搜索结果：Harvard review of psychiatry

The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.

After participating in this CME activity, the psychiatrist should be better able to:• Describe the mental, physical, and social health risks experienced by individuals bereaved by suicide across different kinship groups.• Identify key gaps in the current suicide bereavement research literature and explain their implications for clinical postvention strategies.• Differentiate suicide bereavement-related risks by kinship group (offspring, parents, spouses, siblings) and age at the time of loss.• Recognize populations with the highest suicide bereavement-related vulnerabilities. Suicide bereavement is a global public health problem associated with adverse physical and mental health outcomes. While population-based registry studies offer a promising avenue to understand the impacts of suicide bereavement, there has been no systematic review of results from such studies. This systematic review examines mental, physical, and social health outcomes among suicide-bereaved individuals in global population-based registry studies, with a focus on differences in findings by outcome, kinship, and comparison group. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies registered in PubMed and PsycInfo. The review was conducted in April 2025. The initial search revealed 404 unique records. After screening and full-text review, 36 studies published between 2005-2024 were included. Most frequently, studies examined bereaved offspring (n = 20), followed by bereaved parents (n = 8), spouses (n = 5), siblings (n = 5), and unspecified familial relations (n = 5). Overall, suicide loss was frequently associated with adverse health outcomes, including mortality, particularly due to suicide, and mental health (e.g., major depression, self-harm), and some physical health concerns. Associations meaningfully differed by kinship and comparison group. This is the first systematic review on population-based registry research concerning relationships between suicide loss and adverse mental, physical, and social health outcomes. Future studies should examine patterns of disease comorbidity, expand types of kinship examined (e.g., roommates), and probe how risk varies by time since loss.

Lower respiratory infections (LRIs) remain the world's leading infectious cause of death. This analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides global, regional, and national estimates of LRI incidence, mortality, and disability-adjusted life-years (DALYs), with attribution to 26 pathogens, including 11 newly modelled pathogens, across 204 countries and territories from 1990 to 2023. With new data and revised modelling techniques, these estimates serve as an update and expansion to GBD 2021. Through these estimates, we also aimed to assess progress towards the 2025 Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) target for pneumonia mortality in children younger than 5 years. Mortality from LRIs, defined as physician-diagnosed pneumonia or bronchiolitis, was estimated using the Cause of Death Ensemble model with data from vital registration, verbal autopsy, surveillance, and minimally invasive tissue sampling. The Bayesian meta-regression tool DisMod-MR 2.1 was used to model overall morbidity due to LRIs. DALYs were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs) for all locations, years, age groups, and sexes. We modelled pathogen-specific case-fatality ratios (CFRs) for each age group and location using splined binomial regression to create internally consistent estimates of incidence and mortality proportions attributable to viral, fungal, parasitic, and bacterial pathogens. Progress was assessed towards the GAPPD target of less than three deaths from pneumonia per 1000 livebirths, which is roughly equivalent to a mortality rate of less than 60 deaths per 100 000 children younger than 5 years. In 2023, LRIs were responsible for 2·50 million (95% uncertainty interval [UI] 2·24-2·81) deaths and 98·7 million (87·7-112) DALYs, with children younger than 5 years and adults aged 70 years and older carrying the highest burden. LRI mortality in children younger than 5 years fell by 33·4% (10·4-47·4) since 2010, with a global mortality rate of 94·8 (75·6-116·4) per 100 000 person-years in 2023. Among adults aged 70 years and older, the burden remained substantial with only marginal declines since 2010. A mortality rate of less than 60 deaths per 100 000 for children younger than 5 years was met by 129 of the 204 modelled countries in 2023. At a super-regional level, sub-Saharan Africa had an aggregate mortality rate in children younger than 5 years (hereafter referred to as under-5 mortality rate) furthest from the GAPPD target. Streptococcus pneumoniae continued to account for the largest number of LRI deaths globally (634 000 [95% UI 565 000-721 000] deaths or 25·3% [24·5-26·1] of all LRI deaths), followed by Staphylococcus aureus (271 000 [243 000-298 000] deaths or 10·9% [10·3-11·3]), and Klebsiella pneumoniae (228 000 [204 000-261 000] deaths or 9·1% [8·8-9·5]). Among pathogens newly modelled in this study, non-tuberculous mycobacteria (responsible for 177 000 [95% UI 155 000-201 000] deaths) and Aspergillus spp (responsible for 67 800 [59 900-75 900] deaths) emerged as important contributors. Altogether, the 11 newly modelled pathogens accounted for approximately 22% of LRI deaths. This comprehensive analysis underscores both the gains achieved through vaccination and the challenges that remain in controlling the LRI burden globally. Furthermore, it demonstrates persistent disparities in disease burden, with the highest mortality rates concentrated in countries in sub-Saharan Africa. Globally, as well as in these high-burden locations, the under-5 LRI mortality rate remains well above the GAPPD target. Progress towards this target requires equitable access to vaccines and preventive therapies-including newer interventions such as respiratory syncytial virus monoclonal antibodies-and health systems capable of early diagnosis and treatment. Expanding surveillance of emerging pathogens, strengthening adult immunisation programmes, and combating vaccine hesitancy are also crucial. As the global population ages, the dual challenge of sustaining gains in child survival while addressing the rising vulnerability in older adults will shape future pneumonia control strategies. Gates Foundation.

There is widespread interest in complementary and integrative medicine (CIM) among people with Tourette's syndrome (TS). To perform a systematic review of evidence on the use of CIM to reduce tics and improve tic-related quality of life. We included clinical studies of CIM in children, adolescents and adults with TS and chronic tic disorders, and assessed the change in tic severity and/or tic-related quality of life using validated scales. Risk of bias of randomized controlled trials was assessed using the risk of bias tool of the American Academy of Neurology, which classifies studies into Class I, II, III or IV based on quality criteria. 49 clinical studies and three systematic reviews were included. Most studies were rated Class IV and therefore at high risk of bias. Class I studies demonstrated efficacy of functional MRI neurofeedback, 5-Ling granule, Jingxin Zhidong formula, and Ningdong granule in reducing tic severity. Class II studies suggest efficacy of mindfulness-based intervention for tics, acupuncture combined with atlantoaxial joint bone setting therapy, and art therapy. Systematic reviews summarizing the Chinese literature on acupuncture, acupuncture with herbal medicine and massage therapy suggest greater reduction in tics compared to conventional treatments but there is low confidence in the evidence due to poor methodological quality of included studies. Evidence to support the use of complementary and integrative medicine for TS is limited in methodological quality and widespread applicability. These limitations prohibit evidence-based recommendations for general use among individuals with TS.

Peer support has proven effective in improving clinical, psychosocial, and recovery-oriented outcomes for persons with serious mental health challenges. This review builds on this evidence with the goal of identifying the competencies and implementation features of peer support interventions. We identified 41 articles for inclusion. Eligible studies consisted of randomized controlled trials that tested the effectiveness of peer support services for adults living with serious mental health challenges. We extracted and synthesized data on the competencies peer supporters demonstrated and implementation elements, including recruitment, training, supervision, and quality monitoring. Most studies were from high-income country settings, with the majority from the United States (75.6%). A competency taxonomy was developed based on the Substance Abuse and Mental Health Services Administration's peer support core competencies guidelines, and through additional thematic content analysis. Out of the 16 peer support and clinical competencies identified, the most frequently deployed peer support competencies were collaboration and care (90%), providing support (83%), and communication (73%); the most frequently deployed clinical competency was mental health diagnosis and psychoeducation (51%). Peers were primarily recruited from community organizations. Although reports on training length and format were inconsistent, trainings were most often reported as in person and ranged from a few hours to 192 hours. Supervisors of peer supporters included more experienced peer supporters, clinicians, or other staff, and supervision consisted of reviewing quality ratings and providing feedback on specific cases. Our findings confirm the salience of a relatively small set of competencies across peer support interventions which could be considered universal for standardization and scaling up, as well as best practices for training and supervision. Future research should aim to identify additional competencies that are contextually sensitive or address the needs of vulnerable groups.

The effect of Early Technology Review (ETR) through early engagement with multiple stakeholders on strategic development for technologies at prototype development and proof of concept was examined through two generic case studies of relevant outcomes. In both examples, advice to companies could have significantly changed strategic direction to become more relevant to payers and clinical experts. In one instance, the advice was followed and resulted in an expedited first-in-human study and was considered for a second ETR to inform the proof-of-concept study. In the second example, it was reported that changes in strategic direction were being considered.These reports provide descriptive accounts of very early applications of the ETR process that now spans the entire preclinical trajectory. Had the second case study at proof of concept been able to benefit from this approach at the point of prototype development, it could have avoided the costs and research through earlier advice. This begs the question whether a sequential iterative approach to evidentiary multiple stakeholder advice across the technology life cycle may reduce risk and cost while benefitting from efficiencies of applying adaptive design.

Violence against women and against children are human rights violations with lasting harms to survivors and societies at large. Intimate partner violence (IPV) and sexual violence against children (SVAC) are two major forms of such abuse. Despite their wide-reaching effects on individual and community health, these risk factors have not been adequately prioritised as key drivers of global health burden. Comprehensive x§and reliable estimates of the comparative health burden of IPV and SVAC are urgently needed to inform investments in prevention and support for survivors at both national and global levels. We estimated the prevalence and attributable burden of IPV among females and SVAC among males and females for 204 countries and territories, by age and sex, from 1990 to 2023, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023. We searched several global databases for data on self-reported exposure to IPV and SVAC and undertook a systematic review to identify the health outcomes associated with each of these risk factors. We modelled IPV and SVAC prevalence using spatiotemporal Gaussian process regression, applying data adjustments to account for measurement heterogeneity. We employed burden-of-proof methodology to estimate relative risks for outcomes associated with IPV and SVAC. These estimates informed the calculation of population attributable fractions, which were then used to quantify disability-adjusted life-years (DALYs) attributable to each risk factor. Globally, in 2023, we estimated that 608 million (95% uncertainty interval 518-724) females aged 15 years and older had ever been exposed to IPV, and 1·01 billion (0·764-1·48) individuals aged 15 years and older had experienced sexual violence during childhood. 18·5 million (8·74-30·0) DALYs were attributed to IPV among females and 32·2 million (16·4-52·5) DALYs were attributed to SVAC among males and females in 2023. IPV and SVAC were among the top contributors to the global disease burden in 2023, particularly among females aged 15-49 years, ranking as the fourth and fifth leading risk factors, respectively, for DALYs in this group. Among the eight health outcomes found to be associated with IPV, anxiety disorders and major depressive disorder were the leading causes of IPV-attributed DALYs, accounting for 5·43 million (-1·25 to 14·6) and 3·96 million (1·71 to 6·92) DALYs in 2023, respectively. SVAC was associated with 14 health outcomes, including mental health disorder, substance use disorder, and chronic and infectious disease outcomes. Self-harm and schizophrenia were the leading causes of SVAC-attributed burden, with SVAC accounting for 6·71 million (2·00 to 12·7) DALYs due to self-harm and 4·15 million (-1·92 to 13·1) DALYs due to schizophrenia in 2023. IPV and SVAC are substantial contributors to global health burden, and their health consequences span a variety of individual health outcomes. Importantly, mental health disorders account for the greatest share of disease burden among survivors. Investing in prevention of these avoidable risk factors has the potential to avert millions of DALYs and considerable premature mortality each year. Our findings represent strong evidence for global and national leaders to elevate IPV and SVAC among public health priorities. Sustained investments are needed to prevent IPV and SVAC and to implement interventions focused on supporting the complex social and health needs of survivors. Gates Foundation.

Incarcerated populations face greater health challenges, including higher rates of communicable and mental diseases. However, traditional health measures like disease prevalence and life expectancy do not capture their physical, mental, emotional, and social well-being. This scoping review will summarize the health-related quality of life (HRQoL) outcomes in incarcerated populations using preference-based HRQoL instruments (and measures that can be used to derive utility scores), providing insights for health policies and economic evaluations. A scoping review was conducted following PRISMA-ScR guidelines. Six electronic databases and three health technology assessment agencies were searched for peer-reviewed studies reporting preference-based HRQoL or HRQoL scores that can be used to generate health state utility values in incarcerated populations. Eligibility and data extraction were performed by two independent researchers.Findings were synthesized to identify knowledge gaps. Twenty-two articles met the inclusion criteria, primarily focusing on male and white populations. Ten studies targeted disease-specific populations, with mental health disorders (n = 7) being the most prevalent. Across studies, inmates generally reported lower HRQoL scores than the general population, especially those with mental health issues. Female and Indigenous inmates had lower HRQoL scores than male and non-Indigenous inmates. The variety in HRQoL instruments used, with each assessing different domains, hinders direct comparisons between studies. Validating instruments specific to incarcerated populations may be needed for future research. Overall, incarcerated populations, especially women and Indigenous inmates, demonstrate poorer HRQoL than the general population. There is a need for more diverse, inclusive studies to address these gaps. Incarcerated populations face greater health issues that are not fully captured by traditional health measures. Health-related quality of life (HRQoL) provides a more comprehensive view of their physical, mental, emotional and social well-being. This study summarizes HRQoL research in incarcerated populations using standardized tools. The purpose of this study is to provide a scoping review of the HRQoL outcomes of incarcerated populations, summarizing existing research and identifying gaps in the literature. Our findings reveal that inmates generally have lower HRQoL scores compared to the general population, and those with mental health issues reporting the lowest scores. Additionally, female and Indigenous inmates tend to have poorer HRQoL than male and non-Indigenous inmates. The findings highlight the need for HRQoL tools specifically tailored to incarcerated populations and call for more diverse studies, particularly for underrepresented groups.

Restless legs syndrome (RLS) is a sleep-related movement disorder that affects approximately 3% of US adults to a clinically significant extent and can cause substantial sleep disturbance. Restless legs syndrome is characterized by an overwhelming urge to move the limbs, typically the legs, often accompanied by unpleasant limb sensations (eg, achiness, tingling). Symptoms, provoked by immobility, are relieved while moving and are typically present or most severe in the evening or at night. Restless legs syndrome symptoms may lead to difficulty falling asleep, staying asleep, or returning to sleep. According to population-based studies, approximately 8% of US adults experience RLS symptoms of any frequency annually and 3% experience moderately or severely distressing symptoms at least twice weekly. Patients with RLS have impaired quality of life and elevated rates of cardiovascular disease (29.6% with coronary artery disease, stroke, or heart failure), depression (30.4%), and suicidal ideation or self-harm (0.35 cases/1000 person-years). Restless legs syndrome is common among patients with multiple sclerosis (27.5%), end-stage kidney disease (24%), and iron deficiency anemia (23.9%); during pregnancy and especially in the third trimester (22%); with peripheral neuropathy (eg, diabetic, idiopathic; 21.5%); and with Parkinson disease (20%). Other risk factors include family history of RLS, northern European descent, female sex (2:1 vs male sex), and older age (RLS prevalence of 10% in adults &#x2265;65 years). Restless legs syndrome is diagnosed based on clinical history; polysomnography is not recommended for diagnosis. Iron supplementation with ferrous sulfate (325-650 mg daily or every other day) or intravenous iron (1000 mg) should be initiated for serum ferritin level less than or equal to 100 ng/mL or transferrin saturation less than 20%. If possible, medications associated with RLS, including serotonergic antidepressants, dopamine antagonists, and centrally acting H1 antihistamines (eg, diphenhydramine), should be discontinued. Gabapentinoids (eg, gabapentin, gabapentin enacarbil, pregabalin) are first-line pharmacologic therapy. In randomized clinical trials, approximately 70% of patients treated with gabapentinoids had much or very much improved RLS symptoms vs approximately 40% with placebo (P&#x2009;<&#x2009;.001). Dopamine agonists (eg, ropinirole, pramipexole, rotigotine) are no longer recommended as first-line medications due to the risk of augmentation, an iatrogenic worsening of RLS symptoms, which has an annual incidence of 7% to 10% with these medications. Patients who do not improve with first-line treatment or have augmented RLS often benefit from low-dose opioids (eg, methadone 5-10 mg daily). Restless legs syndrome affects approximately 3% of adults and can have negative effects on sleep and quality of life. Initial management includes cessation of exacerbating medications, as well as iron supplementation for patients with low-normal iron indices. If medication therapy is indicated, gabapentinoids are first-line treatment.

Studies evaluating the effect of anti-inflammatory treatment on depressive symptom severity and anhedonia in depressed individuals report mixed results. In this preregistered systematic review and meta-analysis, the authors evaluated whether anti-inflammatory treatments, compared to placebo, reduce anhedonia and depressive symptom severity in depressed individuals with an inflammatory phenotype. The authors included randomized controlled trials of pharmacological anti-inflammatory treatments that assessed anhedonia or depressive symptom severity and recruited depressed individuals with an inflammatory phenotype or measured baseline inflammatory biomarkers that permitted post hoc analysis. A search was conducted in February 2025 of MEDLINE, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and PsycINFO. Multiple reviewers independently applied criteria, and discrepancies were resolved via consensus. Two reviewers independently extracted data and cross-checked for errors. In randomized controlled trials (k=11) using an established cutoff for elevated inflammation (C-reactive protein &#x2265;2 mg/L), both anhedonia (Hedges' g=0.40, 95% CI=0.08, 0.71) and depressive symptoms (Hedges' g=0.35, 95% CI=0.05, 0.64) were reduced, but no differences in treatment response (relative risk=1.28, 95% CI=0.997, 1.64) or remission rates (relative risk=1.18, 95% CI=0.71, 1.95) were observed. Results did not vary by clinical, interventional, or demographic characteristics. Anti-inflammatory treatments may be safe and effective at reducing depressive symptoms and anhedonia in depressed individuals with heightened inflammation. Not accounting for inflammatory status may help explain prior mixed findings.

Public and Community Psychiatry training prepares residents to care for underserved populations, including people with severe mental illness (SMI), people with substance use disorder (SUD), sexual and gender minorities, and those experiencing homelessness. While Public and Community Psychiatry training primarily occurs in psychiatry rotations, core competencies, such as addressing stigma and providing care for marginalized communities, are also essential in other medical specialties. Assessment methods vary widely, making competency evaluation challenging. This review aimed to examine educational assessments in Public and Community Psychiatry training and evaluate their effectiveness in measuring resident competencies. We conducted a narrative review assessing knowledge, behaviors, and competencies in Public and Community Psychiatry training. A search was performed across PubMed, ERIC, and PsycINFO in August 2024. Studies using validated tools or custom surveys were included. Abstracts, reviews, and non-English publications were excluded. Forty-one studies were categorized into five focus areas: general Public and Community Psychiatry assessment, SMI and mental health stigma, SUD, other marginalized populations, and specialized training. Validated tools such as the Community Attitudes Toward the Mentally Ill Scale (CAMI), Drug and Drug Problems Perceptions Questionnaire (DDPPQ), Health Professionals' Attitudes Toward the Homeless Inventory (HPATHI), Genderism and Transphobia Scale (GTS), and Competency Assessment Instrument for Violence Risk (CAI-V) demonstrated reliability. However, many studies relied on non-validated tools and assessed only short-term changes, limiting generalizability. While validated tools show promise, the lack of standardized, longitudinal assessments limits competency assessment. Integrating validated tools into structured frameworks with long-term assessments could improve training evaluation and better prepare residents across different specialties to provide care for underserved populations.

Scientific research on the mental health effects of disasters has primarily focused on short-term consequences. This review aims to provide a long-term perspective, examining multiple contributing factors simultaneously. We registered this review (PROSPERO 2020, CRD42020108528), and searched Medline, PsycInfo, PTSDpubs, Web of Science, and SocINDEX from inception to July 2024. After screening 33,205 titles and abstracts, we extracted epidemiological longitudinal data from 71 studies, with up to six waves and a total of 137,004 participants. Disaster type (natural/human-made), category (e.g., earthquakes, floods, terrorist attacks), mental health outcome (e.g., posttraumatic stress disorder, depression, anxiety), population type (children/adolescents, adults), disaster year, measurement month, study quality, and country income were included in a multilevel meta-analysis. Pooled average prevalence of current or recent mental health problems was 22.1% (95% CI [10.95-39.57]). When controlling for the other factors, prevalence did not differ by disaster type, category, mental health outcome, population type, year, study quality, or country income. Despite high heterogeneity, the mental health burden in exposed populations decreased from month 1 to 300 after an initial peak in the first months, followed by a second peak after approximately a decade, before declining again ( p <0.001). Mental health burdens post-disaster may be more universally distributed than previously believed. Earlier studies identifying gradual post-disaster recovery may have underestimated the long-term effects. The analysis revealed a shortage of high-quality studies with measurements beyond four years. The topic requires further investigation with consistently repeated measurements at standard intervals to confirm the presence and early predictors of both larger and smaller peaks.

Disaster-related prenatal maternal stress, whether due to natural or human-made crises, can have profound effects on offspring health and development. This narrative review synthesizes research findings on the epigenetic mechanisms through which prenatal maternal stress influences long-term offspring health outcomes. Focusing primarily on DNA methylation, we examine how exposure to stress during gestation alters the epigenetic profile and may contribute to mental, cognitive, and physical health vulnerabilities. Studies were categorized based on disaster type, including time-limited events such as hurricanes, floods, and earthquakes, and stressors like the COVID-19 pandemic and famine. Key findings highlight the timing of exposure, sex-specific epigenetic effects, and the potential for epigenetic markers to mediate stress-induced health outcomes. While considerable progress has been made, our review emphasizes the need for further research on how epigenetics may mediate mental health outcomes and the development of interventions that target these molecular mechanisms.

Objective: To evaluate the effects of gender-affirming surgery (GAS) on quality of life and gender dysphoria (GD) among individuals in the United States. Data Sources: A literature search was conducted using PubMed, Web of Science, APA PsycINFO, APA, CINAHL Combined, and LGBTQ+ Source from February 2017 to February 2023. Randomized controlled trials and case reports/case series that described GD, quality of life, and gender surgery in the context of the United States were included. Study Selection: Five independent reviewers analyzed the studies; conducted screening of titles, abstracts, and full texts; resolved any disagreements through multiple rounds of review; and manually eliminated duplicate references. Reasons for exclusion were documented. The comprehensive search yielded 864 potentially relevant studies, of which 11 were included in the final analysis. Data Extraction: For data analysis, the authors recorded information including mean age, gender assigned at birth, race, sample size, type of GAS, and measures/ questionnaires used to assess GD before and after surgery, concurrent therapies, history of mental health illnesses, and postoperative complications. Results: The results showed that after the participants received combined procedures on the face, chest, or genitalia, there was a significant improvement in self-worth, social and psychological well-being, and sexual and physical appearance satisfaction, improving overall quality of life and GD. Conclusions: Gender identity is a complex subject, and although the research is gaining momentum, much is yet to unfold. Despite the recent increase in access to gender assignment surgeries, there is a paucity of research to assess the quality of life and GD among these individuals after surgical interventions and among individuals who have accepted themselves.

Economic hardship-including poverty, housing insecurity, unemployment, food insecurity, and debt-is among the most consistently documented determinants of mental health. Extensive epidemiologic and social science research shows that adverse economic conditions increase the risk, severity, and persistence of depression, anxiety, suicidality, and severe mental illness. Although social policies can improve mental health outcomes, relatively few interventions within mental health systems target economic determinants. Those that do are often professionally designed and limited in scope. In this perspective article, we argue that advancing effective and equitable interventions that address economic determinants of mental health requires meaningful participation of people with lived experiences of economic hardship and mental health challenges. Drawing on epistemological and empirical literatures, we conceptualize lived experience as a form of expertise and contend that its systematic exclusion constitutes epistemic injustice and a barrier to intervention relevance and effectiveness. Using the International Association for Public Participation's Spectrum of Public Participation, we propose a framework for integrating lived experience expertise across the intervention cycle (i.e., needs assessment, design, implementation, and evaluation). Emphasizing collaboration and empowerment, we illustrate this framework with examples from the literature and highlight both its promise and limitations. We then identify systemic factors underlying these challenges-such as funding structures, governance, regulatory constraints, and capacity gaps-and offer practice-informed recommendations to address them. We conclude with a call to psychiatry and clinical professions to act as allies in redistributing epistemic and decision-making authority, positioning lived expertise as essential to interventions addressing economic determinants of mental health.

Substance use disorder (SUD) remains a major public health crisis in the United States, with significant challenges in treatment access, retention, and workforce capacity. SUD care teams, including addiction medicine physicians and peer recovery coaches (PRCs), support patients receiving SUD treatment but face heavy workloads and burnout. Artificial intelligence (AI) innovations, particularly large language model (LLM)-based chatbots, may extend PRC support and provide patients with on-demand recovery support between clinic visits and PRC contacts. However, evidence on their development, feasibility, acceptability, and usability in addiction services remains limited. This study describes the development, feasibility, acceptability, and usability of an AI-powered health coaching chatbot (Suzy) designed to support patients in SUD recovery. A total of 2 clinicians, 5 researchers, and 2 technology developers led a small, multiphase pilot study. In the formative phase, they conducted focus groups and qualitative in-depth interviews with 12 health care professionals and 8 patients with substance use histories to specify chatbot functions and develop a rule-based chatbot. In phase 2, they conducted usability testing of the rule-based chatbot with 8 patients who reported substance use and completed standardized tasks, surveys, and qualitative interviews. Measures included the System Usability Scale (SUS), Net Promoter Score (NPS), and Single Ease of Use Question (SEQ). In phase 3, they developed an LLM-based chatbot co-designed and fine-tuned with PRCs and other SUD experts. Rule-based chatbot functions included craving management, appointment reminders, resource referrals, care team contacts, and goal setting. Usability task testing supported feasibility. In this small pilot sample, quantitative and qualitative feedback indicated acceptability and usability, with an average SUS score of 93 (benchmark 68), an NPS of 63 (benchmark 35), and a mean SEQ score of 6.5/7. Patients valued Suzy's approachable, nonjudgmental language and features that promoted accountability, self-monitoring, and 24/7 availability, while emphasizing that chatbots should supplement but not replace human support. The LLM-based chatbot development emphasized information accuracy, safety escalation protocols to mitigate risks of inappropriate chatbot responses, human-in-the-loop features, and expanded conversational flexibility and personal tailoring. In this pilot study, a rule-based chatbot designed to support SUD care demonstrated feasibility, usability, and acceptability. LLM-based chatbot development required more robust safety and emergency reporting features, while offering more patient-responsive conversational functions. By providing on-demand coaching, referrals, and reminders, Suzy may extend the reach of care teams, alleviate provider burden, and enhance patient engagement. Additional work is needed to understand how to best integrate Suzy into patients' recovery journeys to ensure human support remains accessible and prioritized. LLM evaluation was based on expert testing and safety review. Clinical effectiveness, including the impact on substance use, was not evaluated. Next steps include evaluating the LLM chatbot in real-world settings with larger samples and assessing its efficacy in reducing substance use.

Climate change is a global health crisis with substantial mental health consequences. Despite its growing impact, climate-related mental health topics remain insufficiently integrated into medical education. This review synthesizes studies describing educational interventions and assessment tools that address the intersection of climate change and mental health. We conducted a narrative literature review across PubMed, Education Resources Information Center, and PsycINFO in March 2025. Studies were included if they described an educational intervention related to climate-health topics with mental health content or relevance, involved learners in health-related fields, and reported outcomes using validated or author-developed instruments. Fifteen studies met inclusion criteria. Seven described educational interventions, including longitudinal curricula, clerkship sessions, telementoring, and innovative formats such as narrative medicine and reflective tool kits. Fourteen studies included assessment tools, though only one reported psychometric validation (Cronbach's &#x3b1;=0.90). To characterize heterogeneity, studies were grouped by type of climate-health educational focus: direct clinical mental health education (n=9), general climate health education with mental health implications (n=3), and climate-health curricular gap analyses (n=3). Across interventions, outcomes demonstrated improved knowledge, confidence, and preparedness to address climate-related psychological impacts, but barriers remain, particularly limited faculty training, institutional constraints, and absence of validated evaluation frameworks. Current efforts to integrate climate-mental health topics into medical education are promising but still fragmented. Advancing the field requires standardized curricula with explicit and related mental health content, validated assessment tools, interdisciplinary faculty development, learner-centered approaches, climate justice and health equity principles in training, inclusion in board exams, and long-term evaluation.

The pathophysiology of depressive disorder (DD) has been linked to the inflammatory process, and neutrophil-to-lymphocyte ratio (NLR) is considered a marker of systemic inflammation. Increasing research suggests a potential correlation between NLR and DD onset and prognosis. Current literature, however, presents conflicting results, highlighting a need for further investigation. A systematic literature search was performed in PubMed, Embase, Web of Science, and the Cochrane Library, from inception to September 4, 2024, to identify studies evaluating the relationship between NLR and DD. The primary outcomes pointed to DD prevalence and suicide risk in individuals with DD. Sensitivity and subgroup analyses were conducted to explore the heterogeneity and robustness of results. Meta-analyses were executed using STATA 15.0 and Review Manager 5.4.1. A total of 37 studies comprising 88,019 participants were included. Categorical analyses showed that high NLR was significantly associated with presence of DD (odds ratio [OR]: 1.57, 95% confidence interval [CI]: 1.28, 1.93). Continuous analyses revealed elevated NLR levels in individuals diagnosed with DD (standardized mean difference [SMD]: 0.73, 95% CI: 0.51, 0.94). Furthermore, increased NLR was associated with heightened suicide risk among those with DD (categorical outcome OR: 1.56, 95% CI: 1.26, 1.94; continuous outcome SMD: 0.42, 95% CI: 0.23, 0.61). Elevated NLR is associated with higher prevalence of DD and increased suicide risk in this patient population. NLR may serve as a promising biomarker for diagnosing and assessing individuals with DD.

Research demonstrates the effectiveness of evidence-based psychological treatment adjunctive to pharmacotherapy for reducing mood symptoms in bipolar disorder. However, access to these treatments is limited, and innovative strategies are needed to ensure that more patients with bipolar disorder receive the gold-standard treatments that may help them achieve wellness. "Stepped care" models of psychological service delivery represent one potential solution to this problem of treatment access. Under a stepped care model, patients are assigned the minimum necessary psychological treatment for symptom improvement. This typically means that patients who are experiencing more symptoms are assigned to a treatment of greater intensity (e.g., weekly individual therapy) whereas patients who are experiencing fewer symptoms are assigned to a treatment of relatively lesser intensity (e.g., biweekly group therapy). Stepped care models are dynamic, meaning that the level of treatment can be modified depending on the patient's response. Stepped care models have been explored in other clinical populations but require further exploration in bipolar disorder. Members of the Psychological Interventions Task Force for the International Society of Bipolar Disorders conducted a narrative review of stepped care models and their application to bipolar disorder. We found evidence that stepped care models are useful approaches to delivering psychosocial treatments for bipolar disorder. We discuss several contextual factors in executing stepped care models in this population (i.e., cultural and pediatric applications), as well as share an example of a stepped care model-Focused Integrated Team-based Treatment for Bipolar Disorder (FITT-BD)-that is currently being evaluated in an academic medical center. Further research is warranted to develop and assess robust stepped care models to determine whether they can improve access to treatment of bipolar disorder while not sacrificing outcomes.