Frontiers in Psychiatry

Depression is one of the most prevalent mental health disorders globally. Social media content can reflect emotional states, offering real-time signals of depressive symptoms. This study aimed to develop a deep learning model to predict depression using Twitter/X data, and to characterize potential causes of depression using a large language model (LLM). Twitter/X posts from April 20, 2023, to July 24, 2024, were obtained using the key phrase ("I" or "me") and "diagnosed with depression". After data cleaning and GPT-4o labelling, 2,275 depressive Twitter users, and an additional 1,661 non-depressive users from tweets using the keyword "today", were identified. A deep learning RoBERTa model for predicting depression was built on tweets from both user groups, with an 80/20 training-testing split. GPT-4o models were subsequently employed to analyze depressive users posts to understand potential causes for depression. The RoBERTa model achieved strong performance in predicting depression among Twitter users from their tweets, with an accuracy of 0.822, an F1 score of 0.855, and an AUC of 0.809. Common reasons for depression identified by GPT-4o models included societal pressure, low self-esteem, cultural influences, and identity-related challenges. These findings highlight the potential of deep learning models in early screening of depression using social media data. Insights into potential reasons for depression may inform targeted prevention strategies, public health interventions, and improved mental health support for at-risk populations.

Objective: The Genetic Risk for Serious Mental Illness and Development ("Paisa Kids") Study is establishing a longitudinal cohort of 3,000 youth enriched transdiagnostically for risk for serious mental illnesses (SMI; i.e., schizophrenia, bipolar disorder, and severe depression) from the Paisa region of Colombia. Its objective is to clarify the early clinical, neurobehavioral, genetic, and environmental profiles associated with later SMI and distinguish transdiagnostic from disorder-specific pathways. This paper describes the study infrastructure, recruitment streams, and baseline assessment battery, and characterizes the first two-thirds of the cohort. Method: Youth aged 6-15 years are being recruited. Youth recruited for high SMI risk either have a first or second degree adult relative with a SMI diagnosis or a psychiatric diagnosis themselves identified through electronic medical records (EMRs) associated with later SMI. Lower-risk youth have a relative without a SMI diagnosis. Baseline measures include psychiatric and developmental history, neurobehavioral functioning, environmental exposures, and genome-wide genotyping. Psychiatric EMRs provide longitudinal follow-up. Results: Among 2,384 participants enrolled thus far (mean age=11.2 years, 45.0% female), 2,211 were recruited for high SMI-risk and 173 for lower SMI-risk. Overall, 73.2% met criteria for a history of one or more psychiatric disorders. Logistic regression comparing rates of diagnoses and ACEs between recruitment streams showed elevated rates of depressive and anxiety disorders, attention-deficit/hyperactivity disorder, oppositional defiant disorder, and several ACEs among high versus lower SMI-risk youth. Conclusion: Integrating multidomain phenotyping, genomic data, and longitudinal EMR follow-up, the Paisa Kids cohort provides a unique resource for investigating pathways of risk and resilience to SMI.

Objective This study aimed at analyzing changes in the prevalence of excessive internet use and to analyze its associations with mental and cognitive health problems among adolescents. Method We used repeated cross-sectional data from the School Health Promotion study, a population-based nationwide classroom survey in Finland. All adolescents in grades 8-11 were invited, with a total of 602,226 responses in 2017-2023. Excessive internet use was measured with the five-item Excessive Internet Use Scale covering core behavioral addiction symptoms. Depressive symptoms, generalized anxiety, and social anxiety were measured with validated questionnaires. Problems in cognitive functioning were assessed with one-item indicators. Analyses were done with Chi-square tests and logistic regression. Results From 2017 to 2023, the prevalence of excessive internet use increased, especially among girls. The increasing trend was significantly (p<0.001) steeper among girls, with the OR for time (in years) being 1.12 in grades 8-9 and 1.14 in grades 10-11, while among boys the corresponding ORs were 1.00 and 1.04, respectively. Excessive internet use associated with short sleep, depressive, generalized anxiety, and social anxiety symptoms (ORs between 1.73-2.42 in boys; 1.92-2.26 in girls; p<0.001) and with difficulties in tasks requiring reading, writing, and mathematics, and difficulties in concentrating (ORs 1.84-2.31 in boys; 1.83-1.98 in girls; p<0.001). Conclusion The prevalence of excessive internet use showed an increasing trend, especially among girls. The associations of excessive internet use with mental health symptoms and cognitive challenges were clear.

Individuals with major depressive disorder (MDD) show an attentional bias toward negatively valenced stimuli and thoughts. In this study, we applied a closed-loop neurofeedback procedure designed to reduce this bias. Participants were shown composite negative faces and neutral scenes with variable opacity and were instructed to attend to the neutral scene while ignoring the negative face. Internal attentional states were decoded in real time from functional magnetic resonance imaging (fMRI) data. When a participant's decoded attentional state indicated a failure to ignore the negative faces, the faces became more visible (higher opacity), thus externalizing the brain's attentional lapse in that moment. Forty-eight individuals with MDD were randomly assigned to a real neurofeedback training group (N = 24) or a sham control group (N = 24); the control group received feedback yoked to a participant in the real group. All participants completed three fMRI neurofeedback sessions. The main outcome quantified the extent to which participants got ``stuck'' in the most negative attentional state of focusing strongly on the negative faces. We hypothesized that the real neurofeedback group would learn to escape that state by the end of training, relative to the sham control group. Consistent with our hypothesis, neurofeedback training reduced the probability of getting stuck in the most negative attentional state. In offline analyses, training reduced fMRI activity in the precuneus/posterior cingulate and the medial prefrontal cortex when participants successfully attended to scenes and ignored faces. These results demonstrate the efficacy of remediating the negative attentional bias in depression with closed-loop neurofeedback from real-time fMRI.

Background: Adolescents frequently consult online resources regarding sensitive health topics, including suicide. Although content analyses demonstrate that online platforms contain both suicide-preventive and pro-suicide material, they rarely incorporate subjective data from adolescents at elevated suicide risk. Aims: This exploratory study examined associations between reasons for seeking suicide-related information online and the digital media used to access such content among adolescents with suicidal ideation. Method: Over one year, 131 adolescents aged 13 to 18 with current or past suicidal ideation were recruited from the Emergency Department of an urban pediatric hospital to complete a cross-sectional survey. Participants reported whether they had sought suicide-related information online, the type of information sought, and the online locations used. Mixed-effects regression models examined associations between reasons for online searches and digital media used. Results: Of 131 enrolled adolescents, 113 completed the survey; 69 (61.1%) reported ever seeking suicide-related information online. Searches were more often intended to assist with acting on suicidal thoughts than to reduce suicidal thoughts (63.7% vs. 55.1%). Social media were used for help-seeking searches slightly more often than professional health organization websites (42.1% vs. 31.6%). Among adolescents who used social media for their searches, discussion forums were significantly more likely to be used when seeking information to act on suicidal thoughts (OR=7.0, p=.02). Conclusion: The majority of adolescents with suicidal ideation may seek out suicide-related content online, particularly to facilitate suicide planning. Social media may be used as frequently as professional mental health websites like 988 or The Trevor Project for suicide-related searches.

Background: People with severe mental illness (SMI) report poorer oral health outcomes than the general population, are less likely to attend regular dental check-ups, and may require additional support to visit a dentist. Our previous research showed that interventions tailored to their needs and support from the mental health care system are needed to improve oral health outcomes in people with SMI. Although there is some provision of urgent dental care for people with SMI, there are currently limited available interventions that integrate dental and mental health care and provide dental support in a mental healthcare setting. To address this gap, the aims of the SMILE project are to 1) co-develop and 2) test the feasibility and acceptability of an oral health intervention for people with SMI, delivered by mental health professionals in secondary community mental health care settings. This paper describes the protocol for the feasibility and acceptability testing of the SMILE intervention. Methods: This is a single-arm, non-randomised feasibility trial assessing the feasibility and acceptability of an intervention to support the oral health of mental healthcare service users with SMI. The intervention was co-produced with service users, carers, mental health and dental health professionals, and includes advice on maintaining good oral hygiene and lifestyle habits to maintain good oral health. The main aim of the study is to assess the feasibility and acceptability of delivering the intervention, using quantitative data collected at baseline, three and six-month follow-up, and qualitative interviews with participants and mental health staff involved in delivering the intervention. Results: The study results will determine whether the intervention can be successfully delivered in secondary community mental health care settings and inform the most appropriate primary and secondary outcomes for a future trial. Conclusion: The findings of this study will inform the feasibility of progression to the pilot stage of a randomised controlled trial to assess the clinical and cost effectiveness of delivering an oral health intervention in a mental healthcare setting.

Social media language and digital lifestyle behaviours are promoted as scalable signals of population mental health, but predictive models are often evaluated in ways that overstate accuracy. We analysed 20,000 tweets from 72 users, labelled by whether the account belonged to a user identified as depressed, and two synthetic datasets (100,000 and 30,000 records) linking screen time, sleep and social media use with self-reported stress. Under a conventional tweet-level split, a term-weighted logistic regression appeared accurate (area under the receiver operating characteristic curve 0.835), but when whole users were held out its performance fell to near chance (0.595; 95% confidence interval 0.505 to 0.686), because the model largely recognised users and their topics. Depression-associated tweets were more often negative (31.7% versus 24.2%), yet sentiment alone could not identify unseen users (0.539). The two behavioural datasets gave opposite answers: strong discrimination in one (0.926), driven by short sleep, and chance in the other (0.506), so synthetic results reflect how the data were generated. At a population prevalence of 10%, positive predictive values would be 0.10 to 0.30. Digital distress signals should be validated across individuals, on real linked data and at realistic prevalence before informing public health surveillance or prevention.

Borderline personality disorder (BPD) has traditionally been viewed as one of the most chronic psychiatric disorders. Although longitudinal studies have demonstrated promising rates of symptomatic remission, recovery and other clinical outcome measures often remain comparatively low. Qualitative research offers an important perspective on how individuals with BPD may extend a more representative view of improvement and change. We collected narratives from 41 participants with a self-reported diagnosis of BPD and analyzed them using thematic analysis. Its national, virtual recruitment approach enabled a relatively large qualitative sample diverse in gender identity, age, U.S. geographic region, treatment history, and current clinical severity, extending the range of perspectives represented in prior work. Three central themes were identified. The first, Differing attitudes toward language, reflected participantsexperiences of recovery language as paradoxically both validating and stigmatizing. While individual language preferences varied, participants generally converged on a sharedunderstanding of what recovery meant to them. The second, Recovery as a dynamic and relational process, described recovery as nonlinear, effortful, and closely tied to interpersonal experiences. The third, Crossroads and uneven change over time, highlighted the role of personal agency, critical decision points in seeking treatment, and the persistence of internal distress even as behavioral symptoms improve. Findings from this study both replicate and extend existing qualitative research by discussing how individuals with BPD understand recovery in ways that may not be captured by traditional clinical outcome measures. These results emphasize the importance of incorporating lived-experience perspectives when defining recovery and setting treatment goals.

Polygenic risk scores (PRS) are rapidly developing, enabling estimates of genetic risk for developing psychiatric disorders. Psychiatric PRS are also increasingly entering consumer and clinical settings. Yet, little is known about how adults with psychiatric disorders perceive their potential use. Here, we conducted semi-structured interviews with 29 adults with psychiatric disorders to examine their perspectives on hypothetically receiving psychiatric PRS for themselves and their current or future children. Key themes emerged around perceived utility, motivations and deterrents to genetic testing, interpretation of PRS, and anticipated responses to results. In particular, participants expressed hope that PRS could support self-understanding, inform better psychiatric care, and enable earlier recognition of difficulties for their children. Participants however raised multiple concerns, including those of privacy, stigma, discrimination, eugenics, and the risk of self-fulling prophecies. Together, these findings offer critical empirical evidence to inform guidance on the responsible use of psychiatric PRS in clinical and consumer settings.

Background: Short-form video elicits a stimulus-driven, passive neural state, yet existing interventions target time of use alone and cannot show whether the mechanism of cognitive control has changed. Objective: This pilot study developed BrainPT, a mini-game-based cognitive intervention, and evaluated whether a single insertion alters the neural state during short-form viewing (Study 1) and whether repeated use improves behavioral self-regulation (Study 2). Methods: Study 1 used a within-subject design (n=9) in which electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) were recorded in the same session across short-form viewing, a single BrainPT set, and goal-directed tasks. Study 2 used a nonrandomized 2-week pretest-posttest design comparing an experimental group that used BrainPT daily (n=13) with a control group (n=8). Both visits followed the same in-laboratory protocol, and app logs and self-report indices were collected over the intervention period. Results: In Study 1, short-form viewing was accompanied by prefrontal deactivation: EEG power fell below baseline in all four bands and most in alpha (-1.72 dB, P=.01; q=.054 after correction). Prefrontal activation was opposite in sign between the goal-directed tasks and viewing (+0.180 vs -0.093, P=.002), and the viewing block immediately after a BrainPT insertion exceeded the block before it (+0.110 vs -0.093, P=.02). The same condition ordering appeared in an independent preintervention sample (n=18). In Study 2, daily short-form use fell from 143.5 to 50.9 min in the experimental group and rose from 104.8 to 132.9 min in the control group, a between-group difference in change of 120.7 min (P=.004). The Adult ADHD Self-Report Scale did not differ between groups (P=.39), and no neural index separated the groups after 2 weeks. Conclusions: A single insertion produced a measurable neural change: prefrontal state during the viewing that followed moved toward the goal-directed task. After 2 weeks of use that neural difference was not detectable between groups although behavior differed, so repeated use may act through the momentary state during viewing rather than by reorganizing the resting state. Both samples were small and nonrandomized, the primary outcome was self-reported, and the analyses were exploratory and not preregistered, so these estimates require confirmation in a preregistered randomized trial with objectively logged use.

While Artificial intelligence (AI) is increasingly being integrated into psychotherapy, little is known about how prospective patients evaluate different levels of AI involvement. Participants (n = 1,003) with depression evaluated vignettes describing psychotherapy options, from treatment delivered without AI integration (Human therapist) to treatments involving different degrees of AI integration (Assistive, Collaborative, Fully Autonomous AI). Participants consistently evaluated Human therapists more favorably, reporting a greater likelihood of seeking treatment, less hesitancy, and greater treatment acceptability. Economically, compared with a Human therapist, participants were willing to pay 31.6% less for therapists using Assistive or Collaborative AI and 57.2% less for Fully Autonomous AI. 18-19% of participants indicated that they would refuse treatment involving Assistive or Collaborative AI, compared with 31% for Fully Autonomous AI. Preference for Human over AI therapists was particularly pronounced at higher levels of therapist experience (doctoral/masters vs. peer/trainee). Overall, participants valued psychotherapy delivered by Human therapists more highly than AI integrated psychotherapy. These findings suggest that, despite increasing AI integration in mental health care, prospective patients continue to view psychotherapy as a distinctly human endeavor.

Suicide risk assessment in clinical conversations relies on the sequential structure of therapist-patient dialogue, yet formal models of how suicide-related content emerges, transitions, and re-ciprocates across conversational turns are lacking. We applied network analysis to C-SSRS-coded utterances from psychotherapy sessions to characterize the topology and dynamics of suicide-related clinical communication. Transcripts of 110 psychotherapy sessions from the SPEAK-SAFE study were classified for suicidality relevance using the Qwen3-32B large language model with an adapted Columbia-Suicide Severity Rating Scale (C-SSRS) schema. From the suicidali-ty-relevant utterances, we constructed a weighted directed category transition network. Centrali-ty, reciprocity, clustering, assortativity, and path length metrics were computed. Independent human expert ratings for a session-level subsample of 30 sessions from this cohort showed sub-stantial agreement with the LLM classifications (Spearman {rho} = 0.885, ICC[2,1] = 0.708). The network was dominated by therapist inquiry. Reciprocity was high, and closeness centrality de-creased monotonically with C-SSRS severity. Active suicidal ideation functioned as a bridge node from which escalation pathways to method, plan, and attempt categories originated. The network exhibited a hub-and-spoke topology with small-world characteristics. Suicide-related clinical dialogue is structured as a therapist-centered hub-and-spoke network with high reciproci-ty and a consistent severity-peripherality gradient. The extension of network theory from intra-individual symptom structures to inter-individual communication dynamics represents a method-ological innovation demonstrated here as a proof of concept, with potential applications to clini-cal training, automated decision support, and multimodal risk assessment. clinical interviews clin-ical interviews

BackgroundAtypical antipsychotics (AAPs) are increasingly prescribed for paediatric patients with autism spectrum disorder (ASD). However, pharmacovigilance data from Saudi Arabia remain scarce. The aim of this study is to detect and characterise signals associated with AAPs and assess gender- and age-related ADR reporting patterns. MethodsA retrospective cross-sectional study with disproportionality analysis was conducted on paediatric patients (0-19 years) using the Saudi Food and Drug Authority (SFDA) database (2021-2024). Disproportionality analyses were performed using the reporting odds ratio (ROR), proportional reporting ratio (PRR), and Bayesian confidence propagation neural network (BCPNN). Age and gender were assessed using odds ratios (ORs), with Firth penalized logistic regression to confirm associations. ResultsOverall, 701 ADR reports were analysed. Most involved males (59.91%) and children aged 0-9 years (82.88%). Olanzapine had the highest proportion of serious reports (44.44%). At the system organ class (SOC) level, signals included nervous system disorders with risperidone (ROR 32.61 [16.62-64.00]; PRR 3.49 [2.22-5.47]; IC025 0.08); cardiac and general disorders with quetiapine; haematological, metabolic, and psychiatric disorders with olanzapine; and gastrointestinal disorders with aripiprazole. Gender-adjusted analyses indicated significant variation in selected ADR signals across age groups, while no significant differences were observed by gender. ConclusionsThis study highlights disproportionality signals associated with AAP use in paediatric patients. Age-related ADR variation supports consideration of age-specific ADR monitoring within current paediatric recommendations. While these findings do not establish causality, they generate hypotheses for further evaluation. Regional pharmacovigilance may complement international paediatric safety monitoring frameworks.

BackgroundPsychotic-like experiences (PLEs) have been shown to increase the risk for mental health problems in later life, especially psychosis. Following previously raised methodological concerns about the assessment of PLEs in adolescents, this study sought to differentiate subtypes of PLEs and to explore their trajectories. MethodsLongitudinally matched data of 671 German adolescents from three surveys over the time span of one year were analysed. Four trajectories were identified, including persisting, subsiding, and emerging highly indicative PLEs (HIPs), and non-highly indicative PLEs (non-HIPs), and longitudinally compared in terms of associated distress, psychopathology, and substance use. A differentiated never PLEs group was considered as a control. ResultsThe persisting HIPs group reported greater distress than the non-HIP group over time and was consistently associated with higher rates of internalising symptoms. The subsiding HIP group showed significant reductions in distress and internalising symptoms over time, but no significant changes regarding externalising symptoms and substance use. There was no difference in the extent of substance use between the groups. ConclusionsScreenings of PLEs should be mindful of different subtypes of PLEs that indicate a greater associated risk of poor mental health. PLE screening should not stop at whether PLEs are present but ask which ones.

Background: Girls are more likely than boys to experience psychological distress during adolescence. Drivers of this gender gap remain under-studied, despite its large impact on later life and outcomes, especially for women. Explanatory factors can be gendered in their prevalence (differential exposure) and/or in their impact (differential susceptibility). We developed a multi-domain framework of explanatory factors for distress and applied it in four low- and middle-income countries. Methods: We first proposed a framework of explanatory factors for psychological distress grouped into seven domains (biological, cognitive, psychological, behavioural, social, environmental and broader societal). We applied this framework to identify explanatory variables assessed in childhood and adolescence in the Young Lives longitudinal cohort studies in Ethiopia (N=908), India (N=952), Peru (N=634) and Vietnam (N=887). Distress symptoms at 18-19 years were measured with the Strengths and Difficulties Questionnaire Emotional Symptoms scale. Gendered prevalence of each explanatory factor was tested with Mann-Whitney tests, and gendered impact with country-specific linear regressions including a gender-by-factor interaction term. Exploratory boosted-tree machine-learning models, interpreted with SHAP values and permutation feature importance, examined the contribution of these factors to the gender gap in each country. Results: Distress was higher in girls than boys in every country, the gap ranging from 0.62 points in Ethiopia and Vietnam to 1.76 in India and 2.45 in Peru. Some explanatory factors were consistently gendered in prevalence (e.g. girls experienced greater role overload in each country), while others were gendered only in some countries (e.g. study amount was higher for girls in Peru and Vietnam, but not Ethiopia or India). Gendered impacts on distress displayed more variability across countries. For example, higher self-esteem was more protective for boys than girls in India, Peru and Vietnam, but more protective for girls in Ethiopia. The machine-learning models identified important predictors across all framework domains, though their salience varied by country. Conclusions: Our findings underscore the importance of considering multi-domain explanations for mental-health outcomes and observed inequalities in mental health. Large cross-country differences in the gender gap and in the prevalence and influence of explanatory factors caution against generalising drivers of mental-health outcomes and inequalities across contexts.

Objective: Parent-adolescent disagreement in ratings of attention-deficit/hyperactivity disorder (ADHD) symptoms can complicate clinical assessment. This study examined parent - adolescent agreement in ADHD symptom ratings and characteristics associated with disagreement. Method: Participants were 1,008 parent-adolescent dyads recruited from a nationally stratified U.S. community sample. Adolescents were 12--18 years old (49.6% female) and along with their parents completed measures of ADHD and depressive symptoms. Agreement on Inattention (IN), Hyperactivity/Impulsivity (HI), and Total ADHD scores was examined. Item-level agreement was assessed using weighted kappa, Gwet 's AC2, percent agreement, and polychoric correlations. Associations between age, sex, and severity of ADHD and depression with levels of agreement were analyzed. Results: Agreement for ADHD factor and total symptom scores was moderate (intraclass correlations = 0.67--0.71), with moderate-to-strong rank-order correspondence. Adolescents reported slightly higher ADHD symptom levels than parents, although the mean difference was small. Item-level agreement was moderate to high (Gwet 's AC2 = 0.79--0.95). Several HI items demonstrated the kappa's paradox, with relatively low kappa values despite high Gwet's AC2 and percent agreement. Q-correlations revealed low agreement on relative strengths and weaknesses. Age and sex were not associated with disagreement and parent-reported ADHD severity and adolescent-reported depressive symptoms were associated with disagreement. Conclusions: Parent and adolescent ratings showed moderate agreement across boys and girls ages 12-- 18; however, disagreement related to relative strengths and weaknesses. Disagreement was associated with ADHD and depressive symptom severity. Findings suggest that ratings from parents and adolescents offer unique perspectives on the assessment of ADHD symptoms.

In Ethiopia, khat (Catha edulis) leaves, containing amphetamine-like alkaloids, are chewed for their psycho-stimulating effects. Khat use has been associated with psychosis. In a psychosis etiology framework, we investigated whether season, fluctuations of khat availability and khat use are associated with khat-induced psychotic experiences and whether trauma load moderates this association. In Southwestern Ethiopia, a cohort of 685 men aged 18-40 years were interviewed twice, during dry and after rainy season (low vs. high khat availability). Khat use was assessed by urine immunoassay and self-report. Trauma load and psychotic experiences were assessed by trained local interviewers. Khat use increased after the rainy season (p < 0.0001). Khat use and seasonality predicted khat-induced psychotic experiences. Main findings comprise increased odds of psychotic experiences among immunoassay-positive individuals with high trauma load. A potential additional interaction with recent trauma emerged. Findings support sensitization-related mechanisms but require replication in larger samples with longer follow-up.

Violence against women is a key contributor to mental health gender disparities, with greater gender gaps observed in low-and middle-income countries. This study examines state-level associations between gender-based violence against women and mental health burden in India over time. We linked 1) annual state-level age-standardised disability-adjusted life year rates (ASDR) from the Global Burden of Disease study for overall mental health disorders, depressive disorders, anxiety disorders, bipolar disorder, schizophrenia and self-harm, with 2) annual state-level gender-based violence rates from the Open Government Data Platform, India. We used descriptive ecological analyses and multilevel modelling to estimate the state-level association between gender-based violence and sex-stratified mental health outcomes over time (2001 - 2021). Results showed higher state-level gender-based violence (GBV) rates were associated with higher state-level ASDR of schizophrenia ({beta}women = 0.39 [95%CI 0.25 - 0.52]; {beta}men = 0.42 [0.29 - 0.55]) and bipolar disorder ({beta}women = 0.02 [0.01- 0.03]; {beta}men = 0.04 [0.03 - 0.05]), after adjustment for state-level social development, but not with other outcomes. Higher GBV rates were associated with a lower gender disparity in depressive disorders. Longitudinal findings revealed that the state-level association between GBV rates and ASDR of overall mental health disorders strengthened over time ({beta}women = 5.08 [3.96 - 6.20]; {beta}men = 3.38 [2.60 - 4.15]), whereas the association weakened for self-harm and schizophrenia. Lagged findings suggested that with an increase in GBV rate, ASDR of overall mental health disorders increased for men over two years and for both sexes over five years. Our findings highlight the importance of considering state-level trends in GBV and related policies, and considering impacts of GBV on both men and women's mental health.

Background: Interoception refers to the processing, integration, interpretation, and regulation of bodily signals by the brain. It is crucial to motivational and affective functioning such as subjective experience of arousal (i.e., intensity of emotion). Previous studies found altered self- report of arousal in people with schizophrenia, but the underlying biological mechanism is unclear. This study aimed to investigate interoceptive processing and emotional experience in schizophrenia by triangulating self-report, cardiac dynamics, and heartbeat-evoked potential (HEP; an event-related potential that reflects cortical processing of heartbeats). Methods: A total of 39 participants with schizophrenia spectrum disorders (SZ; 36% female) and 31 healthy controls (HC; 35% female) reported subjective arousal level when viewing images of varying emotional intensity while electroencephalogram and electrocardiogram were being recorded. Results: We found that intense images led to larger heartrate decelerations and higher subjective arousal ratings in HC, but did not modulate heartrate changes in SZ and were less predictive of their subjective ratings. Subjective ratings were predictive of cardiac dynamics in HC, but not in SZ. SZ showed a less negative HEP amplitude than HC when viewing less intense images. Lastly, SZ with less severe positive and negative symptoms exhibited cardiac dynamics more similar to those of HC. Conclusions: These findings suggest both reduced cardiac reactivity to emotional stimuli and a disconnect between interoceptive afferent signals and cortical processing, leading to different subjective emotional experience in people with schizophrenia. Studying interoception using a multimodal approach may reveal important insights into the underlying mechanisms of altered emotional experience in schizophrenia.

Home-based 2 mA transcranial direct current stimulation (tDCS) was recently approved by the US Food and Drug Administration for depression, but tDCS amplitude has been limited largely by skin tolerance, and higher-intensity, accelerated dosing may be more efficacious or faster-acting. Using a novel high-capacity tDCS (HC-tDCS) stimulator and hydrogel electrodes, we evaluated the safety, tolerability and feasibility of accelerated HC-tDCS (20-minute bifrontal 6 mA sessions, twice daily for five days) in 20 patients with major depressive disorder. A Safety Review Committee reviewed data from the first three participants, who completed a within-day escalation to 6 mA, before the remaining 17 were enrolled. Retention and adherence were 100% (203 of 203 sessions), and 19/20 tolerated the full 6 mA amplitude without dose reduction. There were no serious adverse events. The most common symptoms were fatigue (49% of sessions), burning (46%) and tingling (43%) at the electrode, and difficulty concentrating (40%). Electrode-site erythema occurred in all participants, with no severe reaction or skin breakdown. At 1 week, 7 of 20 reported a residual skin change, mostly peeling or redness, none painful; at 1 month, hyperpigmentation at the electrode site persisted in 2 participants, both Black. At the end of the five-day course, PHQ-9 scores decreased from 15.8 to 7.2 (Hedges g = 1.62); 50% of participants responded, 45% remitted, and improvement was maintained at 1-month follow-up. Accelerated HC-tDCS was feasible, well tolerated, and warrants a sham-controlled trial.