The identification of clinical risk factors in individuals at genetic risk of developing bipolar disorder (BD), and who subsequently go on to develop BD, may enable targeted early intervention. Affective lability has been reported to be increased in youth at familial risk of psychiatric illness, and to predict onset of BD in prospective studies. However, parent-reported and child self-reports of affective instability may be discrepant. We measured affective lability at baseline using both the self- and parent-reported versions of the Children's Affective Lability Scale (CALS) in a multisite (US and Australian) cohort of 315 young unaffected individuals, aged 12-21, at high familial risk of BD (HR), 165 controls, and 13 patients with established BD. New onsets of threshold and subthreshold BD were assessed prospectively. Parental, but not child, reports of affective lability at baseline were significantly higher in HR who later developed first onset of either threshold (N = 12) or subthreshold BD (n = 27); these differences were driven by irritability and anxiety/depression factors but not by the mania factor of the CALS. While our study is well powered for whole group comparisons, the HR subgroup analyses (of threshold and subthreshold BD groups separately) were underpowered. Parental reports of affective lability in youth at increased familial risk to BD may assist clinicians in detecting individuals at elevated risk of converting to BD, but they do not constitute a validated clinical prediction tool.
Mothers of children with physical disabilities often experience caregiving-related stress that may negatively affect their psychological well-being and quality of life. Mindfulness-based interventions may help reduce stress by improving awareness and emotional regulation. This study aimed to examine the effect of a mindfulness-based stress reduction (MBSR) program on parental stress, mindfulness, and quality of life in mothers of children with physical disabilities. This single-blind randomized controlled trial included 62 mothers randomly assigned to either the MBSR group (n = 32) or the control group (n = 30). The intervention group received an 8-week MBSR program with weekly 60-90 minute sessions, while the control group received no intervention. Outcomes were assessed at baseline and post-intervention using the Parent Stress Scale (PSS), Mindful Attention Awareness Scale (MAAS), and World Health Organization Quality of Life Questionnaire-Brief Version (WHOQOL-BREF). Data were analyzed using repeated measures two-way analysis of variance in SPSS version 25. Compared with the control group, the MBSR group showed a significant reduction in parental stress and a significant increase in mindfulness (p < 0.05). Significant improvements were also observed in the psychological and environmental domains of quality of life (p < 0.05), whereas no significant between-group differences were found in the physical and social domains (p > 0.05). The MBSR program increases the level of mindfulness in parents of physically disabled children, reduces perceived stress, and significantly improves the quality of life, particularly in terms of psychological and environmental dimensions. Mindfulness-based interventions may be considered as a supportive approach within family-centered rehabilitation programs.
Peer support has a long history of being offered through community programs, and is increasingly formalized in mental health services to facilitate recovery-oriented care for mental health concerns such as bipolar disorder (BD). This qualitative study explored experiences of community-based peer support programs from the perspective of people with BD, to generate insights to optimise the delivery of peer support in clinical settings. Adults living in Canada with BD, who had participated in or provided peer support, participated in one of five 90-min focus groups. Participants were questioned about interacting with peers, helpful and unhelpful group aspects, and facilitators of positive outcomes. Thematic analysis was used to identify key aspects of peer support. Sixteen individuals with BD (81% women) participated in qualitative focus groups. Four overarching themes were generated to describe the benefits, challenges, and conduct of peer support: 1) Someone who knows what it's like, 2) Learning from one another, 3) Challenging interpersonal dynamics, 4) A good facilitator makes a world of difference. While findings may have been weighted towards the perspectives of individuals with positive experiences, they generate future research questions regarding peer support processes and outcomes that are as yet understudied in the BD literature. Including lived experience perspectives in the design of evaluation studies is therefore recommended to ensure patient-valued outcomes are included. Given the critical role of facilitation in safeguarding against challenging experiences, investment in co-designed training programs is called for, leveraging the expertise of community programs.
The postpartum period is a particularly vulnerable time in the lives of parents, leading to adverse mental health outcomes for them and, as a result, their children. Relative to demand, there is a pronounced lack of inpatient treatment options for mother-baby-dyads in Germany and beyond, creating a need for additional mother-baby units and the assessment of their effectiveness. The present study is a retrospective evaluation based on routine data from the mother-baby unit at the Charité- Universitätsmedizin Berlin, Germany, examining symptom and parenting skills change and outcome predictors. Data were extracted from electronic health records for all patients treated in the unit between October 2021 and June 2025, resulting in a sample of N = 156 women (mean age (years) = 31.10; SD = 6.39) after applying analysis inclusion criteria. Using the Montgomery Åsberg Depression Rating Scale for rater-based depressive symptoms and a custom scale assessing perceived parenting skills, symptom change was examined using unconditional linear mixed models, while descriptive linear mixed models were employed to identify moderators of treatment outcomes. For both outcomes, there was a significant fixed effect for time, indicating that participants showed above-chance improvements in depressive symptoms and parenting skills across the treatment period. While there were no significant predictors for post-treatment parenting skills beyond the baseline value, several diagnostic categories (PTSD, personality disorders, anxiety/OCD) were associated with a higher MÅDRS value at discharge, while educational and occupational status predicted a lower value. Interpretations of the present results are limited by a lack of a control group and post-treatment assessments. Moreover, the main outcome (MÅDRS) only partially captures transdiagnostic symptoms and is not specifically designed to represent depression during the post-partum period. The present study indicates the effectiveness of the Charité mother-baby unit using routine, real-world data. This adds to a hitherto small evidence base on the effectiveness of MBUs in Germany and beyond, both in terms of symptom reduction and parenting skills improvement across the diagnostic spectrum. Overall, the findings highlight the importance of holistic treatment approaches in the postpartum period for the mental health of both parents and their children.
Traumatic brain injuries (TBIs) can cause long-term brain dysfunction. Clinical studies suggest that parental TBI increases the risk of depressive symptoms in offspring. We aimed to investigate: 1) the association between parental TBI of different severities and later diagnosed offspring major depressive disorder (MDD) and 2) the association between the first parental TBI after offspring birth and subsequent offspring MDD, depending on child's age at injury. This nested case-control study identified 37,682 cases aged ≤25 years, 148795 matched controls, and their parents from Finnish national registers. Associations were calculated applying conditional logistic regression, comparable to Cox regression in this study design. Hazard ratios (HR) were estimated with 95% confidence intervals and two-sided significance limits, p < 0.05. Associations were adjusted for parental psychopathology and maternal socio-economic status. After adjustments, maternal and paternal TBIs of all severities were associated with offspring MDD. Concussions {aHR(maternal) 1.26 (95% CI 1.18-1-35); aHR(paternal) 1.14 (95% CI 1.07-1.21)}. Severe intracranial head injuries {aHR(maternal) 1.39 (95% CI 1.18-1.65); aHR(paternal) 1.30 (95% CI 1.18-1.44)}. Any first-time parental TBI occurring after offspring birth was associated with MDD in offspring, aged 1-18 years for mothers and aged 1-12 years for fathers. The association was strongest for offspring aged 0-6 years when maternal TBI happened {aHR 1.47 (95% CI 1.22-1.78)}. Diagnoses were register-based without direct ascertainment. Parental TBIs of all severities were associated with offspring MDD. These families may need supportive services, with special attention warranted for maternal TBI when children are very young.
Although genetic and environmental factors play a key role in the long-term stability of anxiety, the extent to which the genetic and environmental determinants are best characterized by state- versus trait-like components is unclear. Also unclear is whether the genetic and environmental effects underlying trait and state components of anxiety differ across adult development. This study analyses data from twins (N = 4854) in the Washington State Twin Registry (WSTR) that completed a measure of anxious symptoms across seven waves during the COVID-19 pandemic in order to identify the genetic and environmental sources of stability and change in anxiety during adulthood. The sample was divided into three cohorts, representing early, middle, and late adulthood. Application of phenotypic latent trait-state models showed that the latent state component of anxiety accounted for most of the variance in young adulthood and late adulthood whereas the latent trait component accounted for the majority of variance in middle adulthood. Genetically informed models showed that nonshared environmental variance underlying the latent state component accounted for the greatest amount variance in early (50.99%) and late (88.50%) adulthood whereas genetic variance of the trait component accounted for the majority of variance (49.44%) in middle adulthood. These findings highlight different processes (i.e., state vs. trait) that account for stability of anxiety at different periods in adulthood.
Bipolar depression (BD-d) and major depressive disorder (MDD) share overlapping clinical symptoms, posing a significant diagnostic challenge. The inferior fronto-occipital fasciculus (IFOF) is a critical long-range tract that integrates cognitive and affective processes across brain networks. However, it remains unexplored whether bilateral IFOF abnormalities differ between BD-d and MDD and have utility for machine learning classification. Processed data from 47 BD-d, 56 MDD, and 44 healthy controls (HCs) were analyzed for structural and functional alterations in bilateral IFOF metrics (including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD), and amplitude of low-frequency fluctuations (ALFF)) were assessed at both the tract and node levels. Five machine learning models were then employed to evaluate the diagnostic utility of significant features. Tract-level analysis revealed significant alterations in the right IFOF (rIFOF), characterized by decreased FA and AD alongside increased RD among patient groups. Functional ALFF demonstrated opposite changes, being elevated in BD-d but reduced in MDD. Node-wise analysis revealed that structural and functional alterations co-localized within temporal segments. Besides, RD in the rIFOF correlated with HAMD scores in MDD, linking structure to clinical severity, while a k-nearest neighbor (KNN) classifier based on tract-level metrics distinguished BD-d from MDD with 86% accuracy. This multimodal study reveals both shared and distinct segmental alterations in the rIFOF within BD-d and MDD, highlighting a microstructure-function dissociation pattern. These alterations correlate with clinical severity and enable high-accuracy diagnostic differentiation, providing objective biomarkers for understanding depression pathophysiology and improving differential diagnosis.
Bipolar and major depressive disorders are both serious and costly psychiatric disorders. Yet extant research largely focuses on social functioning impairments in mood disorders despite some work suggesting areas of adaptive social functioning. The present study presents a preliminary investigation aiming to further examine distinct facets of prosocial behavior using previously validated survey and behavioral measures among a clinically diagnosed sample of adults with bipolar I disorder (BD; n = 19), major depressive disorder (MDD; n = 28) and non-psychiatric controls (CTL; n = 29). A subset of individuals with BD and MDD were prospectively followed at a 6-month and 12-month follow-up time point. Findings suggest that BD and MDD individuals did not differ in prosocial behavior across eight distinct measures compared to the CTL group. Follow-up findings suggest that prosocial behavior may be associated with better prospective social support outcomes in the MDD and BDD groups. Although these results are preliminary due to the modest sample size, they suggest that some aspects of prosocial behaviors may be preserved among individuals with bipolar and unipolar mood disorders.
Adolescence is a period marked by social, psychological and physiological change, coinciding with a peak in depression onset. Over the last few decades, incidence of depression in adolescents has increased substantially, presenting a serious public health concern. The risk factors associated with depression have mostly been studied in isolation or without consideration for differences between age groups, limiting our ability to infer how factors are associated with each other and with depressive symptomatology. In the current study, we explored the relationships between different psychosocial risk factors and depression in adolescence, using cross-sectional data collected from adolescents aged 11-18 years (n = 202). We estimated two network models. The first focused on depression severity and the second on core depressive symptoms (low mood and anhedonia). In both networks, roughly half of all possible edges were estimated as non-zero (52.78% and 53.32%, respectively). Emotion regulation difficulties, perceived stress and school environment were among the most central factors and showed some of the strongest associations with both depression severity and presence of individual core symptoms. The network structure was largely independent of age, but the quality of school environment was more strongly related to depression severity in older adolescents. The study expands our understanding of the multivariate associations of risk factors and depression at different ages. The findings highlight emotion regulation, stress management skills and school environment as potential prevention and intervention targets, and point towards a need to consider differences between age groups when addressing depression in adolescence.
Limited evidence guides augmentation strategies after selective serotonin reuptake inhibitor (SSRI) in pediatric major depressive disorder (MDD). We conducted an active-comparator, new-user cohort study to evaluate depression-related outcomes among children and adolescents with MDD receiving SSRI augmentation. Using a 25% random sample of the US IQVIA PharMetrics® Plus Closed Health Plan claims from January 2010 to October 2022, we identified individuals aged 8 to 18 with MDD who initiated an atypical antipsychotic (AAP) or bupropion following ≥4 weeks of SSRI and ≥ 7 days of concomitant use with the SSRI. The primary outcome was time to a composite of depression-related hospitalization, emergency department (ED) visit, or a suicide-related outcome. Secondary analyses evaluated each event separately. Propensity scores with inverse-probability-of-treatment-weighting adjusted for baseline covariates, and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Sensitivity analyses were conducted to assess the robustness of our findings. The cohort included 4089 individuals (mean age 15.6 years [SD 2.1]; 65.1% female). Compared with bupropion, AAP augmentation was associated with a higher risk of the composite outcome (HR = 1.69; 95% CI:1.43-1.99), hospitalization (HR = 1.86; 95% CI: 1.52-2.26), ED visits (HR = 1.50; 95% CI: 1.15-2.90), and suicide-related outcomes (HR = 1.88; 95% CI: 1.07-3.33). Sensitivity analyses were consistent with the primary findings. Augmentation strategies for children and adolescents prescribed an AAP do not reduce the risk of hospitalization or suicide-related outcomes relative to bupropion. Further research is needed to guide evidence-based augmentation strategies.
While COVID-19 has a negative impact on mental health, the understanding of its association with distinct psychiatric disorders and symptoms is still limited. Leveraging the PsychGenCOV19 cohort including 1132 participants enrolled in New Haven, CT, we observed that moderate COVID-19 severity was associated with greater odds of internalizing disorders (major depressive disorder, MDD OR = 3.74; generalized anxiety disorder, GAD OR = 2.85; and post-traumatic stress disorder, PTSD OR = 2.32) and with lower odds of panic disorder (OR = 0.44). After modeling comorbidities among these mental health outcomes, the association between moderate COVID-19 severity and MDD remained statistically significant (OR = 2.89, p = 0.006). Investigating internalizing traits, we observed several associations with COVID-19 moderate severity even after accounting for MDD diagnosis (e.g., "lost interest in most things lasting two weeks or more" OR = 3.84; "Feeling nervous, anxious or on edge" OR = 1.82). In the multivariable model accounting for the co-occurrence of PTSD symptoms, moderate COVID-19 severity was also inversely related to "being super-alert or watchful or on guard" (OR = 0.45). In addition to MDD symptoms, certain GAD and PTSD symptoms (e.g., "Feeling jumpy or easily startled", "Feeling nervous, anxious or on edge", "Worrying too much about different things") mediated the association between COVID-19 severity and MDD (proportion mediated 9% to 27%). Finally, a latent class analysis identified PsychGenCOV19 participants characterized by severity patterns of COVID-19 and internalizing symptoms. These findings highlight the symptom-specific association of COVID-19 severity with mental health, underscoring possible transdiagnostic effects across the internalizing spectrum.
Society depends on people willing to serve in high stress occupations, such as healthcare workers who served on the front lines during the COVID-19 pandemic. However, these roles can take a toll on psychological health, fueling turnover and staff shortages. This toll can be mitigated with social connection. Yet, little is known about how the multifaceted constructs of psychological health and social connection influence one another over time. Understanding these dynamics is critical for identifying effective intervention targets in high-stress professions. We conducted a three-wave survey of U.S. healthcare workers (N = 230) within the first year of the COVID-19 pandemic. Each wave assessed facets of social connection (loneliness, giving and receiving support, and social ties) and psychological health (positive mental health, work satisfaction, burnout, and secondary traumatic stress). To identify the direction of associations across time, we modeled a longitudinal network in the form of a Bayesian Directed Acyclic Graph (DAG). Across waves, loneliness and positive mental health exerted the strongest downstream influence on all other psychological and social variables. Giving support had a mutually reinforcing relationship with positive mental health; giving support at wave 1 predicted positive mental health (and work satisfaction) at wave 2, which in turn predicted giving support at wave 3. Findings highlight promising intervention points for healthcare workers during a public health crisis. Using a DAG network on longitudinal data, this study revealed unique insights into the dynamic relationships between psychological health and social connection in the context of occupational stress.
The heart-brain nexus is increasingly recognized as important for human health. Nonetheless, integration of this perspective in research and treatment remains limited in psychiatry, particularly in bipolar disorder (BD). Multisystem vascular imaging may help elucidate mechanisms linking heart and brain health in BD. The ultimate purpose of this review is to inspire and guide integration of vascular imaging more broadly in BD research. An international group of experts reviewed the vascular imaging literature in BD, synthesizing key studies, limitations, and future directions. Findings were organized by organ system (brain, eye, heart, body), including novel methods reported in other psychiatric or neurological disorders that are understudied in BD. Structural and functional vascular differences, reflecting macro- and microvascular health, are reported across the lifespan in BD. State effects are more apparent for functional than structural metrics. BD-related differences in vascular metrics were independent of traditional vascular risk factors in some but not all studies. Accessibility ranged from widespread (e.g., tonometry, retinal imaging) to specialized (e.g., cardiac magnetic resonance imaging [MRI], arterial-spin labeling MRI). Although small BD samples were common, general population cohorts demonstrate feasibility for broader use. BD-related differences in vascular imaging metrics are evident within and beyond the brain. Continued progress is warranted to realize potential implications for brain, heart, and mental health. Larger studies, powered for subgroup analyses and robust covariate modeling, are warranted. Future studies including prospective designs, fluid biomarkers, and lived-experience perspectives would further enhance the relevance of vascular imaging for those with BD.
Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity that impair daily functioning. Accurate diagnosis is therefore essential, particularly in adulthood, where symptom reporting may be influenced by external incentives. Malingering, defined as the deliberate fabrication or exaggeration of symptoms for external gain, is a relevant concern in ADHD assessment, particularly for academic accommodations, stimulant medications, and avoidance of responsibilities. This review examined current evidence on the detection of malingered presentations in adult ADHD assessment. We searched PubMed, Scopus, and Web of Science for empirical studies examining feigned, malingered, exaggerated, or otherwise noncredible ADHD presentations and 29 peer-reviewed studies met the inclusion criteria. Detecting malingering in ADHD remains challenging. Validity measures showed heterogeneous effectiveness, and ADHD symptom scales appeared vulnerable to manipulation. However, the available evidence suggests that performance validity tests, including the Test of Memory Malingering (TOMM), Word Memory Test (WMT), Letter Memory Test (LMT), Digit Memory Test (DMT), and Nonverbal Medical Symptom Validity Test (NV-MSVT), may help differentiate genuine ADHD from noncredible presentations when interpreted within a multi-method assessment framework. Most studies relied heavily on self-report symptom measures, used heterogeneous validity criteria, and lacked independent external corroboration, limiting comparability across findings. Evidence largely comes from the United States, and longitudinal data remain scarce. Distinguishing ADHD from malingering requires a specialist-led assessment. Greater standardization of diagnostic protocols and validity-assessment procedures remains urgently needed.
Suicide mortality is influenced by the lethality of the method used, making it essential for effective suicide prevention. This nationwide study examined whether suicide methods differ by sociodemographic and clinical characteristics among individuals who died by suicide in Denmark. We conducted a retrospective register-based cohort study including all suicide decedents in Denmark between 2010 and 2020 (n = 6257). Data were obtained from Danish national health registers. Multinomial logistic regression examined associations between individual characteristics and suicide methods, using hanging as the reference category. Statistical significance was assessed with Holm-Bonferroni-adjusted p-values. Compared with hanging, self-poisoning with drugs was significantly associated with female sex (male: OR = 0.37, 95%CI [0.31-0.44]), psychotropic drug treatment (OR = 1.61, 95%CI [1.25-2.07]), and previous suicide attempts (OR = 1.46, 95%CI [1.22-1.73]). Self-poisoning with other substances was more common among individuals without known health conditions. Firearms were significantly associated with male sex (OR = 10.11, 95%CI [5.58-18.32]), and absence of psychiatric history (OR = 0.42, 95%CI [0.27-0.64]). Suicide by jumping was significantly associated with recent psychiatric admissions (OR = 2.52, 95%CI [1.87-3.40]), psychotic disorders (OR = 1.69, 95%CI [1.25-2.27]) and OCD (OR = 3.65, 95%CI [1.71-7.76]). Hanging was the most used method among individuals with a history of affective disorders. Suicide methods were associated with distinct sociodemographic and clinical characteristics, indicating heterogeneity in method-specific profiles. Individuals using less lethal methods were more likely to have previous healthcare contact, indicating opportunities for targeted prevention, whereas violent methods appeared more strongly related to access to means and non-help-seeking. These findings support method-specific suicide risk assessment and prevention strategies.
The COVID-19 pandemic and its associated lockdowns had a detrimental impact on adolescent mental health, exacerbating levels of emotional difficulties that were already increasing in this population. The course of these difficulties after lockdown protocols ended, however, is not fully understood. Further, the effects of early life stress (ELS) and biological sex on mental health during and following the pandemic are also not clear. This study leverages data from a longitudinal project examining adolescent mental health that predates the pandemic. Internalizing problems were assessed in 222 children (58.6% females) ages 9-13 years at recruitment (baseline; 2013-2016) and at four more timepoints, each approximately two years apart. Participants also completed an interview assessing ELS at baseline. We assessed internalizing problems across each phase of the pandemic (i.e., pre-COVID, during the COVID lockdown, after reopening) as a function of ELS and biological sex. We found that whereas unpredictability-related ELS was associated with internalizing problems in girls across all COVID phases, the association between threat-related ELS and internalizing problems from pre-lockdown to post-reopening decreased in girls and increased in boys. Further, threat-related ELS was associated with post-reopening internalizing problems in boys through lower adaptability. Sensitivity analysis showed that the attenuation of the threat-internalizing association in girls and strengthening of the association in boys was not due to aging. Collectively, these findings suggest that there are sex- and ELS-specific changes in psychological functioning in relation to the pandemic. Further research is needed to better understand mechanisms that foster risk or resilience following stress exposure.
Childbirth-related post-traumatic stress disorder (CB-PTSD) is an important international health concern. Despite increasing recognition of the public health burden of CB-PTSD, little is known about how CB-PTSD symptoms present across different countries. This study examined cross-national differences in CB-PTSD symptom severity and presentation to inform culturally sensitive screening and intervention strategies. Data were drawn from the International Survey of Childbirth-Related Trauma (INTERSECT) cross-sectional survey of 11,302 women 6-12 weeks postpartum in 31 countries using a standard protocol. CB-PTSD symptoms were assessed using the City Birth Trauma Scale, measuring DSM-5 symptom components (re-experiencing, avoidance, negative cognitions and mood, hyperarousal). Participants were mostly married, aged 30-34 years, with average household income, and higher education. CB-PTSD symptom severity varied substantially across countries, with the highest mean scores in Pakistan (M = 23.49, SD = 13.23) and lowest in Nigeria (M = 1.89, SD = 3.66). Despite these differences, symptom patterns were largely consistent across countries, with avoidance symptoms lowest and hyperarousal symptoms highest. Exceptions were observed in countries with particularly high symptom levels. Decision tree analysis identified avoidance symptoms (>3.1) as the strongest discriminator of CB-PTSD cases vs non-cases (F(1,11,204) = 4820.54, p = .000), followed by negative cognitions and mood (>10; F(1,716) = 143.69, p = .000). While CB-PTSD severity varies internationally, symptom presentation is largely consistent, supporting its relevance as an international construct. Avoidance symptoms were the least commonly endorsed yet the most discriminative for identifying CB-PTSD in decision tree analyses, suggesting they may serve as a useful clinical flag for women who warrant more detailed assessment. Variations in symptom expression in countries with high levels of symptoms highlight the importance of culturally sensitive approaches to screening and assessment.
Although prior studies have examined developmental trajectories of adolescent self-harm in terms of frequency and severity, a fundamental gap remains: we lack a dynamic, state-specific understanding of how self-harm ideation and behavior develop during early adolescence. Moreover, few studies have prospectively examined how baseline predictors relate to subsequent self-harm pathways. Using four annual waves of data from a large-scale Chinese adolescent cohort (N = 11,366; 48.6% female; T1: Mage = 10.72 ± 0.29 years), this study used a person-centered approach to delineate distinct self-harm trajectories and interpretable machine learning methods to identify their baseline predictors. Five heterogeneous trajectories were identified: persistently low-risk, persistent ideation, ideation remission, behavior-to-ideation, and ideation-to-behavior. Although depressive symptoms, self-blame, family stress, and gender emerged as the most influential predictors overall, the predictors varied substantially across trajectories, indicating meaningful differences in their developmental drivers. These findings demonstrate the heterogeneous developmental trajectories of self-harm states in early adolescents and reveal trajectory-specific risk predictors, underscoring the importance of prevention efforts that should consider both shared and distinct factors across pathways.
Childhood adversity is a well-established risk factor for non-suicidal self-injury (NSSI) in adolescents, but how these early experiences become biologically embedded to shape not only self-harm but also broader functional outcomes such as academic functioning remains unclear. We examined cortical morphometry in 45 adolescents with major depression (MDD) and NSSI, and 45 matched healthy controls using structural MRI, as well as childhood experiences and learning burnout. Adolescents with MDD-NSSI showed a regionally specific pattern of cortical alterations: fronto-limbic thickening particularly in the orbitofrontal cortex (OFC), contrasted with thinning in the visual cortex, alongside reduced OFC surface area. These regionally specific cortical alterations were associated with learning burnout and early-experience: OFC cortical thickness was positively associated with learning burnout, visual cortical thickness was positively associated with physical abuse, and right PFC/ACC cortical thickness was negatively associated with paternal emotional warmth. Exploratory indirect-effect analysis suggested a possible pathway linking childhood sexual abuse, left OFC cortical thickness, and learning burnout. These findings suggest that early adversity may be biologically embedded in regionally specific cortical morphology in adolescents with MDD-NSSI and may be linked to broader functional outcomes such as learning burnout.
Public health crises like environmental disasters and COVID-19 place psychological burden on affected communities, with pregnant and new mothers disproportionately impacted. With the escalating incidence of such crises, understanding the mechanisms that support maternal resilience is crucial for effective intervention. We investigated partner support as a potential protective factor for mothers' mental health following the Australian 2019-2020 bushfires and COVID-19 pandemic. Data were from 278 mothers living in the ACT and NSW who were pregnant during the bushfires and participants in the Mother and Child 2020 (MC2020) longitudinal cohort study, and 99 of their partners. Moderation analyses tested whether total partner support (dyadic coping) predicted the impact of crises during pregnancy on maternal mental health at 21-38 months postpartum. Secondary analyses examined how mothers' and partners' perceptions of the support provided to mothers contributed to maternal mental health. Mothers with greater crisis impact reported higher depression, anxiety and stress symptoms, and lower wellbeing at 21-38 months postpartum. The effect of crisis impact on mothers' mental health was not moderated by partner support; however, partner support showed the strongest association with maternal mental health, including improvements from the perinatal period to 21-38 months postpartum. Critically, the relationship between partner support and mothers' mental health was primarily driven by mothers' perceptions of the support they received. Strengthening partner support may significantly enhance maternal mental health and resilience surrounding public health crises. Intervention efforts should focus on guiding partners to provide support that aligns with mothers' needs.