comprehensive university were assessed twice at a four-week interval, with the two time points denoted as T1 and T2. The instruments included the Self-Concept Clarity Scale (SCCS), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Meaning in Life Questionnaire (MLQ). Cross-lagged analysis was conducted to examine the bidirectional relationship between self-concept clarity and meaning in life, and standardized regression coefficients (β) were calculated. Based on this, a two-step multiple regression analysis was used to test the moderating effects of depressive symptoms on the pathways from self-concept clarity to meaning in life and from meaning in life to self-concept clarity. For paths showing significant moderation, simple slope analyses were further conducted to explore the moderating patterns at different levels of depressive symptoms.

Self-concept clarity at T1 significantly and positively predicted meaning in life at T2 (β=0.214, P<0.001), and meaning in life at T1 significantly and positively predicted self-concept clarity at T2 (β=0.211, P<0.001). Depressive symptoms significantly moderated only the predictive effect of self-concept clarity on meaning in life (P=0.035). Simple slope analysis showed that the effect sizes were 0.400 and 0.245 in the high and low depressive symptom groups, respectively. However, the moderating effect of depressive symptoms on the pathway from meaning in life to self-concept clarity was not significant (P=0.258).

This is a reciprocal and mutually reinforcing relationship between self-concept clarity and meaning in life. Depressive symptoms play a moderating role in this relationship, such that higher levels of depressive symptoms strengthen the predictive effect of self-concept clarity on meaning in life. Therefore, in mental health education and intervention among college students, it is important to emphasize the coordinated development of self-concept and meaning construction, and to utilize the moderating role of depressive symptoms to optimize intervention strategies. For students with depressive tendencies, priority should be given to assessing and improving their identity status, promoting self-acceptance, integration, and identity consolidation. For students with unclear self-concept, timely assessment of depressive symptoms and early psychological intervention are recommended to reduce the negative cycle between self-concept and meaning in life and to promote psychological adaptation and healthy development.

Abdominal pain, gastrointestinal symptoms and pelvic pain are common complaints of young females seeking healthcare. These symptoms can co-exist and become recurrent, impacting on quality of life.

This study investigated the relationships between abdominal pain and gastrointestinal symptoms at 17-years of age and pelvic pain bothersomeness (PPB) at 22-years of age in young females.

A cross-sectional observational study utilising 17 and 22-year Gen2 female data of the Raine Study (n = 584). Abdominal pain and gastrointestinal symptoms at 17 years were: frequency, consistency and/or pain of bowel movements, bloating, nausea, vomiting, analgesia for cramps and laxative use in the preceding 3 months. At 22 years, PPB was determined by the Urogenital Distress Inventory Short Form (UDI-6). Additional health-related variables were analysed to understand the symptom patterns of participants.

17-year-old females, with abdominal pain and gastrointestinal data who answered the UDI-6 for PPB (n = 450); 347 (77%) were not bothered by PPB, 64 (14%) reported mild PPB and 39 (9%) reported moderate-severe PPB at 22-years (p = 0.168). Symptoms of varied stool consistency, vomiting, nausea and laxative use, but not isolated abdominal pain, at 17-years were significantly associated with PPB at 22-years. Co-variants of depression, anxiety, bullying, living with a partner, poor sleep and smoking showed increased prevalence with severity of PPB.

Gastrointestinal symptoms in adolescence were associated with pelvic pain bothersomeness (PPB) in young adulthood. Early detection of abdomino-pelvic symptoms may be useful to allow early, targeted and multi-disciplinary management to optimise physical and mental health outcomes.

Dravet syndrome is an early-onset developmental and epileptic encephalopathy in which management must extend beyond seizure control to include the monitoring and treatment of neurodevelopmental and systemic comorbidities.

Well-established treatments, together with recently approved agents, are discussed alongside under-reported therapies. Safety profiles, clinically relevant pharmacokinetic interactions, and practical aspects of dose titration and monitoring are reviewed. Emerging targeted pharmacological and genetic strategies are also briefly considered as potential disease-modifying approaches.

In clinical practice, valproate-based regimens remain central to seizure management, with adjunctive therapies tailored to seizure type, comorbidities, tolerability, and drug interactions. While stiripentol, clobazam, fenfluramine, and cannabidiol are supported by the strongest evidence, less frequently reported therapies, including perampanel, topiramate, levetiracetam, cenobamate, and ketogenic dietary therapies, may benefit selected patients but require cautious use due to heterogeneous efficacy and safety data. The complexity of available options highlights the need for individualized, dynamic treatment strategies. Although emerging targeted and genetic therapies may represent a future paradigm shift beyond symptomatic seizure control, their clinical impact remains to be established, warranting careful implementation and long-term safety evaluation.