搜索结果：Journal of clinical and experimental psychopathology

The diversity of patients' symptomatology among people seeking treatment on community-based mental health services poses significant challenges to traditional models of care. Recent approaches favor identifying transdiagnostic factors that allow a better understanding of patient heterogeneity and designing more effective and quality interventions. This study examines the heterogeneity of patients with internalizing symptoms based on profiles identified with cognitive and motivational control variables. Differences between these profiles on dimensional measures of psychopathology and quality of life are examined. 263 patients were selected by non-probabilistic sampling procedures on mental health services in the province of Huelva (Spain). A latent class analysis on the standardized scale scores of The Behavioral Inhibition/Behavioral Activation System Scales and the Effortful Control Scale of the Adult Temperament Questionnaire Short-Form was conducted. Profiles were compared on the scores of the Inventory of Depression and Anxiety Symptoms-II, the WHO Disability Assessment Schedule II, and the Health Assessment Questionnaire SF-36. The four latent profile solution is the one that showed the best fit indicators and substantive interpretability, with a kappa of 0.94 in the cross-validation procedure with 75% of the sample. No sex differences were found between the profiles (χ32 5.17, p = .160). Profiles #1 and #3, both characterized by an imbalance between low activation and high inhibition, had lower well-being, lower functionality, and quality of life. When comparing profile #2 (featuring the highest inhibitory control) lower scores on most internalizing scales are observed, specially claustrophobia, social anxiety, panic mania. Profile #4 (low control, high activation, and high inhibition) showed greater scores on both mania and euphoria and lower scores on emotional role. We identified four distinctive profiles that had overly increased behavioral inhibition (as expected in internalizing disorders) and differed in the degree of imbalance between inhibition and activation systems, and between motivational systems and top-down cognitive control. The profile characterized by high activation and reduced cognitive (inhibitory) control was the one showing greater mood-related symptoms and lower levels of quality of life. These profiles could be generated by treatment providers to guide clinical management in an evidence-based manner.

Psychiatric diagnoses are not defined by neurobiological measures hindering the development of therapies targeting mechanisms underlying mental illness. Research confined to diagnostic boundaries yields heterogeneous biological results, whereas transdiagnostic studies often investigate individual symptoms in isolation. To develop a framework that groups clinical symptoms compatible with ICD-10 and DSM-5 according to their covariation and shared brain mechanisms. This diagnostic study was conducted in 2 samples, the population-based Reinforcement-Related Behaviour in Normal Brain Function and Psychopathology (IMAGEN) cohort (longitudinal assessments at 14, 19, and 23 years; study duration from March 2010 to the present) and the cross-diagnostic Brain Network Based Stratification of Mental Illness (STRATIFY)/Earlier Detection and Stratification of Eating Disorders and Comorbid Mental Illnesses (ESTRA) samples (study duration from October 2016 to September 2023). The samples are from 8 clinical research hospitals in Germany, the UK, France, and Ireland. For the population-based IMAGEN study, 794 of 1253 23-year-old participants had complete assessments including complete clinical assessments and neuroimaging data across all time points. For the cross-diagnostic STRATIFY/ESTRA samples, 209 of 485 participants aged 18 to 26 years had complete clinical and neuroimaging data. The sample included healthy control individuals and patients with alcohol use disorder, major depressive disorder, anorexia nervosa, and bulimia nervosa. Sparse generalized canonical correlation analysis was used to integrate diverse data from clinical symptoms and 7 brain imaging modalities. The prediction of symptom features was the main outcome. The model was developed in the training set from the IMAGEN Study at age 23 years (70%), then applied in the remaining holdout test sample (30%), the independent STRATIFY/ESTRA patient sample, and longitudinally in the IMAGEN set. In total, 1003 participants were included (425 male and 578 female; mean [SD] age, 22.1 [1.5] years). The reassembly of existing ICD-10 and DSM-5 symptoms revealed 6 cross-diagnostic psychopathology scores. They were consistently associated with multimodal neuroimaging components: excitability and impulsivity (training set: r, 0.26; 95% CI, 0.18-0.33; test set: r, 0.22; 95% CI, 0.10-0.35; STRATIFY/ESTRA set: r, 0.19; 95% CI, 0.07-0.31), depressive mood and distress (training: r, 0.30; 95% CI, 0.20-0.38; test: r, 0.22; 95% CI, 0.09-0.35; STRATIFY/ESTRA: r, 0.19; 95% CI, 0.04-0.33), emotional and behavioral dysregulation (training: r, 0.40; 95% CI, 0.31-0.48; test: r, 0.17; 95% CI, 0.14-0.36; STRATIFY/ESTRA: r, 0.19; 95% CI, 0.06-0.30), stress pathology (training: r, 0.32; 95% CI, 0.19-0.43; test: r, 0.14; 95% CI, 0.05-0.23; STRATIFY/ESTRA: r, 0.12; 95% CI, 0.01-0.22), eating pathology (training: r, 0.34; 95% CI, 0.25-0.42; test: r, 0.26; 95% CI, 0.15-0.37; STRATIFY/ESTRA: r, 0.15; 95% CI, 0.12-0.34), and social fear and avoidance symptoms (training: r, 0.31; 95% CI, 0.25-0.42; test: r, 0.18; 95% CI, 0.15-0.35; STRATIFY/ESTRA: r, 0.12; 95% CI, 0.12-0.33). In this study, the identification of symptom groups of mental illness robustly defined by precisely characterized brain mechanisms enabled the characterization of dimensions of psychopathology based on quantifiable neurobiological measures.

• Explain the steps required for diagnosis of mental disorders in diagnostic handbooks.• Identify current procedures for classifying and reporting prolonged grief disorder. Prolonged grief disorder (PGD) was added to the 11th edition of the International Classification of Diseases in 2018 and to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders in its 2022 text revision. Thus, reporting and classifying PGD according to established guidelines has become fundamental for scientific research and clinical practice. Yet, PGD assessment instruments and criteria are still being developed and debated. The purpose of this article is to examine the adequacy of current procedures for classifying and reporting PGD in research and to suggest guidelines for future investigation and dissemination of knowledge. We outline the standard steps required for diagnosis and assessment of a mental disorder (notably, the administration of clinical interviews). In order to illustrate reporting about the presence/prevalence of PGD in recent scientific articles, we conducted a search of Scopus that identified 22 relevant articles published between 2019 and 2023. Our review of the literature shows that standard classification procedures are not (yet) followed. Prevalences of PGD are based on self-reported symptomatology, with rates derived from percentages of bereaved persons reaching a certain cutoff score on a questionnaire, without clinical interviewing. This likely results in systematic overestimation of prevalences. Nevertheless, the actual establishment of PGD prevalence was often stated in titles, abstracts, and results sections of articles. Further, the need for structured clinical interviews for diagnostic classification was frequently mentioned only among limitations in discussion sections-but was not highlighted. We conclude by providing guidelines for researching and reporting self-reported prolonged grief symptoms and the presence/prevalence of PGD.

People with mental disorders have an increased risk of diabetes, yet conflicting evidence exists regarding the quality of diabetes care they receive. To address this evidence gap, we conducted a systematic review and meta-analysis to assess and compare diabetes quality of care in people with diabetes with mental disorders versus people with diabetes without mental disorders. In this systematic review and random-effects meta-analysis, we searched Scopus, Embase, MEDLINE, and PsycINFO for cohort and case-control studies published between database inception and Feb 8, 2025. We estimated summary odds ratios (ORs) for diabetes quality of care indicators in individuals with any mental disorder versus without mental disorders to investigate the association between the presence of a mental disorder and diabetes quality of care indicators, including overall diabetes monitoring and treatment. Studies were excluded if it was not possible to generate pooled quantitative data. The primary outcome was a binary composite measure of diabetes quality of care, meaning the percentage of people receiving any diabetes monitoring and treatment (ie, urine albumin-creatinine ratio test, HbA1c test, blood pressure measured, foot surveillance, serum creatinine test, serum cholesterol test, BMI recorded, smoking status recorded, retinal monitoring). Secondary outcomes were study-specific diabetes quality of care individual indicators matched to the nine NICE diabetes monitoring indicators and specific diabetes interventions and anti-diabetes medications. We analysed primary and secondary outcomes according to any mental disorder and to specific diagnostic subgroups. Study quality was evaluated using the Newcastle-Ottawa Scale (NOS). Data from 49 studies (42 cohort and seven case-control) were included, comprising 5&#x2009;503&#x2009;712 individuals with diabetes, of whom 838&#x2009;366 (15&#xb7;2%) had a diagnosed mental disorder (defined using ICD-9 or ICD-10 criteria in 40 studies). Sex was reported in 35 of 49 studies, comprising 4&#x2009;250&#x2009;666 individuals, 1&#x2009;956&#x2009;506 (46&#xb7;0%) of whom were female and 2&#x2009;294&#x2009;160 (54&#xb7;0%) were male. The mean age was 61&#xb7;4 years (SD 8&#xb7;7; range 47-82 years). 38 studies reported on various mental disorders, 21 on mood disorders spectrum, 21 on major depressive disorder, 20 on schizophrenia, 11 on bipolar disorder, 11 on substance use disorder spectrum, including alcohol use disorder, six on dementia, five on anxiety disorder spectrum, and one on personality disorder spectrum. Most studies were high quality and spanned Asia, North America, Europe, and Australasia. Significant negative associations were observed between having any mental disorder and the likelihood of receiving any recommended diabetes monitoring (29 studies, OR=0&#xb7;81 [95% CI 0&#xb7;70-0&#xb7;94], p=0&#xb7;0049). Negative associations were also observed for HbA1c measurement (24 studies, 0&#xb7;81 [0&#xb7;68-0&#xb7;97], p=0&#xb7;024), retinal screening (21 studies, 0&#xb7;77 [0&#xb7;63-0&#xb7;95], p=0&#xb7;013), lipid and cholesterol measurement (20 studies, 0&#xb7;83 [0&#xb7;69-0&#xb7;99], p=0&#xb7;043), foot examination (11 studies, 0&#xb7;85 [0&#xb7;76-0&#xb7;95], p=0&#xb7;0044), and renal investigation (16 studies, 0&#xb7;78 [0&#xb7;63-0&#xb7;96], p=0&#xb7;022). A significant positive association was found between any mental disorder and recorded smoking status (two studies, 1&#xb7;09 [1&#xb7;02-1&#xb7;17]; p=0&#xb7;0076). Any mental disorder was significantly associated with higher odds of receiving insulin (ten studies, 1&#xb7;52 [95% CI 1&#xb7;16-1&#xb7;99]; p=0&#xb7;0022), but negatively associated with treatment with a GLP-1 receptor agonist (two studies, 0&#xb7;26 [0&#xb7;13-0&#xb7;49]; p<0&#xb7;0001). There was no evidence of publication bias. Mental disorders are negatively associated with receiving adequate diabetes monitoring and GLP-1 agonist therapy. Addressing these disparities has the potential to address the increased mortality associated with mental disorders. None.

Problematic pornography use (PPU) is a common manifestation of the newly introduced Compulsive Sexual Behavior Disorder diagnosis in the 11th edition of the International Statistical Classification of Diseases and Related Health Problems. Although cultural, gender- and sexual orientation-related differences in sexual behaviors are well documented, there is a relative absence of data on PPU outside Western countries and among women as well as gender- and sexually-diverse individuals. We addressed these gaps by (a) validating the long and short versions of the Problematic Pornography Consumption Scale (PPCS and PPCS-6, respectively) and the Brief Pornography Screen (BPS) and (b) measuring PPU risk across diverse populations. Using data from the pre-registered International Sex Survey [n&#x2009;=&#x2009;82&#x2009;243; mean age (Mage)&#x2009;=&#x2009;32.4&#xa0;years, standard deviation&#x2009;=&#x2009;12.5], a study across 42 countries from five continents, we evaluated the psychometric properties (i.e. factor structure, measurement invariance, and reliability) of the PPCS, PPCS-6, and BPS and examined their associations with relevant correlates (e.g. treatment-seeking). We also compared PPU risk among diverse groups (e.g. three genders). The PPCS, PPCS-6, and BPS demonstrated excellent psychometric properties [for example, comparative fit index&#x2009;=&#x2009;0.985, Tucker-Lewis Index&#x2009;=&#x2009;0.981, root mean square error of approximation&#x2009;=&#x2009;0.060 (90% confidence interval&#x2009;=&#x2009;0.059-0.060)] in the confirmatory factor analysis, with all PPCS' inter-factor correlations positive and strong (rs&#x2009;=&#x2009;0.72-0.96). A total of 3.2% of participants were at risk of experiencing PPU (PPU+) based on the PPCS, with significant country- and gender-based differences (e.g. men reported the highest levels of PPU). No sexual orientation-based differences were observed. Only 4-10% of individuals in the PPU+ group had ever sought treatment for PPU, while an additional 21-37% wanted to, but did not do so for specific reasons (e.g. unaffordability). This study validated three measures to assess the severity of problematic pornography use across languages, countries, genders, and sexual orientations in 26 languages: the Problematic Pornography Consumption Scale (PPCS, and PPCS-6, respectively), and the Brief Pornography Screen (BPS). The problematic pornography use risk is estimated to be 3.2-16.6% of the population of 42 countries, and varies among different groups (e.g. genders) and based on the measure used.

The significant impact of eating disorders on adolescents necessitates the evaluation of current treatments. Family-based Treatment (FBT) is the standard treatment but has modest remission rates, highlighting the need for improvements. Assessing its effectiveness in adolescents with co-occurring mental health conditions is also crucial. In the Netherlands, there is a growing focus on home-based treatment. This study aims to enhance remission rates in FBT by adapting it for use in a home setting (FBT-H). This mixed-method study combines single case studies with qualitative research. The primary objective is to assess the effects and experiences of FBT-H in adolescents with eating disorders and co-occurring mental health conditions across variables such as weight, eating disorder symptoms, anxiety, mood, well-being, quality of life, and family dynamics. Additionally, it explores the experiences of adolescents, parents, and practitioners with FBT-H. Adolescents (12-18 years old) with anorexia nervosa (AN) or other specified feeding or eating disorders (OSFED), alongside co-occurring mental health conditions, will participate in FBT-H, attending about two home sessions per week for 6-12 months. Ten patients will be monitored with intensive measurements over one year. Baseline assessments include somatic screening, clinical interviews, and evaluations of mood, anxiety, and family dynamics. The primary outcome is weight change from baseline to one year post treatment, and secondary outcomes (e.g., eating disorder symptoms, quality of life, parent-child relationships, and caregiving burden) are assessed at baseline and then every three months. General well-being and therapeutic relationships are tracked weekly. One-year post treatment, somatic health, and mood/anxiety symptoms will be reassessed alongside qualitative interviews with adolescents, parents, and practitioners. The FBT-H study has the potential to yield significant findings for providing effective treatments for adolescents with eating disorders and co-occurring mental health conditions. By examining a range of variables beyond weight and eating disorder symptoms, this study aims to provide comprehensive insights into the potential benefits and limitations of this home treatment. The study was approved by the Dutch Medical Ethics Committee 'METC Oost Nederland' (Dossier Number: 2023-16217). NCT06792227, ClinicalTrials.gov, registered on 25 January 2025. Clinical Trial Number: NCT06792227.

Prolonged grief disorder (PGD) is included in the Diagnostic and Statistical Manual of Mental Disorders text-revised fifth edition (DSM-5-TR) and in the International Classification of Diseases Eleventh Edition (ICD-11). While PGD screening instruments exist for adults, these instruments are not applicable to children. Caretakers play a crucial role in screening for PGD in children. We evaluated the psychometric properties of the Traumatic Grief Inventory-Kids-Caregiver-Report (TGI-K-CR) to screen for DSM-5-TR and ICD-11 PGD in children. On a website with information about grief, 196 Dutch caregivers (82% woman; Mage&#x2009;=&#x2009;44) completed questions about their own and their child's (47% girls; Mage&#x2009;=&#x2009;11; 44% lost a parent) background and loss-related characteristics (77% of deaths resulted from illness). Caregivers completed the TGI-K-CR and a self-report measure about their own PGD intensity. Factor structure and internal consistency of DSM-5-TR and ICD-11 PGD items were examined separately. T-tests and correlation analyses examined whether caregiver-ratings of PGD intensity in children differed as a function of background- and loss-related characteristics. Provisional cut-offs for both criteria sets were determined. Confirmatory factor analyses showed support for two distinct, but related, factors for DSM-5-TR and ICD-11 PGD items. We found strong internal consistency (&#x3c9;&#x2009;=&#x2009;.85 for DSM-5-TR; &#x3c9;&#x2009;=&#x2009;.87 for ICD-11), while some factor loadings were poor. In support of known-groups validity, DSM-5-TR and ICD-11 PGD intensity were higher in children when caregivers reported higher PGD intensity for themselves and when deaths occurred more recently. ROC analyses showed optimal cut-off scores of &#x2265;46 and &#x2265;52 to determine probable caseness for DSM-5-TR and ICD-11 PGD, respectively, when summing all 16 items. The psychometric properties of the TGI-K-CR seem promising, but more research among larger samples is needed. This caregiver screening tool for PGD in children (aged 8-18) may advance child bereavement research and care. The Traumatic Grief Inventory-Kids-Caregiver-Report (TGI-K-CR) screens for DSM-5-TR and ICD-11 PGD in children based on caregiver reports.The TGI-K-CR shows promising psychometric properties for screening for PGD in children aged 8&#x2013;18 using caregiver reports.This caregiver screening tool for PGD in children may advance child bereavement research and care. Antecedentes: El trastorno de duelo prolongado (TDP) se incluy&#xf3; en el Manual Estad&#xed;stico y Diagn&#xf3;stico para Trastornos Mentales, quinta edici&#xf3;n texto revisado (DSM-5-TR) y en la Clasificaci&#xf3;n Internacional de Enfermedades, decimoprimera edici&#xf3;n (CIE-11). Mientras que los instrumentos de tamizaje para TDP existen para adultos, estos instrumentos no son aplicables para ni&#xf1;os. Los cuidadores juegan un papel crucial en el tamizaje de TDP en ni&#xf1;os. Objetivo: Se evaluaron las propiedades psicom&#xe9;tricas del Inventario de Duelo Traum&#xe1;tico para Ni&#xf1;os-Reporte del Cuidador (TGI-K-CR por sus siglas en ingl&#xe9;s) para detectar el TDP en ni&#xf1;os seg&#xfa;n el DSM-5-TR y la CIE-11. M&#xe9;todo: En un sitio web con informaci&#xf3;n acerca de duelo, 196 cuidadores holandeses (82% mujeres; Medad&#x2009;=&#x2009;44) completaron preguntas acerca de sus propios antecedentes y las de sus hijos (47% ni&#xf1;as; Medad &#x2009;=&#x2009;11; 44% perdieron a un progenitor) y de las caracter&#xed;sticas relacionadas con la p&#xe9;rdida (77% de las muertes fueron por enfermedad). Los cuidadores completaron la TGI-K-CR y una medida de autorreporte sobre la intensidad de su propio TDP. La estructura factorial y la consistencia interna de los &#xed;tems del TDP seg&#xfa;n el DSM-5-TR y la CIE-11 se examinaron separadamente. Las pruebas T y los an&#xe1;lisis de correlaci&#xf3;n examinaron si la valoraci&#xf3;n de los cuidadores sobre la intensidad del TDP en los ni&#xf1;os difer&#xed;a en funci&#xf3;n de los antecedentes y las caracter&#xed;sticas relacionadas con la p&#xe9;rdida. Se determinaron puntos de corte provisionales para ambos conjuntos de criterio. Resultados: Los an&#xe1;lisis de factor confirmatorio respaldaron la existencia de dos factores distintos, pero relacionados para los &#xed;tems del TDP del DSM-5-TR y la CIE-11. Se encontr&#xf3; una fuerte consistencia interna (&#x3c9;&#x2009;=&#x2009;.85 para el DSM-5-TR; &#x3c9;&#x2009;=&#x2009;.87 para la CIE-11), mientras que algunas cargas factoriales fueron deficientes. En apoyo de la validez de grupos conocidos, la intensidad del TDP del DSM-5-TR y de la CIE-11 fue mayor en los ni&#xf1;os cuando los cuidadores reportaron mayor intensidad de TDP para s&#xed; mismos y cuando las muertes ocurrieron m&#xe1;s recientemente. Los an&#xe1;lisis ROC mostraron puntuaciones de corte &#xf3;ptimas de &#x2265;46 y&#x2009;&#x2265;&#x2009;52 para determinar la probable casu&#xed;stica para el TDP del DSM-5-TR y de la CIE-11 respectivamente, al sumar los 16 &#xed;tems. ConclusionesLas propiedades psicom&#xe9;tricas del TGI-K-CR parecen prometedoras, pero se requiere m&#xe1;s investigaci&#xf3;n con muestras m&#xe1;s grandes. Este instrumento de tamizaje para el TDP en ni&#xf1;os (edades 8&#x2013;18) para cuidadores podr&#xed;a impulsar la investigaci&#xf3;n y la atenci&#xf3;n en duelo infantil.

Eating disorders (EDs), such as (atypical) Anorexia (AN) and Bulimia Nervosa (BN), are difficult to treat, causing socioeconomic impediments. Although enhanced cognitive behavioral therapy (CBT-E) is widely considered clinically effective, it may not be the most beneficial treatment for (atypical) AN and BN patients who do not show a rapid response after the first 4 weeks (8 sessions) of a CBT-E treatment. Alternatively, group schema therapy (GST) may be a valuable treatment for this ED population. Even though GST for EDs has yielded promising preliminary findings, the current body of evidence requires expansion. On top of that, data on cost-effectiveness is lacking. In light of these gaps, we aim to describe a protocol to examine whether GST is more (1) clinically effective and (2) cost-effective than CBT-E for (atypical) AN and BN patients, who do not show a rapid response after the first 4 weeks of treatment. Additionally, we will conduct (3) process evaluations for both treatments. Using a multicenter RCT design, 232 Dutch (atypical) AN and BN patients with a CBT-E referral will be recruited from five treatment centers. Clinical effectiveness and cost-effectiveness will be measured before treatment, directly after treatment, at 6 and at 12 months follow-up. In order to rate process evaluation, patient experiences and the degree to which treatments are implemented according to protocol will be measured. In order to assess the quality of life and the achievement of personalized goals, interviews will be conducted at the end of treatment. Data will be analyzed, using a regression-based approach to mixed modelling, multivariate sensitivity analyses and coding trees for qualitative data. We hypothesize GST to be superior to CBT-E in terms of clinical effectiveness and cost-effectiveness for patients who do not show a rapid response to the first 4 weeks of a CBT-E treatment. To our knowledge, this is the first study protocol describing a multicenter RCT to explore the three aforementioned objectives. Related risks in performing the study protocol have been outlined. The expected findings may serve as a guide for healthcare stakeholders to optimize ED care trajectories. clinicaltrials.gov (NCT05812950).

Early maladaptive schemas are well-established mechanisms between childhood maltreatment (i.e., abuse and neglect) and psychopathology in adulthood. However, research has not yet examined the unique contribution of childhood maltreatment, while controlling for the family dysfunction-related experiences, in shaping specific EMS domains and their associations with distinct psychopathological outcomes. Our aim was to examine the unique role of childhood maltreatment, while controlling for the effects of family dysfunction on early maladaptive schemas and subsequently on personality disorders and psychological distress using structural equation modelling and network analysis. A total of 2,011 unique inpatients aged 18 to 80 years (M = 39.7, SD = 14.18; 53.4% women) admitted to the Alexianen Zorggroep Tienen Psychiatric Hospital between 2011 and 2021 were included in this study. Self-report questionnaires were completed as part of the hospital admission process. Data were analyzed using structural equation modeling and network analysis. The results showed positive associations between childhood maltreatment, family dysfunction, early maladaptive schema domains, symptoms of personality disorders, and psychological distress. Accounting for the effects of family dysfunction-related experiences, early maladaptive schema played a significant mediating role in the association between childhood maltreatment and psychopathological outcomes. The results highlighted the central role of the domains disconnection/rejection and impaired autonomy/performance for personality disorders and psychological distress. There were no significant gender-specific differences in the network of relationships between the variables. These results demonstrate the key role of EMS in the domains of disconnection/rejection and impaired autonomy/performance in the association between childhood maltreatment and personality pathology and psychological distress in psychiatric inpatients. Clinical implications, study limitations, and recommendations for future research are discussed.

Prolonged grief disorder (PGD) has been included in the International Classification of Diseases 11th edition (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). Accurate assessment of the prevalence of PGD is imperative to healthcare policy and practice. Systematic reviews and meta-analyses of at-risk bereaved subgroups (e.g. those bereaved by natural disasters, unnatural causes, and COVID-19) yield very high prevalence rates (24-87%). These findings appear at odds with the well-established finding that most people respond to major negative life events resiliently. This letter explores two potential explanations for overestimated prevalence rates of PGD. First, non-probability sampling, typical to research in vulnerable bereaved subgroups, leads to overestimation of prevalence rates of PGD relative to probability sampling. Secondly, based on epidemiological research in depression and post-traumatic stress disorder, we consider the risk that the use of self-report scales, typical to grief research, may lead to overestimation of prevalence rates compared to clinical interviewing. We recommend international research, based on probability sampling, that systematically assesses loss characteristics and circumstances as well as ICD-11 and DSM-5-TR PGD symptoms, using validated scales, and, ideally, clinical interviewing in a subset of participants, to enable more accurate assessment of prevalence rates of PGD in different bereaved populations. Systematic reviews and meta-analyses of at-risk bereaved samples report exceptionally high prevalence rates of prolonged grief.These differences can partly be explained by overreliance on voluntary response samples and self-report scales in research on at-risk bereaved samples.International research is needed, using probability sampling, self-report, and interview assessment of ICD-11 and DSM-TR prolonged grief symptoms and loss-related characteristics and circumstances. El trastorno de duelo prolongado (TDP) se ha incluido en la und&#xe9;cima edici&#xf3;n de la Clasificaci&#xf3;n Internacional de Enfermedades (CIE-11) y en el Manual Diagn&#xf3;stico y Estad&#xed;stico de los Trastornos Mentales, quinta edici&#xf3;n, revisi&#xf3;n del texto (DSM-5-TR). La evaluaci&#xf3;n precisa de la prevalencia del TDP es imprescindible para la pol&#xed;tica y la pr&#xe1;ctica sanitarias. Las revisiones sistem&#xe1;ticas y los metaan&#xe1;lisis recientes de subgrupos de personas en duelo en riesgo (por ejemplo, las personas en duelo por desastres naturales, causas no naturales y COVID-19) arrojan tasas de prevalencia muy altas (24-87%). Estos hallazgos parecen contradecir la conclusi&#xf3;n bien establecida de que la mayor&#xed;a de las personas responden con resiliencia a los principales acontecimientos negativos de la vida. Esta carta explora dos posibles explicaciones para las tasas de prevalencia sobreestimadas de TDP. En primer lugar, el muestreo no probabil&#xed;stico, t&#xed;pico de la investigaci&#xf3;n en subgrupos vulnerables en duelo, conduce a la sobreestimaci&#xf3;n de las tasas de prevalencia de TDP en relaci&#xf3;n con el muestreo probabil&#xed;stico. En segundo lugar, bas&#xe1;ndonos en la investigaci&#xf3;n epidemiol&#xf3;gica sobre la depresi&#xf3;n y el TEPT, consideramos que el riesgo de que el uso de escalas de autoinforme, t&#xed;picas de la investigaci&#xf3;n del duelo, pueda llevar a sobreestimar las tasas de prevalencia en comparaci&#xf3;n con las entrevistas cl&#xed;nicas. Recomendamos una investigaci&#xf3;n internacional, basada en el muestreo probabil&#xed;stico, que eval&#xfa;e sistem&#xe1;ticamente las caracter&#xed;sticas y circunstancias de la p&#xe9;rdida, as&#xed; como los s&#xed;ntomas de TDP de la CIE-11 y DSM-5-TR, utilizando escalas validadas e, idealmente, entrevistas cl&#xed;nicas en un subconjunto de participantes, para permitir una evaluaci&#xf3;n m&#xe1;s precisa de las tasas de prevalencia de TDP en diferentes poblaciones en duelo.

Depression and anxiety often co-occur, leading to more severe symptoms and poorer treatment outcomes. Both are linked to low meaning in life (MiL), which consist of two inter-related but conceptually distinct dimensions: presence of MiL (P-MiL, perceiving life as meaningful) and search for MiL (S-MiL, seeking or enhancing meaning). This cross-sectional study examined MiL in comorbid anxiety and depression using both dimensional (level of symptoms) and categorical (clinical diagnosis) approaches. Participants (N&#xa0;=&#xa0;1511; Mage&#xa0;=&#xa0;56.35&#xa0;years; 65% female) from the Netherlands Anxiety and Depression Study (NESDA) completed the Inventory of Depressive Symptomatology, Becks Anxiety Inventory, and Meaning in Life Questionnaire. A sub-set (n&#xa0;=&#xa0;281) met diagnostic criteria for a single or comorbid depression and/or anxiety disorder, determined through CIDI interviews. Dimensional analyses showed lower P-MiL and higher S-MiL were associated with more (comorbid) symptoms of anxiety and depression, and vice versa (r(P-MiL)&#xa0;=&#xa0;-.35, r(S-MiL)&#xa0;=&#xa0;.12, ps&#xa0;< .001). However, neither MiL dimension was uniquely linked to the covariation of depression and anxiety symptoms. Depression symptoms were uniquely associated with P-MiL (&#x3b2;&#xa0;=&#xa0;-0.51, p&#xa0;<&#xa0;.001). Categorical analyses showed that participants with comorbid diagnoses reported lower P-MiL and higher S-MiL than those without a diagnosis or with a single (anxiety) disorder. In sum, comorbidity was linked to higher search and lower presence of MiL, but this relationship was mainly driven by depression symptoms. Addressing meaning in life as a modifiable factor may thus be a relevant approach for improving clinical outcomes in depression and comorbidity.

Peer support is a collaborative practice where people with lived experience of mental health conditions engage in supporting like-minded. Peer support impacts on personal recovery and empowerment and creates value at an organisational level. However, the implementation of peer support into existing mental health services is often impeded by barriers embedded in organisational culture and support in role expectations. Non-peer professionals' recovery orientation and attitudes towards peer support workers (PSWs) are essential factors in the implementation of peer support, and this study explored non-peer professionals' understanding of recovery and their attitudes towards PSWs joining existing community mental health teams in one region of Denmark. In total, 17 non-peer professionals participated in three focus groups. Thematic analysis led to three themes: (1) Recovery is a process of "getting better" and balancing personal and clinical perspectives; (2) Realising recovery-oriented practice: a challenging task with conflicting values; and (3) Expectations and concerns about peer support workers joining the team. Recovery-oriented practice faces challenging conditions in contemporary mental health services due to a dominant focus on biomedical aspects in care and treatment. Implementation facilitators and barriers in the employment of PSWs point towards fundamental aspects that must be present when employing PSWs in an organisation. The issues described leading up to the employment of PSWs reflected in this study underpin the importance of preparing an organisation for the employment of PSWs based on the available knowledge.

Background: Altered eating behaviors (AEBs) are not only associated with eating disorders but also play a role in obesity. This study assessed AEBs in individuals with obesity and their association with general and eating psychopathology, using the "Eating Behaviors Assessment for Obesity" (EBA-O). The hypothesis posited that a higher frequency of pathological eating behaviors would correlate with more severe psychopathology. Methods: Participants seeking weight loss treatment answered the EBA-O and other measures of eating and general psychopathology. The analysis employed MANOVA to estimate psychopathological variance based on AEBs and a cluster analysis to identify patient clusters by AEB type and number. Results: Out of the 244 participants, approximately two-thirds reported clinically relevant AEBs, with almost half exhibiting more than two AEBs. Predominant AEBs included sweet eating, binge eating, and hyperphagia. A significant impact of the numbers of AEBs on both eating and general psychopathology severity (p < 0.001; &#x3b7;2 = 0.167) was evident. Three clusters emerged, with Cluster 3 showing the highest AEB frequency and greater psychopathological impairment. Conclusions: The present findings confirm the correlation between the frequency of AEBs and the severity of general and eating psychopathology in individuals with obesity. AEBs deserve clinical attention, and their screening might aid their clinical characterization and foster more tailored treatments.

The International Classification of Diseases Eleventh Edition (ICD-11), and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), now include prolonged grief disorder (PGD). Since criteria for PGD in both classification systems differ from prior proposed grief disorders and each other, the validation of a single instrument to screen for prolonged grief (PG) symptoms of both new diagnoses is critical for bereavement research and care. Therefore, we evaluated the psychometric properties of the Swedish version of the Traumatic Grief Inventory Self-Report Plus (TGI-SR+). Two-hundred and forty-eight bereaved parents completed questions about sociodemographic and loss-related variables, the TGI-SR+, and symptom measures of post-traumatic stress (PTS), depression and an older measure of PG symptoms, the Prolonged Grief Disorder-13 (PG-13). Confirmatory factor analyses showed that a one-factor model best fit DSM-5-TR and ICD-11 PG symptoms and the analyses of the internal consistency and inter-item correlations showed that these symptoms could be reliably assessed. In support of convergent validity, DSM-5-TR and ICD-11 PG symptoms correlated with symptoms of PTS, depression and PG assessed with the PG-13. In support of known-groups validity, DSM-5-TR and ICD-11 PG symptoms were higher among lower educated (vs. higher educated) participants and related negatively to time since loss. ROC analyses showed optimal cut-off score of &#x2265;71 and &#x2265;72 to determine probable caseness for DSM-5-TR and ICD-11 PGD, respectively. Results support the reliability and validity of the Swedish TGI-SR+ as a screening instrument for PG in research and bereavement care.

Research on Criterion A of the alternative model for personality disorders is recently expanding and provides mixed results concerning the unidimensional operational definition of severity by the model, characterized by impaired self (identity and self-direction) and interpersonal (empathy and intimacy) functioning. Studies resulted in one, as well as two or more factor structures. The present study demonstrated the importance of the structural and relational differentiation of self and interpersonal dimensions of personality functioning. One thousand seventy-four participants (community and clinical mixed sample) completed the Level of Personality Functioning Scale - Brief Form 2.0 (LPFS-BF 2.0), the Personality Inventory for DSM-5 Short Form and the Questionnaire for the World Health Organization Disability Assessment. An LPFS-BF 2.0 two-factor structure with self and interpersonal functioning factors was corroborated by confirmatory factor analyses and bifactor modeling. Joint Exploratory Factor Analysis of the LPFS-BF 2.0 domains with maladaptive personality domains clearly differentiated the personality functioning factors. While the self-functioning factor was more closely linked to negative affect (and to disinhibition and psychoticism), the interpersonal functioning factor connected to detachment. Self-functioning predicted functional impairment along and beyond personality domains. The LPFS-BF 2.0 appears a useful tool for clinical routine monitoring of both self and interpersonal functioning.

Prolonged grief disorder (PGD) is defined in DSM-5-TR by the presence of one of two separation distress symptoms (yearning or preoccupation) and three of eight accessory symptoms (e.g., loneliness). This definition yields 657 possible clinical presentations of PGD. Such symptom heterogeneity may hamper the identification of risk and protective factors and effective treatments for PGD. Despite concerns associated with heterogeneity, no studies have yet determined actual patterns of PGD symptoms among people with probable PGD. Data were drawn from two datasets comprising 2679 bereaved adults with probable PGD who completed the Traumatic Grief Inventory-Self Report Plus (TGI-SR+) online. We identified 396 of 657 possible PGD symptom profiles. The most common profile was the presence of all PGD criteria (n&#xa0;=&#xa0;407, 15%). The five most frequently observed PGD symptom profiles were experienced by 37% of participants (n&#xa0;=&#xa0;980). Other PGD symptom profiles were reported by fewer than 2% of the sample (n&#xa0;=&#xa0;1699, 63%). No clinical interview was applied to assess diagnostic status. While there is substantial heterogeneity in profiles of PGD, a relatively small set of profiles can be considered diagnostic prototypes. Future research may help clarify whether risk and protective factors and treatment responses vary dependent on PGD profiles.

Background: While several studies documented a positive correlation between childhood maltreatment severity and dissociation severity, it is currently unknown whether specific dissociative symptoms cluster together among individuals with childhood trauma histories ranging from none to severe.Objective: We aimed to explore symptom constellations across the whole spectrum of dissociative processing from patients with severe dissociative disorders to healthy controls and relate these to maltreatment severity and sociodemographic characteristics.Methods: We employed latent profile analysis to explore symptom profiles based on five subscales, measuring absorption, depersonalization, derealization, somatoform and identity alteration, based on the 20 items of the German short version of the Dissociative Experiences Scale-II (Fragebogen zu Dissoziativen Symptomen-20) in a large aggregate sample (n&#x2009;=&#x2009;3,128) overrepresenting patients with trauma-related disorders. We then related these profiles to maltreatment severity as measured by the five subscales of the Childhood Trauma Questionnaire as well as sociodemographic characteristics.Results: Based on the five FDS subscales, six clusters differentiated by symptom severity, but not symptom constellations, were identified. Somatoform dissociation varied in accordance with the remaining symptom clusters. The cluster with the highest overall symptom severity entailed nearly all subjects diagnosed with Dissociative Identity Disorder and was characterized by extreme levels of childhood maltreatment. Both abuse and neglect were predictive of cluster membership throughout.Conclusions: The higher the severity of dissociative processing in a cluster, the more subjects reported high severity and multiplicity of childhood maltreatment. However, some subjects remain resilient to the development of dissociative processing although they experience extreme childhood maltreatment. Dissociative symptoms, including identity alterations, are closely related to the severity of experienced childhood abuse.Somatoform dissociation occurs on all levels of overall dissociation severity.Some subjects with a history extreme childhood maltreatment do not develop dissociative symptoms, while some subjects with extreme dissociative symptoms do not report any childhood maltreatment. Antecedentes: Aunque varios estudios han documentado una correlaci&#xf3;n positiva entre la severidad del maltrato infantil y la severidad de la disociaci&#xf3;n, actualmente se desconoce si los s&#xed;ntomas disociativos espec&#xed;ficos se agrupan entre individuos con historias de trauma infantil que van desde ninguno a severo. Objetivo: Nos propusimos explorar las constelaciones de s&#xed;ntomas en todo el espectro del procesamiento disociativo de pacientes con trastornos disociativos graves y controles sanos, y relacionarlas con la gravedad del maltrato y las caracter&#xed;sticas sociodemogr&#xe1;ficas. M&#xe9;todos: Se emple&#xf3; el an&#xe1;lisis de perfil latente para explorar los perfiles de s&#xed;ntomas basados en cinco subescalas, que miden la absorci&#xf3;n, despersonalizaci&#xf3;n, desrealizaci&#xf3;n, somatomorfos y alteraci&#xf3;n de la identidad, basados en los 20 &#xed;tems de la versi&#xf3;n corta alemana de la Escala de Experiencias Disociativas-II (Fragebogen zu Dissoziativen Symptomen-20) en una gran muestra agregada (n&#x2009;=&#x2009;3.128) sobrerrepresentada por pacientes con trastornos relacionados con el trauma. Luego relacionamos estos perfiles con la gravedad del maltrato, medida por las cinco subescalas del Cuestionario de Trauma Infantil, as&#xed; como con las caracter&#xed;sticas sociodemogr&#xe1;ficas. Resultados: Sobre la base de las cinco subescalas de la FDS, se identificaron seis cl&#xfa;steres diferenciados por la gravedad de los s&#xed;ntomas, pero no por constelaciones de s&#xed;ntomas. La disociaci&#xf3;n somatomorfa vari&#xf3; de acuerdo con los grupos de s&#xed;ntomas restantes. El cl&#xfa;ster con la mayor gravedad sintom&#xe1;tica global inclu&#xed;a a casi todos los sujetos diagnosticados con Trastorno de Identidad Disociativo y se caracterizaba por niveles extremos de maltrato en la infancia. Tanto el maltrato como la negligencia fueron predictivos de la pertenencia al cl&#xfa;ster en todo momento. Conclusiones: Cuanto mayor era la severidad del procesamiento disociativo en un cl&#xfa;ster, m&#xe1;s sujetos reportaban una alta severidad y multiplicidad de maltrato infantil. Sin embargo, algunos sujetos permanecen resilientes al desarrollo del procesamiento disociativo, aunque experimenten maltrato infantil extremo.

Background: The dissociative subtype of posttraumatic stress disorder (D-PTSD) was introduced in the DSM-5 to identify individuals with PTSD who experience dissociative symptoms, such as derealization and depersonalization. The Dissociative Subtype of PTSD Scale (DSPS) was developed to assess these symptoms but has yet to be validated in Ukrainian, a necessity due to the psychological impact of the ongoing conflict in Ukraine.Objective: This study aimed to develop and validate the Ukrainian version of the DSPS, examining its psychometric properties in a sample of trauma-exposed Ukrainian individuals.Methods: 1,119 Ukrainian participants, recruited using convenience and snowball sampling, took part in an online study assessing dissociative symptoms with the DSPS as well as symptoms of PTSD, depression, generalized anxiety disorder, somatic symptom disorder, and fear of sleep with established questionnaires. DSPS factor structure, internal consistency, and convergent and discriminant validity were assessed.Results: Confirmatory factor analysis confirmed the three-factor structure of the DSPS (derealization/depersonalization, loss of awareness, and psychogenic amnesia) with acceptable model fit indices for both lifetime and current severity items. Internal consistency was high for lifetime and current total scales (Cronbach's alpha&#x2009;=&#x2009;0.83-0.87). Significant correlations with PTSD, depression, anxiety, and somatic symptoms were in the expected size-ranges, supporting convergent and discriminant validity.Conclusions: The Ukrainian DSPS demonstrated robust psychometric properties, validating its use as a reliable and valid tool for assessing dissociative symptoms in individuals exposed to war-related trauma. Its adaptation fills a critical gap in the diagnostic landscape, enabling timely intervention for trauma-exposed populations in Ukraine. First Ukrainian validation of the DSPS among 1,119 trauma-exposed adults.CFA confirmed the three-factor structure for lifetime and current symptoms.Scale shows high internal consistency and strong convergent validity.Dissociation strongly correlates with somatic symptoms in war-affected samples.DSPS is a reliable tool for identifying D-PTSD in ongoing conflict settings. Antecedentes: El subtipo disociativo del trastorno de estr&#xe9;s postraum&#xe1;tico (TEPT-D) se introdujo en el DSM-5 para identificar individuos con TEPT que experimentan s&#xed;ntomas disociativos, como desrealizaci&#xf3;n y despersonalizaci&#xf3;n. La Escala de TEPT Subtipo Disociativo (DSPS) se desarrollo para evaluar estos s&#xed;ntomas, pero aun tiene que validarse en ucraniano, una necesidad debida al impacto psicol&#xf3;gico del conflicto en curso en Ucrania. Objetivo: Este estudio tuvo como objetivo desarrollar y Validar la versi&#xf3;n ucraniana de la DSPS, examinar sus propiedades psicom&#xe9;tricas en una muestra de individuos ucranianos expuestos a trauma. M&#xe9;todos: 1.119 participantes ucranianos, reclutados mediante muestreo por conveniencia y por bola de nieve, tomaron parte en un estudio en l&#xed;nea que evalu&#xf3; los s&#xed;ntomas disociativos con la DSPS, as&#xed; como los s&#xed;ntomas de TEPT, depresi&#xf3;n, trastorno de ansiedad generalizada, trastorno de s&#xed;ntomas som&#xe1;ticos y temor a dormir con cuestionarios establecidos. Se evaluaron la estructura factorial de la DSPS, la consistencia interna, la validez convergente y discriminante. Resultados: El an&#xe1;lisis factorial confirmatorio confirm&#xf3; la estructura trifactorial de la DSPS (desrealizaci&#xf3;n/despersonalizaci&#xf3;n, perdida de conciencia y amnesia psicog&#xe9;nica) con &#xed;ndices de ajuste del modelo aceptables tanto para los &#xed;tems de gravedad actual como para los de gravedad a lo largo de la vida. La consistencia interna fue alta para las escalas totales de por vida y actual (&#x3b1; de Cronbach&#x2009;=&#x2009;0,83-0,87). Las correlaciones significativas con el TEPT, depresi&#xf3;n, ansiedad y s&#xed;ntomas som&#xe1;ticos se mantuvieron dentro de los rangos esperados, lo que respalda la validez convergente y discriminante. Conclusiones: La DSPS ucraniana demostr&#xf3; s&#xf3;lidas propiedades psicom&#xe9;tricas, lo que valida su uso como un instrumento fiable y valido para evaluar s&#xed;ntomas disociativos en individuos expuestos a trauma relacionado con la guerra. Su adaptaci&#xf3;n cubre una brecha critica en el panorama diagn&#xf3;stico, permitiendo una intervenci&#xf3;n oportuna para poblaciones expuestas a trauma en Ucrania.

Stigmatizing attitudes toward individuals with mental disorders represent a major barrier to treatment, recovery, and social inclusion. The present research introduces and psychometrically evaluates the German-language Stigma Toward People with Mental Disorders scale (SToP-MD) across three independent studies with distinct samples.In study 1 (N&#x2009;=&#x2009;266), an initial item pool was developed and refined based on theoretical frameworks and exploratory factor analysis. In study 2 (N&#x2009;=&#x2009;448), confirmatory factor analysis supported a two-factor structure comprising prejudiced stigmatization (SToP-MD-PS) and assumption of problems (SToP-MD-AP). The model demonstrated adequate fit according to conventional indices (CFI = 0.97, TLI = 0.96, SRMR = 0.07), although robust indices indicated only moderate fit (robust CFI = 0.91, robust RMSEA = 0.13). Internal consistency was good for the PS subscale (&#x3c9;&#x2009;=&#x2009;0.83) but limited for the AP subscale (&#x3c9;&#x2009;=&#x2009;0.51). In study 3 (N&#x2009;=&#x2009;266), the scale's sensitivity to short-term change was examined following exposure to differently framed media content.As hypothesized, the SToP-MD subscales were positively associated with depression stigma (DSS) and social distance (SDI), and negatively correlated with openness and agreeableness (NEO-FFI), supporting convergent validity. Discriminant validity was partially confirmed by low or non-significant correlations with attitudes toward physically disabled individuals (ATDP), suicide-related cognitions (CCSS), and socially desirable responding (BIDR).Across all three studies, the SToP-MD demonstrated preliminary yet consistent evidence of structural and construct validity, as well as change sensitivity. It captures both overt prejudices and implicit burden assumptions, offering a nuanced assessment of public stigma toward mental disorders. The scale can serve as a valuable tool in stigma research, public health monitoring, and evaluation of interventions. Future research should extend validation to more diverse samples and test predictive and longitudinal utility.