With the sustained growth of the economy and significant changes in social demographics,the issue of elderly-related diseases has increasingly drawn attention,particularly.Alzheimer’s disease(AD),as a representative ...With the sustained growth of the economy and significant changes in social demographics,the issue of elderly-related diseases has increasingly drawn attention,particularly.Alzheimer’s disease(AD),as a representative disease of neurodegenerative diseases,has become a major challenge,affecting the health and quality of life of the elderly population severely.In recent years,the incidence,prevalence and mortality rates of AD have increased in China,imposing substantial economic burdens on families,society and the entire healthcare system.To proactively address this challenge and respond to the national‘Healthy China Action’initiative,leading experts from authoritative institutions jointly authored the China Alzheimer Report 2025.Building on previous editions,this report updates epidemiological data on AD in China,thoroughly analyses the latest economic burdens of the disease and comprehensively evaluates the current status of AD diagnosis and treatment services,as well as the allocation of public health resources in our country.Its release reflects China’s progress in AD research and prevention,underscores societal concern for elderly health and aims to provide scientific guidance and data support for AD prevention,diagnosis and treatment.It also facilitates academic exchanges and cooperation,enhancing public awareness and promoting active participation in elderly healthcare,towards achieving‘healthy ageing’in China.展开更多
INTRODUCTION.Depressive disorders are mental illnesses that seriously affect public health.There are approximately 320 million patients with depression worldwide,accounting for 4.4% of the total disease burden.1Depres...INTRODUCTION.Depressive disorders are mental illnesses that seriously affect public health.There are approximately 320 million patients with depression worldwide,accounting for 4.4% of the total disease burden.1Depression leads to social and occupational impairment,diminished quality of life and an elevated risk of death by suicide.展开更多
Background Clinical brain-computer interface(BCI)for mental disorders is an emerging interdisciplinary research field,posing new ethical concerns and challenges,yet lacking practical ethical governance guidelines for ...Background Clinical brain-computer interface(BCI)for mental disorders is an emerging interdisciplinary research field,posing new ethical concerns and challenges,yet lacking practical ethical governance guidelines for stakeholders and the entire community.Aims This study aims to establish a multidisciplinary consensus of principles for ethical governance of clinical BCI research for mental disorders and offer practical ethical guidance to stakeholders involved.Methods A systematic literature review,symposium and roundtable discussions,and a pre-Delphi(round 0)survey were conducted to form the questionnaire for the three-round modified Delphi study.Two rounds of surveys,followed by a third round of independent interviews of 25 experts from BCI-related research domains,were involved.We conducted quantitative analysis of responses and agreements among experts to reveal the consensus and differences regarding the ethical governance of mental BCI research from a multidisciplinary perspective.Results The Delphi panel emphasised important concerns of ethical review practices and ethical principles within the BCI context,identified qualified and highly influential institutions and personnel in conducting and advancing clinical BCI research,and recognised prioritised aspects in the risk-benefit evaluation.Experts expressed diverse opinions on specific ethical concerns,including concerns about invasive technology,its impact on humanity and potential social consequences.Agreement was reached that the practices of ethical governance of clinical BCI for mental disorders should focus on patient voluntariness,autonomy,long-term effects and related assessments of BCI interventions,as well as privacy protection,transparent reporting and ensuring that the research is conducted in qualified institutions with strong data security.Conclusions Ethical governance of clinical research on BCI for mental disorders should include interdisciplinary experts to balance various needs and incorporate the expertise of different stakeholders to avoid serious ethical issues.It requires scientifically grounded approaches,continuous monitoring and interdisciplinary collaboration to ensure evidence-based policies,comprehensive risk assessments and transparency,thereby promoting responsible innovations and protecting patient rights and well-being.展开更多
Background Numerous studies have consistently demonstrated that a considerable proportion of patients with major depressive disorder (MDD) frequently exhibit pronounced dyslipidaemia. However, the causal dynamics betw...Background Numerous studies have consistently demonstrated that a considerable proportion of patients with major depressive disorder (MDD) frequently exhibit pronounced dyslipidaemia. However, the causal dynamics between MDD and dyslipidaemia remain elusive.Aims To comprehensively disentangle the genetic causality between MDD and various phenotypes of blood lipids, thereby facilitating the advancement of management strategies for these conditions.Methods We conducted a two-sample univariable Mendelian randomisation (MR) analysis using different models, including the inverse variance weighted (IVW) method and causal analysis using the summary effect (CAUSE) estimates, as well as a multivariable MR analysis. This analysis used summary statistics from genome-wide association studies (GWAS) of MDD and five lipid traits: low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, total cholesterol and triglycerides (TG), encompassing 5 237 893 individuals of European and East Asian ancestries. For MDD, a total of 598 701 individuals were included, with 500 199 individuals of European ancestry (Ncase=170 756, Ncontrol=329 443) and 98 502 of East Asian ancestry (Ncase=12 588, Ncontrol=85 914). Lipid data were collected from 4 639 192 individuals through the Global Lipids Genetics Consortium (European, N=4 096 085;East Asian, N=543 107). Next, we used the two-step MR to explore the mediating factors between MDD and TG, and the risk factors affecting TG through MDD. Finally, we conducted a GWAS meta-analysis and enrichment analysis.Results In univariable MR, we observed a negative causal effect of low-density lipoprotein on MDD in both European populations (IVW: odds ratio (OR): 0.972, 95% confidence interval (CI) 0.947 to 0.998, p=0.037) and East Asian populations (IVW: OR: 0.928, 95% CI 0.864 to 0.997, p=0.042). Additionally, we identified a bidirectional causal relationship between TG and MDD, with TG having a causal effect on MDD (IVW: OR: 1.052, 95% CI 1.020 to 1.085, p=0.001) and MDD having a causal effect on TG (IVW: OR: 1.075, 95% CI 1.047 to 1.104, p<0.001). Multivariable MR analysis further supported the role of TG in MDD (OR: 1.205, 95% CI 1.034 to 1.405, p=0.017). CAUSE estimates indicated that the causal model of MDD on TG provided a better fit than the sharing model (p=0.003), while the association of TG on MDD was more likely due to horizontal correlated pleiotropy than causality. Mediation analyses revealed that waist-hip ratio (WHR) mediated 69% of the total causal effect of MDD on TG, while other identified risk factors exhibited lower mediating proportions either mediated through MDD (≤17%) or originating from MDD (≤29%). The GWAS meta-analysis highlighted potential pathways related to lipid processes and nucleosome assembling, with significant cell types identified in brain regions and liver tissues.Conclusions The findings indicate that genetic proxies of MDD are associated with elevated levels of TG, with WHR serving as a clinical indicator of the association. This suggests that interventions targeting WHR may be effective in reducing TG levels in patients with MDD.展开更多
Background The heterogeneity of depression limits the treatment outcomes of intermittent theta burst stimulation(iTBS)and hinders the identification of predictive factors.This study investigated functional network con...Background The heterogeneity of depression limits the treatment outcomes of intermittent theta burst stimulation(iTBS)and hinders the identification of predictive factors.This study investigated functional network connectivity and predictors of iTBS treatment outcomes in adolescents and young adults with depression.Aim This study aimed to identify default mode network(DMN)-based connectivity patterns associated with varying iTBS treatment outcomes in depression.Methods Data from a randomised controlled trial of iTBS in depression(n=82)were analysed using a data-driven approach to classify homogeneous subgroups based on the DMN.Connectivity subgroups were compared on depressive symptoms and cognitive function at pretreatment and post-treatment.Furthermore,the predictive significance of baseline inflammatory cytokines on post-treatment outcomes was evaluated.Results Two distinct subgroups were identified.Subgroup 1 exhibited high heterogeneity and greater centrality in the posterior cingulate cortex and retrosplenial cortex,while subgroup 2 showed more homogeneous connectivity patterns and greater centrality in the temporoparietal junction and posterior inferior parietal lobule.No main effect for subgroup,treatment or subgroup×treatment interaction was revealed in the improvement of depressive symptoms.A significant subgroup×treatment interaction related to symbol coding improvement was detected(F=5.22,p=0.026).Within subgroup 1,the active group showed significantly greater improvement in symbol coding compared with the sham group(t=2.30,p=0.028),while baseline levels of interleukin-6 and C-reactive protein emerged as significant indicators for predicting improvements in symbolic coding(R2=0.35,RMSE(root-mean-square error)=5.72,p=0.013).Subgroup 2 showed no significant findings in terms of cognitive improvement or inflammatory cytokines predictions.展开更多
Background As the population in China rapidly ages,the prevalence of mild cognitive impairment(MCI)is increasing considerably.However,the causes of MCI vary.The continued lack of understanding of the various subtypes ...Background As the population in China rapidly ages,the prevalence of mild cognitive impairment(MCI)is increasing considerably.However,the causes of MCI vary.The continued lack of understanding of the various subtypes of MCI impedes the implementation of effective measures to reduce the risk of advancing to more severe cognitive diseases.Aims To estimate the prevalence and incidence rates of two MCI subtypes—amnestic MCI(aMCI)and vascular cognitive impairment without dementia(VCIND)—and to determine modifiable factors for them among older individuals in a multiregional Chinese cohort.Method This 1-year longitudinal study surveyed a random sample of participants aged≥60 years from a large,community-dwelling cohort in China.Baseline lifestyle data were self-reported,while vascular and comorbid conditions were obtained from medical records and physical examinations.In total,3514 and 2051 individuals completed the baseline and 1-year follow-up assessments,respectively.Logistic and linear regression analyses were used to identify the modifiable factors for MCI subtypes and predictors of cognitive decline,respectively.Results Among our participants,aMCI and VCIND demonstrated prevalence of 14.83%and 2.71%,respectively,and annual incidence(per 1000 person-years)of 69.6 and 10.6,respectively.The risk factor for aMCI was age,whereas its protective factors were high education level,tea consumption and physical activity.Moreover,VCIND risk factors were age,hypertension and depression.The presence of endocrine disease,cerebral trauma or hypertension was associated with a faster decline in cognition over 1 year.Conclusions MCI is a serious health problem in China that will only worsen as the population ages if no widespread interventions are implemented.Preventive strategies that promote brain activity and support healthy lifestyle choices are required.We identified modifiable factors for MCI in older individuals.The easy-to-adopt solutions such as tea consumption and physical activity can aid in preventing MCI.展开更多
To the editor:The liver’s immune-privileged status allows for a unique microenvironment that supports tumour growth and metastasis.In hepatocellular carcinoma(HCC),the balance between cytotoxic T lymphocytes and regu...To the editor:The liver’s immune-privileged status allows for a unique microenvironment that supports tumour growth and metastasis.In hepatocellular carcinoma(HCC),the balance between cytotoxic T lymphocytes and regulatory T cells plays a crucial role in determining patient outcomes.The expression of programmed cell death ligand 1(PD-1)and other immune checkpoint molecules contributes to a pro-tumourigenic microenvironment and is associated with poor prognosis.Additionally,the heterogeneity of the immune microenvironment adds complexity to disease progression and treatment response.展开更多
Background Evidence on the effects of different exercise interventions on cognitive function is insufficient.Aims To evaluate the feasibility and effects of remotely supervised aerobic exercise(AE)and resistance exerc...Background Evidence on the effects of different exercise interventions on cognitive function is insufficient.Aims To evaluate the feasibility and effects of remotely supervised aerobic exercise(AE)and resistance exercise(RE)interventions in older adults with mild cognitive impairment(MCI).Methods This study is a 6-month pilot three-arm randomised controlled trial.Eligible participants(n=108)were recruited and randomised to the AE group,RE group or control(CON)group with a 1:1:1 ratio.Interventions were delivered at home with remote supervision.We evaluated participants’global cognition,memory,executive function,attention,physical activity levels,physical performance and muscle strength of limbs at baseline,3 months(T1)and 6 months(T2)after randomisation.A linear mixed-effects model was adopted for data analyses after controlling for covariates.Tukey’s method was used for adjusting for multiple comparisons.Sensitivity analyses were performed after excluding individuals with low compliance rates.Results 15(13.89%)participants dropped out.The median compliance rates in the AE group and RE group were 67.31%and 93.27%,respectively.After adjusting for covariates,the scores of the Alzheimer’s Disease Assessment Scale-Cognitive subscale in the AE group decreased by 2.04(95%confidence interval(CI)−3.41 to−0.67,t=−2.94,p=0.004)and 1.53(95%CI−2.88 to−0.17,t=−2.22,p=0.028)points more than those in the CON group at T1 and T2,respectively.The effects of AE were still significant at T1(estimate=−1.70,95%CI−3.20 to−0.21,t=−2.69,p=0.021),but lost statistical significance at T2 after adjusting for multiple comparisons.As for executive function,the Stroop time interference in the RE group decreased by 11.76 s(95%CI−21.62 to−1.90,t=−2.81,p=0.015)more than that in the AE group at T2 after Tukey’s adjustment.No other significant effects on cognitive functions were found.Conclusions Both remotely supervised AE and RE programmes are feasible in older adults with MCI.AE has positive effects on global cognition,and RE improves executive function.展开更多
Rarer dementias are associated with atypical symptoms and younger onset,which result in a higher burden of care.We provide a review of the global literature on longitudinal decline in activities of daily living(ADLs)i...Rarer dementias are associated with atypical symptoms and younger onset,which result in a higher burden of care.We provide a review of the global literature on longitudinal decline in activities of daily living(ADLs)in dementias that account for less than 10%of dementia diagnoses.Published studies were identified through searches conducted in Medical Literature Analysis and Retrieval System Online(MEDLINE),Excerpta Medica Database(Embase),Excerpta Medica Care(Emcare),PsycINFO,and Cumulative Index in Nursing and Allied Health Literature(CINAHL).The search criteria included terms related to‘rarer dementias’,‘activities of daily living’and‘longitudinal or cross-sectional studies’following a predefined protocol registered.Studies were screened,and those that met the criteria were citation searched.Quality assessments were performed,and relevant data were extracted.20 articles were selected,of which 19 focused on dementias within the frontotemporal dementia/primary progressive aphasia spectrum,while one addressed posterior cortical atrophy.Four studies were cross-sectional and 16 studies were longitudinal,with a median duration of 2.2 years.The Disability Assessment for Dementia was used to measure decline in 8 of the 20 studies.The varied sequences of ADL decline reported in the literature reflect variation in diagnostic specificity between studies and within-syndrome heterogeneity.Most studies used Alzheimer’s disease staging scales to measure decline,which cannot capture variant-specific symptoms.To enhance care provision in dementia,ADL scales could be deployed postdiagnosis to aid treatment and planning.This necessitates staging scales that are variant-specific and span the disease course from diagnosis to end of life.展开更多
Background Recovery colleges (RCs) support personal recovery through education, skill development and social support for people with mental health problems, carers and staff. Guided by co-production and adult learning...Background Recovery colleges (RCs) support personal recovery through education, skill development and social support for people with mental health problems, carers and staff. Guided by co-production and adult learning principles, RCs represent a recent mental health innovation. Since the first RC opened in England in 2009, RCs have expanded to 28 countries and territories. However, most RC research has been conducted in Western countries with similar cultural characteristics, limiting understanding of how RCs can be culturally adapted. The 12-item Recovery Colleges Characterisation and Testing (RECOLLECT) Fidelity Measure (RFM) evaluates the operational fidelity of RCs based on 12 components, but cultural influences on these components remain underexplored.Aims To assess associations between Hofstede’s cultural dimensions and RFM items to identify cultural influences on fidelity components.Methods A cross-sectional survey of RC managers was conducted across all 221 RCs. Mixed-effects regression models examined associations between Hofstede’s country-level cultural dimensions and item-level RFM scores, adjusted for healthcare expenditure and income inequality. Four cultural dimensions, obtained from Hofstede, were analysed: individualism (prioritising personal needs), indulgence (enjoyment-oriented), uncertainty avoidance (preference for predictability) and long-term orientation (future-focused).Results The RFM was completed by 169 (76%) RC managers. Seven RFM items showed associations with cultural dimensions. Equality was linked to short-term orientation, while learning was associated with individualism and uncertainty avoidance. Both individualism and indulgence influenced co-production and community focus. Commitment to recovery was shaped by all four cultural dimensions, with the strongest associations seen for individualism and indulgence. Individualism enhanced explicit focus on strengths-based practice, while uncertainty avoidance influenced course distinctiveness.Conclusions This study demonstrates how culture shapes RC fidelity components, providing actionable insights for cultural adaptation. Incorporating under-represented dimensions, such as collectivism and restraint, could improve the RFM’s global applicability, facilitating implementation. Future research should explore cultural nuances, engage diverse stakeholders and refine fidelity measures to enhance RC inclusivity and effectiveness worldwide.展开更多
Post-traumatic stress disorder(PTSD)is a severe neuropsychiatric disorder characterised by reexperiencing,avoidance and hyperarousal.Memory abnormalities manifested as intrusive thoughts and prolonged distressful emot...Post-traumatic stress disorder(PTSD)is a severe neuropsychiatric disorder characterised by reexperiencing,avoidance and hyperarousal.Memory abnormalities manifested as intrusive thoughts and prolonged distressful emotions are postulated as key roles in PTSD development and persistence.Over the past decades,convergent results from human and animal studies have systematically investigated contributions of the amygdala,hippocampus and medial prefrontal cortex(mPFC)in fear memory processes,including fear acquisition,storage,reconsolidation and extinction.These findings provide mechanistic insights for cognitive-behavioural therapy and aid in developing pathological region-targeted neuromodulation treatment for PTSD.Taking advantage of advances in cell-type selective labelling and manipulation technologies,recent studies have focused on the spatiotemporal regulation of neural circuits underlying distinct phases of fear memory processes.These findings have revealed that multiple distributed brain areas participate in the fear memory encoding network.Moreover,the functional role of distinct neuronal ensembles within the amygdala-hippocampus-mPFC pathway,identified by genetic markers and projection profiles,has been assigned to temporally separate features of fear processing,demonstrating the sophistication of the fear encoding circuit.These results provide mechanistic insights into PTSD pathology and might shed light on aetiology-based clinical interventions for PTSD.Therefore,the present review will mainly focus on the recent progress in elucidating neural circuit mechanisms underlying the dynamic regulation of fear memory,with an emphasis on the spatial distribution of fear memory encoding neural networks and the temporal coherence between neuronal ensemble activity and fear expression.展开更多
Background Post-stroke depression(PSD)is a common neuropsychiatric problem associated with a high disease burden and reduced quality of life(QoL).To date,few studies have examined the network structure of depressive s...Background Post-stroke depression(PSD)is a common neuropsychiatric problem associated with a high disease burden and reduced quality of life(QoL).To date,few studies have examined the network structure of depressive symptoms and their relationships with QoL in stroke survivors.Aims This study aimed to explore the network structure of depressive symptoms in PSD and investigate the interrelationships between specific depressive symptoms and QoL among older stroke survivors.Methods This study was based on the 2017–2018 collection of data from a large national survey in China.Depressive symptoms were assessed using the 10-item Centre for Epidemiological Studies Depression Scale(CESD),while QoL was measured with the World Health Organization Quality of Life-brief version.Network analysis was employed to explore the structure of PSD,using expected influence(EI)to identify the most central symptoms and the flow function to investigate the association between depressive symptoms and QoL.Results A total of 1123 stroke survivors were included,with an overall prevalence of depression of 34.3%(n=385;95%confidence interval 31.5%to 37.2%).In the network model of depression,the most central symptoms were CESD3(‘feeling blue/depressed’,EI:1.180),CESD6(‘feeling nervous/fearful’,EI:0.864)and CESD8(‘loneliness’,EI:0.843).In addition,CESD5(‘hopelessness’,EI:−0.195),CESD10(‘sleep disturbances’,EI:−0.169)and CESD4(‘everything was an effort’,EI:−0.150)had strong negative associations with QoL.Conclusion This study found that PSD was common among older Chinese stroke survivors.Given its negative impact on QoL,appropriate interventions targeting central symptoms and those associated with QoL should be developed and implemented for stroke survivors with PSD.展开更多
INTRODUCTION Reports indicating that culturally and linguistically diverse(CALD)people-often with migrant backgrounds-in Australia and New Zealand are more likely to be placed in compulsory community treatment(CCT)hav...INTRODUCTION Reports indicating that culturally and linguistically diverse(CALD)people-often with migrant backgrounds-in Australia and New Zealand are more likely to be placed in compulsory community treatment(CCT)have rightlyraised concernsthat such action might be discriminatory.展开更多
Background Mental disorders rank among the leading contributors to the global disease burden, with depressive disorders being among the most prevalent.Aims The objective of this study is to examine the prevalence, inc...Background Mental disorders rank among the leading contributors to the global disease burden, with depressive disorders being among the most prevalent.Aims The objective of this study is to examine the prevalence, incidence and years lived with disability (YLDs) associated with depressive disorders, particularly major depressive disorder and dysthymia, in Iran from 1990 to 2021. To achieve this, the research focused on analysing these metrics across various dimensions, including temporal trends, sex differences, age categories and subnational regions.Methods The data used in this study are sourced directly from the Institute for Health Metrics and Evaluation, ensuring that the information is both authoritative and reliable. All-age count estimates and age-standardised rates (per 100 000) were calculated for prevalence, incidence and YLDs. The disease burden indicators were analysed for the period spanning from 1990 to 2021, stratified by sex, age and location. The percentage change between 1990 and 2021 was also documented. The 95% uncertainty interval (UI) was reported for each of the reported estimates.Results The prevalence of depressive disorders in Iran demonstrated a notable upward trend from 1990 to 2021, with the rate of growth being particularly pronounced within the country. The age-standardised prevalence rate per 100 000 individuals for depressive disorders in Iran was 5609 (95% UI 4810 to 6488). By 2021, the number of depression cases in Iran reached 5.2 million, which is approximately 2.37 times the figure reported in 1990. The prevalence of depressive disorders was notably higher among females compared with males. The age-standardised prevalence rate per 100 000 individuals for males was 4184 (95% UI 3545 to 4929). For females, this figure was significantly greater, reaching 7077 (95% UI 6115 to 8172). Out of the total reported cases of depressive disorders in Iran, 3.2 million were observed in females, while males accounted for 2 million cases.Conclusions The findings highlighted the considerable impact of depressive disorders in Iran, both nationally and regionally, while also revealing variations across sex and age groups. Given the shifts in the demographic structure and the growing burden of these disorders, it is essential to prioritise screening initiatives, education programmes and strategies aimed at enhancing mental health awareness and ensuring improved access to mental health services in health policy planning.展开更多
Background Antenatal anxiety(AA)is a common mental disorder during pregnancy and adversely affects the wellbeing of both pregnant women and their offspring.The prevalence of AA is exceptionally high in the first trime...Background Antenatal anxiety(AA)is a common mental disorder during pregnancy and adversely affects the wellbeing of both pregnant women and their offspring.The prevalence of AA is exceptionally high in the first trimester,yet there is a lack of studies focusing exclusively on AA in the first trimester.Aims This study aimed to investigate the prevalence and risk factors of AA among Chinese pregnant women during the first trimester.Methods We retrospectively retrieved and analysed data on the mental health screening of perinatal women at Shenzhen Baoan Women’s and Children’s Hospital in China from 1 January 2020 to 31 January 2024.A total of 42013 pregnant women with less than 14 weeks of gestation were assessed using the 7-item Generalized Anxiety Disorder Scale(GAD-7).A GAD-7 score≥10 indicates AA.Univariable analyses and multivariable logistic regression were employed to identify risk factors for AA.Results Among the participants,1066(2.54%)experienced AA in the first trimester.Factors associated with a higher risk of AA included being under 25 years old,temporary residence,below senior high school education,low or moderate economic status,primipara,unplanned pregnancy,smoking,alcohol use,lack of exercise,low or moderate living conditions,low or moderate marital satisfaction and reluctance to discuss troubles with others.Conclusions AA manifests as a multifaceted phenomenon influenced by various sociodemographic,obstetrical,lifestyle and psychosocial factors.Preventing AA requires collaboration among hospitals,communities and families.展开更多
Background Dynamic interpersonal therapy(DIT)is a short-term psychodynamic psychotherapy that has been shown to effectively reduce depressive symptoms in patients with major depressive disorder(MDD).In DIT,the depress...Background Dynamic interpersonal therapy(DIT)is a short-term psychodynamic psychotherapy that has been shown to effectively reduce depressive symptoms in patients with major depressive disorder(MDD).In DIT,the depressive symptoms are formulated as responses to impaired mentalisation.DIT aims to alleviate depressive symptoms by improving mentalising.Aims This study aimed to examine the effect of DIT on improving mentalising and the mediating effect of mentalising in changes in depressive symptoms.Methods Outpatients received either DIT combined with antidepressant medication treatment(DIT group)or antidepressant medication treatment alone(ADM group)for 16 weeks.The Hamilton Depression Rating Scale(HAMD),Patient Health Questionnaire(PHQ)and Reflective Functioning Questionnaire(RFQ)were used.The intention-to-treat principle,mixed linear models,multiple imputation,Pearson's correlation analysis and mediation analysis were conducted.The per-protocol principle was used as sensitivity analysis.Results The DIT group had significantly lower HAMD(least-squares(LS)mean difference=-3.756,p<0.001),PHQ(LS mean difference=-4.188,p<0.001),uncertainty about mental states in the RFQ(RFQ-U,LS mean difference=-2.116,p<0.001)and higher certainty about mental states in the RFQ(RFQ-C,LS mean difference=2.214,p=0.028)scores than the ADM group at post-treatment.The change in RFQ-C was marginally significantly correlated with the change in HAMD(r=-0.218,poretao=0.090),The change in RFQ-U was significantly correlated with the change in HAMD(r=-0.269,poroco-0.024)and the change in PHQ(r=-0.43,Peoretceo l<e0.001).When using RFQ-U as the mediating variable and PHQ as the dependent variable,a significant mediating effect was found(p=0.043,95% confidence interval 0.024 to 1.453).Conclusions The DIT group yielded better outcomes compared with the ADM group in reducing depressive symptoms and improving mentalising.Improvements in mentalising were associated with reductions in depressive symptoms.These findings support that mentalising may contribute to the therapeutic effects of DIT in MDD.展开更多
Background The patient-reported Dimensional Anhedonia Rating Scale(DARS)has been adapted into Chinese,so there is a need to evaluate its measurement properties in a Chinese population.Aims To evaluate the reliability ...Background The patient-reported Dimensional Anhedonia Rating Scale(DARS)has been adapted into Chinese,so there is a need to evaluate its measurement properties in a Chinese population.Aims To evaluate the reliability and validity of the DARS among Chinese individuals with major depressive disorder(MDD)and its treatment sensitivity in a prospective clinical study.Methods Data were from a multicentre,prospective clinical study(NCT03294525),which recruited both patients with MDD,who were followed for 8 weeks,and healthy controls(HCs),assessed at baseline only.The analysis included confirmatory factor analysis,validity and sensitivity to change.Results Patients’mean(standard deviation(SD))age was 34.8(11.0)years,with 68.7%being female.75.2%of patients with MDD had melancholic features,followed by 63.8%with anxious distress.Patients had experienced MDD for a mean(SD)of 9.2(18)months.DARS scores covered the full range of severity with no major floor or ceiling effects.Confirmatory factor analysis showed adequate fit statistics(comparative fit index 0.976,goodness-of-fit index 0.935 and root mean square error of approximation 0.055).Convergent validity with anhedonia-related measures was confirmed.While the correlation between the DARS and the Hamilton Depression Rating Scale was not strong(r=0.31,baseline),the DARS was found to differentiate between levels of depression.Greater improvements in DARS scores were seen with the Hamilton Rating Scale for Depression responder group(effect size 1.16)compared with the non-responder group(effect size 0.46).Conclusions This study comprehensively evaluated the measurement properties of the DARS using a Chinese population with MDD.Overall,the Chinese version of DARS demonstrates good psychometric properties and has been found to be responsive to change during antidepressant treatment.The DARS is a suitable scale for assessing patient-reported anhedonia in future clinical trials.展开更多
Background Ongoing debates question the harm of internet use with the evolving technology,as many individuals transition from regular to problematic internet use(PIU).The habenula(Hb),located between the thalamus and ...Background Ongoing debates question the harm of internet use with the evolving technology,as many individuals transition from regular to problematic internet use(PIU).The habenula(Hb),located between the thalamus and the third ventricle,is implicated in various psychiatric disorders.In addition,personality features have been suggested to play a role in the pathophysiology of PIU.Aims This study aimed to investigate Hb volumetry in individuals with subclinical PIU and the mediating effect of personality traits on this relationship.Methods 110 healthy adults in this cross-sectional study underwent structural magnetic resonance imaging.Hb segmentation was performed using a deep learning technique.The Internet Addiction Test(IAT)and the NEO Five-Factor Inventory were used to assess the PIU level and personality,respectively.Partial Spearman's correlation analyses were performed to explore the reiationships between Hb volumetry,IAT and NEO.Multiple regression analysis was applied to identify personality traits that predict IAT scores.The significant trait was then treated as a mediator between Hb volume and IAT correlation in mediation analysis with a bootstrap value of 5000.Results Relative Hb volume was negatively correlated with IAT scores(partial rho=-0.142,p=0.009).The IAT score was positively correlated with neuroticism(partial rho=0.430,p<0.001)and negatively correlated with extraversion,agreeableness and conscientiousness(partial rho=-0.213,p<0.001;partial rho=-0.279,p<0.001;and partial rho=-0.327,p<0.001).There was a significant indirect effect of Hb volume on this model(β=-0.061,p=0.048,boot 95%confidence interval:-0.149 to-0.001).Conclusions This study uncovered a crucial link between reduced Hb volume and heightened PIU.Our findings highlight neuroticism as a key risk factor for developing PIU.Moreover,neuroticism was shown to mediate the relationship between Hb volume and PIU tendency,offering valuable insight into the complexities of this interaction.展开更多
Lymphatic-venous anastomosis(LVA)surgery has recently emerged as a potential treatment for Alzheimer’s disease(AD)in China.This minimally invasive microsurgical procedure has been used for decades to treat lymphoedem...Lymphatic-venous anastomosis(LVA)surgery has recently emerged as a potential treatment for Alzheimer’s disease(AD)in China.This minimally invasive microsurgical procedure has been used for decades to treat lymphoedema,typically in the limbs,to decompress blocked lymphatic drainage pathways.展开更多
Loneliness is a complex and usually unpleasant emotional response to isolation,which has been considered the latest global health epidemic exacerbated by the coronavirus disease 2019 pandemic,affecting nearly twothird...Loneliness is a complex and usually unpleasant emotional response to isolation,which has been considered the latest global health epidemic exacerbated by the coronavirus disease 2019 pandemic,affecting nearly twothirds of older adults.Some profound health implications carried by loneliness include depression,cognitive impairment,hypertension and frailty.Across the world,there is no consensus definition of loneliness,and its measure is based on the phenomenological perspective of the individual.The 20-item University of California Los Angeles Loneliness Scale version 3(UCLA-20)is the most common measure.This scale demonstrates acceptable psychometric properties but is too long and complex for a phone interview.This paper addresses the increasing need to shorten this scale by adopting classical item response theory and network psychometrics to advance scale development.Through an item reduction analysis,we trimmed the original scale into an effective short form,which is as valid as the original one.With respondents’time at a premium in most research nowadays,this shortform scale is an efficient and practical alternative to the original UCLA-20.展开更多
基金supported by a grant from Brain Science and BrainLike Intelligence Technology of the Ministry of Science and Technology of China(2021ZD0201804).
文摘With the sustained growth of the economy and significant changes in social demographics,the issue of elderly-related diseases has increasingly drawn attention,particularly.Alzheimer’s disease(AD),as a representative disease of neurodegenerative diseases,has become a major challenge,affecting the health and quality of life of the elderly population severely.In recent years,the incidence,prevalence and mortality rates of AD have increased in China,imposing substantial economic burdens on families,society and the entire healthcare system.To proactively address this challenge and respond to the national‘Healthy China Action’initiative,leading experts from authoritative institutions jointly authored the China Alzheimer Report 2025.Building on previous editions,this report updates epidemiological data on AD in China,thoroughly analyses the latest economic burdens of the disease and comprehensively evaluates the current status of AD diagnosis and treatment services,as well as the allocation of public health resources in our country.Its release reflects China’s progress in AD research and prevention,underscores societal concern for elderly health and aims to provide scientific guidance and data support for AD prevention,diagnosis and treatment.It also facilitates academic exchanges and cooperation,enhancing public awareness and promoting active participation in elderly healthcare,towards achieving‘healthy ageing’in China.
基金funded by the Construction Project of the"Flagship"Department of Chinese and Western Medicine Coordination(LiuL/2024-221)the 2024 Medical Service and Security Capacity Improvement Project(National Clinical Key Specialty Construction)(LiuL/Huwei Medical/2024-65)+5 种基金the Shanghai Traditional Chinese Medicine Standardization Project(LiuL/No.2023JSP03)the Shanghai Key Discipline Construction Project of Traditional Chinese Medicine(Clinical)(LiuL/2024-No.3)the Shanghai Technical Standardization Management and Promotion Project(LiuL/No.SHDC22023212)the Shanghai Municipal Health Commission Traditional Chinese Medicine Research Project(2022)(LiuL/No.2022Cx004)Clinical research project of Shanghai Health Commission-Youth Project(LW/No.20214Y0056)Shanghai Institute of Traditional Chinese Medicine for Mental Health(LW/No.SZB2023201).
文摘INTRODUCTION.Depressive disorders are mental illnesses that seriously affect public health.There are approximately 320 million patients with depression worldwide,accounting for 4.4% of the total disease burden.1Depression leads to social and occupational impairment,diminished quality of life and an elevated risk of death by suicide.
基金funded by the Shanghai Philosophy and Social Science Planning Project (2021BZX008)the National Social Science Foundation of China (23BZX110)the National Office for Philosophy and Social Science (20&ZD045).
文摘Background Clinical brain-computer interface(BCI)for mental disorders is an emerging interdisciplinary research field,posing new ethical concerns and challenges,yet lacking practical ethical governance guidelines for stakeholders and the entire community.Aims This study aims to establish a multidisciplinary consensus of principles for ethical governance of clinical BCI research for mental disorders and offer practical ethical guidance to stakeholders involved.Methods A systematic literature review,symposium and roundtable discussions,and a pre-Delphi(round 0)survey were conducted to form the questionnaire for the three-round modified Delphi study.Two rounds of surveys,followed by a third round of independent interviews of 25 experts from BCI-related research domains,were involved.We conducted quantitative analysis of responses and agreements among experts to reveal the consensus and differences regarding the ethical governance of mental BCI research from a multidisciplinary perspective.Results The Delphi panel emphasised important concerns of ethical review practices and ethical principles within the BCI context,identified qualified and highly influential institutions and personnel in conducting and advancing clinical BCI research,and recognised prioritised aspects in the risk-benefit evaluation.Experts expressed diverse opinions on specific ethical concerns,including concerns about invasive technology,its impact on humanity and potential social consequences.Agreement was reached that the practices of ethical governance of clinical BCI for mental disorders should focus on patient voluntariness,autonomy,long-term effects and related assessments of BCI interventions,as well as privacy protection,transparent reporting and ensuring that the research is conducted in qualified institutions with strong data security.Conclusions Ethical governance of clinical research on BCI for mental disorders should include interdisciplinary experts to balance various needs and incorporate the expertise of different stakeholders to avoid serious ethical issues.It requires scientifically grounded approaches,continuous monitoring and interdisciplinary collaboration to ensure evidence-based policies,comprehensive risk assessments and transparency,thereby promoting responsible innovations and protecting patient rights and well-being.
基金supported by the National Natural Science Foundation of China(82071500,82271540,32370724,82401759,81871055,32070679)Shanghai Clinical Research Center for Mental Health(19MC1911100)+11 种基金Shanghai Key Laboratory of Psychotic Disorders(13dz2260500)Shanghai Municipal Administrator of Traditional Chinese Medicine(ZY-(2021-2023)-0207-01)Shanghai Municipal Health Commission Collaborative Innovation Group(2024CXJQ03)Shanghai Science and Technology Innovation Action Program(24JS2840400,24ZR1439900,21Y11921100)Shanghai Municipal Science and Technology Major Project,the National Key R&D Program of China(2023YFA0913804,2024YFA0916603,2022FYC2503300)the Program of Shanghai Academic/Technology Research Leader(21XD1423300)Shanghai Pujiang Program(21PJD063)Shanghai Municipal Science and Technology Major Project(2017SHZDZX01)Shanghai Municipal Commission of Education(2024AIZD016)the National Key R&D Program of China(2019YFA0905400,2017YFC0908105,2021YFC2702100)National Program for Support of Top-Notch Young Professionals,Taishan Scholar Program of Shandong Province(tstp20240526)the Natural Science Foundation of Shandong Province(ZR2019YQ14,YDZX2021009,2021ZDSYS06).
文摘Background Numerous studies have consistently demonstrated that a considerable proportion of patients with major depressive disorder (MDD) frequently exhibit pronounced dyslipidaemia. However, the causal dynamics between MDD and dyslipidaemia remain elusive.Aims To comprehensively disentangle the genetic causality between MDD and various phenotypes of blood lipids, thereby facilitating the advancement of management strategies for these conditions.Methods We conducted a two-sample univariable Mendelian randomisation (MR) analysis using different models, including the inverse variance weighted (IVW) method and causal analysis using the summary effect (CAUSE) estimates, as well as a multivariable MR analysis. This analysis used summary statistics from genome-wide association studies (GWAS) of MDD and five lipid traits: low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, total cholesterol and triglycerides (TG), encompassing 5 237 893 individuals of European and East Asian ancestries. For MDD, a total of 598 701 individuals were included, with 500 199 individuals of European ancestry (Ncase=170 756, Ncontrol=329 443) and 98 502 of East Asian ancestry (Ncase=12 588, Ncontrol=85 914). Lipid data were collected from 4 639 192 individuals through the Global Lipids Genetics Consortium (European, N=4 096 085;East Asian, N=543 107). Next, we used the two-step MR to explore the mediating factors between MDD and TG, and the risk factors affecting TG through MDD. Finally, we conducted a GWAS meta-analysis and enrichment analysis.Results In univariable MR, we observed a negative causal effect of low-density lipoprotein on MDD in both European populations (IVW: odds ratio (OR): 0.972, 95% confidence interval (CI) 0.947 to 0.998, p=0.037) and East Asian populations (IVW: OR: 0.928, 95% CI 0.864 to 0.997, p=0.042). Additionally, we identified a bidirectional causal relationship between TG and MDD, with TG having a causal effect on MDD (IVW: OR: 1.052, 95% CI 1.020 to 1.085, p=0.001) and MDD having a causal effect on TG (IVW: OR: 1.075, 95% CI 1.047 to 1.104, p<0.001). Multivariable MR analysis further supported the role of TG in MDD (OR: 1.205, 95% CI 1.034 to 1.405, p=0.017). CAUSE estimates indicated that the causal model of MDD on TG provided a better fit than the sharing model (p=0.003), while the association of TG on MDD was more likely due to horizontal correlated pleiotropy than causality. Mediation analyses revealed that waist-hip ratio (WHR) mediated 69% of the total causal effect of MDD on TG, while other identified risk factors exhibited lower mediating proportions either mediated through MDD (≤17%) or originating from MDD (≤29%). The GWAS meta-analysis highlighted potential pathways related to lipid processes and nucleosome assembling, with significant cell types identified in brain regions and liver tissues.Conclusions The findings indicate that genetic proxies of MDD are associated with elevated levels of TG, with WHR serving as a clinical indicator of the association. This suggests that interventions targeting WHR may be effective in reducing TG levels in patients with MDD.
基金supported by the Guangzhou Municipal Key Discipline in Medicine(2021-2023)the Guangzhou High-level Clinical Key Specialty,the Guangzhou Research-oriented Hospital,the Innovative Clinical Technique of Guangzhou(2024-2026)+6 种基金the Guangdong Basic and Applied Basic Research Foundation(grant number 2022A1515011567,2020A1515110565)the Guangzhou Science,Technology Planning Project(grant number 202201010714,202103000032)the National Natural Science Foundation of China(grant number 82471546)the Guangdong College Students Innovation and Entrepreneurship Training Project(grant number S202310570038)the Guangzhou Health Science and Technology Project(grant number 20231A010038)the Guangzhou Traditional Chinese Medicine and Integrated Traditional Chinese and Western Medicine Technology Project(grant number:20232A010013)the Science and Technology Plan Project of Guangzhou(2023A03J0842).
文摘Background The heterogeneity of depression limits the treatment outcomes of intermittent theta burst stimulation(iTBS)and hinders the identification of predictive factors.This study investigated functional network connectivity and predictors of iTBS treatment outcomes in adolescents and young adults with depression.Aim This study aimed to identify default mode network(DMN)-based connectivity patterns associated with varying iTBS treatment outcomes in depression.Methods Data from a randomised controlled trial of iTBS in depression(n=82)were analysed using a data-driven approach to classify homogeneous subgroups based on the DMN.Connectivity subgroups were compared on depressive symptoms and cognitive function at pretreatment and post-treatment.Furthermore,the predictive significance of baseline inflammatory cytokines on post-treatment outcomes was evaluated.Results Two distinct subgroups were identified.Subgroup 1 exhibited high heterogeneity and greater centrality in the posterior cingulate cortex and retrosplenial cortex,while subgroup 2 showed more homogeneous connectivity patterns and greater centrality in the temporoparietal junction and posterior inferior parietal lobule.No main effect for subgroup,treatment or subgroup×treatment interaction was revealed in the improvement of depressive symptoms.A significant subgroup×treatment interaction related to symbol coding improvement was detected(F=5.22,p=0.026).Within subgroup 1,the active group showed significantly greater improvement in symbol coding compared with the sham group(t=2.30,p=0.028),while baseline levels of interleukin-6 and C-reactive protein emerged as significant indicators for predicting improvements in symbolic coding(R2=0.35,RMSE(root-mean-square error)=5.72,p=0.013).Subgroup 2 showed no significant findings in terms of cognitive improvement or inflammatory cytokines predictions.
基金supported by the Major Project of Wuxi Municipal Health Commission[grant number:Z202406]the Jiangsu Commission of Health Program[grant number:M2024010]+3 种基金the National Key Research and Development Program[grant number:2022YFC3600600]the China Ministry of Science and Technology grants[grant number:2009BAI77B03]the Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support[grant number:20172029]the Innovative Research Team of High-level Local Universities in Shanghai[grant number:ZDCX20211201].
文摘Background As the population in China rapidly ages,the prevalence of mild cognitive impairment(MCI)is increasing considerably.However,the causes of MCI vary.The continued lack of understanding of the various subtypes of MCI impedes the implementation of effective measures to reduce the risk of advancing to more severe cognitive diseases.Aims To estimate the prevalence and incidence rates of two MCI subtypes—amnestic MCI(aMCI)and vascular cognitive impairment without dementia(VCIND)—and to determine modifiable factors for them among older individuals in a multiregional Chinese cohort.Method This 1-year longitudinal study surveyed a random sample of participants aged≥60 years from a large,community-dwelling cohort in China.Baseline lifestyle data were self-reported,while vascular and comorbid conditions were obtained from medical records and physical examinations.In total,3514 and 2051 individuals completed the baseline and 1-year follow-up assessments,respectively.Logistic and linear regression analyses were used to identify the modifiable factors for MCI subtypes and predictors of cognitive decline,respectively.Results Among our participants,aMCI and VCIND demonstrated prevalence of 14.83%and 2.71%,respectively,and annual incidence(per 1000 person-years)of 69.6 and 10.6,respectively.The risk factor for aMCI was age,whereas its protective factors were high education level,tea consumption and physical activity.Moreover,VCIND risk factors were age,hypertension and depression.The presence of endocrine disease,cerebral trauma or hypertension was associated with a faster decline in cognition over 1 year.Conclusions MCI is a serious health problem in China that will only worsen as the population ages if no widespread interventions are implemented.Preventive strategies that promote brain activity and support healthy lifestyle choices are required.We identified modifiable factors for MCI in older individuals.The easy-to-adopt solutions such as tea consumption and physical activity can aid in preventing MCI.
基金supported by Jiangsu Commission of Health(No.x202308)The Suzhou Gusu Health Talents Scientific Research Project(No.GSWS2021052).
文摘To the editor:The liver’s immune-privileged status allows for a unique microenvironment that supports tumour growth and metastasis.In hepatocellular carcinoma(HCC),the balance between cytotoxic T lymphocytes and regulatory T cells plays a crucial role in determining patient outcomes.The expression of programmed cell death ligand 1(PD-1)and other immune checkpoint molecules contributes to a pro-tumourigenic microenvironment and is associated with poor prognosis.Additionally,the heterogeneity of the immune microenvironment adds complexity to disease progression and treatment response.
基金funded by the National Natural Science Foundation of China(81871854,72374014)the National Key R&D Program of China(2020YFC2008804)+1 种基金the Shanghai Jiao Tong University Young Talent Cultivation Program in Liberal Arts(2024QN041)the Shanghai Jiao Tong University School of Medicine:Nursing Development Program(SJTUHLXK2024).
文摘Background Evidence on the effects of different exercise interventions on cognitive function is insufficient.Aims To evaluate the feasibility and effects of remotely supervised aerobic exercise(AE)and resistance exercise(RE)interventions in older adults with mild cognitive impairment(MCI).Methods This study is a 6-month pilot three-arm randomised controlled trial.Eligible participants(n=108)were recruited and randomised to the AE group,RE group or control(CON)group with a 1:1:1 ratio.Interventions were delivered at home with remote supervision.We evaluated participants’global cognition,memory,executive function,attention,physical activity levels,physical performance and muscle strength of limbs at baseline,3 months(T1)and 6 months(T2)after randomisation.A linear mixed-effects model was adopted for data analyses after controlling for covariates.Tukey’s method was used for adjusting for multiple comparisons.Sensitivity analyses were performed after excluding individuals with low compliance rates.Results 15(13.89%)participants dropped out.The median compliance rates in the AE group and RE group were 67.31%and 93.27%,respectively.After adjusting for covariates,the scores of the Alzheimer’s Disease Assessment Scale-Cognitive subscale in the AE group decreased by 2.04(95%confidence interval(CI)−3.41 to−0.67,t=−2.94,p=0.004)and 1.53(95%CI−2.88 to−0.17,t=−2.22,p=0.028)points more than those in the CON group at T1 and T2,respectively.The effects of AE were still significant at T1(estimate=−1.70,95%CI−3.20 to−0.21,t=−2.69,p=0.021),but lost statistical significance at T2 after adjusting for multiple comparisons.As for executive function,the Stroop time interference in the RE group decreased by 11.76 s(95%CI−21.62 to−1.90,t=−2.81,p=0.015)more than that in the AE group at T2 after Tukey’s adjustment.No other significant effects on cognitive functions were found.Conclusions Both remotely supervised AE and RE programmes are feasible in older adults with MCI.AE has positive effects on global cognition,and RE improves executive function.
基金supported by UKResearch and Innovation(MR/S03546X/1)National BrainAppeal,Economic and Social ResearchCouncil(ES/S010467/1)+4 种基金Wellcome Trust(221915/Z/20/Z),ESRC(ES/W006014/1)Royal National Institute for Deaf People-Dunhill Medical Trust Pauline Ashley(204841/Z/16/Z,PA23)London Hospitals Biomedical Research Centre(221915/Z/20/Z)Bloomsbury and East London Doctoral Training Partnership(ES/P000592/1)National Institute for Health Research.
文摘Rarer dementias are associated with atypical symptoms and younger onset,which result in a higher burden of care.We provide a review of the global literature on longitudinal decline in activities of daily living(ADLs)in dementias that account for less than 10%of dementia diagnoses.Published studies were identified through searches conducted in Medical Literature Analysis and Retrieval System Online(MEDLINE),Excerpta Medica Database(Embase),Excerpta Medica Care(Emcare),PsycINFO,and Cumulative Index in Nursing and Allied Health Literature(CINAHL).The search criteria included terms related to‘rarer dementias’,‘activities of daily living’and‘longitudinal or cross-sectional studies’following a predefined protocol registered.Studies were screened,and those that met the criteria were citation searched.Quality assessments were performed,and relevant data were extracted.20 articles were selected,of which 19 focused on dementias within the frontotemporal dementia/primary progressive aphasia spectrum,while one addressed posterior cortical atrophy.Four studies were cross-sectional and 16 studies were longitudinal,with a median duration of 2.2 years.The Disability Assessment for Dementia was used to measure decline in 8 of the 20 studies.The varied sequences of ADL decline reported in the literature reflect variation in diagnostic specificity between studies and within-syndrome heterogeneity.Most studies used Alzheimer’s disease staging scales to measure decline,which cannot capture variant-specific symptoms.To enhance care provision in dementia,ADL scales could be deployed postdiagnosis to aid treatment and planning.This necessitates staging scales that are variant-specific and span the disease course from diagnosis to end of life.
基金This study is part of the RECOLLECT 2 programme,a five-year(2020-2025)project funded by the National Institute for Health and Care Research,which investigates the effectiveness and cost-effectiveness of recovery colleges.
文摘Background Recovery colleges (RCs) support personal recovery through education, skill development and social support for people with mental health problems, carers and staff. Guided by co-production and adult learning principles, RCs represent a recent mental health innovation. Since the first RC opened in England in 2009, RCs have expanded to 28 countries and territories. However, most RC research has been conducted in Western countries with similar cultural characteristics, limiting understanding of how RCs can be culturally adapted. The 12-item Recovery Colleges Characterisation and Testing (RECOLLECT) Fidelity Measure (RFM) evaluates the operational fidelity of RCs based on 12 components, but cultural influences on these components remain underexplored.Aims To assess associations between Hofstede’s cultural dimensions and RFM items to identify cultural influences on fidelity components.Methods A cross-sectional survey of RC managers was conducted across all 221 RCs. Mixed-effects regression models examined associations between Hofstede’s country-level cultural dimensions and item-level RFM scores, adjusted for healthcare expenditure and income inequality. Four cultural dimensions, obtained from Hofstede, were analysed: individualism (prioritising personal needs), indulgence (enjoyment-oriented), uncertainty avoidance (preference for predictability) and long-term orientation (future-focused).Results The RFM was completed by 169 (76%) RC managers. Seven RFM items showed associations with cultural dimensions. Equality was linked to short-term orientation, while learning was associated with individualism and uncertainty avoidance. Both individualism and indulgence influenced co-production and community focus. Commitment to recovery was shaped by all four cultural dimensions, with the strongest associations seen for individualism and indulgence. Individualism enhanced explicit focus on strengths-based practice, while uncertainty avoidance influenced course distinctiveness.Conclusions This study demonstrates how culture shapes RC fidelity components, providing actionable insights for cultural adaptation. Incorporating under-represented dimensions, such as collectivism and restraint, could improve the RFM’s global applicability, facilitating implementation. Future research should explore cultural nuances, engage diverse stakeholders and refine fidelity measures to enhance RC inclusivity and effectiveness worldwide.
基金supported by the National Natural Science Foundation of China(82401772)the Shanghai Municipal Education Commission(2021-01-07-00-02-E0086).
文摘Post-traumatic stress disorder(PTSD)is a severe neuropsychiatric disorder characterised by reexperiencing,avoidance and hyperarousal.Memory abnormalities manifested as intrusive thoughts and prolonged distressful emotions are postulated as key roles in PTSD development and persistence.Over the past decades,convergent results from human and animal studies have systematically investigated contributions of the amygdala,hippocampus and medial prefrontal cortex(mPFC)in fear memory processes,including fear acquisition,storage,reconsolidation and extinction.These findings provide mechanistic insights for cognitive-behavioural therapy and aid in developing pathological region-targeted neuromodulation treatment for PTSD.Taking advantage of advances in cell-type selective labelling and manipulation technologies,recent studies have focused on the spatiotemporal regulation of neural circuits underlying distinct phases of fear memory processes.These findings have revealed that multiple distributed brain areas participate in the fear memory encoding network.Moreover,the functional role of distinct neuronal ensembles within the amygdala-hippocampus-mPFC pathway,identified by genetic markers and projection profiles,has been assigned to temporally separate features of fear processing,demonstrating the sophistication of the fear encoding circuit.These results provide mechanistic insights into PTSD pathology and might shed light on aetiology-based clinical interventions for PTSD.Therefore,the present review will mainly focus on the recent progress in elucidating neural circuit mechanisms underlying the dynamic regulation of fear memory,with an emphasis on the spatial distribution of fear memory encoding neural networks and the temporal coherence between neuronal ensemble activity and fear expression.
基金supported by Beijing High Level Public Health Technology Talent Construction Project(Discipline Backbone-01-028)the Beijing Municipal Science&Technology Commission(No.Z181100001518005)+2 种基金the Capital's Funds for Health Improvement and Research(CFH 2024-2-1174)the University of Macao(MYRG-GRG2023-00141-FHS,CPG2025-00021-FHS)the Science and Technology Plan Foundation of Guangzhou(No.202201011663).
文摘Background Post-stroke depression(PSD)is a common neuropsychiatric problem associated with a high disease burden and reduced quality of life(QoL).To date,few studies have examined the network structure of depressive symptoms and their relationships with QoL in stroke survivors.Aims This study aimed to explore the network structure of depressive symptoms in PSD and investigate the interrelationships between specific depressive symptoms and QoL among older stroke survivors.Methods This study was based on the 2017–2018 collection of data from a large national survey in China.Depressive symptoms were assessed using the 10-item Centre for Epidemiological Studies Depression Scale(CESD),while QoL was measured with the World Health Organization Quality of Life-brief version.Network analysis was employed to explore the structure of PSD,using expected influence(EI)to identify the most central symptoms and the flow function to investigate the association between depressive symptoms and QoL.Results A total of 1123 stroke survivors were included,with an overall prevalence of depression of 34.3%(n=385;95%confidence interval 31.5%to 37.2%).In the network model of depression,the most central symptoms were CESD3(‘feeling blue/depressed’,EI:1.180),CESD6(‘feeling nervous/fearful’,EI:0.864)and CESD8(‘loneliness’,EI:0.843).In addition,CESD5(‘hopelessness’,EI:−0.195),CESD10(‘sleep disturbances’,EI:−0.169)and CESD4(‘everything was an effort’,EI:−0.150)had strong negative associations with QoL.Conclusion This study found that PSD was common among older Chinese stroke survivors.Given its negative impact on QoL,appropriate interventions targeting central symptoms and those associated with QoL should be developed and implemented for stroke survivors with PSD.
文摘INTRODUCTION Reports indicating that culturally and linguistically diverse(CALD)people-often with migrant backgrounds-in Australia and New Zealand are more likely to be placed in compulsory community treatment(CCT)have rightlyraised concernsthat such action might be discriminatory.
文摘Background Mental disorders rank among the leading contributors to the global disease burden, with depressive disorders being among the most prevalent.Aims The objective of this study is to examine the prevalence, incidence and years lived with disability (YLDs) associated with depressive disorders, particularly major depressive disorder and dysthymia, in Iran from 1990 to 2021. To achieve this, the research focused on analysing these metrics across various dimensions, including temporal trends, sex differences, age categories and subnational regions.Methods The data used in this study are sourced directly from the Institute for Health Metrics and Evaluation, ensuring that the information is both authoritative and reliable. All-age count estimates and age-standardised rates (per 100 000) were calculated for prevalence, incidence and YLDs. The disease burden indicators were analysed for the period spanning from 1990 to 2021, stratified by sex, age and location. The percentage change between 1990 and 2021 was also documented. The 95% uncertainty interval (UI) was reported for each of the reported estimates.Results The prevalence of depressive disorders in Iran demonstrated a notable upward trend from 1990 to 2021, with the rate of growth being particularly pronounced within the country. The age-standardised prevalence rate per 100 000 individuals for depressive disorders in Iran was 5609 (95% UI 4810 to 6488). By 2021, the number of depression cases in Iran reached 5.2 million, which is approximately 2.37 times the figure reported in 1990. The prevalence of depressive disorders was notably higher among females compared with males. The age-standardised prevalence rate per 100 000 individuals for males was 4184 (95% UI 3545 to 4929). For females, this figure was significantly greater, reaching 7077 (95% UI 6115 to 8172). Out of the total reported cases of depressive disorders in Iran, 3.2 million were observed in females, while males accounted for 2 million cases.Conclusions The findings highlighted the considerable impact of depressive disorders in Iran, both nationally and regionally, while also revealing variations across sex and age groups. Given the shifts in the demographic structure and the growing burden of these disorders, it is essential to prioritise screening initiatives, education programmes and strategies aimed at enhancing mental health awareness and ensuring improved access to mental health services in health policy planning.
基金supported by the Joint Funds of the National Natural Science Foundation of China(YZ,U23A20434)the National Natural Science Foundation of China(BL,82371535)(LZ,82171518)+2 种基金the National Key Research and Development Program of China(BL,2021YFF1201204)the Science and Technology Innovation Program of Hunan Province(BL,2023RC3083)the Postgraduate Innovative Project of Central South University(SX,2021zzts0376).
文摘Background Antenatal anxiety(AA)is a common mental disorder during pregnancy and adversely affects the wellbeing of both pregnant women and their offspring.The prevalence of AA is exceptionally high in the first trimester,yet there is a lack of studies focusing exclusively on AA in the first trimester.Aims This study aimed to investigate the prevalence and risk factors of AA among Chinese pregnant women during the first trimester.Methods We retrospectively retrieved and analysed data on the mental health screening of perinatal women at Shenzhen Baoan Women’s and Children’s Hospital in China from 1 January 2020 to 31 January 2024.A total of 42013 pregnant women with less than 14 weeks of gestation were assessed using the 7-item Generalized Anxiety Disorder Scale(GAD-7).A GAD-7 score≥10 indicates AA.Univariable analyses and multivariable logistic regression were employed to identify risk factors for AA.Results Among the participants,1066(2.54%)experienced AA in the first trimester.Factors associated with a higher risk of AA included being under 25 years old,temporary residence,below senior high school education,low or moderate economic status,primipara,unplanned pregnancy,smoking,alcohol use,lack of exercise,low or moderate living conditions,low or moderate marital satisfaction and reluctance to discuss troubles with others.Conclusions AA manifests as a multifaceted phenomenon influenced by various sociodemographic,obstetrical,lifestyle and psychosocial factors.Preventing AA requires collaboration among hospitals,communities and families.
基金funded by Science and Technology Commission of Shanghai Municipality(No.21Y11905400)National Natural ScienceFoundationof China(General Program,No.82371555).
文摘Background Dynamic interpersonal therapy(DIT)is a short-term psychodynamic psychotherapy that has been shown to effectively reduce depressive symptoms in patients with major depressive disorder(MDD).In DIT,the depressive symptoms are formulated as responses to impaired mentalisation.DIT aims to alleviate depressive symptoms by improving mentalising.Aims This study aimed to examine the effect of DIT on improving mentalising and the mediating effect of mentalising in changes in depressive symptoms.Methods Outpatients received either DIT combined with antidepressant medication treatment(DIT group)or antidepressant medication treatment alone(ADM group)for 16 weeks.The Hamilton Depression Rating Scale(HAMD),Patient Health Questionnaire(PHQ)and Reflective Functioning Questionnaire(RFQ)were used.The intention-to-treat principle,mixed linear models,multiple imputation,Pearson's correlation analysis and mediation analysis were conducted.The per-protocol principle was used as sensitivity analysis.Results The DIT group had significantly lower HAMD(least-squares(LS)mean difference=-3.756,p<0.001),PHQ(LS mean difference=-4.188,p<0.001),uncertainty about mental states in the RFQ(RFQ-U,LS mean difference=-2.116,p<0.001)and higher certainty about mental states in the RFQ(RFQ-C,LS mean difference=2.214,p=0.028)scores than the ADM group at post-treatment.The change in RFQ-C was marginally significantly correlated with the change in HAMD(r=-0.218,poretao=0.090),The change in RFQ-U was significantly correlated with the change in HAMD(r=-0.269,poroco-0.024)and the change in PHQ(r=-0.43,Peoretceo l<e0.001).When using RFQ-U as the mediating variable and PHQ as the dependent variable,a significant mediating effect was found(p=0.043,95% confidence interval 0.024 to 1.453).Conclusions The DIT group yielded better outcomes compared with the ADM group in reducing depressive symptoms and improving mentalising.Improvements in mentalising were associated with reductions in depressive symptoms.These findings support that mentalising may contribute to the therapeutic effects of DIT in MDD.
基金supported by the National Natural Science Foundation of China(No.82371530,82171529)the Capital Health Development Special Research Project(2022-1-4111)the National Key Technology R and D Program(No.2015BAI13B01).
文摘Background The patient-reported Dimensional Anhedonia Rating Scale(DARS)has been adapted into Chinese,so there is a need to evaluate its measurement properties in a Chinese population.Aims To evaluate the reliability and validity of the DARS among Chinese individuals with major depressive disorder(MDD)and its treatment sensitivity in a prospective clinical study.Methods Data were from a multicentre,prospective clinical study(NCT03294525),which recruited both patients with MDD,who were followed for 8 weeks,and healthy controls(HCs),assessed at baseline only.The analysis included confirmatory factor analysis,validity and sensitivity to change.Results Patients’mean(standard deviation(SD))age was 34.8(11.0)years,with 68.7%being female.75.2%of patients with MDD had melancholic features,followed by 63.8%with anxious distress.Patients had experienced MDD for a mean(SD)of 9.2(18)months.DARS scores covered the full range of severity with no major floor or ceiling effects.Confirmatory factor analysis showed adequate fit statistics(comparative fit index 0.976,goodness-of-fit index 0.935 and root mean square error of approximation 0.055).Convergent validity with anhedonia-related measures was confirmed.While the correlation between the DARS and the Hamilton Depression Rating Scale was not strong(r=0.31,baseline),the DARS was found to differentiate between levels of depression.Greater improvements in DARS scores were seen with the Hamilton Rating Scale for Depression responder group(effect size 1.16)compared with the non-responder group(effect size 0.46).Conclusions This study comprehensively evaluated the measurement properties of the DARS using a Chinese population with MDD.Overall,the Chinese version of DARS demonstrates good psychometric properties and has been found to be responsive to change during antidepressant treatment.The DARS is a suitable scale for assessing patient-reported anhedonia in future clinical trials.
基金funded by a Grant-in-Aid for Scientific Research(B)(Japan Society for The Promotion of Science,21H02849)Grant-in-Aid for Scientific Research(C)(Japan Society for The Promotion of Science,23K07013)+2 种基金Grant-in-Aid for Transformative Research Areas(A)(Japan Society for The Promotion of Science,JP21H05173)Grant-in-Aid by the Smoking Research FoundationGrant-in-Aid by the Telecommunications Advancement Foundation.
文摘Background Ongoing debates question the harm of internet use with the evolving technology,as many individuals transition from regular to problematic internet use(PIU).The habenula(Hb),located between the thalamus and the third ventricle,is implicated in various psychiatric disorders.In addition,personality features have been suggested to play a role in the pathophysiology of PIU.Aims This study aimed to investigate Hb volumetry in individuals with subclinical PIU and the mediating effect of personality traits on this relationship.Methods 110 healthy adults in this cross-sectional study underwent structural magnetic resonance imaging.Hb segmentation was performed using a deep learning technique.The Internet Addiction Test(IAT)and the NEO Five-Factor Inventory were used to assess the PIU level and personality,respectively.Partial Spearman's correlation analyses were performed to explore the reiationships between Hb volumetry,IAT and NEO.Multiple regression analysis was applied to identify personality traits that predict IAT scores.The significant trait was then treated as a mediator between Hb volume and IAT correlation in mediation analysis with a bootstrap value of 5000.Results Relative Hb volume was negatively correlated with IAT scores(partial rho=-0.142,p=0.009).The IAT score was positively correlated with neuroticism(partial rho=0.430,p<0.001)and negatively correlated with extraversion,agreeableness and conscientiousness(partial rho=-0.213,p<0.001;partial rho=-0.279,p<0.001;and partial rho=-0.327,p<0.001).There was a significant indirect effect of Hb volume on this model(β=-0.061,p=0.048,boot 95%confidence interval:-0.149 to-0.001).Conclusions This study uncovered a crucial link between reduced Hb volume and heightened PIU.Our findings highlight neuroticism as a key risk factor for developing PIU.Moreover,neuroticism was shown to mediate the relationship between Hb volume and PIU tendency,offering valuable insight into the complexities of this interaction.
基金the Ministry of Science and Technology of the People's Republic of China(2021ZD0201804,GW)the National Natural Science Foundation of China(82371416,HW).
文摘Lymphatic-venous anastomosis(LVA)surgery has recently emerged as a potential treatment for Alzheimer’s disease(AD)in China.This minimally invasive microsurgical procedure has been used for decades to treat lymphoedema,typically in the limbs,to decompress blocked lymphatic drainage pathways.
文摘Loneliness is a complex and usually unpleasant emotional response to isolation,which has been considered the latest global health epidemic exacerbated by the coronavirus disease 2019 pandemic,affecting nearly twothirds of older adults.Some profound health implications carried by loneliness include depression,cognitive impairment,hypertension and frailty.Across the world,there is no consensus definition of loneliness,and its measure is based on the phenomenological perspective of the individual.The 20-item University of California Los Angeles Loneliness Scale version 3(UCLA-20)is the most common measure.This scale demonstrates acceptable psychometric properties but is too long and complex for a phone interview.This paper addresses the increasing need to shorten this scale by adopting classical item response theory and network psychometrics to advance scale development.Through an item reduction analysis,we trimmed the original scale into an effective short form,which is as valid as the original one.With respondents’time at a premium in most research nowadays,this shortform scale is an efficient and practical alternative to the original UCLA-20.
