Intrinsic capacity (IC) is a core concept of the World Health Organization's (WHO) Integrated Care for Older People (ICOPE), representing the composite of an individual's physical and mental reserves. While deficits in IC are associated with reduced health-related quality of life (HRQoL), the functional mechanisms underlying this relationship, particularly the role of functional independence as measured by activities of daily living (ADL) remains underexplored. We investigated whether ADL performance mediates the association between IC and HRQoL among Chinese older adults.

In this cross-sectional analysis, 468 community-dwelling and institutionalized adults aged 60 years and older were recruited from the WHO ICOPE pilot in Lianyungang, China. Cumulative IC impairment was evaluated across five domains (cognition, locomotion, nutrition, sensory function, and psychology) using the ICOPE screening tool. ADL dependence was quantified by the Modified Barthel Index, and HRQoL was measured using the EQ-5D-3 L instrument. Multivariable logistic regression was employed to estimate the association between IC and HRQoL, adjusting for sociodemographic and clinical covariates. A nonparametric bootstrap mediation analysis (5000 resamples) quantified the indirect effect of IC on HRQoL via ADL.

After adjusting for covariates, each one-point increase in Cumulative IC Impairment Score was associated with 46% higher odds of impaired HRQoL (adjusted OR = 1.46; 95% CI: 1.26-1.69; p < 0.001). ADL dependence mediated approximately 34.1% of this association (indirect effect = 0.028; 95% CI: 0.006-0.050; p = 0.013). Subgroup analyses revealed that the IC-HRQoL association was significantly stronger among urban residents compared to suburban residents (interaction p = 0.004) and among community-dwelling older adults compared to nursing home residents (interaction p = 0.043).

Intrinsic capacity impairment is associated with compromised HRQoL both directly and indirectly by exacerbating functional dependence. Preserving functional independence serves as a key pathway connecting intrinsic capacity to well-being. These findings highlight the imperative for integrated interventions that simultaneously bolster intrinsic capacity and support daily functional ability, tailored to diverse living environments to promote healthy aging.

Sickle cell trait (SCT) has long been considered a benign carrier condition; however, emerging evidence suggests that individuals with SCT may experience adverse health outcomes, both physical and mental. These findings challenge the conventional notion of SCT as clinically insignificant. Therefore, the present study aims to capture the physical and mental health of SCT individuals among scheduled caste (SC) and scheduled tribe (ST) populations of Odisha, India. This cross-sectional study was conducted in the hard-to-reach regions, primarily located in the mountainous terraces of Koraput district, Odisha. A total of 382 individuals (182 SCT individuals and 200 controls) of either sex, aged between 30 and 58, were recruited for the present study. SCT individuals were identified by screening through the sickle cell slide technique. Somatometric, physiological, and biochemical data were obtained using standard protocols and techniques. Beck’s Depression Inventory (BDI) tool was utilized to assess mental health. Hemoglobin, SpO₂, blood sugar, and pulse rate were significantly affected in SCT individuals. However, they were found to be protected against overweight, obesity, and hypertension. Most importantly, a significantly higher percentage of SCT individuals (17.03%) were depressed compared to the controls (4.5%) (p < 0.001). The present study found that physical health, mental health, and quality of life were affected among individuals with sickle cell trait. Therefore, it is important to recognize that being a carrier of the HbS gene is not always a benign condition.

The functional domain of the cerebellum has expanded beyond motor control to also include cognitive and affective functions. In line with this notion, cerebellar volume has increased over recent primate evolution, and cerebellar alterations have been linked to heritable mental disorders. To map the genetic architecture of human cerebellar morphology, we here studied a large imaging genetics sample from the UK Biobank (n discovery = 27,302; n replication: 11,264) with state-of-the art neuroimaging and biostatistics tools. Multivariate GWAS on regional cerebellar MRI features yielded 351 significant genetic loci (226 novel, 94% replicated). Lead SNPs showed positive enrichment for relatively recent genetic mutations over the last 20-40k years (i.e., overlapping the Upper Paleolithic, a period characterized by rapid cultural evolution), while gene level analyses revealed enrichment for human-specific evolution over the last ∼6-8 million years. Finally, we observed genetic overlap with major mental disorders, supporting cerebellar involvement in psychopathology.

Psychological interventions for delusions may be enhanced by targeting their presumed causal factors. An emotion-oriented variant of cognitive behavioral therapy for delusions (CBTd-E), designed to target affect regulation and maladaptive schemata, was evaluated for its effect on delusions. A single-blind, multicenter, randomized, waitlist-controlled trial was conducted in three German outpatient clinics. Ninety-four patients with psychotic disorders and persistent delusions were randomized to 25 individual sessions of CBTd-E over 6 months (n = 47) or waitlist (n = 47). CBTd-E included two modules designed to improve affect regulation and maladaptive schemata. Assessments were performed at baseline (T1), three months (T2), and six months (T3). Regression-based analysis of covariance at T3 in the intent-to-treat sample indicated no significant benefit for the CBT-E group in the primary outcome (Psychotic Symptom Rating Scale delusions subscale, d = -0.45 [CI: 0.36; -1.26]). Regarding secondary outcomes, a significant effect favoring CBTd-E was observed in general psychopathology (d = -0.56), but no effects on positive and negative symptoms, depression, general and social functioning, or antipsychotic dosage. Regarding the proposed target mechanisms, we found improved cognitive reappraisal (d = 0.59), worrying (d = -0.52), quality of sleep (d = -0.49), and self-esteem (d = 0.36). Despite its effect on the suggested target mechanisms, affect regulation and maladaptive schemata, and on general psychopathology, this emotion-focused variant of CBT did not show an effect on delusions. A possible avenue to achieve stronger effects on delusions is to personalize the modularized interventions.Trial registration: Clinicaltrials.gov Identifier: NCT02787135.

Serum albumin, a reverse acute-phase protein, tends to decrease in response to acute clinical conditions. We hypothesized that albumin levels would exhibit state-dependent dynamics, with distinct patterns between acute episodes and remission states in schizophrenia. To test this, we conducted a retrospective longitudinal study to investigate the dynamic serum albumin levels in 148 schizophrenia patients, starting from their first episode through remission and subsequent relapse. A matched general population sample served as the control group. Classification models were developed using albumin levels (Albumin _current) and changes (ΔAlbumin₁ = Albumin _current-Albumin _{previous remission}, and ΔAlbumin₂ = Albumin _current-Albumin _{previous acute episode}) to distinguish clinical states. Model performance was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). Serum albumin levels were significantly lower during acute episodes (first episode: 45·6, standard deviation (SD) 4·0 g/L; relapse: 44·9, SD 4·0 g/L) compared to remission (48·6, SD 2·9 g/L) and matched controls (48·6, SD 3·4 g/L). Patients in remission showed albumin levels comparable to controls. These findings remained consistent after adjustment for potential confounders using mixed-effects model and in sex-stratified analyses. The classification model incorporating ΔAlbumin₁ and ΔAlbumin₂ achieved an AUC of 0·88 (95% CI: 0·84, 0·92) in distinguishing acute episodes from remission. These findings highlight serum albumin's potential as a clinically useful biomarker of illness activity/state and mental stress in schizophrenia, with utility in differentiating between acute and remitted states.

Lockdowns and social restrictions imposed in response to the Covid-19 pandemic intensified the proximity and reciprocal exposure among members of nuclear families. It is unclear how variation in mental distress during this period is attributed to potential influences of family members. This study used genetic data from adolescents (n = 4 388), mothers (n = 27 852) and fathers (n = 25 953), to disentangle the contributions of parent-driven, child-driven, and partner-driven components to mental distress during the first two months of the Covid-19 lockdown. Separate models also included adolescents' non-pandemic mental distress as outcomes (n = 13 484). Trio genome-wide complex trait analyses separated two types of genetic components; direct-how an individual's genotype is associated with their own mental distress, and indirect-how an individual's genotype is associated with the mental distress of family members. A trio polygenic score (PGS) design was used to investigate associations of specific genetic liability factors with mental distress, and whether these changed over time (PGS×time). Results suggest that family-level genetic factors contribute to mental distress; variance components capturing indirect genetic effects accounted for 10% of adolescent mental distress (mother-driven), 2-3% of maternal (partner-driven), and 5% of paternal mental distress (child-driven). Mothers' depression and ADHD PGS were positively associated with fathers' mental distress. No PGS×time interactions were found. Direct genetic effects accounted for 9-10% variance in mental distress across family members, partly explained by genetic variants associated with anxiety, depression, ADHD and neuroticism. These findings highlight the importance of family dynamics and emphasize the potential value of including family members in mental health interventions.

Multi-voxel pattern analysis (MVPA)-based fMRI neurofeedback is a promising tool for modulating brain states and influencing cognition and behaviour, yet its effectiveness remains unclear. This systematic review investigates its efficacy across emotion regulation, fear conditioning, associative and perceptual learning, attention, craving, semantic neurofeedback and motor rehabilitation, incorporating a meta-analytic synthesis of neural effects. A systematic search of PubMed, Web of Science, IEEE, and DPBL databases identified 29 studies. Published studies exhibit considerable variability in protocol designs and methodological aspects related to the implementation of MVPA-based neurofeedback. Overall, the global meta-analysis revealed a moderate, statistically significant effect of MVPA-based neurofeedback on neural outcomes, with subgroup analysis indicating a similar moderate effect in emotion regulation. Most studies support neural modulation following neurofeedback training across multiple domains, though behavioural outcomes are less consistent. Fear reduction, attention and perceptual learning studies demonstrated both neural and behavioural changes, while associative learning and craving reduction studies showed evidence of neural regulation but unclear behavioural outcomes. Studies on motor rehabilitation and semantic neurofeedback demonstrated neural modulation but lacked behavioural assessments. Emotion regulation studies consistently supported neural modulation, however, only a few studies reported behavioural improvements. While these findings highlight the potential of neurofeedback, they also emphasise the need for standardized methodologies and clearer theoretical frameworks. Clarifying terminology used to define different approaches and addressing MVPA-specific methodological considerations - such as preprocessing, motion correction, and classifier selection - will be critical for refining neurofeedback protocols and unlocking the full potential of MVPA-based neurofeedback for both clinical and research applications.

The best predictor of a suicide attempt is a previous attempt, apart from psychiatric diagnoses also associated. Some studies found other indicators of great risk for suicide reattempts. Machine Learning algorithms offer the potential for systematic detection of features that carry greater risk for an event. This study sought to develop a classification algorithm distinguishing between Single Suicide Attempters (SSA) and Multiple Suicide Attempters (MSA) in a Spanish multicentre national cohort to explore prediction of subsequent attempts in suicidal patients. Two models including the same sociodemographic and clinical variables grouped in more specific (Model I) or broad (Model II) categories were developed to explore risk factors for suicide reattempts. A Least Absolute Shrinkage and Regression Operator logistic regression with a 10-fold cross-validation was adopted. 1443 adult patients from the SURVIVE cohort were included (582 SSA and 861 MSA). Both Model I (AUC = 0.696; BAC = 0.644) and Model II (AUC = 0.678; BAC = 0.621) outperformed naïve majority-class classification for SSA and MSA. Bipolar disorder type II, binge-eating disorder, and schizophrenia variables weighted heavier on Model I for suicide reattempt-related; while eating disorder diagnosis, Africa as birthplace, affective disorder diagnosis, being employed, schizophrenia-spectrum disorder and substance use disorder diagnoses were the most important suicide reattempt-related of Model II. Affective disorders, eating disorders and schizophrenia-spectrum disorders emerged as the most important variables in predicting reattempts. Both models showed similar sensitivity and specificity when discriminating between SSA and MSA. Identifying specific risk factors for reattempts could have a significant impact on tailoring prevention strategies and interventions.

Non-suicidal self-injury (NSSI) in adults after a suicide attempt may follow distinct courses with different clinical profiles and reattempt risk.

Examine NSSI patterns, correlates, and associations with suicide reattempts over 12 months.

Adults (n = 685; 72.4% female; mean age 42 [SD 15.45]) were assessed ≤15 days post-index attempt and followed 12 months. NSSI was assessed using Columbia-Suicide Severity Rating Scale (C-SSRS). Baseline assessments captured psychiatric diagnoses, global psychological distress, impulsivity, fearlessness about death, and childhood trauma (assessed with the MINI, BSI, BIS-11, ACSS-FAD, and CTQ-SF, respectively), and suicide-related variables; reattempts were tracked throughout follow-up.

Four a priori patterns: NN (No NSSI→No NSSI; 53.4%), Onset (No→Yes; 5.7%), Remission (Yes→No; 23.9%), and Persistence (Yes→Yes; 16.9%). Persistence was associated with younger age and higher baseline impulsivity, higher baseline global psychological severity, and greater childhood trauma severity along with substance use before the attempt and higher acquired capability. PTSD predicted reattempt within Persistence. Onset was linked to earlier reattempts, narrowing the intervention window, whereas Persistence showed a modest descriptive delay, consistent with short-term regulation (without implying protection). During follow-up, 22.2% reattempted; median time-to-reattempt 138 days (IQR 55-222; mean 149). In multivariable Cox regression, older age showed lower hazard (HR 0.98, 95% CI 0.96-0.99), and a greater number of prior suicide attempts (HR 1.02, 1.01-1.04). Relative to NN, Remission (HR 0.56, 0.32-0.96) and Persistence (HR 0.58, 0.35-0.96) were associated with reduced 12-month hazard.

While NSSI may briefly down-regulate severe affect, Persistence signals elevated clinical risk and acquired capability; Onset appears linked to earlier reattempts.

Declining mental health among college students is a global concern. This study aimed to compare the effects of a Confucianism-based Internet-delivered Acceptance and Commitment Therapy (C-ACT) with a standard mindfulness-based I-ACT (M-ACT) and to examine the longitudinal relationship between psychological flexibility (PF) and meaning-centered coping (MCC).

In this randomized controlled trial, 300 Chinese college students were assigned to either the C-ACT intervention or the M-ACT active comparison group. Both 8-week online interventions were followed over a 20-week period with assessments at five time points. A parallel process latent growth curve model was used to analyze the change trajectories of PF and MCC.

Both groups demonstrated significant increases in PF and MCC over time. At baseline, higher PF was significantly associated with higher MCC. Furthermore, the rate of change in PF was positively correlated with the rate of change in MCC across both groups. Crucially, the C-ACT group showed a significantly greater rate of increase in MCC compared to the M-ACT group. No significant group difference was found for the rate of change in PF.

While the findings support the general efficacy of I-ACT for improving psychological well-being in college students, the superior effect of the culturally adapted C-ACT on meaning-centered coping specifically highlights the potential benefits of integrating indigenous cultural values, such as Confucian ethics, into evidence-based psychological interventions to enhance specific therapeutic outcomes.

ChiCTR2400090851.