Depression and anxiety are highly comorbid during pregnancy, yet their symptom patterns may vary across gestational stages. Most existing studies rely on cross-sectional designs and overlook the dynamic interplay of symptoms over time. This study employs both cross-sectional and longitudinal network analyses to identify core and bridge symptoms and explore their temporal evolution throughout pregnancy. A total of 41,140 pregnant women in Shenzhen, China, were assessed between 2020 and 2022 during early, mid, and late pregnancy. Depressive and anxiety symptoms were measured using the nine-item Patient Health Questionnaire (PHQ-9) and the seven-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Cross-sectional networks were constructed using graphical Gaussian models with regularization, while longitudinal relationships were analyzed via cross-lagged panel network models. Symptom centrality and bridge roles were examined, and network accuracy and stability were assessed through bootstrapping. Across trimesters, core symptoms included excessive worry (GAD-A3), low energy (PHQ-D4), and anhedonia (PHQ-D1), with their prominence shifting over time. From early to mid-pregnancy, worthlessness (PHQ-D6) predicted anhedonia, while from mid to late pregnancy, anhedonia, worthlessness, and excessive worry had the strongest predictive effects. Cognitive rumination may underlie persistent worry and emotional distress, particularly in the context of unmet family support. Antenatal depression and anxiety are marked by dynamic shifts in worry, fatigue, and loss of pleasure. Findings underscore the need for trimester-specific screening and culturally adaptive intervention frameworks that account for dynamic symptom evolution.
Family members of individuals experiencing a first-episode psychosis may experience disruptions in their interpersonal emotion regulation processes during this period, which may in turn lead to internalised stigma. A cross-sectional study was conducted between January 2023 and January 2024 with 101 relatives of patients receiving inpatient treatment for first-episode psychosis in a state hospital in Türkiye. Data were collected using a sociodemographic form, the Self-Stigma Inventory for Families of Patients with Schizophrenia and the Cognitive Emotion Regulation Questionnaire. Group comparisons were performed using Mann-Whitney U and Kruskal-Wallis H tests. Associations were examined using Spearman's correlation, and linear regression assessed the association between self-stigma (independent variable) and total cognitive emotion regulation (dependent variable). Levels of internalised stigma were found to be low; however, they were significantly associated with total cognitive emotion regulation scores (β = 0.172, p = 0.049). Amongst the maladaptive strategies, self-blame, catastrophising and blaming others were positively associated with social withdrawal and concealment of the illness, whereas putting events into perspective was negatively associated with perceived worthlessness (p < 0.05). Differences were observed in certain subscales of the Cognitive Emotion Regulation Questionnaire across some sociodemographic variables; however, no significant differences were identified in the subscales of the Inventory for Families of Patients with Schizophrenia (p > 0.05). Maladaptive cognitive emotion regulation strategies are associated with higher internalised stigma and social withdrawal amongst relatives of individuals with first-episode psychosis. Integrating cognitive emotion regulation assessment into early intervention frameworks may strengthen family-focused psychosocial support.
The family is a fundamental social unit that significantly influences individual development and mental health. This study aimed to identify potential profiles of family health and explore the interrelationships between family health, depression, and self-efficacy among Chinese adults. A nationwide cross-sectional survey was conducted, and 9859 participants were selected from the sample population. The Short Form of the Family Health Scale (FHS-SF), the Patient Health Questionnaire-9 (PHQ-9), and the New General Self-Efficacy Scale (NGSES) were used in this survey. Latent profile analysis was performed based on FHS-SF items, followed by network analysis to explore the interrelationships among these variables. The family health status of Chinese adults was categorised into three profiles: dysfunctional family health group (25.5 %), moderate family health group (41.3 %), and optimal family health group (33.2 %). The network analysis showed that the central nodes of the three network models were D6 (Feeling of worthlessness), S2 (Confidence to accomplish difficult tasks), and S5 (Confidence to overcome challenges). Among the bridge nodes, D9 (Thoughts of death), F6 (Distrust of healthcare professionals), and F7 (Family external social support) played a bridging role across network models. Family health patterns among Chinese adults show significant heterogeneity. Early identification of high-risk individuals with dysfunctional family health and development of targeted family-focused interventions are essential. Strategies such as personalised psychological interventions, improved healthcare quality, and strengthened social support networks may enhance family health and reduce emotional disorder risks.
Depression and anxiety are prevalent among hospice patients. A detailed understanding of the symptom comorbidity and key symptoms of depression and anxiety among Chinese hospice patients can promote targeted interventions. This study investigates the depression and anxiety symptom network and compares networks in different symptom groups in 388 Chinese hospice patients. Patient Health Questionnaire-9 and the Seven-Item Generalized Anxiety Disorder Scale were used to measure depression and anxiety. Psychometric network analysis and latent class analysis were conducted using R and MPLUS. Hopelessness and anhedonia in depression and excessive worry and nervousness in anxiety symptoms were identified as the most central symptoms. Hopelessness, nervousness, and irritability were identified as the bridging symptoms. Latent class analysis identified two groups based on sixteen symptoms: "mild-symptom" and "moderately-severe-symptom." Significant global strength differences were found between the networks of the mild-symptom group and the moderately-severe-symptom group. In the mild-symptom network, hopelessness, excessive worry, uncontrollable worry, and anhedonia were the central symptoms, while hopelessness, worthlessness, and uncontrollable worry were the bridging symptoms. In the moderately-severe-symptom network, nervousness, difficulty relaxing, fatigue, impending doom, and uncontrollable worry were the central symptoms, while hopelessness and nervousness were the bridging symptoms. These findings suggest that hopelessness should be a primary intervention target to reduce overall depression and anxiety symptoms. Additional focus should be placed on anhedonia, excessive worry, and nervousness. Intervening in hopelessness, nervousness, and irritability helps reduce the concurrence between depression and anxiety. Nuanced intervention strategies should be implemented based on the severity of symptoms among hospice patients.
Chronic orofacial pain (COP) is a complex condition often resistant to treatment and associated with psychological comorbidities. Yet, its neuropsychological profile remains under-investigated. This case-control study aims to identify the cognitive, behavioral, and psychological profiles of COP and their associations with clinical symptoms, with a focus on persistent idiopathic facial pain (PIFP), a condition particularly underexplored. A cohort of 42 patients (COPc), including 23 with PIFP, and 42 healthy controls (HCs) underwent a comprehensive assessment of mood, coping strategies, personality traits, cognitive functioning, and social well-being. Between-group and correlation analyses were performed, and Bonferroni correction was applied to account for multiple comparisons. The psychological framework of COPc was marked by depressive symptoms, loneliness, alexithymia, poor quality of life, and low physical and mental well-being. Personality assessment indicated worthlessness. Catastrophizing was a dominant coping strategy, characterized by helplessness and rumination. Cognitive assessments revealed deficits in attention and executive functions. PIFP patients exhibited particularly psychological vulnerabilities, namely, catastrophizing thinking and difficulties in describing their own feelings. Correlation analyses showed complex relationships between cognitive, behavioral, and psychological impairments in COPc, and a strong association between the negative impact of pain symptoms on social life and psychological, catastrophizing, and cognitive functioning. This is the first study to characterize the neuropsychological profile of PIFP and COP conditions, revealing a complex interplay of cognitive, behavioral, and psychological vulnerabilities. These findings underscore the importance of addressing both neuropsychological and social functioning in the management of chronic pain to improve patient well-being.
This study aims to construct a depression symptom network in elderly hypertensive patients, identify central and bridging symptoms, and explore the association between network structure and modifiable risk factors. This study adopts a retrospective research design, reviewing the medical records and survey data of 562 elderly hypertensive patients from a tertiary comprehensive hospital from September 2022 to May 2023. The data was retrospectively collected from patient health records including a general demographic questionnaire, Insomnia Severity Index-7(ISI-7), 9-item Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Connor Davidson Resilience Scale-25 (CD-RISC-25). Calculate centrality indices (intensity, betweenness centrality, and intimacy) to identify core symptoms. A comprehensive network model integrating GAD-7, ISI-7, CD-RISC-25, and demographic variables was constructed. A total of 562 patients were enrolled in the study. The average score of PHQ-9 is (10.69 ± 3.42) points. Network analysis shows that anhedonia (PHQ1) exhibits the highest intensity centrality. The strongest partial correlation was observed between Sleep problems(PHQ3) and PHQ1 (weight=0.40), fatigue (PHQ4) and depressed mood (PHQ2) (weight=0.29), and PHQ4 and PHQ1 (weight=0.29). There are two different symptom clusters: somatic affective clusters (PHQ1, PHQ3, PHQ4) and cognitive vegetative clusters (appetite problems(PHQ5), feeling of worthlessness (PHQ6), concentration problems (PHQ7)). Suicide ideation (PHQ9) exhibits the lowest centrality. The comprehensive network model indicates a strong positive correlation between depression and anxiety (PHQ-GAD), depression and insomnia (PHQ-ISI), and anxiety and insomnia (GAD-ISI). The dimensions of psychological resilience, including self reinforcement, resilience, and optimism, are negatively correlated with PHQ scores (all P<0.001), while GAD-7 scores are positively correlated. There are edge connections between exercise (EX) and ISI, disease course (DU), and gender (GD). Drink (DR) is positively correlated with GD, while degree of education (DOE) is connected within demographic clusters and has an edge with GD. Network analysis revealed that in the depressive network of patients with hypertension, anhedonia is the most central symptom, indicating that it may become a primary intervention target. The comprehensive network uncovered significant interconnections among depression, anxiety, and insomnia. Furthermore, the resilience dimension negatively correlates with depressive symptoms, while there are edge connections between exercise and both insomnia and demographic factors, highlighting modifiable protective factors.
This study estimated the prevalence of past-two-week suicidal ideation and examined its demographic, clinical, and health-related correlates in a nationally representative Malaysian sample using machine learning. The National Health and Morbidity Survey (NHMS) 2019 in Malaysia comprised a nationally representative sample of 11,674 adults aged 18 and above. Suicidal ideation was assessed using Item 9 of the Patient Health Questionnaire-9 (PHQ-9), "Thoughts that you would be better off dead or of hurting yourself in some way" during the past two weeks. Exposure variables included depressive symptoms (PHQ-9 Items 1-8), self-rated health, acute physical health problems, chronic bodily pain, and medical check-up history. Three machine learning models, Random Forest, Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression, and K-Nearest Neighbours (KNN), were applied to identify significant predictors of suicidal ideation, with feature importance assessed using permutation importance and SHapley Additive exPlanations (SHAP) analyses. The estimated prevalence of past-two-week suicidal ideation was 2.3%. Depressive symptoms, especially low mood, worthlessness, appetite loss, fatigue, and concentration difficulties, were the strongest correlates. Among models, LASSO logistic regression showed the best balance of performance (Area Under the Curve [AUC] 0.80, accuracy 98%, sensitivity 100%), followed by Random Forest (AUC 0.88) and KNN (AUC 0.74). Key predictors included depressive symptoms, health-related factors, and sociodemographic variables such as being male, older, married, less educated, or having a lower income. The results underscore the need for targeted suicide prevention strategies that address both mental health and social determinants within the Malaysian context.
Late-life depression is common and often co-occurs with cognitive impairment, complicating its assessment and clinical management. Network analysis allows for a nuanced understanding of how individual depressive symptoms interact. This study examines differences in the network structure of depressive symptoms in geriatric patients with and without cognitive impairment. We included monocentric cross-sectional data of 3,990 hospitalized geriatric inpatients whose depressive symptoms were rated using the 15-item Geriatric Depression Scale (GDS). Patients were stratified into an unimpaired and impaired cognition group depending on the Mini-Mental State Examination (MMSE) (cut-off < 24 points). Network analyses were estimated separately for both groups using regularized logistic regression models. A network comparison test was conducted for group comparison. Our study showed that worthlessness was the most central depressive symptom. However, the network structures differed notably between the two groups, with less impact of feeling empty when cognitive impairment is present, as well as a stronger association between feeling unsatisfied and unhappy, and a weaker connection between feeling empty and bored. These differences highlight the need for clinicians and public health professionals to adapt their screening and intervention strategies to take into account the subtle presentation of depressive symptoms in older adults according to cognitive status.
Network analysis has been extensively used to study posttraumatic stress disorder (PTSD), but only a few studies have examined the network structure of ICD-11 complex PTSD (CPTSD). Currently, no networks of all CPTSD symptoms have been estimated on military samples. Therefore, this study aims to (1) explore the connections of CPTSD symptoms and (2) identify the most central symptoms in a clinical sample of military veterans presenting with CPTSD symptomatology. Danish treatment-seeking soldiers and veterans completed the International Trauma Questionnaire prior to commencing treatment at the Military Psychology Department in the Danish Defense. Network psychometrics were used to analyze the symptom structure and centrality strength index of self-reported CPTSD symptoms in veterans meeting criteria for CPTSD (N = 279). Stability of our results was assessed following the recommended guidelines to ensure reliability. Consistent with prior research, symptoms within the same CPTSD cluster were most strongly connected, except for affective dysregulation. Across all CPTSD symptoms, ‘external avoidance’ and ‘feelings of worthlessness’ emerged as the most central. These findings are consistent with prior networks reported in non-military samples (e.g., community samples) and may support the generalizability of the CPTSD symptom network across trauma-exposed groups. Not applicable. The online version contains supplementary material available at 10.1186/s12888-026-07954-w.
Suicidal ideation and behavior represent a serious public health concern, particularly during adolescence, and are closely linked to symptoms of depression and anxiety. Although previous studies have examined the network structure of suicidality and emotional symptoms, gaps remain regarding how different stages of suicidal ideation and behavior relate to internalizing symptoms. This study aimed to estimate the lifetime prevalence of suicidal ideation and behavior, examine the associations between depressive and anxiety symptoms and distinct forms of suicidal behavior, and compare symptom networks between adolescents who had or had not reported such experiences. A total of 4160 Spanish adolescents participated in this nationwide study, completing the Paykel Suicide Scale and the Assessment System of Children and Adolescents. 12.7 % of participants reported suicidal ideation and 3.6 % had attempted suicide, with higher rates among girls and older adolescents. Network analyses revealed that worthlessness, anhedonia, sadness, crying, panic attacks and intrusive thoughts were consistently associated with both passive and active suicidal ideation and attempts. Moreover, adolescents who had experienced suicidal ideation or attempts displayed stronger interconnections among depressive symptoms and between depressive and anxiety symptoms. The sample was partially based on convenience sampling, and the large amount of network comparisons limited power. These findings provide a comprehensive view of the psychopathological structure underlying suicidality in adolescence and contribute to the identification of key emotional symptoms that may be targets for early intervention and prevention strategies.
Internet addiction and depressive symptoms are common comorbid mental health problems among adolescents. This study aims to employ a cross-lagged panel network (CLPN) model to examine the longitudinal dynamic interactions between adolescent internet addiction and depressive symptoms at the symptom level, and to explore gender-specific patterns. A total of 1 138 adolescents from a middle school in a northern city were followed for 5 months with two waves of assessment. Internet addiction and depressive symptoms were measured using the Internet Addiction Test (IAT) and the Patient Health Questionnaire-9 (PHQ-9), respectively. CLPN was conducted using R software version 4.4.0 to estimate out-expected influence (out-EI) and in-expected influence (in-EI). The cross-lagged effects of depressive symptoms on internet addiction were stronger than the reverse effects. In the overall sample, feelings of worthlessness showed the highest out-EI. Gender-specific CLPN results indicated that, in males, suicidal ideation had significant negative cross-lagged effects on salience, neglect of work, and anticipation in internet addiction. In females, excessive internet use and lack of control showed significant positive cross-lagged effects. Depressive symptoms are key drivers of internet addiction in adolescents, with notable gender differences in symptom pathways. Future research and interventions should consider gender sensitivity and target specific symptom pathways to develop precise prevention and intervention strategies. 目的: 网络成瘾与抑郁症状是青少年常见的共病心理健康问题。本研究旨在采用交叉滞后网络模型，从症状层面揭示青少年网络成瘾与抑郁症状之间的纵向动态相互作用，并探究其性别差异模式。方法: 对北方城市一所中学的1 138名青少年进行为期5个月、共2次的纵向追踪调查，采用网络成瘾量表(Internet Addiction Test，IAT)和患者健康问卷(Patient Health Questionnaire-9，PHQ-9)分别评估其网络成瘾和抑郁症状。使用R 4.4.0软件进行交叉滞后网络分析(cross-lagged panel network analysis，CLPN)，评估发出预期影响(out-expected influence，out-EI)和接收预期影响(in-expected influence，in-EI)。结果: 抑郁症状对网络成瘾的交叉滞后效应强于反向效应。总样本中，无价值感是out-EI最高的症状。性别分组CLPN结果显示，自杀意念在男性组中对网络成瘾的突出性、忽视工作和预期有显著的负向交叉滞后效应;女性组中，网络过度使用和缺乏控制有显著的正向交叉滞后效应。结论: 青少年的抑郁症状是引发其网络成瘾的关键因素，其中不同性别的症状路径存在显著差异。未来需关注性别敏感性，针对不同性别的特定症状路径设计精准的预防和干预策略。.
The Patient Health Questionnaire-9 (PHQ-9) is one of the most widely used tools for screening and assessing depression. However, previous research has yielded inconsistent results regarding its factor structure, with studies suggesting either a one- or two-factor model. One possible explanation is socially desirable responding (SDR), which may arise if some items are perceived as more sensitive than others. This study examines whether such differences in perceived sensitivity exist and how they correspond to patterns reported in prior factor-analytic research. A total of 273 participants completed 36 paired comparisons of the PHQ-9 items, indicating which symptoms they would find more uncomfortable to disclose. Additionally, absolute judgments were collected, where participants rated each item as either uncomfortable or not uncomfortable to disclose. Data were analyzed using a paired comparisons model rooted in Thurstone’s law of comparative judgment to estimate the relative sensitivity of each item and whether they were more or less likely to be judged as (not) uncomfortable to disclose. Kendall’s coefficients of consistence and agreement were calculated to evaluate the internal consistency of participants’ responses and the level of agreement between them. Results showed that cognitive/affective symptoms, such as feelings of worthlessness and depressed mood were perceived as more sensitive than somatic symptoms like fatigue and sleep disturbances. Notably, the sensitivity estimates obtained in this study align closely with prior factor analytic findings that have supported a two-factor model distinguishing cognitive/affective and somatic symptoms. These findings suggest that social desirability may contribute to the underreporting of certain depression symptoms, potentially helping to explain inconsistencies in the PHQ-9’s factor structure. Researchers and clinicians should consider the impact of SDR when interpreting PHQ-9 scores to enable more accurate assessments of depression symptom severity. The online version contains supplementary material available at 10.1186/s40359-026-04067-7.
This study examined differential item functioning of the Geriatric Depression Scale - Short Form (GDS-SF) in the National Alzheimer's Coordinating Center (NACC) Uniform Data Set (UDS) to identify potential variables that produce measurement bias. Data from 14077 individuals' first NACC visit were analyzed. Multiple indicator, multiple causes (MIMIC) models assessed differential item functioning (DIF) of the 15-item GDS-SF across race, Hispanic ethnicity, primary language, sex, and cognitive status (Clinical Dementia Rating [CDR] scale scores), while adjusting for educational attainment. Participants were on average 73 (SD = 9.1) years old and 54.4% women. The majority (13 of 15) of the GDS-SF items demonstrated DIF. For many items, participants with any level of CDR cognitive impairment were more likely to endorse depressive symptoms. Findings indicate the presence of widespread DIF by cognitive impairment severity such that individuals with even mild cognitive impairment may respond differently to certain items on this measure. The Geriatric Depression Scale - Short Form (GDS-SF) showed differential item functioning (DIF) in 13 of 15 items across demographic and cognitive groups. Only two items-hopelessness and worthlessness-were invariant across all groups. Cognitive status (Clinical Dementia Rating [CDR]) most strongly influenced item endorsement patterns. Our study used a large, diverse sample (National Alzheimer's Coordinating Center Uniform Data Set [NACC UDS]) and robust DIF analytic methods. Findings highlight both reliable and problematic GDS-SF items for older adults.
Patients with polycystic ovary syndrome (PCOS) often experience anxiety, depression, and sleep problems in addition to endocrine and metabolic abnormalities, which may adversely affect their quality of life and disease progression. However, research on the co-occurrence patterns and interconnections among these psychological symptoms in PCOS remains limited. This study applied network analysis to explore the relationships among anxiety, depression, and sleep problems in women with PCOS, aiming to identify key symptom nodes and provide evidence for targeted psychological interventions. This retrospective study included 1,068 patients with PCOS. Anxiety, depression, and sleep problems were assessed using the Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire (PHQ-9), and Pittsburgh Sleep Quality Index (PSQI). Symptom networks were estimated using the Least Absolute Shrinkage and Selection Operator (LASSO) and Extended Bayesian Information Criterion (EBIC) in R software. Central and bridge symptoms were identified using expected influence (EI) and bridge expected influence (BEI). Network stability and accuracy were evaluated through bootstrap methods. The Network Comparison Test (NCT) was applied to analyze network differences across subgroups that vary by marital status and weight status. Network analysis revealed that the strongest edge was the connection between "Daytime dysfunction" and "Low energy" (PSQI7-PHQ4), spanning different symptom communities. Another edge of high intensity was observed between "Worthlessness" and "Suicidal ideation" (PHQ6-PHQ9). "Trouble relaxing" (GAD4) and "Sad mood" (PHQ2) exhibited the highest EI values within the network. Meanwhile, "Daytime dysfunction" (PSQI7) and "Low energy" (PHQ4) showed the highest BEI values. Network comparison analysis revealed no significant differences across marital and weight status subgroups. This study is the first to explore the symptom interrelationships among anxiety, depression, and sleep problems in PCOS patients. Targeting these central symptoms (e.g., trouble relaxing, sad mood) and bridging symptoms (e.g., daytime dysfunction, low energy) may more effectively alleviate patients' overall psychological issues and potentially interrupt the spread of comorbid psychiatric conditions. The findings of this study can inform the development of personalized mental health management strategies for patients with PCOS.
Objective: To evaluate the role of non-suicidal self-injury (NSSI) characteristics, negative affective states, and stressful life experiences (SLEs) in differentiating risk for suicidal ideation (SI) vs suicide attempt (SA) in college students. Participants: College students (n = 1,940; 1,493 women, 447 men) from a Florida university. Methods: Participants recruited via email completed an online survey. Network analysis was used to estimate and compare four risk networks. Results: Cutting, trauma, worthlessness, and depression were directly associated with both SI and SA, with cutting demonstrating the strongest associations. Cutting and discrimination were uniquely associated with SA, while burning and anger were uniquely associated with SI. Several gender differences were identified in associations between suicide risk factors. Conclusions: Our findings highlight the role of gender in differentiating NSSI features associated with suicide risk. Moreover, they emphasize the need to evaluate NSSI method and SLEs, particularly cutting and discrimination, in suicide risk assessment for college students.
This study aims to develop and validate a risk estimation model for identifying suicidal tendencies among middle school students. The effectiveness of the model is evaluated, offering insights for preventing and managing student suicides in educational institutions. This study employed a cross-sectional design. From December 2018 to January 2019, a total of 12,798 middle school students from all 18 public schools in an urban district of Suzhou were surveyed. After data cleaning, 12,063 valid questionnaires were included and randomly divided into a training set (n=8,444) and a validation set (n=3,619) in a 7:3 ratio for model development and internal validation, respectively. Predictors were selected through univariate analysis and LASSO regression, with independent associated factors subsequently identified by multivariable logistic regression. Based on these factors, a nomogram risk estimation model was constructed using R software. To assess generalizability, external validation was performed using data from 6,262 valid questionnaires collected from 11 public middle schools in Changshu, Suzhou, in 2023. The nomogram incorporated nine selected factors: trouble asking for help, parents' marital relationship, gender, school bullying, nightmares, depressive mood (PHQ02), sleep disturbance (PHQ03), feelings of worthlessness (PHQ06), and psychomotor changes (PHQ08). The model demonstrated good discrimination in the internal validation set area under the curve (AUC) 0.807 (95% CI [0.790, 0.824]) and in a temporal external validation cohort AUC 0.764 (95% CI [0.751, 0.778]). Calibration was satisfactory internally but required adjustment in the external cohort. This study developed and validated a multidimensional nomogram that effectively discriminates middle school students at risk of suicide, providing a framework for initial risk stratification. For application in new settings, local calibration of the model's risk estimates is mandatory. This tool holds potential to aid early identification in school and primary care contexts.
Major depressive disorder (MDD) is the leading cause of non-fatal disability in youth and disproportionately affects adolescent females. Structural MRI studies of adolescent depression have yielded inconsistent findings, potentially reflecting symptom heterogeneity and rapid developmental changes in brain morphology. In this longitudinal study, we examined associations between specific depressive symptoms and structural brain MRI measures in 9,722 youth (53% male, age range = 10.0-17.7, 24,378 observations) from the Adolescent Brain Cognitive Development (ABCD) Study. A four-wave panel graphical vector autoregression (GVAR) model was estimated to separate within-person (contemporaneous and temporal networks) from stable between-person effects. Brain measures included cortical thickness in the insula, cingulate, medial orbitofrontal cortex (mOFC) and fusiform gyrus, as well as hippocampal volume. Depressive symptoms included parent-reported depressed mood, anhedonia, lethargy, and worthlessness. Additionally, sex-differences in network structures were tested. Strong within-domain associations were observed among brain measures and among symptoms, with the largest effects in the symptom domain. Cross-domain (brain-symptom) associations emerged only at the within-person level, where elevated depressed mood was associated with contemporaneous and subsequent reductions in cingulate and fusiform gyrus thickness (partial r = [-0.02 - 0.04]). No cross-domain associations were detected in the between-person networks. Sex-differences emerged only in the within-person networks. Associations between brain structure and depressive symptoms were subtle, symptom-specific, and dynamic rather than reflecting stable individual differences. Longitudinal within-person approaches are therefore important for understanding neurodevelopmental contributions to adolescent depression risk.
Suicide is a complex and multidimensional public health problem that affects hundreds of thousands of people worldwide every year. This study was conducted to evaluate traumatic experiences and coping strategies from the perspective of individuals with repeated suicide attempts. Using a phenomenological design from qualitative research methods, this study was conducted with 18 individuals with repeated suicide attempts. Criterion sampling method, one of the purposeful sampling methods, was used in the study. Interviews continued until data saturation was achieved. All interviews were recorded with a voice recorder and then transcribed. The research data were analyzed using Colaizzi's phenomenological method, and the research was conducted and reported in accordance with the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. Three main themes (traumatic life events, psychological trauma and affect, coping strategies) and nine sub-themes (abuse, neglect, family dynamics, social problems, feelings of worthlessness and emptiness, anger and inner conflict, hopelessness and burnout, functional pathways, and hopeful steps) were obtained. This study highlights the multidimensional nature of suicidal behavior by revealing that repeated suicide attempts are closely related to traumatic events experienced by individuals, intense emotional processes, and the coping strategies they use.
Financial gambling inducements such as ‘free’ bets and welcome bonuses involve complex wagering requirements that many consumers miscomprehend. UK regulations cap these wagering requirements at x10 (i.e., users must wager x10 the bonus before withdrawal) but don’t require worked examples to aid comprehension. This study assessed UK bettors’ comprehension of inducement wagering requirements, whether comprehension varied by gambling severity, whether perceived attractiveness differed when worked examples were displayed, and bettors’ broader perceptions of inducements. A between-subjects, mixed-methods online experiment randomised UK bettors (n = 585) to view a welcome bonus inducement either with or without (control) a worked example detailing its wagering requirement. Participants completed measures of comprehension, perceived attractiveness, gambling severity, and qualitative questioning. Participants in the control condition significantly underestimated the inducement’s wagering requirements (p<.001, r=.94), with a median estimate of £500 versus the correct value of £750. Underestimation did not differ by gambling severity. The inducement was rated significantly less attractive (p<.001, η²=.18) when the worked example was displayed (M = 2.39, SD = 1.46) compared to the control (M = 3.75, SD = 1.48). However, this effect was moderated by gambling severity (B=-0.112, p=.005), with the reduction in perceived attractiveness associated with the worked example becoming smaller as gambling severity scores increased. Qualitative analysis identified three overarching perceptions of inducements: as manipulative, economically worthless, and requiring better regulation. UK bettors significantly underestimate inducements’ wagering requirements, while worked examples significantly reduce their mistaken attractiveness. These findings demonstrate how informed choice can be enhanced via worked examples.
Depression and social anxiety are frequently co-occurring conditions that significantly impact young people. Anhedonia may be important to consider in early interventions for these conditions, but the roles of specific dimensions of anhedonia-anticipatory and consummatory-are not well understood. This study explored the symptom connectivity of depression and social anxiety in university students, focusing on how the two dimensions of anhedonia relate to symptoms of both conditions. We conducted a cross-sectional network analysis of data from 672 university students (19-24 years). A Gaussian graphical model was used to investigate the relationship between anticipatory and consummatory anhedonia and symptoms of depression and social anxiety. Anticipatory anhedonia was distinctively connected with specific depression nodes (low mood and suicidal ideation) and social anxiety nodes (avoiding being the centre of attention and less fear of embarrassment). Consummatory anhedonia was related to a wider range of depression nodes (worthlessness/guilt, suicidal ideation, concentration problems and sleep problems) and all social anxiety nodes. Both dimensions of anhedonia demonstrated strong bridge expected influence (EI), alongside worthlessness/guilt and avoiding being the centre of attention, highlighting their relevance to both social anxiety and depression nodes. The findings refine our understanding of the psychopathology of depressive and social anxiety symptoms in young people and exemplify the importance of distinguishing the dimensions of anhedonia. Given its transdiagnostic associations, anhedonia may be important to account for in early interventions for depression and social anxiety. Future research should incorporate clinical samples and longitudinal data.