Harvard Review of Psychiatry最新文献

{"title":"From Discrimination to Disease: The Role of Inflammation.","authors":"Adolfo G Cuevas, Steven W Cole","doi":"10.1097/HRP.0000000000000422","DOIUrl":"10.1097/HRP.0000000000000422","url":null,"abstract":"<p><strong>Abstract: </strong>Discrimination is an established social determinant of mental health that contributes to psychiatric illness disparities among marginalized populations. There is emerging research elucidating the biological mechanisms connecting discrimination to mental health outcomes, revealing inflammation as a key pathway. This column synthesizes evidence from existing literature on the links between discrimination and inflammation, and outlines both the opportunities and challenges in this field. The discussion highlights the necessity of a multifaceted approach to address discrimination, and thus, reduce inflammation at both individual and population levels.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 2","pages":"83-89"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12037116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541447","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":"Cultural Factors, Social Structures, and Social Determinants of Health: The Need for Clarity in Assessing Psychopathology.","authors":"Neil Krishan Aggarwal","doi":"10.1097/HRP.0000000000000407","DOIUrl":"10.1097/HRP.0000000000000407","url":null,"abstract":"<p><strong>Abstract: </strong>Over the past decade, researchers translating anthropological theories for clinical use have debated how practitioners should assess cultural factors, social structures, and social determinants of health with patients. Advocates of structural competency have suggested that clinical cultural competency programs demonstrate limited effects on health outcomes because of the static understanding of culture employed. They recommend that cultural factors be reformulated with an emphasis on social structures. In response, researchers in cultural psychiatry specializing in cultural assessments have developed three models-sociocultural formulation, the cultural-ecosocial view, and the contextual developmental assessment-to integrate cultural and structural factors. Their methods for integration, however, differ, resulting in various understandings of psychopathology mechanisms. This paper analyzes arguments from all four positions in this debate. It reveals a lack of consensus about interrelationships among these constructs, their definitions, and methods for assessment. The article concludes with recommendations, such as developing consensus definitions with broad stakeholder involvement; adopting a data-driven approach to clarify how specific cultural, social, or structural factors interact; and identifying how extant assessments capture clinically relevant factors across constructs to develop additional assessment tools.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":" ","pages":"54-66"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946664","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":"Reproductive Justice Interventions in Pregnancy: Moving Toward Improving Black Maternal Perinatal and Intergenerational Mental Health Outcomes.","authors":"Simone R Dreux, Natalie Ramsey, Tre D Gissandaner, Nicole Alarcon, Cristiane S Duarte","doi":"10.1097/HRP.0000000000000424","DOIUrl":"10.1097/HRP.0000000000000424","url":null,"abstract":"<p><strong>Learning objective: </strong>After participating in this CME activity, the psychiatrist should be better able to:• Discuss the effects of structural racism on pregnancy and obstetric care and their contributions to maternal mental health challenges and inequitable outcomes.• Outline the current understanding of interventions initiated during pregnancy or childbirth that use reproductive justice principles to improve Black maternal perinatal and intergenerational mental health outcomes.</p><p><strong>Background: </strong>There are significant racial disparities in maternal outcomes for Black compared to White birthing people in the United States (US). Maternal mental health problems negatively affect mothers and their infants. Effects of structural racism during pregnancy and obstetric care may contribute to inequitable maternal mental health challenges and negative offspring outcomes. A reproductive justice framework provides a path for addressing these inequities. This systematic review examines whether pregnancy care interventions driven by reproductive justice principles have successfully improved Black maternal perinatal and intergenerational mental health outcomes.</p><p><strong>Methods: </strong>This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies identified in November 2024 in PubMed, PsycInfo, and CINAHL. The studies included randomized clinical trials of Black birthing parents in the US and their offspring. Interventions incorporating reproductive justice principles were defined as those explicitly designed to increase autonomy, community input, racial equity, and/or cultural relevance.</p><p><strong>Results: </strong>The search revealed 619 unique records. After screening and full-text review, 12 studies were included. Of these, 7 studies reported statistically significant effects on mental health outcomes. The interventions included interpersonal therapy, culturally tailored cognitive behavioral therapy, group prenatal care, community health worker home visits, and an educational online platform. Six studies reported positive effects on maternal mental health outcomes (e.g., depressive symptoms or anxiety). One study reported positive infant mental health or developmental effects.</p><p><strong>Conclusions: </strong>The effects of reproductive justice-driven interventions on Black maternal and offspring mental health outcomes are promising, but studies are limited. Future studies should further identify active intervention components and assess mental health-related outcomes in both generations to improve the mental health of Black mothers and prevent negative intergenerational effects.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 2","pages":"90-101"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541451","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":"When the Structural, Social, and Biological Domains Converge: The Case of Neighborhood Ethnic Density and Psychosis.","authors":"Deidre M Anglin, Alexandria T Selloni","doi":"10.1097/HRP.0000000000000420","DOIUrl":"10.1097/HRP.0000000000000420","url":null,"abstract":"<p><strong>Abstract: </strong>Biological mechanisms associated with psychosis risk are often formed by generations of social-environmental experiences within families, communities, and neighborhoods, and further shaped by structural policies. This column first describes conceptual work that integrates macrolevel structural, individual-level social, and biological domains to better understand psychosis risk. It then highlights the interconnection of low neighborhood ethnic density and racial exclusion as an example of how social determinants connect to social and biological consequences associated with psychosis outcomes. Neighborhood ethnoracial diversity may be protective against social and biological mechanisms connected to psychosis outcomes among minoritized groups at risk for psychosis. This is particularly salient during childhood because such diversity attenuates stress processes associated with social exclusion and discrimination. Moreover, ethnoracially diverse communities foster close relationships and social connection. We provide supportive literature to illustrate the importance of multilevel/multifactorial approaches for identifying psychosis risk and protective factors. Investing further in integrative approaches for understanding psychosis risk and prognosis may translate into more substantial improvements for individuals with these lived experiences.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 2","pages":"78-82"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541467","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 Role of Social Determinants in Racial and Ethnic Mental Health Disparities: Getting It Right.","authors":"Margarita Alegría, Mara Xiong, Mayra L Sánchez González","doi":"10.1097/HRP.0000000000000421","DOIUrl":"10.1097/HRP.0000000000000421","url":null,"abstract":"<p><strong>Abstract: </strong>Despite increased research on and attention to mental health, significant racial and ethnic disparities in this area persist. We propose that racial and ethnic disparities in mental health should be examined through the lens of social determinants of mental health (SDoMH). In this perspective article, we review current definitions and frameworks of SDoMH, discuss their strengths and shortcomings, and provide recommendations for a framework to better capture the causal pathways of mental health for racially and ethnically minoritized populations. We also discuss efforts to address SDoMH, focusing on policy-level SDoMH interventions, and review progress and challenges in integrating SDoMH approaches into mental health care.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 2","pages":"67-77"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541466","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.","authors":"Neil Krishan Aggarwal, Roberto Lewis-Fernández","doi":"10.1097/HRP.0000000000000423","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000423","url":null,"abstract":"","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 2","pages":"51-53"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541449","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":"Chronic Use of Benzodiazepine in Older Adults and Its Relationship with Dementia: A Systematic Review and Meta-Analysis.","authors":"Juan Rivas, Mauricio Hernández, Jose Miguel Erazo, María Juliana Martínez, Carlos González, María Paulina Cortés, Jhonny Muñoz, Carlos Miranda","doi":"10.1097/HRP.0000000000000414","DOIUrl":"10.1097/HRP.0000000000000414","url":null,"abstract":"<p><strong>Learning objective: </strong>After participating in this CME activity, the psychiatrist should be better able to:• Explain current understanding of the relationship between chronic benzodiazepine use and dementia.</p><p><strong>Background: </strong>Chronic use of benzodiazepines (BZ) for managing conditions such as anxiety disorders, depression, sleep disorders, and other chronic diseases is widespread; yet, there is considerable controversy regarding its potential links to dementia risk. This systematic review and meta-analysis aims to clarify this relationship by synthesizing and analyzing the available evidence to provide a clearer understanding of whether prolonged BZ use contributes to developing dementia.</p><p><strong>Methods: </strong>This study adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO to ensure methodological rigor and transparency. The research strategy incorporated terms such as \"benzodiazepines\" OR \"benzodiazepine\" AND \"cognitive dysfunction\" OR \"dementia\" AND \"adult\" OR \"elderly\" OR \"aged.\" We included prospective and retrospective observational studies, as well as case-control studies. Data were meticulously extracted regarding chronic BZ use and dementia risk. Each study's risk of bias was assessed to ensure result validity. Statistical analysis was performed using hazard ratios (HR) as the primary meta-analysis summary measure to provide a precise evaluation of associated risk.</p><p><strong>Results: </strong>Analysis of five studies showed that chronic BZ use was associated with a nonsignificant risk of dementia-without specification of cause-with an HR of 1.17 (95% CI: 0.96-1.43). Regarding Alzheimer's disease, three studies found no significant association with an HR of 1.00 (95% CI: 0.87-1.15).</p><p><strong>Conclusions: </strong>Our findings did not reach statistical significance, suggesting no strong link between chronic BZ use and dementia. Further research is needed to clarify this potential association.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 1","pages":"1-7"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947670","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":"Pain Catastrophizing and Substance Misuse: A Scoping Review of the Literature.","authors":"Juliette A Bichon, Allen J Bailey, Stephanie Friree Ford, Victoria S Lesser, R Kathryn McHugh","doi":"10.1097/HRP.0000000000000415","DOIUrl":"10.1097/HRP.0000000000000415","url":null,"abstract":"<p><strong>Background: </strong>Pain catastrophizing, or the interpretation of pain as unbearable or intolerable, can increase pain-related anxiety and severity. High levels of pain catastrophizing have also been linked to substance use, particularly for substances with analgesic properties. Importantly, behavioral treatments can reduce pain catastrophizing, making them promising interventions for mitigating pain-related substance use. The aim of this scoping review is to summarize literature investigating the relationship between pain catastrophizing and substance use in adults.</p><p><strong>Methods: </strong>We performed a scoping review of peer-reviewed literature. Included articles had both a measurement of pain catastrophizing and substance use, and reported analyses characterizing the relationship between the two.</p><p><strong>Results: </strong>Of the 341 abstracts identified, 47 articles met eligibility criteria. Most studies focused on people with chronic pain. Some studies also considered samples with substance use disorders (with and without chronic pain) or acute pain, and general population samples. There was generally a positive association between pain catastrophizing and substance misuse; this association was consistent across multiple samples and substances. Most studies were cross-sectional, although associations were also detected in longitudinal studies. The magnitude of associations tended to be stronger for higher severity substance use and more proximal tests of association. More longitudinal and experimental studies are needed, however, to better delineate these effects.</p><p><strong>Discussion: </strong>Findings indicate a consistent positive association between pain catastrophizing and substance use, highlighting the potential for interventions targeting pain catastrophizing to reduce negative substance-related consequences.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 1","pages":"8-30"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065273","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":"Borderline Personality Disorder and Loneliness: Broadening the Scope of Treatment for Social Rehabilitation.","authors":"Sam A Mermin, Georgia Steigerwald, Lois W Choi-Kain","doi":"10.1097/HRP.0000000000000417","DOIUrl":"10.1097/HRP.0000000000000417","url":null,"abstract":"<p><strong>Abstract: </strong>Borderline personality disorder (BPD) has been described as a condition of intolerance of aloneness. This characteristic drives distinguishing criteria, such as frantic efforts to avoid abandonment. Both BPD and loneliness are linked with elevated mortality risk and multiple negative health outcomes. Psychodynamic theories of BPD emphasize fundamental impairment in attachment and interpersonal functioning. Empirical research demonstrates an association between BPD diagnosis and increased loneliness. Individuals with BPD experience higher levels of loneliness than the general population, and their social networks are systematically smaller, less diverse, and less satisfying. Differences in the subjective experience of loneliness persist when controlling for these relevant social network features, indicating that people with BPD experience more loneliness than others in the same objective social circumstances. According to patients with BPD, increased social connection is often a primary treatment goal and marker of satisfying recovery. There are, however, few evidence-based approaches that primarily target loneliness and building life structures that support durable connections with others. Therefore, loneliness persists as an intractable problem, often failing to remit alongside other symptoms, and few resources are routinely implemented to address this problem. In this article, we argue that loneliness is central to the symptomatic oscillations and subjective experiences of many patients with BPD. We propose that treatment extend beyond the overemphasized therapeutic alliance relationship to also promote socialization and group and vocational settings to enhance patients' social networks. Building larger social networks that rely less on exclusive caregiving and/or romantic relationships and more on role-bound identity building and community relationships would more directly target long-term identity diffusion and relational instability. Such interventions can harness nonclinical community resources, such as group treatment, vocational supports, and peer supports.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 1","pages":"31-40"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946916","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":"Self-Diagnosed Cases of Dissociative Identity Disorder on Social Media: Conceptualization, Assessment, and Treatment.","authors":"Michael Salter, Bethany L Brand, Matt Robinson, Rich Loewenstein, Joyanna Silberg, Marilyn Korzekwa","doi":"10.1097/HRP.0000000000000416","DOIUrl":"10.1097/HRP.0000000000000416","url":null,"abstract":"<p><strong>Abstract: </strong>Recent global popularity of social media content about dissociative identity disorder (DID) has coincided with increased self-diagnosis among children and young people who have formed large online communities and presented in clinical settings seeking to affirm their self-diagnoses. We situate this phenomenon within a broader trend toward self-diagnosis due to the widespread visibility and accessibility of mental health content on social media. Social media propelled self-diagnosis raises particular questions for the study and treatment of DID due to long-standing debates over whether the condition is traumagenic, sociogenic, or iatrogenic. This paper draws from the current state of knowledge about psychiatric self-diagnosis, the influence of social media on youth mental health, and the authors' clinical experience to present preliminary conceptualizations of DID self-diagnosis and its significance for clinical practice. Established etiological models for DID acknowledge the role of sociocultural and contextual factors in shaping and reinforcing the elaboration of DID self-states. We hypothesize that multiple forms of online sociality and interaction encourage such elaborations. Social media content regarding DID, however, is routinely unreliable and low quality, often mischaracterizing the condition's symptoms and minimizing associated suffering and disability. This paper considers the likelihood that the self-diagnosing DID cohort includes genuine, genuine but exaggerated, imitative, and malingering cases, and underscores the importance of careful and personalized assessment and diagnosis.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"33 1","pages":"41-48"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947686","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}