Concerns have been raised regarding the common off-label use of antipsychotic (AP) medications among older adults. However, comprehensive knowledge of the determinants of AP off-label use in this population remains limited. We examined characteristics and predictors of AP off-label use in a nationwide Finnish cohort of community-dwelling older adults with psychiatric morbidity-but without Alzheimer's disease-using longitudinal register data on sociodemographic and illness-related factors. The sample comprised four groups: those prescribed APs off-label (n = 20,563), those with non-psychotic mental disorders without off-label APs (CG1, n = 22,891), those with psychosis or bipolar disorder with APs (CG2, n = 8,966), and those with psychosis or bipolar disorder without APs (CG3, n = 4,585). Sociodemographic and illness-related factors were compared between the off-label and the comparison groups using logistic regression. Compared to comparison groups, individuals with off-label use more frequently had cardiovascular diseases and strokes. Compared to CG1 and CG3, individuals with AP off-label use were more often female, had a lower prevalence of asthma/chronic obstructive pulmonary disease, and a higher use of psychotropic medications and opioids. Compared to CG2, individuals with off-label use were more often male and had a lower prevalence of diabetes, epilepsy, as well as a lower use of psychotropic medications and a higher use of opioids. Risperidone (43%) and quetiapine (39%) were the most used APs off-label. Alternative treatments are needed to curb off-label AP use among community-dwelling older adults, given the high prevalence of cardiovascular disease and stroke. Monitoring guidelines are needed to promote safer prescribing practices.
To study the lifetime and point prevalence of eating disorders (ED) among mental health care providers and compare those working with patients with ED to those who work in other fields of psychiatry to examine whether the overrepresentation of ED among professionals seen in ED clinics are also true for professionals in other psychiatric outpatient clinics. Digital questionnaires were sent out to professionals working with patients in psychiatric outpatient clinics in Sweden. The questionnaire included questions from the Mini International Neuropsychiatric Interview 7.0.1 and the Eating Disorder Examination Questionnaire 6.0. 173 respondents completed the questionnaire. The lifetime prevalence of ED among professionals in ED-clinics was 35.2% (women 41.9%, men 10.0%) and in non-ED clinics 24.4% (women 27.7%, men 16.1%). The point prevalence was 11.1 and 10.9% respectively. The lifetime prevalence of any ED in the Swedish general population is 2-3.5%. Our results suggest a 10-fold higher prevalence among mental health care providers, regardless of if working with patients with ED or not. This result could have multiple explanations; such as an increased willingness to help others based on personal experience of ED or increased risk of developing ED when working with patients with ED. There is always a risk of reporting bias when conducting studies using digital questionnaires. The findings can have implications for the psychosocial work environment and health of employees as well as for the assessment and treatment of patients. The lifetime prevalence of eating disorders (ED) was 35% among mental health care providers working with ED and 24% among mental health care providers working within other fields of psychiatry.The point prevalence of ED among the mental health care workers was 11%, regardless of if working with ED or in other fields of psychiatry.Only a few of those with a personal history of ED were open about it in their workplace, which might be due to a (self-) stigma surrounding their own problems with mental health among mental health care professionals.
The Alcohol Use Disorders Identification Test (AUDIT) is a widely used screening instrument for harmful alcohol use. Comorbidity between alcohol use disorders and other mental disorders is common, but there is a shortage of studies investigating AUDIT's diagnostic accuracy in young adult psychiatric patients. The aim of this study was to examine AUDIT's diagnostic accuracy and psychometric properties in young adult psychiatric outpatients. In data from two samples of young adults (18-25 years) from general psychiatric outpatient clinics in Sweden, recruited in 2002-2003 (n = 197) and 2012-2016 (n = 283) psychiatric diagnoses were assessed using the Structured Clinical Interview for DSM-IV, axis I disorders, clinical version (SCID-I-CV) or the Mini International Neuropsychiatric Interview (MINI 6.0). Internal consistency of AUDIT, sensitivity, specificity, positive and negative predictive values (PPV and NPV), receiver operator characteristic (ROC) curves, and area under the curve (AUC) were calculated. The internal consistency of AUDIT was acceptable (Cronbach's alpha = 0.76). For the samples combined the optimal cut-off was 10, sensitivity 87% and specificity 82%, PPV 0.28 and NPV 0.99. For Sample 2002-2003, the optimal cut-off point was nine For Sample 2012-2016, the optimal cut-off point was 10. ROC curves are presented, with an AUC of 0.88 (95% CI= 0.81-0.95) for both samples combined, 81.1% for Sample 2002-2003 (95% CI = 0.63-0.99) and an AUC of 90.6% for Sample 2012-2016 (95% Cl = 0.85-0.96). The full version of AUDIT is a reliable and valid screening instrument for alcohol use disorders, as shown in two samples of young adult psychiatric outpatients.
Mental health problems are increasing among children and adolescents. Parents play a pivotal role in care, and intervention programmes have been introduced directed towards children with mild to moderate mental health problems. Due to long waiting times for specialised psychiatric care, such programmes could serve as means to ease the burden on mental health clinics for children 6-14 years. The aim of this study was to evaluate parents' assessments of the quality of care of an intervention programme and associations with the children's physical and mental health after treatment. Parents' assessment of the quality of care was investigated through a questionnaire. Outcome variables were parents' perceptions of the children's physical and mental health after treatment. Explanatory variables were background factors, care organisation and the content of care. 31% of the parents assessed their child's physical health as less than good, and 46% their child's mental health as less than good, after treatment. Long waiting times (OR 2.50; 1.17-5.30), parents' ability to have private conversations with the therapist (OR 0.45; 0.22-0.94), and deficiencies in the content of care were associated with less good physical health after treatment. Less good mental health after treatment was associated with older age of children (OR 2.01; 1.01-3.99) and deficiencies in care content. Age of the child, long waiting time, and perceived deficiencies in the content of care were associated with less physical and mental well-being of the child after the intervention. These findings call for improvement of care.
Discharge from a psychiatric hospital is associated with an elevated risk of suicide. Previous studies have linked a higher number of psychiatric admissions to suicide risk. However, findings are mixed, and the association between admission frequency and suicide risk remains unclear. This study aimed to investigate whether frequent psychiatric admissions and the persistence of readmission patterns serve as risk factors for suicide. This prospective total cohort study included all patients consecutively admitted to the psychiatric acute ward at Haukeland University Hospital in Bergen, Norway, between 2005 and 2014 (N = 7000). The cohort was divided into independent groups according to the number of admissions per year and the persistence of this pattern. Demographic and clinical data were collected at each admission. Patients were followed for up to 19 years by linking the cohort to the Norwegian Cause of Death Registry. Cox and competing risk regression analyses were applied to investigate the association between the frequency of admissions and the risk of suicide. There was an approximately threefold (AHR = 2.91) increase in the risk of suicide in patients with five or more admissions on average per utilisation year, when adjusted for gender, suicidal ideation, self-harm and diagnosis. The risk was particularly high (AHR = 5.93) immediately after the last discharge. These findings might assist the identification of a subgroup of individuals at particular risk of suicide within a population of hospitalised psychiatric patients.
In Sweden, in the wake of deinstitutionalization, in 1995 the responsibility for support regarding accommodation, employment, and an active everyday life for persons with severe mental illness (SMI) became a matter for the municipality's social services. The overall aim of this study was to investigate whether there are differences in functioning and needs among older adults (65+) with severe mental illness (SMI) when divided into Psychosis and Non‑Psychosis groups. Data was collected from 5 surveys, and data from national registers. A group of older adults with SMI, with a history of long-term stays in mental hospitals, was identified and divided into two groups: Psychosis diagnosis (N = 222) and Non-Psychotic diagnosis (N = 253). The level of functioning was significantly lower in the Psychosis group, but at the same time, long periods of institutionalization, regardless of diagnosis category, also contributed to lower functioning scores. Diagnostic group did not explain differences in the proportion of unsatisfied needs; however, the length of institutionalization did. Although there were diagnostic group differences in functioning, there were no diagnostic group differences in unmet needs, suggesting that social services were responding to individuals' actual level of functioning. In line with the studies by Barton and by Goffman, it can be argued that the long periods of institutionalization were the most decisive factors influencing functional levels.
Differences in the effectiveness of antidepressant medications by age are uncertain, with no compelling evidence of medication outperforming others in older adults. This real-world study compared the acceptability (efficacy and tolerability) of 20 antidepressants in younger and older patients using filled prescription sequences. A nationwide cohort from the French national health system (SNDS) identified new antidepressant users over one year. The primary outcome was clinical acceptability, measured by the continuation/change ratio over the six-month period after initiating first-line treatment. Continuation was defined as at least two refills of the same treatment. Change was defined as at least one filled prescription of another antidepressant, an antipsychotic medication, or a mood-stabilizer. Antidepressant medications were compared by clinical acceptability while stratifying on age (<65 vs ≥65 years). Multivariable logistic regression models were used to calculate odds ratios adjusted for sex, social deprivation, comorbidity, specialty of first prescriber and benzodiazepine or Z-drug prescriptions. To further examine the moderating effect of age, we searched for an age by medication interaction. Escitalopram had the highest acceptability in both participants aged <65 (n = 257,504) and ≥65 (n = 83,673). Acceptability substantially differed between groups, in particular for mianserin and mirtazapine, ranking 2nd and 7th in older patients and 15th and 19th among younger ones. This large real-world study suggests differences in the acceptability of first-line antidepressants between older and younger patients. Although escitalopram ranked first regardless of age, alpha-2 blockers (mianserin and mirtazapine) emerged as acceptable options in older patients only. Differences in the effectiveness of antidepressant medications according to age are uncertain. In a nationwide cohort from the French national health system, filled prescription sequences were used to compare the acceptability of 20 antidepressants by patient age. The primary outcome was clinical acceptability measured by the continuation/change ratio over the six-month period following introduction of the first-line treatment. 257,504 participants aged <65 and 83,673 aged ≥65 were included. Acceptability substantially differed between age groups.
Young adults (18-25 years) have the highest prevalence of psychiatric disorders of any age group. This qualitative study aims to gain perspectives on individual change and recovery, and the influence of psychiatric care, 20 years after being treated as young adults. Semi-structured interviews were conducted at 20-year follow-up with 18 participants from the original 'Young Adult' study in Uppsala, Sweden from 2002/2003. All interviews were audio-recorded and transcribed. The data were analysed using inductive thematic analysis. The analysis resulted in three themes: Personal recovery, Communication and participation in psychiatric care, and Organization of psychiatric care. Personal recovery included subthemes: Acceptance of vulnerability, Maturity, and Social stigma. Communication and participation in psychiatric care included subthemes: Personal approach, and Individually-adapted care and individual responsibility. Organization of psychiatric care included subthemes: Availability of health care, Resources, and Diagnostics and treatment. Personal recovery for young adults included social changes, comparison with peers, being between dependence and independence, and stigma. Acceptance of vulnerability and maturity helped to increase stability. Communication, participation and the organization of psychiatric care were described within the framework of patient-centred care, with an emphasis on an empathetic approach and the availability of psychiatric care. These findings offer clinically relevant insights into how psychiatric services can support long-term recovery.
Knowledge about how medication management in the treatment of psychosis aligns with guideline recommendations is limited. This study aimed to investigate the extent to which current antipsychotic medication management adheres to guideline recommendations for the treatment of psychotic disorders in specialist mental healthcare in Norway. Antipsychotic medication management was assessed using 44 criteria from the Antipsychotic Medication Management Fidelity Scale in Norwegian public mental health specialist units. The scale measures adherence (fidelity) to core components of medication management, as recommended in guidelines, at both unit level (N = 16 units) and patient level (N = 147 patient records). At the unit level, the mean fulfilment of criteria for maintaining a list of current medications and for systematic monitoring of side-effects were 8.8 (55%) and 5.5 (34%) units, respectively.At the patient level, lists of medications and doses were systematically updated in 112 (76%) patient records. The choice of antipsychotic medication and dosage was in accordance with the guidelines in 79 (54%) and 69 (47%) patient records, respectively. Mean fulfilment of criteria for monitoring and reducing side-effects was 42.8 (29%) patient records. Systematic monitoring of symptoms was not documented in any patient record. Our study found structural and procedural shortcomings in medication management for psychosis in specialist mental healthcare. Low adherence to guidelines poses a significant patient safety risk. Addressing the implementation of clinical guidelines is essential to improve patient outcomes and the quality of care in specialist mental health services. NCT03271242, 5 Sept. 2017.
This narrative review provides an in-depth description of gender-affirming breast surgery within the context of publicly funded healthcare systems in the Nordic countries. A comprehensive literature search was conducted in collaboration with two information specialists, focusing on original research, reviews, and clinical guidelines published in English. The prevalence of transgender and non-binary individuals in the Nordic region ranges from 0.04% to 0.6%, depending on the country and study methodology. Gender-affirming treatment, including hormone therapy and surgical interventions such as breast augmentation and mastectomy, plays a critical role in reducing gender dysphoria and improving psychological well-being, with low rates of reported regret. Transfeminine individuals often pursue breast augmentation with implants or autologous fat grafting; procedures tailored to their unique anatomical considerations. These surgeries are associated with improved health-related quality of life and high levels of satisfaction. Surgical planning involves careful consideration of implant type, placement, and incision strategy. Transmasculine individuals commonly undergo chest masculinization, with techniques adapted to breast size, ptosis, skin quality, and individual goals. Both implant-based and mastectomy procedures are generally safe, though complications such as capsular contracture, hematoma, or wound healing disturbances may occur. Although regret is rare, it underscores the need for comprehensive assessment, informed consent, and mental health support throughout the transition process. Breast cancer screening guidelines remain inconsistent, with barriers to access due to legal gender markers and varying levels of provider knowledge While Nordic countries vary in their approaches, all aim to balance medical necessity, individual autonomy, and healthcare equity. Future priorities include refining surgical protocols, expanding research on long-term outcomes, and addressing systemic barriers to ensure inclusive, evidence-based care for all gender-diverse individuals.
Physical exercise is an effective treatment for depression, yet little is known about the temporal dynamics of symptom improvement during exercise interventions. In this randomized controlled trial, 64 adults with moderate to severe depressive symptoms were allocated to a 10-week supervised Nordic walking (NW) program (n = 48) or a non-active control condition (n = 16). The NW group completed two weekly training sessions at moderate intensity (65-75% HRmax). Depressive symptoms were assessed at baseline, mid-intervention (Week 5), and post-intervention (Week 10) using the Beck Depression Inventory-II. Primary analyses examined Group × Time effects on symptom severity. Secondary analyses explored (via a Group × Depression intensity × Time ANOVA) whether baseline depression intensity moderated treatment response. A significant Group × Time interaction indicated greater reductions in depressive symptoms in the NW group compared with controls. Symptom improvement was most pronounced during the first half of intervention (Hedges's g = -0.98), with smaller changes thereafter (Hedges's g = -0.40 from mid- to post-intervention). In addition, a significant Group × Depression intensity × Time interaction suggests that participants with severe baseline depression experienced larger and more rapid improvement than those with moderate symptoms in the first five weeks. Supervised Nordic walking was found to be associated with substantial reductions in depressive symptoms within five weeks, particularly among individuals with severe depression. Implications of our findings and study's limitations are discussed.
Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in adolescence resulting in functional impairment that often persist to adulthood. Girls seem to be diagnosed with ADHD later in life than boys and more often have a comorbid major depressive disorder (MDD). It has been suggested that comorbidity with MDD can interfere with early identification of ADHD. The aim of the study was to investigate the diagnostic delay for boys and girls with ADHD in child and adolescent outpatient settings as well the interference of self-reported symptoms of MDD. Adolescent psychiatric outpatients were assessed with DSRS-A Screener (version of Depression Self-Rating Scale for Adolescents) at intake. Diagnostic delay for ADHD was estimated with Kaplan-Meier survival curve with separated analysis for boys/girls and for negative/positive MDD screening. Cox regression analysis was used to examine the association of sex and MDD screening. Diagnostic delay for N = 252 (41% boys, mean age =15.23 years) was 3.5 years, 1.4 for boys and 4.9 for girls (p = 0.004). Positive MDD screening was associated with prolonged diagnostic delay (from 1.4 to 4.9 years p = 0.002), which in separated analyses was statistically significant only for girls from 1.8 to 4.9 years (p = 0.018). In Cox regression male sex was associated with decreased diagnostic delay (p = 0.023) while positive MDD screening with prolonged diagnostic delay (p = 0.015). The diagnostic delay of ADHD was more than three times longer for girls. Co-occurring symptoms of MDD prolonged diagnostic delay significantly only for girls.
Psychosocial support plays a crucial role in gender-affirming treatments. This pilot randomized controlled trial, conducted in Finland, aimed to determine whether early-onset psychotherapy affects the mental distress and well-being of individuals seeking gender-affirming treatment. Participants (N = 58) were enrolled from individuals seeking gender-affirming treatment referred to the Gender Identity Clinic at Helsinki University Hospital. Participants were randomized into two groups: early therapy or the standard evaluation process. Evaluations using the General Health Questionnaire-12 items (GHQ-12) and Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS) were conducted at baseline and at the end of the evaluation period, approximately one year after enrollment. The effectiveness of the treatment was assessed with analysis of covariance (ANCOVA). In addition, participants reported their experiences through written and oral feedback. The group that received early-onset psychotherapy showed a significant change in GHQ-12 score compared with the control (p < 0.05). The estimated effect of the intervention was a change of -4.0 (95% Cl -7.9, -0.2), indicating lower mental distress. According to feedback collected from participants, psychotherapeutic support was perceived as significant and was particularly desired at the beginning of the gender-affirming process, where the need for self-reflection was greatest. Additionally, psychosocial support was also desired to aid the transition process. A complete RCT study with larger intervention and control groups is needed to make definitive conclusions about the effectiveness of early- onset trans- sensitive therapy. However, the results of this pilot trial support the continuation of the current clinical use of trans-sensitive psychotherapy in Finland.
COVID-19 challenged health care personnel from spring 2020 to the introduction of vaccines. This prospective cohort study evaluated the psychological impact of cumulated exposure to COVID-19 frontline work and COVID-19-related potentially traumatic events (PTEs) on all hospital personnel. PTEs, posttraumatic stress disorder (PTSD) symptoms, psychological distress, insomnia, anxiety and depression symptoms were assessed with screening tools monthly during the first year and later bimonthly in this study among HUS Helsinki University Hospital personnel who participated in this study. The initial number of participants was N = 4910 (19% of the hospital personnel), 85% of whom reparticipated in some of the 16 follow ups and N = 1128 at 24 months (last follow up). The most important PTE before PTSD symptoms was strong anxiety due to fear of one's own or a close one's infection (odds ratio, OR 2.39, 95% confidence interval, CI 1.92-2.98), followed by exceptionally disturbing or distressing pandemic work assignments (OR 1.69, 95% CI 1.41-2.02). Frontline work and direct exposure to pandemic patients alone did not statistically significantly increase PTSD risk (OR 1.05, 95% CI 0.89-1.23). Accumulation of PTEs (OR 1.07 per PTE, 95% CI 1.03-1.12) and prolonged frontline work (OR 1.05, 95% CI 1.01-1.10) over time were risk factors for psychological distress. Accumulated exposures to PTEs and frontline work constitute an additional risk of distress and stress-related disorders. The subjective nature of the most prominent risk, PTE (fear of infections), suggests that workplace interventions and emotional support might prevent distress during a pandemic.
The effectiveness of transcranial magnetic stimulation (TMS) in the treatment of major depressive disorder (MDD) may be enhanced through individualized targeting in the dorsolateral prefrontal cortex (DLPFC). Recent clinical trials have used TMS targeting based on the subgenual anterior cingulate cortex (sgACC) or right anterior insula (rAI) functional connectivity. However, the repeatability of such individual targeting may present significant challenges for feasibility. We aimed to compare the repeatability of the novel depression core network model-based (CNM) target maps with the sgACC functional connectivity-based and the rAI effective connectivity-based target maps. We further tested whether using a movie stimulus increases the feasibility of individualized functional connectivity-based targeting. In a final sample of 31 patients with treatment-resistant MDD, the repeatability of the target maps was computed as the within-subject spatial correlation among imaging sessions in the DLPFC. Repeatability was compared across the connectivity models. Furthermore, repeatability, head movement, and subjective alertness and comfortableness during functional magnetic resonance imaging (fMRI) were compared between movie and resting-state acquisition. The CNM functional connectivity-based DLPFC target maps were more repeatable than the sgACC- or rAI-based target maps when using a movie stimulus. In particular, the cingulo-opercular seeds from the CNM produced target maps with high repeatability in both resting-state and movie stimulus conditions. Compared with the resting-state, the movie stimulus reduced head movement during fMRI but did not enhance repeatability at a statistically significant level. Our findings support future investigations of multiseed functional connectivity targeting methods, including those focused on the cingulo-opercular regions. These findings also encourage further research on the use of engaging naturalistic stimuli to enhance the feasibility of individualized TMS targeting.
Negative attitudes among mental health professionals toward individuals who self-harm can impact the quality of care and contribute to antipathy and stigma. This study aimed to investigate the psychometric properties of a Danish version of the Self-Harm Antipathy Scale (SHAS-DR), designed to measure mental health professions attitudes toward patients who self-harm. The SHAS-D was administered to 261 mental health professionals. Confirmatory factor analysis (CFA) was used to examine dimensionality and structural validity. Internal consistency was evaluated using Cronbach's alpha reliability and McDonald's omega coefficients, and discriminant validity was assessed via factor intercorrelations. Neither a unidimensional global factor nor the originally proposed six-factor model, based on all 30 items, were supported. Consistent with a previous study, a 17-item three-factor solution and a 19-item five-factor solution showed acceptable model fit. Internal consistency was acceptable for most subscale scores. The three-factor model was superior to the five-factor model in terms of internal consistency and discriminant validity. The 17-item form of the SHAS-DR, capturing three subscales, is a structurally valid and reliable tool for assessing attitudes toward self-harm in Danish mental health care. The three factors of 'Sympathy and Support', 'Judgmental Perception', and 'Acceptance and Understanding' point to central areas of antipathy and may be important targets for future training and stigma-reduction efforts among mental health care staff working with patients who engage in self-harm.
Dopaminergic medication used in disorders like Parkinson's disease (PD) and restless legs syndrome can cause impulsive-compulsive behaviour (ICB), often with strong negative effects on patients' quality of life. This narrative review presents translational evidence on iatrogenic ICB, taking findings from epidemiological, clinical, neuroimaging and preclinical studies into consideration. Epidemiological and clinical studies find dopamine agonists with high D2/3-selectivity to be most strongly linked to ICB. Their effect on ICB has often been shown to be dose-dependent, but the impact of combining different dopaminergic drugs or applying extended-release formulations is less clear. Intervention studies support tapering or replacing dopamine agonists for ICB reduction, whereas no efficacious pharmacotherapy has been identified for ICB treatment specifically. Adequate animal models for mimicking different types of ICB are available, and point, in line with human neuroimaging studies, towards an involvement of striatum and prefrontal cortex in iatrogenic ICB. Overall, complementary research designs have led to profound evidence regarding the occurrence of ICB in PD and establishing methods transferable to other, less-studied patient populations. A combined approach integrating insights from human studies and animal models could contribute to developing dopaminergic drugs with lower ICB risk but also specific pharmacotherapies for impulsivity or compulsivity in the future. Diseases like Parkinson's disease and restless legs syndrome are treated with drugs that affect dopamine activity in the brain. As a side effect, these drugs can lead to a lower impulse control, manifested, for example, as gambling disorder or hypersexuality. This article summarises research on these side effects, collected through a variety of scientific methods. The drug type with the highest risk for behavioural side effects has been identified, but many details remain unclear, especially in patients with other disorders than Parkinson's disease. Results from both human brain imaging and animal models start to reveal brain pathways involved.
Health inequities have drawn increasing attention, yet evidence on the moderating role of socioeconomic status (SES) in the relationship between mental disorders and multiple behavioural risks is inconsistent. This study examines the role of SES in the relationship between prior mental disorder diagnoses and later multiple behavioural risks. The study was based on registry-linked survey data from 2021-2022 among the Estonian adult population. The analytic sample included 1,561 individuals aged >25. Poisson regression was used to examine associations between mental disorders and behavioural risks. Latent class analysis was used to identify behavioural risk classes, and multinomial logistic regression to assess their relationship with prior diagnoses. Depression was associated with a higher number of behavioural risks and higher odds of belonging to multiple risk classes, while anxiety was linked to the overweight/obesity class. Lower SES index, secondary education, and medium income were associated with increased behavioural risks compared to higher SES index, education, and income. While the SES index showed no interactions, education and income demonstrated moderating effects. Respondents with medium income and depression had lower risk of behavioural risks and lower odds of belonging to multiple risk classes, compared to the higher-income group. Individuals with anxiety and secondary education had a lower risk of behavioural risks and lower odds of the overweight/obesity category, compared to those with higher education. These results highlight the relevance of socioeconomic context and the need for further longitudinal research. Findings point to the importance of addressing behavioural risks within psychiatric care.
Social capital theory is predominantly built around social networks, relationships, and functions of society. Social capital dimensions have been found to be inversely associated with depressive symptoms. This study aimed to investigate the association between cognitive and structural dimensions of social capital and depressive symptoms (outcome variable) at an epidemiological level. Social capital consisted of cognitive (actual support, emotional support and generalized trust) and structural (taking care of family members) dimensions. Depressive symptoms were calculated using the Hopkins Symptoms Checklist- 15. Data used was derived from the Northern Finland Birth Cohort 1966, utilizing a sample of 46-year-old participants (N = 6522). The study used cross-sectional design. Binary logistic regression analyses were used to explore the association between these dimensions of social capital and depressive symptoms after adjusting for gender, education level, and marital status. Cognitive social capital variables were associated with depressive symptoms: those who received 'not at all' emotional or actual support from their partners were significantly more likely to exhibit depressive symptoms (odd ratios (OR) being 2.04 (95% CI = 1.57, 2.65) and 2.29 (95% CI = 1.76, 2.98), respectively) than those whose partners supported them a lot/quite a lot. Furthermore, those having extra low generalized trust had over 7-fold (OR = 7.55, 95% CI= 5.42, 10.53) increased risk of exhibiting depressive symptoms. Structural social capital was not associated with depressive symptoms. A significant association between cognitive social capital and depressive symptoms was found, suggesting that social capital may play a significant role in the trajectory of depressive symptoms.
Numerous studies have explored the possibility of developing automatic detection pipelines that can seamlessly diagnose patients with bipolar disorder (BD) and other mental illnesses. Such novel diagnostic tools increasingly rely on data sources, such as facial movements, whose relationships to BD have yet to be fully elucidated. As such, these detection pipelines offer limited clinical value, despite promising performance estimates. A vital next step toward achieving clinically reliable models is to conduct granular interpretability analyses to determine which subsets of facial movements are responsible for determining patient or control class membership. In this work, we rely on facial movements encoded as Action Units (AUs) of 32 participants recorded while watching emotional film clips. Our objective is to delineate the specific facial micro-movements responsible for the differences between patients with BD and controls by applying the interpretable Fisher's Linear Discriminant Analysis (LDA) in a binary, supervised classification design. We report how the movement of brow lowering (AU4) differentiates patients from controls with AUROC scores up to 69%. Our exploratory study argues for the necessity of devising inherently interpretable machine learning models for the clinical domain. Furthermore, we critically discuss the implications of identifying AU4 as a key discriminative feature and assess the clinical value of specific facial movements for the diagnostic process.