Epidemiology and Psychiatric Sciences最新文献

{"title":"The association between chronotype and incident dementia: exploring age, educational-attainment and sex differences.","authors":"Ana Neeltje Wenzler, Aart C Liefbroer, Richard Oude Voshaar, Nynke Smidt","doi":"10.1017/S2045796026100687","DOIUrl":"10.1017/S2045796026100687","url":null,"abstract":"<p><strong>Aims: </strong>Chronotype reflects individual variation in circadian rhythm (CR) (e.g., morningness versus eveningness). CR and chronotype have been associated with dementia pathology, and recent literature suggests that impaired sleep quality and CR disturbances may represent relevant causal factors for dementia. Current evidence is scarce and consists of just a small number of cross-sectional analyses and one longitudinal study. The aim of this study is to investigate the longitudinal association between chronotype and dementia risk in the older adult population, aged 60 years and older.</p><p><strong>Methods: </strong>Linking data from the Lifelines Cohort Study and data from Vektis obtained by Statistics Netherlands led to a sample for analysis of <i>n</i> = 16,757 participants. Chronotype was measured with the Munich ChronoType Questionnaire (MCTQ) between 2011 and 2015. Chronotype was categorised into five categories: extremely early, slightly early, intermediate, slightly late, extremely late. Dementia incidence was based on having at least one dementia indicator from the Vektis dataset in the years 2018 until 2024. A discrete-time survival model was used to examine the association between chronotype and dementia. Age was specified as the underlying time scale in the discrete-time logistic survival analysis. Sex was included as a covariate. Interactions between age, sex, and educational attainment and chronotype were measured by including relevant interaction terms in the model.</p><p><strong>Results: </strong>The median age in the sample was 65 years old, and 54% was female. In total, 7% got dementia during a mean follow-up period of 6.6 years. Most individuals had an intermediate chronotype (56%), with about 20% of the individuals having a slightly early and late chronotype, and only about 3% having an extremely early and late chronotype. Individuals with a slightly early (HR, 1.26 [95% CI: 1.08, 1.46]) and an extremely late chronotype (HR, 1.42 [95% CI: 1.00, 2.02]) had an elevated risk of dementia. There were no significant interactions.</p><p><strong>Conclusions: </strong>Having a slightly early as well as an extremely late chronotype was associated with an elevated risk of dementia.</p>","PeriodicalId":11787,"journal":{"name":"Epidemiology and Psychiatric Sciences","volume":"35 ","pages":"e31"},"PeriodicalIF":6.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evolution of suicide mortality in Europe: decline with persistent disparities in an age-period-cohort analysis.","authors":"Bo Zhang, Maggie Meiqi Xin, Manqi Zheng, Zijuan Fan, Luyao Hu, Chun Hao, Jing Gu, Wangnan Cao, Vivian Yawei Guo, Dannuo Wei, Stuart Gilmour, Sophia Achab, Anise Man Sze Wu, Yu Tao Xiang, Fengsu Hou, Jinghua Li","doi":"10.1017/S2045796026100663","DOIUrl":"10.1017/S2045796026100663","url":null,"abstract":"<p><strong>Aims: </strong>Pronounced variations in suicide mortality persist across Europe. Understanding long-term temporal patterns through age, period and cohort (APC) effects, alongside suicide means, is essential for tailored prevention. This study aims to determine how suicide mortality rates in Europe have changed across APC dimensions at national and subregional levels.</p><p><strong>Methods: </strong>Our analysis was restricted to European countries with complete age- and sex-specific suicide mortality data from 1990 to 2019 within the World Health Organization mortality database. The analysis comprised two components. The first component disentangled long-term suicide mortality trends (1990-2019) into APC dimensions using an age-period-cohort model via the National Cancer Institute's APC Web Tool. The second component involved an assessment of suicide means, restricted to 2010-2019 and to countries with detailed International Classification of Diseases, 10th Revision (ICD-10) cause-of-death data.</p><p><strong>Results: </strong>In 2019, Europe recorded 47,793 male and 13,111 female suicide deaths. Overall suicide mortality rates declined in most subregions from 1990 to 2019, with the largest reductions among Eastern European men, from 77.81 (95% CI: 77.17-78.45) per 100,000 in the mid-1990s to 22.93 (95% CI: 22.58-23.28) per 100,000 by 2019, although this region retained the highest male suicide burden. Age-specific risk patterns differed markedly: among men, risk peaked in early adulthood and then declined in Eastern Europe, while in Western and Southern Europe, it was lower and more stable but rose after age 60; for women, risk was generally lower, with peaks in early adulthood in Eastern Europe and in midlife elsewhere. Period reflected continued improvement, especially in Eastern Europe where the period risk in 2015-2019 was approximately 60% lower than 2000-2004. Cohort effects similarly showed progressive declines. However, upward trends emerged among younger generations. In Northern Europe, the cohort relative risk for females increased from 0.73 (95% CI: 0.68-0.78) in the 1980 cohort to 0.90 (95% CI: 0.70-1.04) in the 2000 cohort. While the completeness of suicide means analysis varied by subregion, the primary data indicated that hanging was the predominant means for both sexes during 2010-2019.</p><p><strong>Conclusions: </strong>Despite an overall decline, suicide mortality in Europe exhibits persistent regional and demographic differences. This study reveals emerging risks among younger cohorts, specifically Northern European women and Southern European men, signalling shifting patterns that are not apparent from overall temporal trends alone. This evolving risk profile calls for sustained surveillance and research to investigate the drivers of these population-specific vulnerabilities.</p>","PeriodicalId":11787,"journal":{"name":"Epidemiology and Psychiatric Sciences","volume":"35 ","pages":"e30"},"PeriodicalIF":6.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No turning point? Suicide trends in Brazil and the impact of the COVID-19 pandemic.","authors":"Lucas Silva, Jorge Artur Peçanha de Miranda Coelho, Valfrido Leão de-Melo-Neto","doi":"10.1017/S2045796026100675","DOIUrl":"10.1017/S2045796026100675","url":null,"abstract":"<p><strong>Aims: </strong>The COVID-19 pandemic has exerted significant mental health impacts worldwide, with a major concern in the literature being its potential effect on suicide rates. Brazil, one of the countries most severely affected by the pandemic, still lacks clear evidence regarding the consequences of the crisis on self-inflicted deaths. This paper aims to estimate the impact of the COVID-19 pandemic on suicide rates in Brazil.</p><p><strong>Methods: </strong>We employed an interrupted time series design with seasonal adjustments to estimate changes in suicide rates per 100,000 population. The analysis was based on deaths from all forms of self-inflicted injury, as classified by the International Classification of Diseases. We estimated trends for the total population, stratified by sex and administrative region.</p><p><strong>Results: </strong>Suicide rates increased significantly before the pandemic (<i>β</i>₁ = 0.00148, <i>p</i> < 0.001). No significant change in trend was observed after the onset of the pandemic at the national level (<i>β</i>₃ = 0.00092, <i>p</i> > 0.05). Among men, both the pre-pandemic trend (<i>β</i>₁ = 0.00236, <i>p</i> < 0.001) and the post-pandemic increase (<i>β</i>₃ = 0.00155, <i>p</i> < 0.05) were significant. For women, the pre-pandemic trend was modest (<i>β</i>₁ = 0.00065, <i>p</i> < 0.001), and the post-pandemic slope was not significant (<i>β</i>₃ = 0.00033, <i>p</i> = 0.10). Regionally, the Central-West (<i>β</i>₃ = 0.00217, <i>p</i> < 0.01) and North (<i>β</i>₃ = 0.00186, <i>p</i> < 0.05) experienced significant post-pandemic increases, while the Southeast (<i>β</i>₃ = 0.00087, <i>p</i> > 0.05) and South (<i>β</i>₃ = -0.00034, <i>p</i> > 0.05) showed no significant changes. Seasonal effects revealed consistent mid-year declines across all groups and regions.</p><p><strong>Conclusions: </strong>The COVID-19 pandemic did not produce a statistically significant shift in national suicide trends but coincided with the persistence of pre-existing upward patterns in specific demographic and regional contexts. These findings underscore the need for targeted and region-specific suicide prevention strategies.</p>","PeriodicalId":11787,"journal":{"name":"Epidemiology and Psychiatric Sciences","volume":"35 ","pages":"e29"},"PeriodicalIF":6.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental health and sexual identity inequalities in individuals with past experiences of homelessness: findings from a nationally representative survey.","authors":"Amal R Khanolkar, Sally McManus, Jayati Das-Munshi, Laia Becares, Natasha Chilman","doi":"10.1017/S2045796026100651","DOIUrl":"10.1017/S2045796026100651","url":null,"abstract":"<p><strong>Aims: </strong>Homelessness is increasing and associated with poor mental health (MH). Few studies have examined how experiences of homelessness and sexual identity intersect to effect MH. We used an intersectional approach to examine MH inequalities related to sexual identity and past homelessness in a nationally representative private household sample, and whether associations were explained by discrimination.</p><p><strong>Methods: </strong>Analysis of the 2007 and 2014 Adult Psychiatric Morbidity Surveys included 10,428 individuals aged 16-64 (58% female/3.8% non-heterosexual). The Clinical Interview Schedule-Revised (CIS-R) identified common mental disorders (CMDs). Self-harm, attempted suicide, alcohol dependence, substance use, sexual identity, discrimination/bullying, past homelessness and health behaviours were self-reported. Associations between sexual identity and homelessness were examined using multivariable Poisson regression. Prevalence ratios (PRs) for MH and health behaviours by intersectional sexual identity-past homelessness were examined using Poisson regression and adjusted for age, sex, area-level deprivation and further for discrimination/bullying.</p><p><strong>Results: </strong>Bisexual (adjusted PR [aPR]: 2.52, 95% CI: 1.48-4.29) and gay/lesbian (aPR: 1.76, 0.97-3.19) individuals were more likely to report past homelessness than heterosexual peers. Sexual minority (SM) and heterosexual individuals with past homelessness had higher prevalence of all MH outcomes compared to heterosexual peers without homelessness, with associations strongest in the SM-homelessness group (e.g., CMD: aPR: 2.67 [2.37-3.01] for heterosexual-homeless, aPR: 4.11 [3.00-5.63] for SM-homeless, aPR: 1.82 [1.45-2.28] for SM-not homeless groups), and similarly for depression/self-harm/attempted suicide. Likewise, the SM-homeless group had highest prevalence for drug dependence (aPR, 7.38 [3.15-17.29]) compared to the heterosexual-homeless (aPR, 4.03 [3.00-5.42]) and SM-not homeless (aPR, 2.19 [1.27-3.79]) groups. Adjustment for discrimination and bullying substantially attenuated point estimates, with the greatest attenuation (30-50%) in the SM-homeless compared to the heterosexual-homeless groups.</p><p><strong>Conclusions: </strong>Individuals with past experiences of homelessness have significantly worse MH than heterosexuals without homelessness, with associations highest in the SM-homeless group. Considering experiencing homelessness and SM identity together identifies a group facing particular adversity, which is often lost when examined separately. Discrimination and bullying explained much of the worse MH in SM- and heterosexual-homeless groups, but especially the former. Investigation into the mechanisms leading to MH inequalities is needed, alongside policies and services to support this group.</p>","PeriodicalId":11787,"journal":{"name":"Epidemiology and Psychiatric Sciences","volume":"35 ","pages":"e28"},"PeriodicalIF":6.1,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13126408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intolerance of uncertainty as a prospective predictor of generalized anxiety and depression in adolescents: evidence from a three-wave, 12-month study.","authors":"Haoxian Ye, Linmao Zou, Zixuan Shao, Jiaqi Wang, Jiaxiong Zhang, Keying Liu, Yiming Zhang, Ranran Wang, Fang Fan","doi":"10.1017/S204579602610064X","DOIUrl":"10.1017/S204579602610064X","url":null,"abstract":"<p><strong>Aims: </strong>Intolerance of uncertainty (IU) - a dispositional inability to react effectively to uncertain situations - has been increasingly conceptualized as a transdiagnostic risk factor for internalizing problems such as generalized anxiety and depression. However, evidence for its temporal role in the development of these conditions remains limited, particularly in adolescents, a group at heightened risk for psychopathology.</p><p><strong>Methods: </strong>A total of 5,291 adolescents (46.2% boys; M age = 14.40 ± 1.56, range = 10-18 years) completed self-report measures of IU, generalized anxiety and depressive symptoms at baseline, 6 months and 12 months. Linear and logistic regression analyses examined whether baseline IU predicted subsequent symptom severity and elevated (above-cut-off) symptom levels over time.</p><p><strong>Results: </strong>Higher baseline IU significantly predicted increases in generalized anxiety and depressive symptoms, as well as higher odds of elevated generalized anxiety and depressive symptom levels at both 6- and 12-month follow-ups, even after adjusting for baseline symptom severity or baseline elevated symptom status. Baseline IU also predicted the new-onset and persistence of elevated symptoms across both intervals. Stratified analyses revealed developmental and sex differences: IU's predictive effects were strongest in early adolescence for girls and in middle-to-late adolescence for boys.</p><p><strong>Conclusions: </strong>IU emerged as a transdiagnostic longitudinal predictor of generalized anxiety and depressive symptoms in adolescents, supporting its value as an early screening marker of vulnerability. Interventions targeting IU may offer an effective strategy for reducing broad internalizing risk during this critical developmental period.</p>","PeriodicalId":11787,"journal":{"name":"Epidemiology and Psychiatric Sciences","volume":"35 ","pages":"e27"},"PeriodicalIF":6.1,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public stigma of mental illness in Australia: shifts in attitudes across nationally representative surveys in 2011 and 2024.","authors":"Amy Morgan, Anna Ross, Gayle McNaught, Rachel Green, Nicola Jane Reavley","doi":"10.1017/S2045796026100602","DOIUrl":"10.1017/S2045796026100602","url":null,"abstract":"<p><strong>Aims: </strong>Reducing stigma and discrimination towards people with mental ill-health is a key priority in Australian mental health policy. Population-based surveys conducted in Australia between 2003 and 2011 showed some improvement in stigmatising attitudes, but also a deterioration in attitudes about dangerousness and unpredictability, particularly in relation to schizophrenia. This study aimed to investigate whether stigmatising attitudes have changed since the 2011 national survey.</p><p><strong>Methods: </strong>Two large, nationally representative samples of Australian adults were surveyed in 2011 (<i>n</i> = 1967) and 2024 (<i>n</i> = 1984). At each time point, participants were presented with vignettes of a person in the early stages of depression or schizophrenia and completed questionnaires about stigmatising attitudes towards the person in the vignette (Personal Stigma Scale) and willingness to interact with them (Social Distance Scale). Using weighted data, logistic regressions assessed change from 2011 to 2024 while controlling for sociodemographic characteristics. Results were considered significant at <i>p</i> < .01.</p><p><strong>Results: </strong>There were significant reductions in endorsement of stigmatising attitudes towards depression and early schizophrenia. Notably, there were large reductions in beliefs about dangerousness (depression 22.5-4.8% and schizophrenia 37.1-18.1%). Conversely, the willingness to interact with a person with depression remained unchanged and had worsened for schizophrenia, with the odds of being unwilling to interact approximately doubling (11.0-26.9% unwilling to make friends and 18.8-33.2% unwilling to work closely with them).</p><p><strong>Conclusions: </strong>The data show mixed findings regarding change in stigma in the Australian population. Despite negative beliefs diminishing over time, this has not translated into greater willingness to interact with people with depression or schizophrenia. Key action is needed on understanding the barriers to interacting with people with mental health conditions and reducing perceptions of unpredictability, particularly for schizophrenia, which remains more highly stigmatised.</p>","PeriodicalId":11787,"journal":{"name":"Epidemiology and Psychiatric Sciences","volume":"35 ","pages":"e26"},"PeriodicalIF":6.1,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating burden of disease attributable to child maltreatment using findings from the Australian Child Maltreatment Study.","authors":"Rosana Pacella, Ben Mathews, David Lawrence, Monica Madzoska, Eva Malacova, Holly E Erskine, Hannah J Thomas, Daryl J Higgins, Divna Haslam, Franziska Meinck, James G Scott","doi":"10.1017/S2045796026100572","DOIUrl":"10.1017/S2045796026100572","url":null,"abstract":"<p><strong>Aims: </strong>Prevention of child maltreatment - incorporating physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence - is a clearly defined global policy priority. Global Burden of Disease studies have focused on estimating burden attributable to childhood sexual abuse omitting other forms of child maltreatment. This study aims to estimate burden attributable to child maltreatment using data from the first comprehensive national study, the Australian Child Maltreatment Study (ACMS), accounting for the co-occurrence of multiple forms, the complex impact of multi-type maltreatment and the contribution of interrelated factors.</p><p><strong>Methods: </strong>We estimated burden attributable to child maltreatment by age and gender for Australia in 2021. Risk-outcome pairs that met criteria for sufficient evidence for a causal relationship were included. Relative risks were estimated as a function of exposure based on data from the ACMS incorporating increased risk with multi-type maltreatment and adjustment for confounding. Levels of exposure in each of the 32 mutually exclusive combinations or patterns of child maltreatment were estimated based on ACMS data by age and gender. The theoretical minimum risk exposure level was determined as no exposure to child maltreatment in the population and population attributable fractions (PAFs) were calculated. Attributable mortality, years of life lost, years lived with disability and disability-adjusted life years (DALYs) were estimated by multiplying PAFs by the relevant burden of disease estimates by age and gender for Australia in 2021. Sensitivity analyses were conducted to assess the robustness of the results. Uncertainty was propagated into attributable burden estimates using Monte Carlo simulation methods.</p><p><strong>Results: </strong>Overall, child maltreatment accounted for 6.6% (95% uncertainty interval (UI), 6.2-6.9%) of all DALYs for women and 6.4% (95% UI, 6.0-6.7%) of all DALYs for men in Australia in 2021. An estimated 71.2% of self-harm, 57.1% of anxiety disorders and 49.3% of major depressive disorder (MDD) DALYs in women, and 63.8% of self-harm, 55.9% of anxiety disorders and 42.9% of MDD DALYs in men were attributable to child maltreatment.</p><p><strong>Conclusions: </strong>Child maltreatment contributes to a substantial proportion of burden of disease in Australia, equivalent to leading lifestyle-related risk factors such as high body mass index, high blood pressure and smoking. This research significantly advances knowledge of the disease burden attributable to child maltreatment and provides novel methodology for measuring the impact of all five forms of child maltreatment combined on mental health and health risk behaviours nationally and globally.</p>","PeriodicalId":11787,"journal":{"name":"Epidemiology and Psychiatric Sciences","volume":"35 ","pages":"e25"},"PeriodicalIF":6.1,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-cultural validity of the generalized anxiety disorder 7-item scale (GAD-7): a systematic review and standardized assessment.","authors":"Anastasia Mantzari, Lorena Botella-Juan, Prateek Yadav, Grace Lavelle, Ana Henriques, Daniel Munblit, Amy Ronaldson, Alex Dregan, Ioannis Bakolis, Mariana Pinto da Costa, Maria Carmen Viana, Alba Marcos-Delgado, Antonio J Molina, Vicente Martín, Jose M Valderas, Gemma Vilagut, Jordi Alonso, Jorge Arias de la Torre","doi":"10.1017/S2045796026100560","DOIUrl":"10.1017/S2045796026100560","url":null,"abstract":"<p><strong>Aims: </strong>The Generalized Anxiety Disorder 7-Item Scale (GAD-7) is a brief self-reported measure for screening for anxiety symptoms. However, the evidence about its cross-cultural validity is fragmentary and usually focused on specific settings. Therefore, we aimed to critically review and synthesize the existing evidence about the cross-cultural validity of the GAD-7.</p><p><strong>Methods: </strong>We conducted a systematic review of studies assessing the cross-cultural validity of the GAD-7 in following the PRISMA guidelines. Additionally, the quality of the studies was assessed following the COSMIN guidelines, and the quality of the evidence was assessed with the GRADE. Data were synthesized narratively.</p><p><strong>Results: </strong>Out of 1,965 unique records, 9 unique studies were deemed eligible for the COSMIN appraisal and the narrative synthesis (total sample: 11,894, 53.7% females and 20 different cultural groups). Most studies (7) had adequate quality and showed evidenced of the unitary structure of the GAD-7 across cultural groups. In 4 studies also assessing possible cultural bias, the effect on the general score was deemed negligible.</p><p><strong>Conclusions: </strong>The evidence about the cross-cultural validity of the GAD-7 is very limited. Although more research is needed, the evidence available shows that the GAD-7 could be a cross-culturally valid tool for the assessment of anxiety symptoms in clinical contexts and epidemiological studies. Until new high-quality evidence will be available, these results would constitute a key first step for supporting the use of the GAD-7 in multi-cultural clinical settings and to inform clinical, public health and global health decision making in relation to anxiety.</p>","PeriodicalId":11787,"journal":{"name":"Epidemiology and Psychiatric Sciences","volume":"35 ","pages":"e24"},"PeriodicalIF":6.1,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147671488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The interplay of multimorbidity and depressive symptoms: mediation role of functional dependence.","authors":"Rui She, Haiyue Luo, Shanquan Chen, Fangfei Xiong, Karen P Y Liu, Marco Y C Pang","doi":"10.1017/S2045796026100626","DOIUrl":"10.1017/S2045796026100626","url":null,"abstract":"<p><strong>Objective: </strong>Mental-physical multimorbidity is an emerging prevalent global health challenge. This study aims to examine reciprocal relationships between depressive symptoms and multimorbidity, with the mediation role of functional dependence in activities of daily living.</p><p><strong>Methods: </strong>Data were derived from the China Health and Retirement Longitudinal Study, which included 11,572 Chinese residents aged 45 years and older, surveyed in 2011, 2013, 2015 and 2018. Depressive symptoms were assessed using the Chinese version of the Center for Epidemiologic Studies Depression Scale (CESD-10) at baseline and each follow-up survey. Multimorbidity was operationalized as the condition count and the patterns identified via exploratory factor analysis. Four-wave cross-lagged panel models (CLPM) with bootstrapping were employed to estimate the path coefficients and the mediation effect of functional dependence.</p><p><strong>Results: </strong>Multimorbidity (cardiometabolic and respiratory-degenerative) and depressive symptoms exhibited bi-directional associations. Multimorbidity had a stronger impact on later depression (β: 0.042-0.130) than depression on multimorbidity (β: 0.005-0.064). Associations were stronger for respiratory-degenerative (β: 0.027-0.104) than cardiometabolic diseases (β: 0.005-0.065). Functional dependence partially mediated these links, with higher mediation for cardiometabolic (9-21%) than respiratory-degenerative diseases (4-6%). Additionally, some sex- and age-specific differences were identified in these dynamic associations.</p><p><strong>Conclusions: </strong>The study revealed bi-directional links between multimorbidity and depressive symptoms among Chinese adults. Functional dependence was a significant pathway in the cycle of multimorbidity and depressive symptoms, especially for cardiometabolic diseases. These insights suggest that interventions aimed at preventing functional dependence may be beneficial in mitigating the risk of coexisting mental and physical disorders.</p>","PeriodicalId":11787,"journal":{"name":"Epidemiology and Psychiatric Sciences","volume":"35 ","pages":"e21"},"PeriodicalIF":6.1,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extending the ecological model of distress to social functioning among refugees and asylum-seekers.","authors":"Gülşah Kurt, Philippa Specker, Belinda J Liddell, David Keegan, Randy Nandyatama, Atika Yuanita, Rizka Argadianti Rachmah, Joel Hoffman, Angela Nickerson","doi":"10.1017/S2045796026100614","DOIUrl":"10.1017/S2045796026100614","url":null,"abstract":"<p><strong>Aim: </strong>Social functioning is a crucial aspect of psychosocial adaptation following forced displacement. Yet, it has received far less attention than understanding and addressing mental health problems among refugees and asylum-seekers. This study aimed to extend the ecological model of refugee distress - one of the most widely used frameworks in refugee mental health - to social functioning, and to identify direct and indirect pathways from established conflict- and displacement-related factors to social functioning alongside mental health problems.</p><p><strong>Method: </strong>An online study with 1,235 refugees in Indonesia was conducted over a 2-year period. Conflict-related traumatic experiences before arrival in Indonesia, post-displacement stressors in the past 12 months, were measured at the onset of the study, while social functioning and mental health outcomes (symptoms of posttraumatic stress disorder, depression, and anger) were assessed 1 year later.</p><p><strong>Results: </strong>Longitudinal Structural Equation Modelling analysis revealed that diversity of conflict-related trauma predicted more post-displacement stress (<i>β =</i> 0.45, SE = 0.03, <i>p</i> < 0.001), higher mental health problems (<i>β =</i> 0.13, SE = 0.05, <i>p</i> = 0.004), but increased social functioning 1 year later (<i>β =</i> 0.10, SE = 0.04, <i>p</i> = 0.011), while post-displacement stressors predicted poorer mental health (<i>β =</i> 0.46, SE = 0.05, <i>p</i> < 0.011) and reduced social functioning (<i>β = -</i>0.09, SE = 0.04, <i>p</i> = 0.041). The indirect pathway from traumatic experiences via post-displacement stressors was positive for mental health (<i>β =</i> 0.21, 95% CI = 0.162-0.257) and negative for social functioning (<i>β = -</i>0.04, 95% CI = -0.082 to -0.003).</p><p><strong>Conclusions: </strong>This study conceptually and empirically extended the ecological model of refugee distress to social functioning by highlighting the dual influences of conflict-related traumatic experiences. The findings provide a springboard for advancing research and practice in the mental health and psychosocial field.</p>","PeriodicalId":11787,"journal":{"name":"Epidemiology and Psychiatric Sciences","volume":"35 ","pages":"e22"},"PeriodicalIF":6.1,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}