Motivated behaviors vary widely across individuals and are controlled by a range of environmental and intrinsic factors. However, due to a lack of objective measures, the role of intrinsic v. extrinsic control of motivation in psychiatric disorders remains poorly understood.

We developed a novel multi-factorial behavioral task that separates the distinct contributions of intrinsic v. extrinsic control, and determines their influence on motivation and outcome sensitivity in a range of contextual environments. We deployed this task in two independent cohorts (final in-person N = 181 and final online N = 258), including individuals with and without depression and anxiety disorders.

There was a significant interaction between group (controls, depression, anxiety) and control-condition (extrinsic, intrinsic) on motivation where participants with depression showed lower extrinsic motivation and participants with anxiety showed higher extrinsic motivation compared to controls, while intrinsic motivation was broadly similar across the groups. There was also a significant group-by-valence (rewards, losses) interaction, where participants with major depressive disorder showed lower motivation to avoid losses, but participants with anxiety showed higher motivation to avoid losses. Finally, there was a double-dissociation with anhedonic symptoms whereby anticipatory anhedonia was associated with reduced extrinsic motivation, whereas consummatory anhedonia was associated with lower sensitivity to outcomes that modulated intrinsic behavior. These findings were robustly replicated in the second independent cohort.

Together this work demonstrates the effects of intrinsic and extrinsic control on altering motivation and outcome sensitivity, and shows how depression, anhedonia, and anxiety may influence these biases.

Postpartum anxiety (PPA) symptoms have harmful effects on child development and mother–infant interactions. Accordingly, in-depth knowledge of associated risk factors is crucial for prevention policies. This study aimed to estimate PPA symptom prevalence at 2 months and to identify associated risk factors in a representative sample of all women who gave birth in France in 2021, and in two subgroups: women with no postpartum depression (PPD) symptoms, and those with no history of mental health care.

Among the 12,723 women included in the representative French national perinatal survey 2021ENP, 7,133 completed the Edinburgh Postnatal Depression Scale (EPDS) self-administered questionnaire – including three anxiety-specific items (EPDS-3A) – at 2 months postpartum. We estimated the adjusted prevalence ratios (aPR) of PPA symptoms using Poisson regression models with robust variance.

PPA symptom prevalence at 2 months was 27.6% (95% CI [26.5–28.8]). Associated risk factors were: age ≤ 34 years (maximum aPR = 1.38 [1.22–1.58] obtained for persons aged 25–29 years vs. 35–39 years), poorer health literacy (1.15 [1.07–1.23]), a history of medical termination of pregnancy (1.32 [1.05–1.68]), psychological (1.31 [1.17–1.47]) or psychiatric (1.42 [1.24–1.63]) care history since adolescence, nulliparity (1.23 [1.12–1.35]), no weight gain or loss (1.29 [1.03–1.61] vs. 9–15 kg gain) or gain ≥23 kg (1.20 [1.00–1.43]) during pregnancy, ≥3 pregnancy-related emergency consultations (1.16 [1.03–1.31] vs. none), poor/good support during pregnancy, (1.16 [1.00–1.34] and 1.15 [1.05–1.26], respectively, vs. very good), sadness (1.52 [1.36–1.69]), anhedonia (1.48 [1.27–1.72]), or both (1.99 [1.79–2.21]) during pregnancy, not at all/not very satisfied with pain management during childbirth (1.16 [1.01–1.32] vs. quite/very satisfied). Similar risk factors were found in the ‘no PPD symptoms’ and ‘no history of mental health care’ subgroups.

Estimated PPA symptom prevalence at 2 months in our study sample was 27.6%. The risk factors we identified may guide future prevention policies.

Cognitive behavioural therapy (CBT) interventions are effective in reducing subjective stress. Nevertheless, the longitudinal links between mental health indicators are rarely studied in intervention research. Therefore, it is unknown how the intervention effects are sustained.

The current study investigated mechanisms explaining sustained intervention effects in a sample of medical nurses who receive a CBT-based internet-delivered stress recovery program.

A single-group longitudinal study design with three measurement points, pre-test, post-test, and 3-month follow-up, was used in the current study. The sample consisted of nurses and assistant nurses from Lithuania (n=111, age: M (SD) = 41.69 years (10.85)) who had participated in a 6-week CBT internet intervention targeting stress recovery. Data were collected as the randomised control trial, the treatment samples were combined, and the data were analysed using cross-lagged panel analysis with four variables representing the psychological well-being and symptoms of stress, anxiety, and depression.

The results revealed that decreased anxiety and increased psychological well-being at post-test predicted reduced stress levels at the 3-month follow-up. In addition, decreased anxiety at post-test predicted decreased depression at follow-up.

Decreased anxiety and increased well-being could explain the sustainability of reduced stress following a CBT-based internet intervention for nurses. The implications of this for research and practice are discussed.

The population of adult CHD patients is continuously increasing. The underlying CHD affects performance and prognosis, but also has a significant impact on quality of life, psychosocial behaviour, anxiety and emotional disturbances. This study analyzes these parameters of patients after one or more heart operations and the possible psychological effects of medical and psychosocial complications at the Department of Cardiology of the Kepler University Hospital Linz.

A total of 81 subjects participated in the questionnaire survey of the Institute of Cardiology and Clinical Psychology during their annual cardiological check-up. Of these, 80 participants were included in the study and three showed a mild CHD, 49 a moderate one, and 28 a severe one. This study has an exploratory design to assess possible stress factors and limitations in quality of life. For this purpose, a self-administered sociodemographic questionnaire and three standardised questionnaires were used. In summary, the quality of life of adult CHD is considered depending on the severity of the symptoms and compared with the healthy population. Differences in this regard are observed in individuals with lower symptom severity, who report higher psychological well-being. Sex differences are observed in physical role function and physical functioning.

Based on the results, regular repetitions of the study, as well as continuous psychological and psychosocial support, are necessary, since challenges are predictable with the increasing age of adult CHD patients and since the upholding of good quality of life and dealing with difficult life circumstances must be supported.

A growing number of studies among adolescents have reported early maladaptive schemas (EMS) to associate with anxiety and depression within non-clinical samples. However, there is a gap of knowledge concerning clinical populations.

The current study’s aim was to explore the potential association between EMS domains and anxiety and depressive symptoms within clinical sample of adolescents.

The current study included 176 adolescent psychiatry out-patients. The EMS domains were measured with the Young Schema Questionnaire-Short Form 2-Extended (YSQ). Their association with anxiety symptoms (the Overall Anxiety Severity and Impairment Scale) and depressive symptoms (the Beck Depression Inventory II) were analysed with general linear models while controlling for significant confounding factors.

Depressive symptoms were associated with three of the four EMS domains: Disconnection and Rejection (η2p=0.047, p=0.005), Impaired Autonomy and Performance (η2p=0.074, p<0.001), and Impaired Limits (η2p=0.053, p=0.003). Anxiety symptoms were associated with two EMS domains: Impaired Autonomy and Performance (η2p=0.046, p=0.005) and Excessive Responsibility and Standards (η2p=0.054, p=0.002).

Various EMS domains were associated with depressive and anxiety symptoms among adolescent out-patients. Further studies are needed on the effect of EMSs on the treatment outcomes for depression and anxiety.

England's primary care service for psychological therapy (Improving Access to Psychological Therapies [IAPT]) treats anxiety and depression, with a target recovery rate of 50%. Identifying the characteristics of patients who achieve recovery may assist in optimizing future treatment. This naturalistic cohort study investigated pre-therapy characteristics as predictors of recovery and improvement after IAPT therapy.

In a cohort of patients attending an IAPT service in South London, we recruited 263 participants and conducted a baseline interview to gather extensive pre-therapy characteristics. Bayesian prediction models and variable selection were used to identify baseline variables prognostic of good clinical outcomes. Recovery (primary outcome) was defined using (IAPT) service-defined score thresholds for both depression (Patient Health Questionnaire [PHQ-9]) and anxiety (Generalized Anxiety Disorder [GAD-7]). Depression and anxiety outcomes were also evaluated as standalone (PHQ-9/GAD-7) scores after therapy. Prediction model performance metrics were estimated using cross-validation.

Predictor variables explained 26% (recovery), 37% (depression), and 31% (anxiety) of the variance in outcomes, respectively. Variables prognostic of recovery were lower pre-treatment depression severity and not meeting criteria for obsessive compulsive disorder. Post-therapy depression and anxiety severity scores were predicted by lower symptom severity and higher ratings of health-related quality of life (EuroQol questionnaire [EQ5D]) at baseline.

Almost a third of the variance in clinical outcomes was explained by pre-treatment symptom severity scores. These constructs benefit from being rapidly accessible in healthcare services. If replicated in external samples, the early identification of patients who are less likely to recover may facilitate earlier triage to alternative interventions.

There is a high prevalence of depression among refugee youth in low- and middle-income countries, yet depression trajectories are understudied. This study examined depression trajectories, and factors associated with trajectories, among urban refugee youth in Kampala, Uganda.

We conducted a longitudinal cohort study with refugee youth aged 16–24 in Kampala, Uganda. We assessed depression using the Patient Health Questionnaire-9 and conducted latent class growth analysis (LCGA) to identify depression trajectories. Sociodemographic and socioecological factors were examined as predictors of trajectory clusters using multivariable logistic regression.

Data were collected from n = 164 participants (n = 89 cisgender women, n = 73 cisgender men, n = 2 transgender persons; mean age: 19.9, standard deviation: 2.5 at seven timepoints; n = 1,116 observations). Two distinct trajectory clusters were identified: “sustained low depression level” (n = 803, 71.9%) and “sustained high depression level” (n = 313, 28.1%). Sociodemographic (older age, gender [cisgender women vs. cisgender men], longer time in Uganda), and socioecological (structural: unemployment, food insecurity; interpersonal: parenthood, recent intimate partner violence) factors were significantly associated with the sustained high trajectory of depression.

The chronicity of depression highlights the critical need for early depression screening with urban refugee youth in Kampala. Addressing multilevel depression drivers prompts age and gender-tailored strategies and considering social determinants of health.

Implementation of video call-based cognitive behavioural therapy (CBT) has increased significantly since the COVID-19 pandemic, enabling more flexible delivery, but less is known about user experience and effectiveness. This systematic review and meta-analysis investigated feasibility, acceptability, and effectiveness of individual video call-based CBT for adults with mild to moderate mental health conditions (Prospero CRD42021291055). Medline, Embase, PsycINFO and Web of Science were searched until 4 September 2023. The Effective Public Health Practice Project Quality Assessment Tool (EPHPP) assessed methodological quality of studies. Meta-analysis was conducted in R. Thirty studies (n=3275), published 2000 to 2022, mainly in the USA (n=22/30, 73%), were included. There were 15 randomised control trials, one controlled clinical trial, and 14 uncontrolled studies. Findings indicated feasibility, acceptability and effectiveness (effect size range 0.02–8.30), especially in post-traumatic stress disorder (PTSD) for military populations. Other studies investigated depression, obsessive-compulsive disorder, panic with agoraphobia, insomnia, and anxiety. Studies indicated that initial challenges with video call-based CBT subsided as therapy progressed and technical difficulties were managed with limited impact on care. EPHPP ratings were strong (n=12/30, 40%), moderate (n=12/30, 40%), and weak (n=6/30, 20%). Meta-analysis on 12 studies indicated that the difference in effectiveness of video call-based CBT and in-person CBT in reducing symptoms was not significant (SMD=0.044; CI=–0.086; 0.174). Video calls could increase access to CBT without diminishing effectiveness. Limitations include high prevalence of PTSD studies, lack of standardised definitions, and limited studies, especially those since the COVID-19 pandemic escalated use of video calls.

1. (1) This review assesses feasibility, acceptability, and effectiveness of individual video call-based CBT for adults with mild to moderate common mental health conditions, as defined by the ICD-11.

2. (2) Secondary aims were to assess if the therapeutic relationship is affected and identify any potential training needs in delivering video call-based CBT.

3. (3) The adjunct meta-analysis quantitatively explored whether video call-based CBT is as effective as in-person interventions in symptom reduction on primary outcome measures by pooling estimates for studies that compare these treatment conditions.

The relationship between adolescent alcohol use and emotional problems remains unclear and contradictory. These inconsistencies may in part be due to differences in the measurement and operationalization of alcohol use and emotional problems across studies, as well as confounder selection and missing data decisions. This study explores the associations between common specifications of adolescent alcohol use and emotional problems in a large sample of adolescents.

A multiverse analysis (also known as specification curve analysis or vibration of effects) was done with 7680 unique model specifications in a large longitudinal sample of 6639 Australian adolescents (aged ~14.7–15.7, 2021–2022).

While alcohol use and emotional problems nearly universally co-occurred in minimally adjusted cross-sectional models (98–99%), the operationalization of emotional problems, temporality of prospective relationships, and choice of confounders substantially impacted findings. Emotional problems appeared to predict later alcohol use more-so than the reverse, depression-focused measures yielded more consistent associations with alcohol use than anxiety-focused measures, and certain confounders (i.e. conduct, ADHD, smoking) explained most of the associations between adolescent alcohol use and emotional problems. Missing data decisions and whether outcomes were modelled continuously v. dichotomously had minimal impact on findings.

While adolescent alcohol use and emotional problems commonly co-occur, inconsistencies in the magnitude, direction, and significance of effects are closely tied to researcher decisions that are often made arbitrarily.

The World Health Organization (WHO) has defined Post-COVID-19 Condition (PCC) as the onset of symptoms within three months after resolution of an acute SARS-CoV-2 infection, wherein symptoms persist for at least two months and cannot be explained by another medical/psychiatric condition. Persons living with PCC report debilitating symptoms including, but not limited to, depressive symptoms and motivational deficits. The aim of this post-hoc analysis was to evaluate the association between depressive symptoms and motivation in adults with PCC.

We conducted a post-hoc analysis of an 8-week, double-blind, randomized, placebo-controlled trial evaluating adults (18 years or older) in Canada with WHO-defined PCC and cognitive symptoms. This post-hoc analysis is comprised of baseline data that evaluates the association between depressive symptom severity measured by the 16-item Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR-16) and motivational systems measured by the Behavioral Inhibition System/Behavioral Activation System Questionnaire (BIS/BAS).

There was a statistically significant association between depressive symptoms and BIS (β = -0.041 95% CI [-0.066, -0.016], p<0.05), BAS reward responsiveness (β = 0.043 95% CI [0.012, 0.074], p<0.05), sex (β = -0.137 95% CI [-0.266, -0.008], p<0.05), and confirmed COVID-19 infection (β = 0.196 95% CI [0.061, 0.332], p<0.05).

Depressive symptoms were associated with motivational deficits in persons living with PCC. Optimizing treatment for depressive symptoms may potentially improve aspects of motivational impairment amongst persons with PCC. All patients presenting with MDD and a history of COVID-19 infection should be assessed for the presence of PCC.

Among those with common mental health disorders (e.g. mood, anxiety, and stress disorders), comorbidity of substance and other addictive disorders is prevalent. To simplify the seemingly complex relationships underlying such comorbidity, methods that include multiple measures to distill which specific addictions are uniquely associated with specific mental health disorders rather than due to the co-occurrence of other related addictions or mental health disorders can be used.

In a general population sample of Jewish adults in Israel (N = 4002), network analysis methods were used to create partial correlation networks of continuous measures of problematic substance (non-medical use of alcohol, tobacco, cannabis, and prescription sedatives, stimulants, and opioid painkillers) and behavioral (gambling, electronic gaming, sexual behavior, pornography, internet, social media, and smartphone) addictions and common mental health problems (depression, anxiety, and post-traumatic stress disorder [PTSD]), adjusted for all variables in the model.

Strongest associations were observed within these clusters: (1) PTSD, anxiety, and depression; (2) problematic substance use and gambling; (3) technology-based addictive behaviors; and (4) problematic sexual behavior and pornography. In terms of comorbidity, the strongest unique associations were observed for PTSD and problematic technology-based behaviors (social media, smartphone), and sedatives and stimulants use; depression and problematic technology-based behaviors (gaming, internet) and sedatives and cannabis use; and anxiety and problematic smartphone use.

Network analysis isolated unique relationships underlying the observed comorbidity between common mental health problems and addictions, such as associations between mental health problems and technology-based behaviors, which is informative for more focused interventions.

Suicide accounts for a proportion of the early mortality in people affected by psychotic disorders. The early phase of illness can represent a particularly high-risk time for suicide. Therefore, in a cohort of young people presenting with first-episode psychosis, this study aimed to determine: (i) the prevalence of suicidal ideation, intent with plan and self-harm and any associated demographic or clinical factors and (ii) the prevalence of depressive symptoms and any associated demographic or clinical factors.

Young people with a first episode of psychosis attending the Early Psychosis Prevention and Intervention Centre in Melbourne were included. Suicidal behaviours were recorded using a structured risk assessment – ‘Clinical Risk Assessment and Management in the Community’, and depressive symptoms were measured using the PHQ-9.

A total of 355 young people were included in the study. 57.2% were male, 95.4% were single and over one quarter were migrants. At the time of presentation, 34.6% had suicidal ideation, 6.2% had suicidal intent with a plan, and 21.4% had engaged in self-harm before their presentation. Combined, 39.7% (n = 141) presented with suicidal ideation, intent with plan or self-harm. A total of 71.5% (n = 118) had moderately severe or severe depressive symptoms, which was strongly associated with suicidal ideation or behaviours at the time of presentation (OR = 4.21, 95% C.I. 2.10–8.44).

Depressive symptoms, self-harm and suicidal behaviours are commonly present in the early phases of a psychotic disorder, which has important clinical implications for assessment and management.

Most evidence on associations between child maltreatment and subsequent common mental disorders (CMDs) comes from retrospective studies. Such findings may be affected by recall bias. Prospective studies of reports to statutory agencies are less common and may be subject to attrition bias.

To examine the associations of child maltreatment with emergency department presentations and in-patient admissions for CMDs in individuals up to 40 years old.

Queensland-wide administrative health data were linked to a prospective birth cohort, including agency-reported and substantiated notifications of child maltreatment. Outcomes were emergency department presentations and in-patient admissions for CMDs.

There were 6087 participants, of which 10.1% had been the subject of a child maltreatment notification. Admissions for CMDs occurred in 198 participants (3.3%) and emergency department presentations in 291 (4.8%). In the adjusted analysis, substantiated child maltreatment was associated with both admissions (odds ratio 1.92; 95% CI = 1.19–3.00) and emergency department presentations (odds ratio 2.10; 95% CI = 1.45–3.03). All agency-reported and substantiated child maltreatment subtypes (neglect, physical, sexual and emotional abuse) were associated with emergency department presentations for CMDs and notifications for more than one child maltreatment subtype. In the subgroup analysis, child maltreatment was associated with emergency department presentations for both anxiety (odds ratio 2.73; 95% CI = 1.68–4.43) and depression (odds ratio 2.23; 95% CI = 1.62–3.26) but with admissions only for depression (odds ratio 2.10; 95% CI = 1.15–3.84).

Child maltreatment is associated with both emergency department presentations and hospital admissions for CMDs in individuals up to 40 years old. Screening for child maltreatment in people presenting to hospital with CMDs may be indicated, as well as a greater awareness that survivors of child maltreatment may be at higher risk of developing such symptoms.

The COVID-19 pandemic posed an unprecedented global challenge, with past evidence suggesting negative psychological effects with the additional concern that social and physical restrictions might disproportionately affect adolescents.

To explore mental health and its wider determinants in young people in the UK during 1 year of the COVID-19 pandemic (August 2020–August 2021).

A representative sample of 11 898 participants (48.7% female) aged between 13 and 19 years (mean = 16.1) participated in five waves of data collection. Using validated self-reported questionnaires for loneliness, anxiety and depression, this survey measured the extent and nature of the mental health impacts of the coronavirus pandemic and help-seeking behaviours, and changes over time.

Young people experienced higher levels of anxiety during the summer and fall 2020, followed by higher levels of depression during the winter 2020–2021, with loneliness gradually increasing then peaking during the spring and summer of 2021. Young people who were older, female, with pre-existing mental-health issues and experiencing financial difficulties were at higher risk of anxiety, depression and loneliness. Help-seeking behaviours reduced the risk of depression and loneliness.

The COVID-19 pandemic had substantial impact on young people, whether on their mental health, their social contacts and interactions or their perspective on what the future holds for them. Young people strongly advocated for better teacher training, and a better integration of mental health services, particularly within their schools.