Harvard Review of Psychiatry最新文献

{"title":"Charting a Course Through the Ineffable and the Inflammatory: Studying Youth Firearm Suicide.","authors":"Matthew Kelly","doi":"10.1097/HRP.0000000000000461","DOIUrl":"10.1097/HRP.0000000000000461","url":null,"abstract":"<p><p>The United States' epidemic of youth firearm suicide represents both a clinical challenge and an existential crisis, with firearm suicide rates increasing yearly. Efforts to mount effective responses, however, are thwarted by cultural, social, and political barriers that affect our ability to understand youth firearm practices, develop risk-reduction strategies, and communicate those strategies to families. The psychological autopsy, a methodology wherein researchers interview the family members and associates of youth firearm suicide decedents, offers tremendous potential for reconstructing the lived experience of children and adolescents lost to suicide. Since its introduction in the 1950s, however, the psychological autopsy has largely developed into a tool that filters lived experience through the lens of clinical scales and validated batteries to facilitate quantitative analysis of suicide risk factors. I argue that we cannot build a deep or actionable understanding of the cultural, sociological, and historical circumstances that subtend youth firearm suicide if we rely solely upon analytical models rooted in the quantitative analysis of clinical constructs. To attain an actional understanding of this tragic epidemic, we must develop practices that apply psychological autopsy methodologies in the service of generating thick descriptions of youth firearm practice and suicide. Several disciplinary traditions, including anthropological ethnography and oral history practice, offer insights that can help us realize psychological autopsy's potential to generate new knowledge, develop interventions to stem the rising tide of youth firearm suicide, and communicate these interventions in an increasingly polarized political environment.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"34 3","pages":"128-130"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introduction to the Special Issue: Social Determinants of Psychopathology.","authors":"Stephen E Gilman, Neil Krishan Aggarwal","doi":"10.1097/HRP.0000000000000467","DOIUrl":"10.1097/HRP.0000000000000467","url":null,"abstract":"","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"34 3","pages":"125-127"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Poverty, Policy, and Mental Health Inequities: Evidence, Challenges, and Opportunities.","authors":"Rita Hamad","doi":"10.1097/HRP.0000000000000458","DOIUrl":"10.1097/HRP.0000000000000458","url":null,"abstract":"<p><p>Poverty is a key upstream determinant of mental health and a driver of persistent inequities in the United States (US). There is growing recognition that we need to target upstream social drivers of mental health inequities, particularly through economic policies aimed at reducing poverty. This article describes the relationship between poverty and mental health and synthesizes evidence on the mental health impacts of major US income support policies, including the Earned Income Tax Credit, Child Tax Credit, Temporary Assistance for Needy Families, minimum wage laws, and unemployment insurance. Existing literature suggests that income support policies, especially those delivering reliable and unconditional aid, can alleviate psychological distress and promote mental well-being. The reach and effectiveness of these policies, however, are constrained by complex eligibility criteria, administrative burdens, restrictive conditions, and insufficient generosity-disproportionately limiting access for those with mental illness or those in deepest poverty. Additionally, lump-sum payments only provide temporary relief, underscoring the potential benefits of more regular disbursements. Significant gaps in the evidence base remain for several policies, hindering evidence-based decision-making. To fully realize the mental health benefits of income policies, clinicians, researchers, and advocates can take specific actions to enhance patient take-up of income supports, promote policy reforms that reduce administrative barriers and expand access, invest in improved data infrastructure, and integrate social policy training into mental health education. A multisector, equity-oriented approach is essential to support population-level mental health and advance health equity amidst an evolving policy landscape.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"34 3","pages":"210-216"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social Correlates of Trauma and Posttraumatic Stress Disorder: The Importance of Context.","authors":"Lukoye Atwoli, Linnet Ongeri","doi":"10.1097/HRP.0000000000000459","DOIUrl":"10.1097/HRP.0000000000000459","url":null,"abstract":"<p><p>Understanding trauma and posttraumatic stress disorder (PTSD) requires a contextual perspective that considers historical legacies, social environments, and cultural realities. This paper draws on empirical evidence from Kenya and Uganda to demonstrate the limitations of applying trauma frameworks developed in high-income countries to African contexts. Findings from the Orphaned and Separated Children's Assessment Related to Their Health and Well-Being (OSCAR) study challenge assumptions about care environments. The study reveals higher PTSD rates among orphans in family-based settings compared to institutional care, and highlights the protective roles of religion and social support. The Neuropsychiatric Genetics of African Populations-Psychosis (NeuroGAP-Psychosis) study provides crucial insights into context-specific trauma types often overlooked by standardized Western assessment tools. These categories, along with a detailed breakdown of \"other\" traumas, are essential for a nuanced understanding of distress in regions like Kenya. PTSD patterns vary significantly among countries, reflecting unique regional and historical influences. These findings emphasize the importance of culturally grounded research and trauma-informed interventions tailored to local contexts and realities. A sensitive, context-aware approach is vital to accurately understanding the experiences of trauma survivors and to developing effective, ethically responsible mental health interventions that resonate with and empower communities in resource-limited settings.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"34 3","pages":"180-188"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Competencies and Implementation of Peer Support Interventions for People with Serious Mental Health Challenges: A Systematic Review.","authors":"Ernesto Isaac Lara, Laura Bond, Adarsh Ratnakaran, Muxi Zheng, Emily Song, Kacey Fang, Priyanka Suneja, Saniya Ballikar, Malvina Carmel Mendes, Kathryn O'Neill, Natali Carmio, Ravindra Narayan Agrawal, Vikram Patel","doi":"10.1097/HRP.0000000000000460","DOIUrl":"10.1097/HRP.0000000000000460","url":null,"abstract":"<p><p>Peer support has proven effective in improving clinical, psychosocial, and recovery-oriented outcomes for persons with serious mental health challenges. This review builds on this evidence with the goal of identifying the competencies and implementation features of peer support interventions. We identified 41 articles for inclusion. Eligible studies consisted of randomized controlled trials that tested the effectiveness of peer support services for adults living with serious mental health challenges. We extracted and synthesized data on the competencies peer supporters demonstrated and implementation elements, including recruitment, training, supervision, and quality monitoring. Most studies were from high-income country settings, with the majority from the United States (75.6%). A competency taxonomy was developed based on the Substance Abuse and Mental Health Services Administration's peer support core competencies guidelines, and through additional thematic content analysis. Out of the 16 peer support and clinical competencies identified, the most frequently deployed peer support competencies were collaboration and care (90%), providing support (83%), and communication (73%); the most frequently deployed clinical competency was mental health diagnosis and psychoeducation (51%). Peers were primarily recruited from community organizations. Although reports on training length and format were inconsistent, trainings were most often reported as in person and ranged from a few hours to 192 hours. Supervisors of peer supporters included more experienced peer supporters, clinicians, or other staff, and supervision consisted of reviewing quality ratings and providing feedback on specific cases. Our findings confirm the salience of a relatively small set of competencies across peer support interventions which could be considered universal for standardization and scaling up, as well as best practices for training and supervision. Future research should aim to identify additional competencies that are contextually sensitive or address the needs of vulnerable groups.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"34 3","pages":"131-158"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suicide Loss and Its Impacts on Mortality, and Mental, Physical, and Social Health Outcomes: A Systematic Review of Registry-Based Studies.","authors":"Rachel Slimovitch, Michelle Flesaker, Anthony J Rosellini, Jaimie L Gradus","doi":"10.1097/HRP.0000000000000462","DOIUrl":"10.1097/HRP.0000000000000462","url":null,"abstract":"<p><strong>Learning objectives: </strong>After participating in this CME activity, the psychiatrist should be better able to:• Describe the mental, physical, and social health risks experienced by individuals bereaved by suicide across different kinship groups.• Identify key gaps in the current suicide bereavement research literature and explain their implications for clinical postvention strategies.• Differentiate suicide bereavement-related risks by kinship group (offspring, parents, spouses, siblings) and age at the time of loss.• Recognize populations with the highest suicide bereavement-related vulnerabilities.</p><p><strong>Background: </strong>Suicide bereavement is a global public health problem associated with adverse physical and mental health outcomes. While population-based registry studies offer a promising avenue to understand the impacts of suicide bereavement, there has been no systematic review of results from such studies. This systematic review examines mental, physical, and social health outcomes among suicide-bereaved individuals in global population-based registry studies, with a focus on differences in findings by outcome, kinship, and comparison group.</p><p><strong>Methods: </strong>We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies registered in PubMed and PsycInfo. The review was conducted in April 2025.</p><p><strong>Results: </strong>The initial search revealed 404 unique records. After screening and full-text review, 36 studies published between 2005-2024 were included. Most frequently, studies examined bereaved offspring (n = 20), followed by bereaved parents (n = 8), spouses (n = 5), siblings (n = 5), and unspecified familial relations (n = 5). Overall, suicide loss was frequently associated with adverse health outcomes, including mortality, particularly due to suicide, and mental health (e.g., major depression, self-harm), and some physical health concerns. Associations meaningfully differed by kinship and comparison group.</p><p><strong>Conclusions: </strong>This is the first systematic review on population-based registry research concerning relationships between suicide loss and adverse mental, physical, and social health outcomes. Future studies should examine patterns of disease comorbidity, expand types of kinship examined (e.g., roommates), and probe how risk varies by time since loss.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"34 3","pages":"159-171"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Structural Influences on Mental Health and Mental Health Care.","authors":"Joshua Breslau","doi":"10.1097/HRP.0000000000000463","DOIUrl":"10.1097/HRP.0000000000000463","url":null,"abstract":"<p><p>Structural influences on mental health and mental health care have been a core focus from the origins of population-based mental health research. This perspective piece provides context for current work by discussing a selection of theoretical ideas and empirical study examples. The goal is to illustrate several basic concepts that have guided research over the past century and a half and highlight a selection of recent empirical findings that continue presenting challenges to the field. The examples emphasize that, despite the long history of research and theory connecting social structure and mental health, major, robust findings remain unexplained. These examples demonstrate the importance of continuing to research structural influences on mental health. Doing so will guide our understanding of causality and policy design to address inequities in illness burden and treatment.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"34 3","pages":"172-179"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anti-GAD65 Encephalitis: A Cryptic Case Requiring a Multidisciplinary Approach.","authors":"Seo Ho Song, Dennis Fitzgerald, Alejandro Y Mendoza, Xing Yi Chen, Kerry L Bloomingdale, Subha Subramanian","doi":"10.1097/HRP.0000000000000455","DOIUrl":"10.1097/HRP.0000000000000455","url":null,"abstract":"<p><p>Anti-GAD65 encephalitis-like other autoimmune encephalitis conditions-poses a significant diagnostic challenge; its heterogeneous neuropsychiatric phenotypes mimic primary psychiatric disorders. The broad pathophysiological spectrum, ranging from limbic dysfunction to catatonia, underscores the need for systematic approaches that integrate immunotherapy with neuromodulation when standard interventions fail. We present a 78-year-old woman with no prior psychiatric history who developed acute-onset catatonia with visual hallucinations. Neurological evaluation revealed markedly elevated anti-GAD65 antibodies despite unremarkable neuroimaging and electroencephalography. Initial treatment with lorazepam and intravenous immunoglobulin achieved partial response. Recurrent catatonia and treatment-refractory psychosis prompted a trial of electroconvulsive therapy (ECT), which led to sustained remission through maintenance ECT. This case illustrates three critical clinical practice points: (1) late-onset catatonia necessitates comprehensive evaluation of autoimmune etiologies, including paired serum-cerebrospinal fluid antibody testing; (2) partial response to immunotherapy does not preclude more aggressive symptomatic management; and (3) ECT can effectively treat catatonia secondary to autoimmune illnesses. We conclude that successful management of anti-GAD65 encephalitis necessitates a multidisciplinary team for thorough neuro-immunological assessment, nuanced psychopharmacology, and timely neuromodulation.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"34 2","pages":"118-124"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147369456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous Haloperidol, Agitation, and the QTc: Misconceptions and Heuristics.","authors":"Erik Levinsohn, Varsha Radhakrishnan, Sunita Singh, Christopher M Celano, Scott R Beach","doi":"10.1097/HRP.0000000000000456","DOIUrl":"10.1097/HRP.0000000000000456","url":null,"abstract":"<p><p>Clinicians are commonly asked to make complex and potentially risky decisions in the face of uncertainty and incomplete information. Physicians frequently employ heuristics, or mental shortcuts, to convert challenging clinical questions into much simpler ones. Psychiatrists often encounter such challenges when asked to comment on the safety of intravenous haloperidol (IVH), particularly regarding risks of prolonging the corrected QT interval (QTc) or developing Torsades de Pointes (TdP). In light of the 2007 Food and Drug Administration warning about the risk of developing TdP with IVH, some providers, and even some institutions, have used QTc cut-off values to indicate when one can and cannot use IVH safely for managing acute agitation. In this perspective, we argue that (1) this practice represents an inappropriate use of a heuristic rather than a necessary risk-benefit calculation, and (2) that our updated understanding of the complex relationships among IVH, QTc, and TdP does not support the use of QTc cut-off values. We address some common misconceptions about the associations among IVH, QTc, and TdP, and discuss how reframing the decision-making process related to this dilemma may improve clinical care.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"34 2","pages":"95-107"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147369541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metadata in Smartphone-Based Cognitive Assessments: Current State and Emerging Evidence in Psychiatric Disorders.","authors":"Ko Woon Kim, Andrew Jin Soo Byun, Juan Castillo, Young Chul Youn, John Torous","doi":"10.1097/HRP.0000000000000453","DOIUrl":"10.1097/HRP.0000000000000453","url":null,"abstract":"<p><p>Smartphone-based cognitive assessments have emerged as promising tools for frequent and ecologically valid monitoring of cognitive function in real-world settings. These tools enable continuous capture of cognitive and behavioral patterns, including intra-individual variability, practice-related improvement, and contextual influences. Repeated assessments offer a unique opportunity to detect subtle cognitive changes over time. The interpretability and clinical utility of the metadata generated by such assessments, however, remain underexplored. In this review, we consider the current landscape of smartphone-derived cognitive metadata in the context of cognitive and affective disorders. We focus on emerging evidence linking metadata features to functional outcomes and symptom fluctuations across conditions such as schizophrenia, bipolar disorder, and depression. Additionally, we discuss methodological considerations for optimizing metadata analysis, including test design, sampling frequency, and analytical strategies. We propose that cognitive metadata may serve as sensitive indicators of early cognitive change and support personalized mental health monitoring and targeted intervention.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"34 2","pages":"85-94"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147389864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}