The International Journal of Psychiatry in Medicine

The relationship between testosterone deficiency (TD) and depressive symptoms among obese individuals has not been fully clarified. This study explores the relationship between TD and depressive symptoms in obese males and possible mediating factors.

These cross-sectional analyses included 6177 participants from the National Health and Nutrition Examination Survey (NHANES) conducted between 2011 and 2016. Logistic regression models were employed to assess the association of TD with depressive symptoms in different subgroups. Sensitivity analyses were performed using restricted cubic splines (RCS), subgroup analysis, and mediation analysis.

There was a significant positive correlation between TD and depressive symptoms in obese males (OR = 1.33, 95% CI = 1.04-1.69, P = 0.023). The analysis further demonstrated a significant L-shaped nonlinear relationship between testosterone levels and depressive symptoms in obese males. The analysis of the threshold effects showed that the risk of depressive symptoms increased below testosterone levels of 273 ng/dL. Furthermore, the study also found that inflammatory markers demonstrated a statistically significant partial mediating effect in the observed association between TD and depressive symptoms.

In obese males, testosterone levels exhibit an L-shaped correlation with depressive symptoms, with inflammation acting as a statistical mediating factor. These findings offer new hypotheses for future clinical interventional studies.

Pain and depressive symptoms are highly prevalent among middle-aged and older adults and frequently co-occur, yet the temporal ordering and directionality of the relationship between pain and depressive symptoms are inconsistent. This study aimed to examine the longitudinal bidirectional relationship between pain burden and depressive symptoms among middle-aged and older adults in China.

Data were derived from five waves (2011-2020) of the China Health and Retirement Longitudinal Study (CHARLS). Pain burden was assessed as the number of body sites with pain (range: 0-15), and depressive symptoms were measured using the 10-item Center for Epidemiological Studies Depression Scale (CESD-10; range: 0-30). Cross-lagged panel models (CLPM) were applied to evaluate the temporal associations between pain burden and depressive symptoms across five waves, while adjusting for baseline sociodemographic characteristics, health behaviors, self-rated health, function limitation, and number of chronic diseases.

A total of 7288 participants were included in the study. Pain burden demonstrated significant autoregressive stability over time and consistently predicted higher levels of depressive symptoms at subsequent waves. These prospective associations remained robust after adjustment for covariates. In contrast, depressive symptoms did not show a significant or consistent longitudinal effect on subsequent pain burden. Overall, the findings indicated a predominantly unidirectional temporal relationship, with pain burden preceding and contributing to later depressive symptoms.

These findings highlight the importance of considering cumulative pain as an early risk signal for depression and underscore the need to integrate pain assessment into mental health screening and chronic disease management strategies for aging populations.

Autism spectrum disorder (ASD) can affect vision both directly through central nervous system involvement and indirectly by complicating ophthalmological examinations due to limited eye contact and poor cooperation. Visual impairments may exacerbate social interaction difficulties and affect motor development in individuals with ASD. Previous studies reported ophthalmological involvement in 27-71% of children with ASD, including refractive errors, strabismus, and amblyopia. The purpose of this study was to investigate visual impairments in children with ASD and examine their relationship with ASD severity, anxiety levels, and attention disorders, while highlighting the importance of routine ophthalmological examinations.

Participants were 57 children aged 7-18 years diagnosed with ASD. All except for 2 participants underwent comprehensive ophthalmological examinations and were assessed using the Childhood Autism Rating Scale (CARS), Turgay DSM-IV-based Child and Adolescent Behavior Disorders Screening Scale (T-DSM-IV-S), Strengths and Difficulties Questionnaire (SDQ), Screen for Child Anxiety Related Emotional Disorders (SCARED), and Repetitive Behaviors Scale-Revised (RBS-R).

Visual impairment was detected in 24 (42.1%) participants, with exotropia (21%), stereopsis deficits (15.8%), and convergence insufficiency (5.3%) being the most common findings. The visually impaired group showed significantly higher scores in attention deficit (P < .001), peer relationship problems (P = .003), social phobia (P < .001), stereotypic behaviors (P < .001), and self-injurious behaviors (P < .001) compared to those without visual impairment.

Visual impairments significantly impact attention, peer relationships, social anxiety, and repetitive behaviors in children with ASD. Early identification and treatment of visual disorders through routine ophthalmological screening may improve overall outcomes in this population.

This study aimed to compare serum leucine-rich repeat and fibronectin type III domain-containing protein-5 (LRFN5) and olfactomedin-4 (OLFM4) levels and aggregate index of systemic inflammation (AISI) values between hospitalized subjects with bipolar disorder (BD) experiencing acute manic episodes with psychotic features and healthy controls (HCs), and to examine their associations with clinical features and symptom severity.

In this cross-sectional study, participant characteristics and clinical features were assessed by structured clinical interviews. LRFN5 and OLFM4 levels were measured in the BD (n = 37) and HC (n = 35) groups using Enzyme-Linked ImmunoSorbent Assay kit.

Serum LRFN5 (adjusted P = 0.0117) and OLFM4 (adjusted P = 0.0117) levels were significantly lower, whereas AISI (adjusted P = 0.0005) levels were significantly higher in the BD group compared with HCs, after adjusting for age, gender, body mass index, and smoking status. Within the BD group, a strong positive correlation was observed between LRFN5 and OLFM4 levels (r = 0.702, adjusted P = 0.006) and AISI showed a significant positive correlation with manic symptom severity score after controlling for age, gender, body mass index, and smoking status (r = 0.472, adjusted P = 0.030). In binary logistic regression analysis adjusted for age, gender, body mass index, and smoking status, lower OLFM4 levels (odds ratio (OR) = 0.970, P = 0.020, adjusted P = 0.003) and higher AISI values (OR = 1.008, P = 0.002, adjusted P = 0.001) were independently associated with BD status, alongside smoking status (OR = 19.213, P = 0.005, adjusted P = 0.001) (apparent area under the curve (AUC) = 0.914, optimism-corrected AUC = 0.884). After repeated stratified holdout validation, the mean and median test AUCs were 0.868 and 0.876, respectively.

Subjects with BD experiencing acute manic episodes with psychotic features exhibited decreased circulating LRFN5 and OLFM4 levels alongside an increased systemic inflammatory burden, as reflected by AISI. AISI showed the strongest association with BD status and symptom severity and OLFM4 remained significant in adjusted analyses. Rather than indicating definitive diagnostic utility, the observed alterations may instead reflect underlying biological processes related to BD.

To evaluate how specific psychiatric comorbidities relate to index length of stay (LOS), hospital costs, and in-hospital mortality during readmissions after HF hospitalization.

A retrospective cohort study was conducted using the 2016-2022 Nationwide Readmissions Database. Adults with a principal HF diagnosis were included. Psychiatric comorbidities were depression, anxiety, bipolar disorder, schizophrenia/psychotic disorders, post-traumatic stress disorder (PTSD), and substance use disorder (SUD). Outcomes were index LOS, inflation-adjusted costs, and in-hospital mortality during readmissions within 30 days and up to 1 year after discharge. Survey-weighted multivariable models adjusted for demographics, socioeconomic factors, hospital characteristics, discharge disposition, and comorbidity burden; P ≤ 0.001 was prespecified as the level of statistical significance.

Among 31,886,859 weighted HF hospitalizations, psychiatric comorbidity was common. Anxiety was associated with longer LOS (β = 0.88 days; P < 0.001) and higher costs (β = $2779; P < 0.001) but there were no differences in 30-day or 1-year mortality. However, several diagnoses were associated with lower mortality, including depression (30-day OR = 0.86; 1-year OR = 0.86), bipolar disorder (0.66; 0.68), schizophrenia/psychotic disorders (0.68; 0.72), PTSD (0.73; 0.78), and SUD (0.87; 0.92) (all P < 0.001). Bipolar disorder showed the largest cost reduction (β = −$1320; P < 0.001) compared to HF patients without bipolar disorder.

Psychiatric comorbidity in HF is common. Anxiety is associated with increased hospital utilization, but is not associated with mortality, whereas several other diagnoses are associated with lower mortality. Costs were lower for depression and bipolar disorder. These diagnosis-specific patterns support targeted screening, early consultation, and integrated consultation-liaison care pathways during HF hospitalization.

This narrative review examines the intersection of serial infidelity, coercive control, and psychological abuse as an under-recognised form of betrayal trauma.

Guided by PRISMA principles, a systematic search of four databases (PsycINFO, PubMed, Scopus, and Web of Science) identified 47 peer-reviewed studies published between 1990 and 2025 that met inclusion criteria. Studies were included if they examined repeated infidelity within intimate relationships, associated patterns of coercive control, gaslighting (defined here as psychologically manipulating a person into questioning their own perceptions, memory, or sanity), or the psychological sequelae of sustained relational betrayal. Data were analysed using a narrative synthesis approach to identify convergent theoretical, clinical, and diagnostic themes.

Findings indicate that serial infidelity frequently co-occurs with coercive and gaslighting behaviours, producing psychological effects consistent with trauma responses observed in intimate partner violence. Despite these effects, relational betrayal involving sustained deception and control remains largely absent from psychiatric nosology, contributing to diagnostic blind spots and therapeutic misclassification.

This review highlights the distinction between moral judgement of behaviour and the clinical recognition of trauma-based harm. An evidence-informed framework is proposed for identifying betrayal trauma within diagnostic and clinical settings, emphasising trauma-informed assessment and intervention rather than behavioural or personality-based explanations.

This study examined the association between the Systemic Inflammatory Response Index (SIRI) and depressive symptoms among emerging adults aged 18-25 years, with an emphasis on the indirect role of sleep duration.

This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) 2005-2023. A total of 6563 participants with complete data on the Patient Health Questionnaire-9 (PHQ-9), complete blood count parameters for SIRI calculation, and self-reported sleep duration were included. Depressive symptoms were defined as a PHQ-9 score ≥10. Weighted multivariable logistic regression, restricted cubic spline analysis, and bootstrap-based exploratory mediation analysis (n = 1000) were employed.

Overall, 604 participants (9.2%) met the criteria for depressive symptoms. After full adjustment for covariates, SIRI demonstrated a significant positive association with depressive symptoms (Model 4: OR = 1.16, 95% CI = 1.02-1.33, P = 0.03). Participants in the highest SIRI quartile (Q4) exhibited 33% higher odds of depressive symptoms compared to the lowest quartile (Q1) (OR = 1.33, 95% CI = 1.09-1.61, P = 0.005). No significant nonlinearity was observed (P for nonlinearity = 0.066). Exploratory mediation analysis revealed a negative indirect effect through sleep duration (β = −0.009), accounting for approximately 6.2% of the total effect.

Higher SIRI levels were associated with increased odds of depressive symptoms among emerging adults. Sleep duration played a modest suppressor role in this relationship, suggesting complex interactions between inflammation, sleep, and mental health warranting further investigation through prospective studies.

Reports from caregivers and other witnesses describe episodes of unexpected or paradoxical lucidity among adults diagnosed with dementia. However, until now, there has not been a representative national survey documenting its prevalence in the U.S. adult population. This study reports on (a) the prevalence of terminal or unexpected lucidity in adults diagnosed with Alzheimer’s disease or other dementias, and (b) its distribution across sociodemographic characteristics and parameters of clinical cases.

Data are from a nationally representative population-based survey of observers (N = 5940) of dementia patients, aged 40+, who experienced one or more episodes of unexpected lucidity.

The national prevalence of unexpected lucidity, according to observers, is 43.6% (weighted n = 2587). Episodes occur regardless of the age or sex of patients, parameters of the clinical case, or characteristics of observers.

Findings reveal that lucid episodes are not rare, but possibly a normative feature of the dementing process. If so, this has implications for clinical practice and ethical decision-making involving “deeply forgetful people.”

This study used population-scale administrative data to quantify the frequency, risk factors, and healthcare utilization implications of postoperative depression and anxiety.

A retrospective cohort analysis was conducted using the U.S. Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) database from 2016 to 2022, encompassing 4.2 million surgical procedures across 47 states. Newly coded postoperative psychiatric disorders were identified using ICD-10 diagnostic codes (F32. x for depression and F41.x for anxiety) within 30 days post-surgery. Multivariable logistic regression and propensity score matching (1:1 nearest neighbor, caliper width 0.2σ) were employed to evaluate associations between surgical characteristics and psychiatric outcomes, adjusting for demographics, comorbidities, and institutional factors.

The overall frequency of newly coded postoperative psychiatric disorders was 14.3%, including depression (9.1%), anxiety (8.7%), and mixed presentations (3.5%). Hip fracture surgery demonstrated the highest adjusted odds ratio (aOR 2.34, 95% CI = 2.18-2.51), followed by thoracotomy (aOR 1.89, 95% CI = 1.76-2.03) and cardiac procedures (aOR 1.67, 95% CI = 1.58-1.76). Significant associated factors included female sex (aOR 1.43, 95% CI = 1.39-1.47), age >65 years (aOR 1.28, 95% CI = 1.23-1.33), and operative duration exceeding 5 hours (aOR 1.52, 95% CI = 1.47-1.57). Propensity-matched analysis revealed substantial healthcare utilization disparities, including prolonged hospitalization (13.2 vs 8.4 days, P < 0.001), higher 30-day readmission rates (28.9% vs 19.6%, P < 0.001), and increased total costs ($47,680 vs $31,250, P < 0.001).

This comprehensive population-based analysis demonstrated substantial heterogeneity in the risk of postoperative psychiatric disorders across surgical specialties, with profound implications for healthcare utilization. These findings support the implementation of systematic psychiatric screening protocols and targeted perioperative interventions for high-risk surgical populations.

To compare the distribution of specific causes of death occurring during psychiatric and non-psychiatric hospitalizations in the state of Ceará, Brazil, over an 11-year period.

A retrospective matched case-case study was conducted using data from the Brazilian Mortality Information System from 2012 to 2022. A total of 115 deaths occurring in psychiatric hospitals were identified. For each psychiatric hospital death, 5 comparison deaths from non-psychiatric hospitals were randomly selected and matched by year of death, sex, and exact age.

Cardiovascular diseases were the most frequent cause of death in psychiatric hospitals (39.1%) and were more frequent than in non-psychiatric hospitals (18.3%) (OR = 2.87, 95% CI = 1.87-4.42). Deaths attributed to mental and behavioral disorders (OR = 7.72, 95% CI = 2.87-20.75), ill-defined natural causes (OR = 3.12, 95% CI = 1.39-7.01), and events of undetermined intent (OR = 28.60, 95% CI = 8.13-100.59) were also comparatively more frequent in psychiatric settings, whereas neoplasms were markedly less frequent (OR = 0.03, 95% CI = 0.00-0.26).

Cardiovascular diseases were the most common specific cause of death during psychiatric hospitalization. The comparatively higher frequency of diagnostically broad categories suggests challenges in clinical monitoring, diagnostic capacity, cause-of-death certification, as well as potential stigma-related influences on the classification of deaths of undetermined intent, including possible suicides, in psychiatric inpatient settings. These findings underscore the need for closer integration between psychiatric and general medical care.

Transgender individuals (TGs) experience discrimination, socio-cultural, and financial challenges, along with disparities in access to health care as well as gender affirming care, all of which are compounded by the presence of psychiatric morbidity. The objective of this study was to estimate the prevalence of psychiatric morbidity among TGs and assess the unmet needs of those with psychiatric morbidity.

This cross-sectional study was conducted from October 2023 to May 2024 in India. A convenience sample of 128 transgender women assigned male at birth, with gender dysphoria attending awareness camps about mental health issues were assessed using DSM-5-TR. They were administered a semi-structured interview, and the Camberwell Assessment of Needs Short Appraisal Schedule (CANSAS).

The prevalence of any DSM-5-TR mental disorder was 72% (n = 92). Major depressive disorder (n = 51, 40%) was the most common diagnosis. The mean number of needs on CANSAS was 6.1. Only 8.5% of these needs were met. The most commonly reported unmet needs among those with psychiatric disorder were money (79.3%), welfare benefits (69.5%), basic education (40.1%), psychological distress (44.5%), intimate relationships (37%), accommodation (34%), transportation (32%), and information on condition and treatment (29.3%).

The prevalence of any DSM-5-TR mental disorder was high, with depression being the most common. Most of the needs expressed by the transgender individuals with psychiatric disorders were unmet, with the most reported needs being access to basic amenities, financial difficulties, and unaddressed psychological distress.

Repetitive transcranial magnetic stimulation (rTMS) is an established treatment for comorbid post-traumatic stress disorder (PTSD) and major depressive disorder (MDD). However, there are no universal protocols regarding the type of rTMS recommended, including among military and first responders. This study aimed to describe high frequency rTMS applied to the left dorsolateral prefrontal cortex (DLPFC) administered to inpatients with comorbid PTSD and MDD at Ward 17, Austin Health in Melbourne, Australia.

Retrospective review of patient files was undertaken for adult inpatients admitted between 01/01/2017 and 01/12/2024 with PTSD and MDD who received ten or more rTMS treatments during admission. Paired t-tests were used for statistical analysis.

Among 65 patients and 118 admissions, the majority received high frequency rTMS to the left DLPFC (n = 106, 89.8%), followed by rTMS applied to the right DLPFC (n = 8, 6.8%). The group who received left-sided rTMS had an average of 6 fewer treatments and admission length that was 10 days shorter, but almost half required readmission for further rTMS treatments. The most common side effects reported were pain, fatigue, light-headedness or dizziness, and increased anxiety. Left-sided rTMS was associated with significant improvements in MADRS (Cohen’s D = 1.36, 95% CI = 1.06-1.65, P < .001), PCL-5 (D = 1.18, 95% CI = 0.72-1.63, P < .001), HoNOS (D = 1.20, 95% CI = 0.94-1.46, P < .001), and MoCA scores (D = −0.56, 95% CI = −0.81 to −0.31, P < .001).

High frequency left-sided rTMS is generally well tolerated and may reduce both depressive and PTSD symptoms. Further research to assess rTMS subtypes and target specific symptomatology would support standardization of care and inform future protocol guidelines.

Deep brain stimulation (DBS) has emerged as a promising intervention for severe, treatment-resistant psychiatric disorders such as obsessive-compulsive disorder (OCD) and treatment-resistant depression (TRD), where conventional therapies often fail. Despite overlapping neurocircuitry, the clinical trajectories and translational challenges of these conditions differ substantially. This review examines the current evidence and advancements in DBS for severe, treatment-resistant psychiatric disorders.

A literature search was conducted to identify relevant studies on DBS for OCD and TRD. The search was performed in PubMed and Google Scholar, covering publications from 2020 to 2025. Older studies were included if deemed essential references. Keywords and Boolean combinations such as “DBS,” “deep brain stimulation,” “OCD,” “TRD,” “treatment-resistant depression,” and “psychiatric neuromodulation” were used to refine the search and enhance specificity.

Clinical findings demonstrate sustained long-term benefits of DBS in OCD, although recent sham-controlled trials report smaller effect sizes than earlier open-label studies. In TRD, outcomes remain inconsistent, with open-label trials showing high response rates but larger randomised trials failing to significantly outperform sham stimulation. Emerging innovations include connectomic-guided targeting, AI-assisted predictive models, and closed-loop DBS systems driven by neural biomarkers.

DBS remains a promising therapy for refractory OCD and TRD. Future progress depends on addressing methodological, ethical, and translational challenges while advancing personalised, data-driven neuromodulation strategies.

Chopra Wellbeing Index (CWI) was developed as a multidimensional measure of wellbeing, integrating physical, emotional, social, and spiritual domains consistent with contemporary models of human flourishing. The purpose of this study was to systematically evaluate the psychometric properties of this measure.

The psychometric properties of the CWI were assessed in 1637 participants (ages 18-83) who completed the CWI alongside established comparator measures of wellbeing, mental health, and quality of life. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to test the dimensionality of the instrument. Internal consistency was assessed using Cronbach’s alpha and McDonald’s omega. Criterion validity was assessed via correlations with validated scales. Measurement invariance testing was conducted with respect to several demographic dimensions to assess generalizability of the scale’s underlying factor structure.

The 24-item CWI demonstrated strong internal consistency across subscales. Factor analyses supported a multidimensional structure with four correlated subscales: physical, psychological, social, and spiritual wellbeing. Evidence of criterion validity was found via positive correlations with wellbeing and life satisfaction measures along with negative correlations with measures of depression, anxiety, and negative emotions. Partial measurement invariance was supported with respect to gender, education, marital status, employment status, income, race/ethnicity, and country.

The Chopra Wellbeing Index is a reliable and valid tool for assessing multidimensional wellbeing in adults. Its integration of spiritual and existential domains alongside traditional health indicators distinguishes it from existing instruments, making it suitable for use in holistic health research, clinical practice, and population wellbeing monitoring.

This study explored the effects of adverse childhood experiences (ACEs) in older adults on long-term intrinsic capacity (IC) and trajectories of change in IC over 5 years from 2011 to 2015.

A total of 2847 participants aged 60 years and older from the China Health and Retirement Longitudinal Study (CHARLS) were included in analyses. Twelve ACEs were retrospectively assessed by questionnaire in 2014. The number of ACEs was summed and categorized into 5 groups: 0, 1, 2, 3, and 4 or more ACEs. IC was assessed using a measure that examined five domains: locomotor, cognitive, sensory, vitality, and psychological.

Overall, 87.4% of participants reported exposure to at least 1 of the 12 ACEs (Group 2) and 16.6% had experienced 4 or more ACEs (Group 5). Compared to participants without ACEs exposure (Group 1), those experiencing 1, 2, 3 and 4 or more ACEs (Groups 2-5) predicted worse IC (β = 0.085, 95% CI = −0.169 to −0.001, P < 0.05, to β = −0.44, 95 % CI = −0.54 to −0.34, P < 0.001, respectively across the four groups, demonstrating a dose-effect response. Three IC trajectories were identified (low-stable, moderate-stable, and high stable). Individuals with experience 2, 3 and 4 or more ACEs (Groups 3-5) predicted a significantly increased risk of moderate-stable and low-stable IC trajectories. In addition, physical abuse, household mental illness, domestic violence, bullying and parental disability was negatively related to IC and predicted an increased risk of moderate-stable and low-stable trajectory in long-term follow-up.

Exposure to ACEs negatively impacts IC and predicts increased risk of moderate-stable and low-stable IC trajectory (vs. high stable) over time.

Individuals living with HIV are at increased risk for psychiatric disorders. In this pilot randomized clinical trial, the effects of probiotics on improving psychiatric symptoms among patients living with HIV was examined.

A total of 50 patients living with HIV were randomly assigned to one of two groups: one group received a probiotic capsule. In contrast, the other received a placebo for 12 weeks, determined by a simple randomization method. Patients were evaluated at weeks 0, 4, 8, and 12 using the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Simplified Nutritional Appetite Questionnaire (SNAQ), and the Pittsburgh Sleep Quality Index (PSQI).

Compared to the control group, HIV patients in the intervention group receiving probiotics exhibited a significantly greater reduction in anxiety symptoms and greater improvement in appetite compared to those in the placebo group (time*group interaction: F (3, 144) = 6.63, P < 0.001 for anxiety symptoms; F (3, 144) = 18.74, P < 0.001 for appetite).

Probiotics may be beneficial in alleviating anxiety symptoms and anorexia in persons living with HIV. Future studies in multicenter settings with larger sample sizes and extended follow-up periods are needed to replicate these results.