Multimorbidity, especially physical–mental multimorbidity, is an emerging global health challenge. However, the characteristics and patterns of physical–mental multimorbidity based on the diagnosis of mental disorders in Chinese adults remain unclear.

A cross-sectional study was conducted from November 2004 to April 2005 among 13,358 adults (ages 18–65years) residing in Liaoning Province, China, to evaluate the occurrence of physical–mental multimorbidity. Mental disorders were assessed using the Composite International Diagnostic Interview (version 1.0) with reference to the Diagnostic and Statistical Manual of Mental Disorders (3rd Edition Revised), while physical diseases were self-reported. Physical–mental multimorbidity was assessed based on a list of 16 physical and mental morbidities with prevalence ≥1% and was defined as the presence of one mental disorder and one physical disease. The chi-square test was used to calculate differences in the prevalence and comorbidity of different diseases between the sexes. A matrix heat map was generated of the absolute number of comorbidities for each disease. To identify complex associations and potential disease clustering patterns, a network analysis was performed, constructing a network to explore the relationships within and between various mental disorders and physical diseases.

Physical–mental multimorbidity was confirmed in 3.7% (498) of the participants, with a higher prevalence among women (4.2%, 282) than men (3.3%, 216). The top three diseases with the highest comorbidity rate and average number of comorbidities were dysphoric mood (86.3%; 2.86), social anxiety disorder (77.8%; 2.78) and major depressive disorder (77.1%; 2.53). A physical–mental multimorbidity network was visually divided into mental and physical domains. Additionally, four distinct multimorbidity patterns were identified: ‘Affective-addiction’, ‘Anxiety’, ‘Cardiometabolic’ and ‘Gastro-musculoskeletal-respiratory’, with the digestive-respiratory-musculoskeletal pattern being the most common among the total sample. The affective-addiction pattern was more prevalent in men and rural populations. The cardiometabolic pattern was more common in urban populations.

The physical–mental multimorbidity network structure and the four patterns identified in this study align with previous research, though we observed notable differences in the proportion of these patterns. These variations highlight the importance of tailored interventions that address specific multimorbidity patterns while maintaining broader applicability to diverse populations.

Psychological and existential distress is prevalent among patients with life-threatening cancer, significantly impacting their quality of life. Psilocybin-assisted therapy has shown promise in alleviating these symptoms. This systematic review aims to synthesize the evidence on the efficacy and safety of psilocybin in reducing cancer-related distress.

We searched MEDLINE, APA PsycINFO, Cochrane database, Embase, and Scopus from inception to February 8, 2024, for randomized controlled trials (RCTs), open-label trials, qualitative studies, and single case reports that evaluated psilocybin for cancer-related distress. Data were extracted on study characteristics, participant demographics, psilocybin and psychotherapy intervention, outcome measures, and results. Two authors independently screened, selected, and extracted data from the studies. Cochrane Risk of Bias for RCTs and Methodological Index for Non-Randomized Studies criteria were used to evaluate study quality. This study was registered with PROSPERO (CRD42024511692).

Fourteen studies met the inclusion criteria, comprising three RCTs, five open-label trials, five qualitative studies, and one single case report. Psilocybin therapy consistently showed significant reductions in depression, anxiety, and existential distress, with improvements sustained over several months. Adverse effects were generally mild and transient.

This systematic review highlights the potential of psilocybin-assisted therapy as an effective treatment for reducing psychological and existential distress in cancer patients. Despite promising findings, further large-scale, well-designed RCTs are needed to confirm these results and address existing research gaps.

This study aimed to refine the content of a new patient-reported outcome (PRO) measure via cognitive interviewing techniques to assess the unique presentation of depressive symptoms in older adults with cancer (OACs).

OACs (≥ 70years) with a history of a depressive disorder were administered a draft measure of the Older Adults with Cancer – Depression (OAC-D) Scale, then participated in a semi-structured cognitive interview to provide feedback on the appropriateness, comprehensibility, and overall acceptability of measure. Interviews were audio-recorded and transcribed, and qualitative methods guided revision of scale content and structure.

OACs (N = 10) with a range of cancer diagnoses completed cognitive interviews. Participants felt that the draft measure took a reasonable amount of time to answer and was easily understandable. They favored having item prompts and response anchors repeated with each item for ease of completion, and they helped identify phrasing and wording of key terms consistent with the authors’ intended constructs. From this feedback, a revised version of the OAC-D was created.

The OAC-D Scale is the first PRO developed specifically for use with OACs. The use of expert and patient input and rigorous cognitive interviewing methods provides a conceptually accurate means of assessing the unique symptom experience of OACs with depression.

Mindfulness is a promising psychological resource that can alleviate dysfunctional fear responses and promote mental health. We investigated how mindfulness affects fear and depression in isolated patients with coronavirus disease 2019 (COVID-19), and whether it acts as a mediator.

We conducted an online survey of COVID-19 patients undergoing at-home treatment from February to April 2022. The survey included a questionnaire on fear of COVID-19 (measured by the Fear of COVID-19 Scale), mindfulness (measured by the Mindful Attention Awareness Scale), and depression (measured by the Patient Health Questionnaire). A total of 380 participants completed the questionnaire. We analyzed the correlation between each variable and performed a mediation analysis using hierarchical regression and bootstrapping to verify the statistical significance of the mediating effects.

Each variable was significantly correlated. Hierarchical regression analysis showed that the association between the fear of COVID-19 and depression decreased from 0.377-0.255, suggesting that mindfulness partially mediates the relationship between fear of COVID-19 and depression. Bootstrapping analysis showed that the indirect effect of the mediating variable (mindfulness) is 0.121, which accounts for 32.3% of the total effect.

Interventions that promote mindfulness in patients with acute COVID-19 may be beneficial for their mental health.

Pubertal development variations have consequences for adolescent internalizing problems, which likely continue into adulthood. Key questions concern the extent of these links between pubertal timing and adult symptoms, as well as the underlying mechanisms.

Longitudinal data were available for 475 female and 404 male participants. Pubertal timing was indicated by age at mid-puberty for both groups and age at menarche for female participants (both assessed continuously). Adult self-reported outcomes of recent and lifetime depression and anxiety were predicted from pubertal timing, also controlling for adolescent (then childhood) internalizing problems. Emerging adulthood self-esteem, body dissatisfaction, education level, and age at sexual initiation were examined as mediators of the pubertal timing-adult internalizing link. Multilevel models tested hypotheses.

Pubertal timing had persisting and sex-dependent psychological associations. Specifically, in female, but not male, adults, early puberty was associated with all adult internalizing outcomes, and for past year and lifetime depression symptoms, even after controlling for adolescent internalizing problems. Pubertal timing links with past-year depression symptoms were mediated by age at sexual initiation, while all other persisting pubertal timing links with adult symptoms were mediated by body dissatisfaction. Most findings concerning depression held when childhood internalizing problems were also a covariate.

Leveraging data spanning four developmental periods, findings highlight the associations between pubertal variations and adult internalizing symptoms by revealing underlying sex-dependent behavioral pathways. Only for female participants did pubertal timing affect depression and anxiety in established adulthood, with body dissatisfaction and age at sexual initiation as unique developmental mechanisms.

Preliminary evidence suggests that mental imagery may be an important clinical feature in hoarding. Individuals who hoard use objects as receptacles for memories, and experience more frequent, intrusive and distressing images compared with the general community. However, the specific nature of these associations remains poorly understood.

We aimed to investigate whether hoarding traits were related to the ability to voluntarily generate imagery in different sensory modalities, and uniquely with the tendency to experience negative intrusive imagery. We also aimed to understand the mechanism by which mental imagery experiences may confer vulnerability to hoarding problems.

Undergraduates (n=328) completed questionnaires assessing hoarding, beliefs about objects, imagining ability across the senses, and negative intrusive imagery, as well as symptom measures of depression, obsessive-compulsive disorder and post-traumatic stress. We conducted Pearson’s correlations, hierarchical regressions, and mediational analyses.

Hoarding tendencies were associated with reduced visualising ability, but not with the capacity to deliberately generate imagery in other senses. Hoarding was also uniquely associated with the tendency to experience negative involuntary imagery when controlling for symptoms of depression, obsessive-compulsive disorder, and post-traumatic stress. Object-memory beliefs partially mediated the relationship between hoarding and reduced visualising ability. Object attachment partially mediated the relationship between hoarding and negative intrusive imagery.

Results suggest that visualisation difficulties may promote a reliance on objects to facilitate recall, and experiencing negative intrusive imagery may strengthen object attachment. Findings may inform imagery-based conceptualisations and treatments of hoarding problems, such as imagery training or modification interventions.

Older people with depression exhibit better response to electroconvulsive therapy (ECT). We aimed to measure the total effect of age on ECT response and investigate whether this effect is mediated by psychotic features, psychomotor retardation, psychomotor agitation, age of onset, and episode duration.

We pooled data from four prospective Irish studies where ECT was administered for a major depressive episode (unipolar or bipolar) with baseline score ≥21 on the 24-item Hamilton Depression Rating Scale (HAM-D). The primary outcome was change in HAM-D between baseline and end of treatment. The estimands were total effect of age, estimated using linear regression, and the indirect effects for each putative mediator, estimated using causal mediation analyses.

A total of 256 patients (mean age 57.8 [SD = 14.6], 60.2% female) were included. For every additional 10 years of age, HAM-D was estimated to decrease by a further 1.74 points over the ECT period (p < 0.001). Age acted on all putative mediators. Mechanistic theories, whereby a mediator drives treatment response, were confirmed for all putative mediators except age of onset. Consequently, mediation of the effect of age on change in HAM-D could be demonstrated for psychotic features, psychomotor retardation, psychomotor agitation, and episode duration but not for age of onset.

A total of 43.1% of the effect of older age on increased ECT response was explained by the mediators. Treatment planning could be improved by preferentially offering ECT to older adults, especially if presenting with psychotic features, greater severity of psychomotor disturbance, and earlier in the episode.

Delphi studies allow for the generaztion of a consensus among experts. This has historically been professional experts in their field. This study aimed to obtain a consensus regarding the most important components of cognitive behavioural therapy (CBT) for depression not only for professional experts (therapists) but also for adult experts by experience. Perceptions of importance between therapists and experts by experience differed in multiple areas including content components such as behavioural activation and experiments, psychoeducation, and homework, which the latter did not agree were important. Experts by experience found several components relating to delivery process important which therapists did not, such as delivery method and session length. The strongest agreement from both groups involved the importance of positive therapist factors such as being non-judgemental, knowledgeable, understanding, and trustworthy. Both groups were in agreement on the importance of cognitive restructuring. Neither experts by experience nor therapists met consensus agreement on the inclusion of mindfulness as part of a wider CBT intervention for depression, being rated among the lowest components for both groups. Findings highlight several aspects of CBT content and delivery which may benefit from review in order to increase acceptability for recipients.

1. (1) To identify what recipients and deliverers feel are the most important parts of a CBT intervention for depression.

2. (2) To compare these responses, and consider reasons why these similarities and differences may exist.

3. (3) To discuss ways in which these differences could impact acceptability and perceived efficacy of cognitive behavioural therapy.

4. (4) To reflect on ways gained knowledge could be used to consider ways to improve the delivery of cognitive behavioural therapy.

As the use of guided digitally-delivered cognitive-behavioral therapy (GdCBT) grows, pragmatic analytic tools are needed to evaluate coaches’ implementation fidelity.

We evaluated how natural language processing (NLP) and machine learning (ML) methods might automate the monitoring of coaches’ implementation fidelity to GdCBT delivered as part of a randomized controlled trial.

Coaches served as guides to 6-month GdCBT with 3,381 assigned users with or at risk for anxiety, depression, or eating disorders. CBT-trained and supervised human coders used a rubric to rate the implementation fidelity of 13,529 coach-to-user messages. NLP methods abstracted data from text-based coach-to-user messages, and 11 ML models predicting coach implementation fidelity were evaluated.

Inter-rater agreement by human coders was excellent (intra-class correlation coefficient = .980–.992). Coaches achieved behavioral targets at the start of the GdCBT and maintained strong fidelity throughout most subsequent messages. Coaches also avoided prohibited actions (e.g. reinforcing users’ avoidance). Sentiment analyses generally indicated a higher frequency of coach-delivered positive than negative sentiment words and predicted coach implementation fidelity with acceptable performance metrics (e.g. area under the receiver operating characteristic curve [AUC] = 74.48%). The final best-performing ML algorithms that included a more comprehensive set of NLP features performed well (e.g. AUC = 76.06%).

NLP and ML tools could help clinical supervisors automate monitoring of coaches’ implementation fidelity to GdCBT. These tools could maximize allocation of scarce resources by reducing the personnel time needed to measure fidelity, potentially freeing up more time for high-quality clinical care.

Social anhedonia, indicating reduced pleasure from social interaction, is heightened in autistic youth and associated with increased internalizing symptoms transdiagnostically. The stability of social anhedonia over time and its longitudinal impact on internalizing symptoms in autism have never been examined.

Participants were 276 autistic children (Mage = 8.60, SDage = 1.65; 211 male) with IQ ≥ 60 (MIQ = 96.74, SDIQ = 18.19). Autism severity was measured using the Autism Diagnostic Observation Schedule, Second Edition. Caregivers completed the Child and Adolescent Symptom Inventory, Fifth Edition (CASI-5) at baseline, 6 weeks, and 6 months. The CASI-5 includes a social anhedonia subscale derived from relevant items across domains. ICC (Intraclass Correlation Coefficient) analysis assessed stability, while cross-lagged panel models examined associations among social anhedonia, depression, and social anxiety across time.

At baseline, social anhedonia correlated with autism severity, as well as parent-reported social anxiety and depression. Social anhedonia showed relative stability (ICC = 0.763) over 6 months, with a significant decline between baseline and 6 weeks (β = −0.52, p < .001). Cross-lagged models revealed a bidirectional relationship between social anhedonia and depression over time, while social anxiety displayed concurrent, but not predictive, associations across time.

Social anhedonia demonstrated stability over 6 months, suggesting that it may be a relatively stable characteristic in autistic children. Concurrent relationships were observed between social anhedonia and depression, as well as social anxiety and attention-deficit/hyperactivity disorder. Only depression demonstrated a bidirectional longitudinal association with social anhedonia. This bidirectional relationship aligns with developmental models linking early negative social experiences to subsequent internalizing symptoms in autistic children, underscoring the clinical significance of social anhedonia assessment in this population.

Late-life affective disorders (LLADs) are common and are projected to increase by 2050. There have been several studies linking late-life depression to an increased risk of dementia, but it is unclear if bipolar affective disorder or anxiety disorders pose a similar risk.

We aimed to compare the risk of LLADs progressing to all-cause dementia, and the demographic and clinical variables mediating the risk.

We used the South London and Maudsley National Health Service Foundation Trust Clinical Records Interactive Search system to identify patients aged 60 years or older with a diagnosis of any affective disorder. Cox proportional hazard models were used to determine differences in dementia risk between late-life anxiety disorders versus late-life depression, and late-life bipolar disorder versus late-life depression. Demographic and clinical characteristics associated with the risk of dementia were investigated.

Some 5695 patients were identified and included in the final analysis. Of these, 388 had a diagnosis of bipolar affective disorder, 1365 had a diagnosis of an anxiety disorder and 3942 had a diagnosis of a depressive disorder. Bipolar affective disorder was associated with a lower hazard of developing dementia compared to depression (adjusted model including demographics and baseline cognition, hazard ratio: 0.60; 95% CI: 0.41–0.87). Anxiety disorders had a similar hazard of developing dementia (adjusted hazard ratio: 1.05; 95% CI: 0.90–1.22). A prior history of a depressive disorder reduced the risk of late-life depression progressing to dementia – suggesting the new onset of a depressive disorder in later life is associated with higher risk – but a prior history of anxiety disorders or bipolar affective disorder did not alter risk.

LLADs have a differential risk of developing all-cause dementia, with demographic- and illness-related factors influencing the risk. Further prospective cohort studies are needed to explore the link between LLADs and dementia development, and mediators of the lower risk of dementia associated with late-life bipolar disorder compared to late-life depression.