This article discusses the diagnosis and conceptualization of suicide. Addressing suicide and related phenomena is a top priority in mental health care but is not adequately reflected in the current categorical diagnostic system, the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition, Text Revision. Suicide demonstrates the pitfalls of categorical conceptualization of psychopathology and should be thoroughly examined within dimensional frameworks. This is particularly relevant as development of the newest iteration of the DSM-and renewed discussion of diagnosis and conceptualization of psychopathology-begins. The categorical nature of diagnosis has been critiqued at length, with the proposed alternative positing transdiagnostic dimensions that account for overlaps across and variations within diagnoses. Suicide and related phenomena do not appear as a distinct psychopathology/diagnosis in the DSM, Fifth Edition, Text Revision, instead comprising a symptom/criterion for only two of the almost 300 disorders. A transdiagnostic conceptualization of suicide aligns with historical and modern theories of suicide, none of which focus on psychiatric diagnoses as primary explanatory factors in suicide, and most of which emphasize transdiagnostic patterns of distress and biopsychosocial processes that better explain suicidal behavior. Discussion to date about limitations of the current diagnostic system regarding suicide has focused on adding suicide-related diagnoses or even positing an additional suicide-related axis when the DSM previously used an axial structure. Based on the characteristics of suicide and related phenomena described previously, the author hypothesizes that suicide-related processes comprise higher level dimensions-including a range of nonpathological (e.g., developmental changes in acceptance of death) to pathological phenomena and factors aligned with suicide theory (e.g., capability)-that interact with cross-cutting psychopathological and biopsychosocial factors to lead to varying phenotypes. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Long-acting injectable antipsychotic (LAI) treatment is associated with improved adherence and reduced relapse and hospitalization rates, compared with oral antipsychotics, in patients with schizophrenia. TV-46000, an LAI formulation of risperidone, is approved for the treatment of schizophrenia in adults. TV-46000 administered once monthly (q1m) and once every 2 months (q2m) has previously been shown to be effective and safe in patients with schizophrenia in the phase 3 studies, RISE and SHINE. Here, the effect of long-term treatment with TV-46000 on psychopathological symptoms and severity of illness was evaluated. In RISE, patients were stabilized on oral risperidone for 12 weeks before randomization to subcutaneous treatment with TV-46000 q1m, q2m, or placebo (1:1:1) until study endpoint. Patients who successfully completed RISE (placebo and TV-46000 rollover cohorts) and newly recruited patients (de novo cohort) were eligible to enroll in SHINE to receive TV-46000 q1m or q2m for up to 56 weeks. Symptom severity was evaluated with the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impressions-Severity (CGI-S) scale, and the Clinical Global Impressions-Improvement (CGI-I) scale, as prespecified exploratory endpoints from the RISE and SHINE studies. Overall, 543 adult patients were enrolled in RISE (TV-46000 q1m, n = 183; q2m, n = 179; placebo, n = 181) and 333 in SHINE (TV-46000 q1m, n = 173 and q2m, n = 160; source groups: de novo, n = 106; placebo rollover, n = 55; TV-46000 rollover, n = 172). In RISE, PANSS total scores decreased after randomization to end of treatment (EoT) for TV-46000 (least squares mean [LSM] change [SE], q1m: -3.5 [0.69]; q2m, -4.9 [0.73]), but increased for placebo (1.1 [0.86]; P < 0.0001 for both TV-46000 q1m and q2m versus placebo). Corresponding changes from baseline to last assessment (LA) were -0.9 (0.97) for q1m, -0.2 (0.99) for q2m, and 7.4 (0.99) for placebo; P < 0.0001 for both versus placebo. Similar results were seen for the PANSS positive and general psychopathology subscales (P < 0.001 for both TV-46000 q1m and q2m versus placebo). These symptom improvements were maintained or improved in the TV-46000 q1m and q2m groups in SHINE, with notable improvements observed in patients without prior TV-46000 exposure. Similar results were observed in RISE and SHINE when PANSS scores were categorized by Marder factors of schizophrenia symptoms. CGI-I scores at EoT and LA were significantly better with TV-46000 than with placebo in RISE (LSM at EoT and LA: 3.3 and 3.6 for TV-46000 q1m, 3.2 and 3.6 for q2m; 3.9 and 4.4 for placebo, respectively [P < 0.0001 versus placebo]). These scores were maintained in the TV-46000 groups in SHINE, with larger improvements seen in the de novo cohort than in the placebo rollover and TV-46000 rollover cohorts. Treatment with TV-46000 provided sustained overall symptom improvement in the RISE and SHINE studies in patients with schizophrenia who were stabilized on oral risperidone. RISE (ClinicalTrials.gov identifier: NCT03503318) and SHINE (ClinicalTrials.gov identifier: NCT03893825). TV-46000 is an antipsychotic medicine to treat schizophrenia in adults. It is injected under the skin once monthly or once every 2 months. TV-46000 was previously tested in two clinical trials, RISE and SHINE. In RISE, patients first took pills and then received TV-46000 or inactive treatment (placebo). Patients treated with TV-46000 had a longer period without schizophrenia symptoms returning than those who took placebo treatment. New patients and patients who finished RISE were allowed to participate in the SHINE study. In SHINE, patients were regrouped to receive TV-46000. Results showed that long-term treatment with TV-46000 was safe. This report used existing data from the RISE and SHINE studies to see if TV-46000 improved schizophrenia symptoms and disease severity. In RISE, schizophrenia symptoms improved with TV-46000 but worsened with placebo. Symptoms were further improved in patients who continued taking TV-46000 in SHINE. The overall disease severity was also improved in RISE and SHINE.
Our aim in this special issue was to cover the emerging work in passive sensing of behavioral markers of psychopathology. On the one hand, given the recent explosion of studies in clinical science integrating smartphone-based and other wearable sensor technologies to aid in the assessment of behavioral correlates of psychopathology, we sought to organize an exposition of cutting-edge work in this growing area of research. On the other hand, recognizing the potential misuse of passive sensing technologies-much like the wild west of experience sampling methodology in earlier decades-we aimed to highlight key issues related to potential pitfalls regarding the unknown reliability and validity of these measures and inferences made from their data. Along these lines, we sought to incorporate articles with null effects and those that summarized effect sizes across existing work, going beyond reliance on one-off studies with small samples. Across 14 articles and two invited commentaries, this special issue covers a wide range of applications of sensor data for understanding an array of psychopathology domains and disorders, including in depression, trauma, and serious mental illness, among others. Following a brief overview of passive sensing and its applications to clinical science, we summarize these articles, fitting them into cohesive themes, and describe their contribution to the emerging work in this area. We end with a discussion of issues worthy of further consideration in the application of these technologies to our understanding of psychopathology. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
Disinhibited individuals show heterogeneity in their neuropsychosocial characteristics. To better understand this variability, we used a person-centered approach to identify transdiagnostic profiles of disinhibition based on a range of personality and neurocognitive indicators. A community sample of adults (N = 363; ages 18-55; 50.1% female; data collected 2019-2024), enriched for externalizing disorders, completed a multilevel assessment encompassing clinical symptoms, personality traits, neuropsychological task performance, and trauma history. Latent profile analysis of disinhibition-related indicators identified three distinct profiles that differed in both the severity and configuration of disinhibitory features. Two profiles exhibited elevated disinhibition: The Neurocognitive Disinhibition profile (n = 72) was characterized by low cognitive and executive functioning performance but average impulsive personality traits, whereas the Personality Disinhibition profile (n = 103) was marked by high levels of trait impulsivity and intact cognitive-executive functioning. A third profile, Low Disinhibition (n = 188), was characterized by relatively low impulsivity and strong executive functioning. The Neurocognitive and Personality Disinhibition profiles showed higher levels of externalizing psychopathology and self- and other-directed violence compared with the Low Disinhibition profile. In addition, the Neurocognitive Disinhibition profile demonstrated greater specificity for externalizing psychopathology and a more extensive history of trauma exposure, whereas the Personality Disinhibition profile was characterized by elevations across both externalizing and internalizing psychopathology. Together, these findings indicate that symptom-agnostic, person-centered classification approaches can delineate meaningful subtypes of disinhibition that differ across personality, neurocognitive, and environmental risk domains. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
People with mental disorders have an increased risk of diabetes, yet conflicting evidence exists regarding the quality of diabetes care they receive. To address this evidence gap, we conducted a systematic review and meta-analysis to assess and compare diabetes quality of care in people with diabetes with mental disorders versus people with diabetes without mental disorders. In this systematic review and random-effects meta-analysis, we searched Scopus, Embase, MEDLINE, and PsycINFO for cohort and case-control studies published between database inception and Feb 8, 2025. We estimated summary odds ratios (ORs) for diabetes quality of care indicators in individuals with any mental disorder versus without mental disorders to investigate the association between the presence of a mental disorder and diabetes quality of care indicators, including overall diabetes monitoring and treatment. Studies were excluded if it was not possible to generate pooled quantitative data. The primary outcome was a binary composite measure of diabetes quality of care, meaning the percentage of people receiving any diabetes monitoring and treatment (ie, urine albumin-creatinine ratio test, HbA1c test, blood pressure measured, foot surveillance, serum creatinine test, serum cholesterol test, BMI recorded, smoking status recorded, retinal monitoring). Secondary outcomes were study-specific diabetes quality of care individual indicators matched to the nine NICE diabetes monitoring indicators and specific diabetes interventions and anti-diabetes medications. We analysed primary and secondary outcomes according to any mental disorder and to specific diagnostic subgroups. Study quality was evaluated using the Newcastle-Ottawa Scale (NOS). Data from 49 studies (42 cohort and seven case-control) were included, comprising 5 503 712 individuals with diabetes, of whom 838 366 (15·2%) had a diagnosed mental disorder (defined using ICD-9 or ICD-10 criteria in 40 studies). Sex was reported in 35 of 49 studies, comprising 4 250 666 individuals, 1 956 506 (46·0%) of whom were female and 2 294 160 (54·0%) were male. The mean age was 61·4 years (SD 8·7; range 47-82 years). 38 studies reported on various mental disorders, 21 on mood disorders spectrum, 21 on major depressive disorder, 20 on schizophrenia, 11 on bipolar disorder, 11 on substance use disorder spectrum, including alcohol use disorder, six on dementia, five on anxiety disorder spectrum, and one on personality disorder spectrum. Most studies were high quality and spanned Asia, North America, Europe, and Australasia. Significant negative associations were observed between having any mental disorder and the likelihood of receiving any recommended diabetes monitoring (29 studies, OR=0·81 [95% CI 0·70-0·94], p=0·0049). Negative associations were also observed for HbA1c measurement (24 studies, 0·81 [0·68-0·97], p=0·024), retinal screening (21 studies, 0·77 [0·63-0·95], p=0·013), lipid and cholesterol measurement (20 studies, 0·83 [0·69-0·99], p=0·043), foot examination (11 studies, 0·85 [0·76-0·95], p=0·0044), and renal investigation (16 studies, 0·78 [0·63-0·96], p=0·022). A significant positive association was found between any mental disorder and recorded smoking status (two studies, 1·09 [1·02-1·17]; p=0·0076). Any mental disorder was significantly associated with higher odds of receiving insulin (ten studies, 1·52 [95% CI 1·16-1·99]; p=0·0022), but negatively associated with treatment with a GLP-1 receptor agonist (two studies, 0·26 [0·13-0·49]; p<0·0001). There was no evidence of publication bias. Mental disorders are negatively associated with receiving adequate diabetes monitoring and GLP-1 agonist therapy. Addressing these disparities has the potential to address the increased mortality associated with mental disorders. None.
This study aimed to characterize the structure of psychopathology in older adults and determine whether cognitive dysfunction predicts transdiagnostic symptom dimensions throughout later life. Competing models of psychopathology (i.e., one-factor, correlated-factors, bi-factor, and higher-order models) were examined using confirmatory factor analysis (CFA) in participants aged 55-78 years old from the UK Biobank (N = 112,694, male = 44.6%, M = 65.05 years). Multigroup CFA was used to examine measurement invariance of the optimal model across four age groups (i.e., 55-59, 60-64, 65-69, and 70-78 years). Structural equation modelling was used to examine cognitive dysfunction as a predictor of transdiagnostic symptom dimensions in the full sample and across age-stratified subsamples. A higher-order model was selected as the optimal model of psychopathology, including a general factor and three lower-order factors (i.e., internalizing, externalizing/substance use, thought disorder). This model demonstrated acceptable model-fit (CFI = .932, TLI = .928, RMSEA = 0.047) and reliability of the lower-order factors (H = .850-.974). This model also demonstrated configural, lower-order metric/scalar, and higher-order metric/scalar invariance across age groups (change in CFI values ≤ .002). Cognitive dysfunction predicted greater general psychopathology and uniquely predicted internalizing and thought disorder in the full sample (βs = .066-.154, ps < .01) and across age-stratified subsamples (βs = .052-.143, ps < .01). There was no association with externalizing/substance use. Findings support the hierarchical organization of psychopathology throughout older adulthood and indicate that cognitive dysfunction is prospectively associated with general psychopathology and emotionally-focused (internalizing) and psychosis-like (thought disorder) symptom dimensions. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Research on different aspects of mentalizing is essential for understanding the mechanisms underlying personality disorders (PDs) and for informing psychotherapy approaches, in which mentalizing is considered a key mechanism of change. This study aimed to explore whether self- and other-mentalizing, in interaction with attachment insecurity, differentially explain Criteria A (level of personality functioning) and B (maladaptive traits) of the Alternative Model for Personality Disorders in the DSM-5. Our sample consisted of 109 participants (54% female, 41% male and 5% nonbinary). We used the Structured Clinical Interview for DSM-5 Personality Disorders, a Movie for the Assessment of Social Cognition, the Reflective Functioning Questionnaire, the Experiences in Close Relationships-Revised, the Self and Interpersonal Functioning Scale and the Personality Inventory for DSM-5. Regression analyses show that self-mentalizing deficits uniquely predict both Criterion A domains (self and interpersonal functioning) and all five maladaptive traits, while other-mentalizing is relevant only to interpersonal functioning. Explained variance (adjusted R2) ranges from 55% to 18%. Additionally, mentalization moderates the relationship between insecure attachment and personality pathology (interpersonal functioning, Negative Affectivity and Detachment), mainly with greater mentalization deficits linked to more severe personality dysfunction under heightened attachment insecurity. Our findings authorize mentalizing as a crucial factor in PD, supporting the potential value of mentalization-focused interventions in addressing both the severity and the 'flavour' of PD. Notably, our findings suggest a hierarchy within self- and other-mentalizing, indicating that self- mentalizing plays a more foundational role in PD. Through a comprehensive, multimethod assessment of mentalization, this study offers a refined understanding of its role in psychopathology, providing valuable insights that could guide the development of more targeted therapeutic interventions.
Childhood trauma is a well-established risk factor for poor clinical outcomes in bipolar disorder (BD), yet most studies have relied on cumulative trauma scores, potentially overlooking heterogeneity in trauma exposure and its differential impact on psychopathology. This study employed latent profile analysis (LPA) to identify distinct subtypes of childhood trauma based on the Childhood Trauma Questionnaire (CTQ) among 725 individuals with BD in a Chinese clinical sample. Differences across trauma profiles were examined in relation to demographic features, psychiatric symptoms (anxiety, depression, mania), and suicidal ideation (Beck Scale for Suicide Ideation, BSSI). A four-class solution was identified, and the relationship with mental health outcomes was analyzed. Class 4 group, characterized by the most severe emotional abuse and physical neglect, along with the lowest emotional neglect, reported the highest levels of anxiety (HAMA), depression (HAMD), and suicidal ideation (BSSI). In contrast, manic symptoms (YMRS) were present across all groups but did not differ significantly between trauma profiles. Logistic regression indicated that emotional abuse was the strongest predictor of trauma class membership. Distinct trauma profiles in BD are differentially associated with symptom severity and suicide risk. These findings highlight the clinical value of moving beyond cumulative trauma scores to identify trauma-specific subtypes. Early identification of high-risk trauma configurations may inform personalized assessment and intervention strategies for individuals with BD.
Using the Hierarchical Taxonomy of Psychopathology (HiTOP) framework, we constructed hierarchical-dimensional phenotypes for internalizing disorders in a nationally representative sample of U.S. veterans that oversampled for women (N = 781, 62% women). Based on responses to the Eating Pathology Symptoms Inventory and the Expanded Form of the Inventory of Depression and Anxiety Symptoms, HiTOP models were constructed using L. R. Goldberg's bass-ackwards method with exploratory structural equation modeling. We identified one large superordinate factor that assessed broad internalizing psychopathology, three subfactors (Eating Pathology, Fear, and Distress in women; Eating Pathology, Fear/Distress, and low Well-being in men), and six dimensional syndromes (Bulimia, Fitness Concerns, Restriction, Fear, Mixed Arousal-Distress, and low Well-being). The model demonstrated gender invariance across both time points. Factors showed evidence of measurement stability over time, as indicated by high Tucker's congruence coefficients and low average levels of differences in the loadings across assessments. Results suggested that the HiTOP framework is a robust, longitudinally stable framework for assessing internalizing symptoms. Our findings have implications for future research seeking to improve diagnostic precision for internalizing psychopathology. Empirically based phenotypes have the potential to lead to improved treatments that target shared maintenance mechanisms underlying internalizing dimensions and, in turn, improve clinical care and treatment efficacy. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Mental health morbidity is a proximal factor in suicide. Using the research domain criteria (RDoC) framework to investigate sex and age differences in psychopathology at the time of death may provide better characterization than focusing on clinical diagnosis alone. To (1) evaluate whether token-based and large language model scoring of RDoC can be successfully applied to law enforcement and coroner or medical examiner death narratives in the US National Violent Death Reporting System (NVDRS), and (2) investigate sex and age differences in clinically relevant scores to illuminate underidentified dimensions of mental health dysfunction proximal to suicide. This cross-sectional study drew on death records in the restricted-access 2020 to 2021 NVDRS. Participants were limited to suicide decedents aged 12 years and older from all 50 states whose death record included a law enforcement and coroner or medical examiner death narrative of 20 words or more. Analyses were conducted between May 2024 and September 2025. Sex and age of decedents. RDoC symptom scores; mental health status measures in death records (mental health diagnosis, current depressed mood, and alcohol or drug misuse). Using both a token-based system and a large language model approach, law enforcement and coroner or medical examiner narratives of 72 585 suicide decedents were scored (mean [SD] age, 46.3 [19.3] years; 57 770 [80.6%] male). Both methods were previously validated with psychiatric electronic health records. To validate this approach, token density and large language model scores were compared with current NVDRS mental health status measures. Both scoring methods correlated with precoded measures and demonstrated levels of neurobehavioral dysfunction at the time of death similar to psychiatric inpatients on admission. Sex- and age-related differences in clinically relevant dysfunction showed the highest levels among female vs male and younger vs older decedents after adjusting for demographic confounding. This cross-sectional study of suicide decedents found that information relevant to RDoC domains is encoded in NVDRS death narratives and can be extracted using large language models. The approach used here observed more pervasive neurobehavioral dysfunction among suicide decedents than that captured by currently employed NVDRS measures of mental health.
Pregnancy and postpartum are times of increased risk for a variety of mental health problems. Historically, these symptoms have been conceptualized via ostensibly distinct, consensus-based diagnostic categories. However, applying an empirically based, dimensional approach to psychiatric classification may significantly advance understanding of common and specific risk factors during this highly dynamic period. In the present study, we used exploratory psychometric methods to examine the structure of psychopathology symptoms from the "bottom-up" or using symptom-level co-occurrence to derive common factors in a sample of individuals (N = 347) across earlier pregnancy (M = 17.4 weeks gestation), later pregnancy (M = 34.6 weeks gestation), and postpartum (M = 25.3 weeks postpartum). We examined changes (or invariance) in symptom structure longitudinally. Results demonstrated a hierarchical structure of symptoms including a robust broad distress factor at the highest level, followed by replicable internalizing and externalizing factors. The best lower-order solutions included eight to nine factors at each timepoint. Across earlier to later pregnancy and postpartum, psychopathology structure showed both significant invariance and nuanced changes, indicating that perinatal symptom factors are largely robust, while the structure of select subfactors (e.g., low mood, general anxiety) differs slightly across time. Consistent pregnancy anxiety, traumatic stress, somatic problems, detachment, anger-antagonism, and inattention-hyperactivity factors emerged across timepoints. Factors relating to positive affect, low mood, general anxiety, and social anxiety were structured similarly although not identically across time. These longitudinal trends in psychopathology structure have important implications for empirically based psychopathology classification in this critical developmental phase. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Schizotypy is a multidimensional construct encompassing clinical and subclinical expressions of schizophrenia-spectrum psychopathology that is composed of positive, negative, and disorganized dimensions. These dimensions are differentially associated with disruptions in emotional experience; however, few studies have examined the association of multidimensional schizotypy with emotion regulation (ER). The present study employed experience sampling methodology (ESM) to examine the hypothesis that there are differential associations of positive, negative, and disorganized schizotypy with ER strategies (acceptance, cognitive reappraisal, distraction, avoidance, suppression, and sharing) in daily life. A sample of 708 nonclinically ascertained young adults was signaled eight times daily for 7 days to complete ESM questionnaires about emotional experiences and ER strategy use from February 2024 to May 2025. Consistent with our hypotheses, the schizotypy dimensions displayed differential patterns of associations with emotional experiences and ER strategy use. Disorganized schizotypy was associated with rumination, distraction, and suppression, in addition to lower awareness of emotions and increased distress from emotions. Positive schizotypy was associated with increased use of rumination, cognitive reappraisal, distraction, and suppression, whereas negative schizotypy was associated with decreased awareness of emotions and decreased use of ER strategies, including cognitive reappraisal, distraction, sharing with others, and acceptance. Overall, this study provides evidence for differential patterns of ER difficulties in schizotypy and suggests increased selection of putatively maladaptive strategies (e.g., rumination, suppression) or disengagement of ER strategies across positive, negative, and disorganized dimensions of schizotypy. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
The evidence for the structure of the Hierarchical Taxonomy of Psychopathology (HiTOP) model relies heavily on analyses of correlations among Diagnostic and Statistical Manual of Mental Disorders diagnoses, which entrenches some of their limitations. In this study, we deconstructed the mental disorders covered in HiTOP into individual symptoms-with personality disorders represented via item-level assessment of the Alternative Model for Personality Disorders facets-and rebuilt the HiTOP model from the ground up. Participants self-selected into an online mental health study and were randomly split into primary (n = 11,762) and holdout (n = 3,000) samples to identify a robust hierarchy of empirically derived constructs, ranging from symptoms and syndromes to very broad "superspectra" of psychopathology. In each sample, both hierarchical clustering and hierarchical principal components analyses were used; the final hierarchical structure was derived based on points of cross-sample and cross-method agreement. The resulting model was remarkably similar to the HiTOP model, including nearly all of the same subfactors, spectra, and superspectra-albeit with some reorganization in the structure. The inclusion of broad disinhibition/hypomania and pathological introversion dimensions represented the most prominent differences compared with the current higher order structure of HiTOP. The detailed lower order constructs found here also mirrored many of the existing components and traits in HiTOP, as well as indicating some potential areas for revision. Finally, we remapped the disorders included in the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-5th Edition onto the new framework model. Overall, the results suggest that the structural foundations of the HiTOP model are largely sound. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Behavioral economics highlights external influences on alcohol's reinforcing value and suggests life transitions in the mid-to-late 20s may increase costs of drinking, contributing to developmentally mediated drinking reductions among emerging adults. However, higher value for alcohol and fewer substance-free alternatives are theorized to predict persistent risky drinking. The current study compared behavioral economic indices of alcohol value with internalizing symptoms (e.g., anxiety, depression), an established correlate of drinking, as predictors of trajectories of heavy drinking days (HDDs) and alcohol problems among emerging adults. Participants (N = 495, 61.8% female) aged 21.5-25 years at enrollment who reported recent drinking (MHDD = 1.58) completed questionnaires every 4 months for 3 years about alcohol consumption and problems, internalizing symptoms, alcohol and substance-free rewards, and demographics. HDD and alcohol-related problems were characterized with latent growth curve models. Baseline predictors were regressed onto alcohol growth curves. Both HDD and alcohol-related problems demonstrated quadratic reductions over time. Adjusting for demographics, demand intensity (consumption at zero price) and demand elasticity (sensitivity to changes in cost) were significantly associated with the HDD slope. Demand elasticity, internalizing symptoms, and environmental reward were significantly associated with the alcohol problems slope; lower elasticity and environmental reward scores were associated with accelerated early declines followed by deceleration of change in alcohol problems near the study's end. Results suggest that elevated alcohol reward value, limited access to substance-free rewards, and internalizing symptoms confer persistent drinking risk, and that demand elasticity is a robust unique predictor of these outcomes. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Reports an error in "Heart rate variability as a biomarker for transdiagnostic depressive and anxiety symptom trajectory in adolescents and young adults" by Alainna Wen, Tomislav D. Zbozinek, Julian Ruiz, Richard E. Zinbarg, Robin Nusslock and Michelle G. Craske (Journal of Psychopathology and Clinical Science, 2024[Nov], Vol 133[8], 638-646; see record 2025-40884-007). In the article, the authors several errors related to the Anhedonia-Apprehension variable. These errors do not affect the main findings or conclusions of the article. (The following abstract of the original article appeared in record 2025-40884-007). Internalizing psychopathology is associated with abnormalities in heart rate variability (HRV). Lower HRV that reflects reduced parasympathetic nervous system activity has been observed in depressive and anxiety disorders. Existing studies predominantly used categorical rather than dimensional approaches, the latter of which better addresses clinical comorbidity and heterogeneity. Moreover, there is little evidence on the role of HRV in longitudinal symptom trajectory in adolescents and young adults. The current study examined the association between HRV and internalizing symptom trajectory using a dimensional approach-the tri-level model of depression and anxiety. Adolescents and young adults (N = 362) were recruited in a 3-year longitudinal study, where they completed electrocardiogram recordings and self-report symptom questionnaires. Multilevel modeling was conducted with high-frequency power bands (HF power) of interbeat intervals at baseline as the predictor, and tri-level symptom factors over 3 years as the outcome. HF power significantly predicted the trajectory of the broad General Distress symptom factor, but not the intermediate Fears or Anhedonia-Apprehension symptom factors. Higher HF power was associated with a decline in General Distress over time. This association was held when neuroticism, other tri-level symptom factors, and demographic variables were covaried. That is, greater parasympathetic nervous system activity at baseline was significantly associated with a greater decline in the broad internalizing symptom factor, but not symptom factors that are more specific to depressive or anxiety disorders. Parasympathetic activity, therefore, may be a transdiagnostic biomarker for internalizing symptoms in adolescents and young adults. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Advances in cancer care require ongoing monitoring of patient satisfaction using rigorous questionnaires. The EORTC Quality of Life Group has cross-culturally developed a patient satisfaction core questionnaire (PATSAT-C33) to be used in any hospital cancer care settings and an outpatient satisfaction module (OUT-PATSAT7) to address specific aspects of ambulatory care. This multi-center international prospective study aimed to validate the PATSAT-C33 and OUT-PATSAT7, including assessing its acceptability. Patients (N = 690) affected by any cancer site or stage equally distributed by age and gender, were enrolled in in- and out-patient cancer settings from 20 institutions, 12 countries and 5 geographic/cultural areas. Among them, 675 completed the PATSAT-C33 alongside the EORTC QLQ-C30, Oberst's perception of care quality 5-item, and 'intention to recommend the hospital' 1-item. Among the 532 outpatients, 526 also completed the OUT-PATSAT7. A subset completed a two-week retest (N = 120 & 96 for the PATSAT-C33 & OUT-PATSAT7, respectively) or one-year responsiveness-to-change assessment (RCA) (N = 166 & 155). Comprehensive psychometric testing was performed. Full item completion was high (85% & 88%), 83% of patients took ≤ 20 min to complete both questionnaires (40 items); 5% of patients required help with understanding questionnaire items. Confirmatory factor analyses evidenced satisfactory fit on the eleven PATSAT-C33 and two OUT-PATSAT7 multi-item scales (CFI/TLI > 0.90; RMSEA < 0.10 and = 0.108, respectively). Internal consistency was good to excellent (all ≥ 0.80); test-retest reliability was fair (0.48, 1 scale), good (0.60-0.74, 11 scales) to excellent (≥ 0.75, 7 scales). Convergent validity was supported by correlations of ≥ 0.40 with related Oberst's scales and < 0.30 with unrelated QLQ-C30 scales. Known-groups differences was shown for comorbidity, toxicity, global health, care expectations and intention to recommend the hospital. Change over time was captured in groups defined based on change in global health, cancer care setting, and the receipt of supportive care over the past year. This study supports the psychometric robustness of the EORTC PATSAT-C33 and OUT-PATSAT7 and their promising usefulness in monitoring cancer care within and across cancer care settings from different cultures and cancer patient populations. ClinicalTrials.gov ID: NCT05989191, August 2, 2023.
Suicidal ideation (SI) is understood to emerge usually from the interplay of stable vulnerabilities and fluctuating situational stressors. This study explicitly tested this notion by examining whether impairments in personality functioning moderate the relationship between momentary loneliness and SI in daily life. A total of 180 participants (N = 85 inpatients, N = 95 community members) completed a baseline assessment of personality functioning (Operationalized Psychodynamic Diagnosis Structure Questionnaire) and a signal-contingent 10-day ecological momentary assessment of loneliness and passive SI. Linear mixed-effects models disaggregated between- and within-person components of loneliness and examined both concurrent and lagged effects on SI, including interactions of within-person loneliness with personality functioning. There were 9,001 observations in total (M = 48.37, SD = 18.82, per participant). Impairments in personality functioning were associated with higher mean levels of loneliness and SI. At the same measurement point, within-person increases in loneliness were associated with heightened SI, particularly among individuals with more severe impairments in personality functioning. Prospective models failed to identify a significant lagged effect of loneliness or its interaction with personality functioning; only trait-level loneliness and the level of personality functioning remained predictive of subsequent SI. Findings support a Person × Situation interaction model of SI, indicating that experiences of loneliness are a particularly strong risk factor for SI for individuals with low levels of personality functioning. By integrating trait- and state-level perspectives on risk, ecological momentary assessment offers a promising tool for capturing dynamic processes and real-time, personalized intervention approaches. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
Research has identified numerous personal, school, and family factors associated with youth mental health, yet it remains unclear which correlates best predict mental health outcomes accurately. This study used machine learning to identify the strongest personal, school, and family correlates of mental well-being, overall mental health problems, and internalizing (anxiety and depression) and externalizing (attention deficit and hyperactivity disorder, conduct disorder, and oppositional defiant disorder) symptoms among school-age children and youth and examines whether associations vary across demographic subgroups. Data were drawn from the 2014-2015 School Mental Health Survey in Canada. Machine learning-based feature importance analyses on 24,692 youth (12,754 [51.7%] girls) identified school belonging as the strongest correlate of general mental well-being, lifestyle behaviors (e.g., sleep and exercise) as the strongest correlate of internalizing symptoms, and class preparedness as the strongest correlate of externalizing symptoms. By leveraging generalized random forest models, we found that the strongest correlates of general well-being and internalizing symptoms, but not externalizing symptoms, exhibited statistically significant group differences by gender, family immigration background, and parent education. For example, although school belonging was the strongest correlate of general mental well-being for both genders, higher belonging was associated with greater well-being among girls compared with boys. In addition, higher academic achievement and family relationship quality were associated with fewer internalizing symptoms among youth from immigrant families than those from nonimmigrant families. These findings highlight unique sets of personal, school, and family factors related to mental health among diverse youth, which may inform tailored interventions targeting these multilevel factors. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Since the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, and the 11th revision of the International Classification of Diseases introduced dimensional assessment of personality functioning (PF), PF impairments have been linked to transdiagnostic mental-health risk factors. Using ecological momentary assessment data from 16,038 mental health app users, we tested whether baseline PF impairment, affect-event dynamics, and depression predict future PF impairment and depression severity, hypothesizing a central role of PF. In the first month, users completed 69.3 mood (range 31-142) and 63.3 event assessments (25-133) on average. Dynamic structural equation models linked baseline depression to lower concurrent and cross-lagged mood-positive event links, lower inertia, and reduced likelihood of positive events. In contrast, baseline PF impairment related to persistence, emotional impact, and volatility of interpersonal conflict and greater mood instability. Over 1-year follow-up (N = 1,464, M = 1,236 assessments per user), future PF impairment and depression were predicted by weaker concurrent mood-positive event links, lower volatility of positive events, and baseline average mood/events. Among affect-event dynamics, cross-lagged effects of interpersonal conflicts on mood explained the highest unique variance in future PF impairment (ΔR2 = 5.9%). Baseline PF showed the strongest overall predictive utility (ΔR2 = 19.5%), followed by baseline depression (ΔR2 = 11.9%); PF explained more variance in future depression than vice versa. PF assessment may inform duration, goals, and strategies of treatments beyond those focused on personality disorders. Results are interpreted considering limitations, particularly the single-method design. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
Poor intimate relationship quality is prospectively associated with elevated levels of depressive symptoms and higher incidence of a major depressive episode. Propensity score matching analyses, which statistically equate people in the exposure sample (e.g., people in distressed relationships) with a comparison sample (e.g., people in nondistressed relationships), provide a complementary means to traditional covariate analyses for addressing confounding in observational research, thereby enhancing the ability to evaluate potential causal associations. In this preregistered study, propensity score matching analyses were conducted using a probability sample of married adults in the United States aged 50 years and older who participated in 2014/2016 or 2016/2018 waves of the Health and Retirement Study and who were (a) not depressed at baseline and (b) continuously married at baseline and 2-year follow-up. Women (n = 407) and men (n = 525) in distressed relationships were matched with an equal number of women and men in nondistressed relationships on the propensity to experience relationship distress. Women and men in distressed relationships were significantly more likely than propensity-matched women and men in nondistressed relationships to meet criteria for a past-year major depressive episode at follow-up. In the full sample of women (n = 2,273) and men (n = 2,345), similar results were obtained for covariate analyses using the propensity score as well as traditional covariate analyses examining covariates independently. Findings provide strong support for the perspective that relationship distress is causally associated with depression and support the use of couple-based interventions for preventing and treating depression in middle-aged and older adults. (PsycInfo Database Record (c) 2026 APA, all rights reserved).