Journal of Affective Disorders Reports

Objectives To describe the prevalence of anxiety and depression symptoms among Black-Latines compared to other racial/ethnic groups in the United States. Methods This cross-sectional analysis leveraged data from the 2022 National Health Interview Survey (NHIS) to estimate the prevalence of anxiety and depression as measured by the GAD-7 and PHQ-8, respectively. Anxiety and depression scores in Black-Latine were compared to White-Latine, Non-Latine White, and Non-Latine Black respondents. Results Black-Latines were more likely to score higher on both the GAD-7 and PHQ-8 indicating higher prevalence of more than minimal anxiety (22.0%) and more than minimal depression (26.0%) than both Non-Latine Black, anxiety (18.0%) and depression (22.0%), and White-Latine, anxiety (16.0%) and depression (18.0%), respondents. Conclusions Black-Latines are more likely to report more depression and anxiety symptoms than their Non-Latine Black and White-Latine counterparts. Studies should try to disaggregate Black subgroups in order to identify the most vulnerable populations.

Adolescent suicidal ideation is a critical public health issue, yet empirical evidence on its prevalence and associated factors among adolescents in northern Bangladesh remains limited. This study estimated the 12-month prevalence of suicidal ideation and examined its associated factors among school-going adolescents in Nilphamari District, Bangladesh. A cross-sectional survey was conducted between May and June 2026 among 365 adolescents aged 13-19 years across eight secondary schools and colleges. Self-administered questionnaires assessed suicidal ideation alongside validated tools for depression (PHQ-9), anxiety (GAD-7), and perceived social support (MSPSS). Factors associated with suicidal ideation were examined using multivariable logistic regression. The 12-month prevalence of suicidal ideation was 30.7% (112/365; 95% CI 26.0%-35.7%). In the primary multivariable model, moderate depression (AOR = 6.05, 95% CI 1.03-35.38; p = 0.046) and moderately severe depression (AOR = 6.86, 95% CI 1.05-44.62; p = 0.044) were associated with higher odds of suicidal ideation compared to minimal depression. However, this association was not statistically significant in a sensitivity analysis using the PHQ-8 score after excluding Item 9 (AOR = 1.06, 95% CI: 0.96-1.17; p = 0.228). Loneliness "often" showed the strongest association with suicidal ideation (AOR = 10.59, 95% CI: 2.53-44.35; p = 0.001). Suicidal ideation was also associated with truancy of 6-9 days (AOR 4.44, 95% CI 1.24-15.90; p = 0.022), truancy of [≥]10 days (AOR 3.77, 95% CI 1.34-10.59; p = 0.012), intentional self-harm (AOR = 2.51, 95% CI: 1.17-5.41; p = 0.018), and physical harm exposure (AOR = 2.63, 95% CI: 1.24-5.57; p = 0.012). Maternal secondary education was associated with lower odds of suicidal ideation (AOR = 0.34, 95% CI: 0.12-0.99; p = 0.048). Suicidal ideation was common among school-going adolescents in northern Bangladesh, affecting nearly one in three participants. Early school-based identification and support for adolescents experiencing mental-health and psychosocial difficulties, together with family engagement and strengthened suicide-prevention services, are warranted.

Background: Substance use is common among individuals with depression. Transcranial magnetic stimulation (TMS) is an effective treatment for depression, but current clinical guidelines have discouraged TMS treatment for individuals with depression and co-occurring substance use given concerns for limited efficacy. However, limited data exists on whether substance use affects response to TMS. Methods: Using electronic health record data from patients who received a standard course of TMS for major depressive disorder at an academic medical center, we investigated associations between substance use frequency and response to TMS, defined as change in Patient Health Questionnaire-9 (PHQ-9) scores. Substance use frequency was extracted for alcohol, cannabis, nicotine, stimulants, benzodiazepines, opioids, inhalants, psychedelics, and other drugs. We performed ANCOVA and multiple regression analyses to predict change in PHQ-9 score based on substance use frequency, controlling for pre-TMS PHQ-9 score, age, sex, and number of TMS sessions received. Results: We extracted data from 219 TMS courses. Alcohol was the substance used most commonly (34.2%), followed by prescription benzodiazepines (28.3%), and prescription stimulants (21.0%). Across all substance categories, substance use was not associated with change in PHQ-9 score (all p > 0.05, Cohens d=0.00 to 0.30). In multiple regression models to compare individual levels of substance use frequency (e.g., daily use vs. no use), level of substance use was not associated with change in PHQ-9 score (all p > 0.05). The range of plausible effects of substance use frequency on PHQ-9 change was generally below the minimal clinically important difference for PHQ-9, suggesting substance use was unlikely to have a meaningful clinical effect on antidepressant response to TMS. Conclusions: Low to moderate substance use does not have a clinically significant effect on antidepressant response to TMS. Low-level substance use should not exclude individuals with depression from receiving TMS.

Background. Post-stroke anxiety and depression frequently co-occur, and whether each is independently associated with cognitive impairment remains unclear because most studies model one without adjusting for the other variable. In a five-year cohort, we tested whether anxiety and depression have distinct cognitive correlates and whether early affective status predicted subsequent cognitive recovery. Methods. Patients from the STROKDEM cohort were assessed at 6, 12, 36, and 60 months post-stroke for anxiety, depression, and five cognitive domains (memory, executive functioning, attention, visuospatial functioning, and language). Two symmetric random-intercept linear mixed models regressed each affective score on the cognitive domains while adjusting for other scores. Repeated-measures correlations, multiple imputations for attrition, and exploratory trajectory and prognostic models were also used. Results. After mutual adjustment and correction, depression was independently associated with executive and visuospatial function, whereas anxiety showed no independent cognitive correlation. Repeated-measures correlation confirmed this dissociation. The anxiety findings were stable across the sensitivity analyses and multiple imputations. Attrition was selective for baseline cognition, and exploratory associations between early affect and cognitive recovery did not survive multiple imputations and were inconclusive. Limitations. Attrition was substantial and selective on baseline cognition; the persistent anxiety subgroup was small, limiting the power for trajectory analyses; and psychiatric history, psychotropic medication, and cognitive reserve beyond education were unavailable. Conclusions. The cognitive burden of post-stroke affective disorders is carried by depression, rather than anxiety. Because anxiety-related cognitive impairment largely reflects comorbid depression, screening for depression rather than anxiety alone may better identify stroke survivors at risk of cognitive impairment.

Brief assessments reduce clinician and patient burden and increase utilization. Recently, five core depression symptoms (low mood, poor concentration, low self-worth, loss of interest, low energy) have been shown to be particularly sensitive to treatment effects in adults. How these core depressive symptom domains perform for screening or diagnostic purposes in youth is unknown. To address this question, we extracted five analogous symptom items from four widely used symptom assessment tools for children and adolescents (Child Behavior Checklist [CBCL], Youth Self Report [YSR], Parent General Behavior Inventory [P-GBI], and Adolescent General Behavior Inventory [A-GBI]) to create 5-item short forms. We evaluated their psychometric properties and diagnostic utility in a large (N=1185), racially diverse sample (48% Black youth) across community and academic outpatient mental health settings, with diagnoses established through LEAD consensus. All short forms correlated highly with full-length measures (r=.74-.92) and demonstrated comparable inter-item correlations (r =.19-.46). The short forms did not differ meaningfully from the full measures in correlations with psychiatric diagnoses, demographics, or diagnostic interviews. Area under the curve (AUC) values for identifying depression and any mood disorder diagnosis (determined by semi-structured diagnostic interviews) were fair to good (AUC=0.60-0.79), which were not worse than full measures, except for the P-GBI. The CBCL-5, YSR-5, P-GBI-5, and A-GBI-5 may be useful brief depression assessments in youth. How these five symptom domains perform as outcome measures in treatment deserves study.

Background: Major depressive disorder (MDD) is a severe mental illness associated with severe clinical consequences and substantial societal burden. It's characterized by immune-inflammatory dysregulation and immune sensitization. Objective: To determine whether in vitro ketamine attenuates phytohemagglutinin (PHA)/lipopolysaccharide (LPS)-induced immune sensitization in patients with MDD and healthy controls (HCs). Methods: Whole blood from 18 patients with MDD and 18 HCs was stimulated with PHA/LPS and exposed to ketamine (0.3 M, 0.6 M, and 6 M) for 72 hours. Cytokines, chemokines, growth factors, and composite immune profiles, including M1/M2 macrophages, T helper (Th)1/2/17, the immune-inflammatory response system (IRS), and compensatory immunoregulatory system (CIRS), were synthesized and determined. Results: Under PHA and LPS stimulation in vitro, the MDD group exhibited markedly elevated immune profiles, including M1, M2, Th1, Th2, Th17, IRS, CIRS, chemokines, and growth factors, consistent with immune sensitization. Significant group-by-treatment interactions were observed for Th1-Th2, M2, growth factors, IL-12(p70), M1, and chemokines. Ketamine produced minimal changes in HCs but broader suppression in MDD, particularly at the highest concentration, without normalizing the sensitized immune phenotype. Among the immune markers with no notable group-by-treatment interactions, ketamine exerted diagnosis-independent effects, decreasing MIP-1{beta}, IL-1&{beta}, Th1, TNF-{beta} IRS, IFN-{gamma}, and IL-2 compared to the control condition. Conclusions: Ketamine exhibited two distinct immunoregulatory patterns: selective, disease-dependent attenuation of sensitized immune pathways and broader, diagnosis-independent suppression of the stimulated immune response, predominantly at higher concentrations. However, these effects were insufficient to normalize the immune-sensitized phenotype of MDD.

Accelerated 5x5 repetitive Transcranial Magnetic Stimulation (rTMS; five stimulation sessions per day for five days) is an effective treatment for Major Depressive Disorder (MDD), and has efficacy comparable to conventional once-daily rTMS. Considering the heterogeneity of symptoms in patients with MDD, it is critical to determine how accelerated 5x5 and conventional rTMS affect depression symptom domains. We compared symptom change over time in patients treated with either accelerated 5x5 rTMS (25 total sessions, n = 40) or conventional once-daily rTMS administered over six weeks (30 total sessions, n = 135). Accelerated 5x5 patients received either prolonged intermittent theta burst stimulation (piTBS) or personalized "resonant frequency" (RF) stimulation. Mixed-effects linear models were built to compare the two protocols, with the primary outcome variables being the Inventory of Depression Symptomology Self-Report (IDS), the Ruminative Response Scale (RRS), and the Profile of Mood States - Brief (POMS), yielding measures of 14 unique depression symptom domains. Both protocols led to similar improvements in all 14 depression symptom domains (all interaction term p-values > .05). Subsequent exploratory analyses demonstrated that accelerated 5x5 and conventional rTMS may differ in the time courses of their effects on anxiety, rumination, mood, depression, and vigor (p-values < .05, uncorrected). These results suggested that accelerated 5x5 rTMS has a similar efficacy in alleviating 14 depression symptom domains compared to conventional once-daily rTMS, and that either protocol may be appropriate for MDD patients with a variety of symptom profiles.

Background: Stroke survivors frequently experience post-stroke depression (PSD) and post-stroke anxiety (PSA), which may be underexamined by clinicians if patient mood status between discharge and follow-up is unknown. Digital monitoring may enable early identification of mood disturbances. Ecological momentary assessments (EMA) have been tested to capture mood fluctuations in patients regular environments, but no standardized procedure for monitoring PSA or PSD has been developed. Objective: Determine the feasibility and validity of EMA for evaluating subacute PSA and PSD in non-severe stroke patients. Methods: Patients with non-severe stroke discharged home responded to daily smartphone EMA questions concerning mood and activity for twelve weeks until follow-up. Questions based on symptoms of anxiety and depression were used to derive EMA Anx and EMA Dep indices, computed over five 15-day intervals. Convergent validity was assessed using follow-up Generalized Anxiety Disorder-7 (GAD-7) and Centre for Epidemiological Studies-Depression (CES-D) scores. Logistic regression models predicted PSA and PSD status at follow-up, with baseline models comprising stroke severity, age, sex, and mood status, to which EMA Anx or Dep were added. Results: Data from 118 patients were analyzed. EMA adherence was moderate, with 89 patients (75.4%) responding on 75 or more days. Correlations between EMA Anx and GAD-7 and between EMA Dep and CES-D generally strengthened at later intervals, with the average mood index generally showing the strongest associations. Adding EMA data from the third time interval (31-45 days) significantly improved model fit beyond the baseline models (Anxiety: {chi}-square = 7.08, p = 0.008, {delta}R-square = 0.060; Depression: {chi}-square = 28.0, p < 0.001, {delta}R-square = 0.256). Discussion: EMA is feasible in mild-to-moderate stroke patients and may facilitate early identification of post-stroke mood disturbances. Further analyses in more diverse populations are required to validate these findings.

Depression and treatment-resistant depression (TRD) are significant public health issues, but the associated network-level neurobiological mechanisms remain poorly understood. This study used magnetoencephalography (MEG) to identify altered resting-state connectivity within the default mode (DMN), executive control (ECN), salience (SN), dorsal attention (DAN), motor (MN), and visual (VN) networks as potential biomarkers of depression and treatment resistance. The study recruited 168 participants (80 healthy volunteers (HVs) and 88 currently experiencing a major depressive episode (74 with TRD and 14 without TRD (noTRD))). Data Integration Analysis for Biomarker Discovery using Latent Variable Approaches for Omics Studies (DIABLO) was used to differentiate the depression, TRD, and HV subgroups and identify neural markers of depression and treatment resistance. For differentiating the depression and HV groups, the triple network model (area under the receiver operating curve (AUROC): 0.759-0.787) - which includes the DMN, ECN, and SN - outperformed the six-network model (AUROC: 0.747-0.762) across different bandwidths. For differentiating the TRD and HV groups, the triple network model demonstrated reasonable prediction across different bandwidths (AUROC: 0.737-0.807); potential within-network connectivity differences distinguished those with TRD from HVs, especially DMN within-network connectivity between the inferior parietal lobule and precuneus in the beta band (FDR-corrected p<.05). Hyperconnectivity within the SN (superior parietal lobule and frontal operculum in the alpha band) and DMN (inferior parietal lobule and lateral prefrontal cortex in the beta band) was associated with number of treatment failures (ps<.05). These findings highlight key brain regions and connectivity patterns, advancing our understanding of neural mechanisms underlying depression and treatment resistance.

Background: Medical students face significant mental health challenges, yet psychological distress and post-traumatic stress remain insufficiently characterized in lower-resource settings like Vietnam. Among potential stressors, sexual violence (SV) exposure represents a critical but understudied risk factor. This study evaluated the severity of psychological distress (PD) and post-traumatic stress symptoms (PTSS) among medical students in Northern Vietnam and examined their associations with past-year non-contact and contact SV exposure. Methods: A cross-sectional survey was conducted in May 2025 using REDCap among a probability sample of 555 medical students (years 2 to 5). Mental health outcomes were evaluated using validated instruments: the 21-item Depression, Anxiety, and Stress Scales (DASS-21) for past-week PD and the PTSD Checklist for DSM-5 (PCL-5) for past-month PTSS. Past-year non-contact and contact SV exposures were measured using the Sexual Experiences Survey-Victimization (SES-V). Multivariable linear regression modeled adjusted associations between SV exposure types and mental health symptom severity, testing for sex-specific differences. Results: Overall mental health symptom scores escalated significantly with SV exposure. Median PTSS scores increased from 11 among unexposed students to 20 for non-contact SV and 30 for contact SV (p < 0.001). Similarly, median PD scores increased from 7 (unexposed) to 11.5 (non-contact SV) and 21 (contact SV) (p < 0.001). Adjusted linear models demonstrated robust associations where both non-contact and contact SV exposure were strong independent predictors of heightened PD and PTSS severity, with no significant moderation by sex. In terms of exposure prevalence, 21.26% of students reported non-contact SV (higher in females: 26.24% vs. males: 16.12%) and 10.66% reported contact SV. Conclusions: Vietnamese medical students exposed to sexual violence experience a heavy mental health burden marked by elevated psychological distress and post-traumatic stress symptoms. To protect student mental health in lower resource settings, medical institutions must establish comprehensive trauma-informed psychological support, confidential counseling services, and targeted intervention strategies addressing both contact and non-contact stress exposures. Keywords: psychological distress, post-traumatic stress, non-contact sexual violence, contact sexual violence, university students, Vietnam

Purpose: There is a long-standing perception that individuals who stutter are less intelligent, with the disfluencies unique to stuttered speech often assumed to be the overt reflection of lower intelligence, despite no supporting evidence. The purpose of the present study was to explore the validity of this assumption by examining the cognitive abilities of adults who stutter compared to the general population using the NIH Toolbox (C) Cognition Battery (NIHTB-CB). Method: Sixty-three adults who stutter completed the NIHTB-CB, which includes seven standardized measures assessing crystallized cognition (Picture Vocabulary, Oral Reading) and fluid cognition (List Sorting Memory Test, Pattern Comparison Processing Speed Test, Flanker Inhibitory Control Test, Dimensional Change Card Sort Test, Picture Sequence Memory Test). The NIHTB-CB generates t-scores adjusted for demographic variables based on a large sample of neurotypical adults. Results: Composite scores of overall cognition for adults who stutter were not statistically equivalent, rather, their scores were higher than the general population. Higher scores were driven by crystallized cognition, with significantly higher scores on Oral Reading subscale. Conclusions: Present findings demonstrate that adults who stutter possess cognitive skills that are comparable to or potentially higher, than the general population. These results challenge the misconception that stuttering reflects diminished intelligence and offer evidence to mitigate stereotype threat.

Background Suicide and violence are major contributors to youth mortality. Effective prevention strategies require understanding of their psychological underpinnings. We therefore aimed to determine the interconnections among victimisation, physical violence, depression and suicidal ideation and attempts, among young adults in a North India city. Methods We used data from a survey of young adults aged 18-22 years, recruited across six colleges by random sampling. Our theory-based structural equation model specified suicidal ideation and attempts as an outcome of victimisation, indicated by dating violence, campus bullying and cyberbullying. We coded "suicidal ideation and attempts" as a single ordinal variable, with five levels from "did not consider suicide" to "had a suicide attempt requiring medical treatment". We used the probit link function and theta parameterisation for categorical endogenous variables. We computed standardised path coefficients, p-values and global fit measures. Results Among 752 survey respondents (median age 19 years, 64.4% women), 16.6% had been involved in a physical fight, 24.2% had had depressive symptoms and 4.5% had seriously considered suicide in the past 12 months. We found indirect associations between victimisation and suicidal ideation and attempts, mediated by physical violence and depressive symptoms. Direct effects of victimisation on suicidal ideation and attempts were negligible. Global model fit was acceptable. Discussion Our findings suggest that youth victimisation predisposes to suicidal behaviour, by increasing physical aggression and depression. Prevention of suicide among youth requires multi-level action, including measures to stop bullying and violence, life skills education, and treatment of underlying depression.

Aim: The Patient Safety Screener-3 (PSS-3) is a brief suicide-risk screening tool. Item 1 of this scale assesses depressive mood but is not included in the total score. We examined the association of item 1 with depressive symptom severity and characterized the suicide-related risk captured by PSS-3 total positivity. Methods: We conducted a nationwide cross-sectional survey among resident physicians in Japan. Associations between PSS-3 item 1 endorsement and Patient Health Questionnaire-9 (PHQ-9) scores were evaluated using the Wilcoxon rank-sum test. Diagnostic performance of item 1 was evaluated using PHQ-9 positivity ([&ge;]10) as reference standard. We also compared Short-form Scale for Suicide Ideation (SIS-6) scores according to PSS-3 total positivity and PHQ-9 item 9 positivity. Results: A total of 1,844 participants were included. PSS-3 item 1 was endorsed by 443 physicians (24.0%), and 47 (2.5%) met the criteria for PSS-3 total positivity. Item 1 showed 79.3% sensitivity and 79.5% specificity for PHQ-9 positivity. SIS-6 scores were higher in the PSS-3 total-positive group than in the total-negative group (median [IQR], 6 [5-9] vs 0 [0-1]; p<0.001). The SIS-6 showed a higher area under the receiver operating characteristic curve (AUC) and Youden index using PSS-3 total positivity (AUC, 0.961; optimal cutoff, 3) than PHQ-9 item 9 positivity (AUC, 0.907; optimal cutoff, 2). Discussion: PSS-3 may support brief, simultaneous screening for depressive symptoms and suicide-related risk. Compared with PHQ-9 item 9, PSS-3 may capture a more severe spectrum of suicide-related risk. PSS-3 may facilitate identification of individuals requiring further mental health assessment.

Background/Aims: Pre-stroke depression has been shown to be associated with worse functional outcomes and depression after stroke. However, it is not currently well understood whether pre-stroke mood disorders (e.g., depression, anxiety, mood and psychotic disorders, substance use disorder) are associated with withdrawal of life-sustaining treatment (WOLST) after a severe stroke. Methods: This was a retrospective cohort study within the Tufts Vascular Neurology Registry of patients hospitalized with severe acute ischemic stroke (AIS, defined as NIHSS [&ge;]10) or severe nontraumatic intracerebral hemorrhage (ICH, defined as ICH score [&ge;]2) between 2018 and 2022. Multivariate logistic regression was performed to identify predictors of WOLST. Results: This study included 405 patients with severe stroke. Patients who opted for WOLST were more likely to be older, female, have AIS, and experience more severe strokes. In an adjusted analysis (basic demographics, stroke type), a pre-stroke mood disorder was associated with WOLST (OR 2.15, 95% CI 1.11-4.15). In models stratified by stroke type (AIS vs. ICH) and adjusted for stroke severity, WOLST was associated with age in both groups and with mood disorder in patients with ICH. The WOLST event rate was higher in the ICH group (19% vs 11%). Conclusion: Pre-stroke mood disorder was associated with increased rates of withdrawal of care after severe stroke in this patient population. Opportunities to actively treat depression may be useful to include in goals of care discussions to mitigate the potential impact of this factor in decision-making. Consistent with prior studies, we observed a higher proportion of WOLST in older, female, and ICH patients. Future studies regarding the quality and content of goals of care discussions may help elucidate the differing effects of pre-stroke mood disorders on WOLST by stroke type seen in this study.

Negative emotional bias, including reduced processing of positive information and negative interpretation of ambiguous stimuli, is a core feature of depression. Esketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist with rapid antidepressant effects in treatment-resistant depression (TRD), reduces depressive symptoms, but its effects on distinct components of emotional processing remain unclear. Fifty-three patients with TRD and 53 healthy controls performed an Emotional Facial Expression Morphing task. Patients were assessed at baseline, 24 hours after the first esketamine administration, and after 4 weeks of treatment. Statistical models examined detection thresholds for happy and sad faces, negative categorisation of neutral faces, and signal detection indices separating emotion-neutral discrimination sensitivity (d') from response criterion (c), indexing the evidence required to report the presence of an emotion. At baseline, patients required greater happy-face intensity for emotion detection and were more likely to categorise detected neutral faces as negative. They also showed a more conservative response criterion without group difference in discrimination sensitivity. Responders showed an early increase in d'; and, by week 4, less negative categorisation of neutral faces than non-responders. A lower baseline response criterion was associated with responder status and, in secondary continuous analyses, with greater subsequent MADRS improvement. These findings indicate that TRD involves abnormalities across detection-related, valence-related, and decisional aspects of facial-emotion processing that are differently associated with esketamine response: baseline response criterion emerged as a candidate prognostic marker, whereas negative categorisation of neutral faces tracked clinical response. Assessing these domains may inform clinical evaluation, pending independent replication.

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.

Introduction: Functional Neurological Disorder (FND) affects women approximately three times more often than men. This disparity has largely been attributed to higher trauma prevalence and diagnostic bias, while the potential contribution of hormonal influences has received little attention. Methods: An online questionnaire was distributed through FND clinics in thirteen countries, assessing self-reported symptom change across five hormonal events: hormonal contraception, pregnancy, the menstrual cycle, menopause, and gender-affirming hormone therapy. Eligible participants were cisgender women with a diagnosis of FND, or gender minority individuals (transgender or non-binary). Perceived symptom change was rated on a five-point scale ranging from large improvement to large worsening. Results: Among 262 respondents (96% female; mean age 39 years), several hormonal contexts were associated with self-reported symptom changes. Overall, hormonal contraception and pregnancy were frequently associated with worsening of motor and cognitive symptoms, and menopause with worsening across all symptom domains. Menstrual cycle analysis revealed a phase-dependent pattern: worsening was most frequently reported during menstruation and the luteal phase, whereas improvement was most frequent during the follicular phase. Reported changes were not uniform, with a substantial proportion of participants describing no change or improvement. Conclusion: Self-reported FND symptom severity appears to vary with hormonal context, with motor and cognitive symptoms most consistently affected. Given the retrospective, self-report design, these findings are hypothesis-generating and support prospective research into the role of hormonal transitions in FND.

Objective: Mindfulness is a robust predictor of mental health, yet the psychometric properties of the short-form Five Facet Mindfulness Questionnaire (FFMQ-15) have not been examined in Iranian populations. This study evaluated the psychometric properties, factor structure, and diagnostic utility of the FFMQ-15 among medical sciences students. Participants: A total of 348 students (178 females, 170 males) from Kermanshah University of Medical Sciences participated. Methods: Participants completed the FFMQ-15, Penn State Worry Questionnaire (PSWQ), Difficulties in Emotion Regulation Scale (DERS), and Emotion Regulation Questionnaire (ERQ). Data were analyzed using exploratory and confirmatory factor analyses, composite reliability, and ROC curve analysis. Results: Both EFA and CFA supported the five-factor model, revealing a culturally unique item loading pattern. The FFMQ-15 demonstrated strong convergent and discriminant validity. ROC analysis indicated acceptable diagnostic accuracy for distinguishing high- and low-worry groups (AUC = 0.72, 95% CI: 0.66-0.78). Conclusions: The FFMQ-15 demonstrated acceptable psychometric properties in Iranian medical students. The non-reactivity facet exhibited cultural variability, suggesting that cross-cultural adaptation is essential. The instrument shows promise for screening in high-stress educational settings.

Cognitive deficits in depression often persist despite pharmacological and psychotherapeutic treatment. Existing cognitive retraining programs are typically time- and resource-intensive, and place limited emphasis on addressing subjectively perceived cognitive difficulties or generalization of gains. This proof-of-concept study aimed to adapt the Integrated Cognitive Control Training (ICCT) into a brief format for patients with depression and to generate preliminary evidence of feasibility and effectiveness. The intervention was adapted into a manualized five-session program through a literature review, expert surveys involving clinicians and individuals with lived experience of depression, and a trial run. The study followed a single-group, open-label pre-post design (N = 16). Significant improvements were observed in cognitive flexibility (Color Trails Test-2: t = 3.52, p = 0.003, d = 0.88), depression severity (Montgomery-[A]sberg Depression Rating Scale: t = 6.66, p < 0.001, d = 1.67), and subjective cognition (Perceived Deficits Questionnaire: t = 5.06, p < 0.001, d = 1.3). The intervention demonstrated high acceptability and demand. These findings suggest that the Brief ICCT is a feasible and potentially effective approach for addressing cognitive deficits, with improvements extending to depressive symptom severity and socio-occupational functioning. These proof-of-concept findings justify further evaluation of Brief ICCT in adequately powered randomized controlled trials.

Background: Adolescent major depressive disorder (MDD) is heterogeneous, with diverse and frequently co-occurring psychopathological manifestations. Although family-related experiences, childhood trauma, rumination, and psychological resilience have each been linked to adolescent mental health, less is known about how they are interrelated and jointly associated with distinct psychopathological domains. This study examined these associations within an integrative framework. Methods: This cross-sectional study included 80 adolescents with MDD and 53 healthy controls. Family functioning, parenting, childhood trauma, rumination, psychological resilience, and four clinical domains, including affective distress, suicidal ideation, the non-suicidal self-injury (NSSI) spectrum, and self-regulation difficulties, were assessed using validated instruments. Partial least squares structural equation modeling (PLS-SEM) examined their multivariate associations. Sensitivity analyses restricted to the MDD sample and covariate-adjusted regression models assessed the robustness of the findings. Results: The four clinical domains showed high reliability and acceptable discriminant validity. Family dysfunction was associated with maladaptive parenting and childhood trauma, and maladaptive parenting was associated with childhood trauma (beta = .383-.600; all p < .001). Childhood trauma was associated with greater rumination (beta = .625) and lower psychological resilience (beta = -.405; both p < .001). Rumination and psychological resilience showed opposing associations with all four domains (rumination: beta = .280-.559; resilience: beta = -.265 to -.399; all p <= .006). Family dysfunction, maladaptive parenting, and childhood trauma showed significant total indirect associations with each domain (all p < .001). The model explained 53%-85% of the variance across the four domains. The MDD-only analysis reproduced the principal associations observed in the combined sample and additionally showed direct associations between maladaptive parenting and all four clinical domains. Covariate-adjusted analyses retained all principal associations except the resilience-NSSI association. Conclusions: The findings support a multidimensional characterization of adolescent MDD comprising distinguishable yet interrelated domains of affective-psychosomatic distress, suicidal ideation, the NSSI spectrum, and self-regulation difficulties. The partly shared and partly distinct associations of these domains with family-related adversity, rumination, and psychological resilience support considering domain-level psychopathology alongside diagnostic status and global depression severity in research on adolescent MDD.