JAMA Psychiatry最新文献

{"title":"Online Sports Betting Legalization and Behavioral Health Care Use.","authors":"Benjamin Westermeyer, Matthew D Eisenberg, Mark K Meiselbach","doi":"10.1001/jamapsychiatry.2026.3175","DOIUrl":"10.1001/jamapsychiatry.2026.3175","url":null,"abstract":"<p><strong>Importance: </strong>The number of states with legal online sports betting has grown from 1 to 31 since 2018, expanding access to gambling. Despite the known behavioral health burdens associated with gambling, little is understood about legalization's impact on mental health and substance use treatment use.</p><p><strong>Objective: </strong>To evaluate the association between online sports betting legalization and treatment use for mental health conditions and substance use disorders (SUD).</p><p><strong>Design, setting, and participants: </strong>This was a quasi-experimental staggered difference-in-differences study using claims data from January 2016 to December 2023. The setting was a large, national convenience sample of people with employer-sponsored health insurance. Included in the analysis were men and women aged 18 to 64 years living in states that legalized online sports betting during 2018-2022 or had not by the end of the study period.</p><p><strong>Exposure: </strong>State legalization of online sports betting.</p><p><strong>Main outcomes and measures: </strong>Outcomes were measured at the state-year level, weighted by number of enrollees as follows: proportions of enrollees with 1 or more prescription fills for antidepressant, antianxiety, or SUD medications and proportions of enrollees with 1 or more outpatient, emergency department, or inpatient visits with a diagnosis for depression, anxiety, or SUD.</p><p><strong>Results: </strong>Among 61 951 305 enrollee-years, 31 914 852 (52%) were women, and the mean (SD) age was 41.9 (13.5) years. Online sports betting legalization was associated with increases in the probability of antidepressant use (men: 0.57 percentage points; 95% CI, 0.26-0.89 percentage points; women: 1.08 percentage points; 95% CI, 0.23-1.94 percentage points) and antianxiety use (men: 0.32 percentage points; 95% CI, 0.14-0.50 percentage points; women: 0.64 percentage points; 95% CI, 0.16-1.12 percentage points), but there was no detectable change in SUD medication use. Legalization was also associated with increases in the probability of an outpatient diagnosis for depression (men: 0.34 percentage points; 95% CI, 0.20-0.49 percentage points; women: 0.57 percentage points; 95% CI, 0.25-0.89 percentage points) and anxiety (men: 0.67 percentage points; 95% CI, 0.32-1.01 percentage points; women: 1.15 percentage points; 95% CI, 0.50-1.81 percentage points) but not SUD. Legalization was not associated with behavioral health diagnoses in the emergency department and inpatient settings.</p><p><strong>Conclusions and relevance: </strong>Results of this quasi-experimental difference-in-differences study suggest that online sports betting legalization was associated with an increase in outpatient and prescription mental health care use among people with employer-sponsored health insurance. These findings underscore the importance of prevention and treatment of potential adverse health consequences of legalized on","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":""},"PeriodicalIF":18.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Need to Clarify Regulation of Mental Health Artificial Intelligence.","authors":"William R Smith, Brian D Earp, Benjamin Buck, Paul S Appelbaum","doi":"10.1001/jamapsychiatry.2026.3226","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.3226","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":""},"PeriodicalIF":18.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Reported Changes in Alcohol Use Following Glucagon-Like Peptide-1 Receptor Agonist Initiation.","authors":"Lori Uscher-Pines, Jessica Sousa, Alisa B Busch, Ateev Mehrotra, Andrew Muzyk, Dominic Hodgkin, Shelly Greenfield, Haiden A Huskamp","doi":"10.1001/jamapsychiatry.2026.3242","DOIUrl":"10.1001/jamapsychiatry.2026.3242","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":""},"PeriodicalIF":18.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caring Letters and Suicide Mortality Among US Veterans Who Contacted the Veterans Crisis Line: A Prespecified Secondary Analysis.","authors":"Mark A Reger, Melissa M Garrido, MaryGrace Lauver, Caitlin Manchester, Sivagaminathan Palani, Aaron Legler, Jolie E Bourgeois, Samantha G Auty","doi":"10.1001/jamapsychiatry.2026.2866","DOIUrl":"10.1001/jamapsychiatry.2026.2866","url":null,"abstract":"<p><strong>Importance: </strong>Caring letters (CL) is one of the only suicide prevention interventions to ever reduce suicide mortality in a randomized clinical trial, but the results have not been replicated. The US Department of Veterans Affairs Veterans Crisis Line (VCL) CL intervention was previously evaluated, but suicide mortality data were not available at that time.</p><p><strong>Objectives: </strong>To examine the association of the VCL CL intervention with suicide mortality among US veterans, and to determine whether there are differences in outcomes by signatory.</p><p><strong>Design, setting, and participants: </strong>This prespecified secondary analysis of a randomized clinical trial includes a randomized parallel trial of US veterans, combined with an observational comparison of no CL receipt with any CL receipt. Veterans Health Administration (VHA) patients (aged ≥18 years) who contacted the VCL between June 11, 2020, and June 10, 2021, were randomized to receive CL from either a VA clinician or a peer veteran signatory. Veterans who contacted the VCL between June 11, 2018, and June 10, 2021, and did not receive the intervention were included as an observational historical control group. Suicide mortality analyses were completed between March and September 2025.</p><p><strong>Intervention: </strong>Veterans received 9 CL messages over a period of 1 year from either a clinician or peer veteran signatory. The signatory was randomly assigned.</p><p><strong>Main outcomes and measures: </strong>The main outcome for these analyses was suicide mortality among veterans in the 12 months following the index VCL contact. Suicide mortality was compared using χ2 tests and time-to-event models.</p><p><strong>Results: </strong>This study included 227 502 VHA patients (mean [SD] age, 53.6 [16.9] years; 84.4% men) who contacted the VCL. A total of 87 926 veterans received the CL intervention; the remaining 139 576 comprised the historical control group. A total of 625 suicides (0.27%) occurred during the study period. The suicide mortality rate was similar between the CL and historical control groups (0.29% and 0.27%, respectively; P = .31). Within the CL group, outcomes did not differ between peer letter and clinician letter recipients (0.21% and 0.22%; P = .95).</p><p><strong>Conclusions and relevance: </strong>In this analysis, among VHA patients who contacted the VCL, CL receipt was not associated with suicide mortality, and no differences in outcomes were identified by signatory. Future research should explore the potential benefits of increased health care utilization, a finding reported in the parent trial.</p><p><strong>Trial registration: </strong>isrctn.org Identifier: ISRCTN27551361.</p>","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":""},"PeriodicalIF":18.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Error in Discussion.","authors":"","doi":"10.1001/jamapsychiatry.2026.3411","DOIUrl":"10.1001/jamapsychiatry.2026.3411","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":""},"PeriodicalIF":18.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Voice-First Mental Health Care for Older Adults in Africa","authors":"Isaac Akinkunmi Adedeji,Saheed Akinmayowa Lawal,Andrew Sixsmith,David C. Henderson","doi":"10.1001/jamapsychiatry.2026.3198","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.3198","url":null,"abstract":"This Viewpoint proposes voice-first systems as a design hypothesis warranting priority development and evaluation to support mental health care for older adults in Africa.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"86 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing Artificial Intelligence Psychosis in a Large Medical Setting","authors":"Zachary Bergson,Sarah G. Vassall,Adam Wright,Allison B. McCoy,Katherine M. Schafer,Margaret C. Achee,Julia M. Sheffield","doi":"10.1001/jamapsychiatry.2026.2923","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.2923","url":null,"abstract":"This cohort study estimates the prevalence of AI psychosis, characterizes affected patients, and defines the role of conversational AI in documented psychotic episodes.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"1 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attention-Deficit/Hyperactivity Disorder and Late-Life Cognitive Impairment","authors":"Guilherme Bauer-Negrini,Douglas Teixeira Leffa,Pamela C. L. Ferreira,Bruna Bellaver,Guilherme Povala,Marina S. Medeiros,Firoza Z. Lussier,Dana L. Tudorascu,Samuele Cortese,Luis Augusto Rohde,Brooke S. G. Molina,Tharick A. Pascoal","doi":"10.1001/jamapsychiatry.2026.3165","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.3165","url":null,"abstract":"Importance Attention-deficit/hyperactivity disorder (ADHD) affects tens to hundreds of millions of adults worldwide, and preliminary evidence suggests it may be associated with increased risk of mild cognitive impairment (MCI) and dementia. However, concerns regarding diagnostic ascertainment and residual confounding remain. Objective To investigate the association of ADHD with incident cognitive impairment, defined as MCI or dementia, using electronic health record (EHR) diagnoses and genetic liability measured using genome-wide ADHD polygenic risk score (ADHD PRS) in the same individuals. Design, Setting, and Participants This cohort study used data from the US All of Us Research Program (enrollment May 6, 2018, to October 1, 2023; EHR data from January 4, 1985, to October 1, 2023; mean [SD] follow-up 10.26 [6.75] years). A total of 187 341 participants aged 50 years and older with available EHR and genomic data were included. Data were analyzed from October 2025 to July 2026. Exposures ADHD diagnosis and ADHD PRS. Main Outcomes and Measures Incident MCI or dementia. Results Among 187 341 participants (mean [SD] age, 56.41 [7.88] years; 107 266 [57%] female), 3026 (1.6%) had ADHD. Among participants with ADHD, 203 (6.7%) developed cognitive impairment, compared with 6259 (3.4%) among those without ADHD. In adjusted Cox models, ADHD was associated with a more than 4-fold higher hazard of cognitive impairment (hazard ratio [HR], 4.60; 95% CI, 3.99-5.29; P  &amp;amp;lt; .001). Adjustments for comorbidities, educational attainment, and health care utilization attenuated but did not eliminate the association. Similarly, ADHD PRS was associated with incident cognitive impairment (highest vs lowest quintile: HR, 1.35; 95% CI, 1.25-1.46; P  &amp;amp;lt; .001). Among participants who developed cognitive impairment, comorbid ADHD diagnosis was associated with a nearly 2-fold higher odds of suboptimal mental health (odds ratio [OR], 1.69; 95% CI, 1.18–2.39; P  = .01), quality of life (OR, 1.66; 95% CI, 1.14-2.39; P  = .02), social satisfaction (OR, 2.39; 95% CI, 1.69–3.37; P  &amp;amp;lt; .001), and 20% higher health care utilization (incidence rate ratio, 1.20; 95% CI, 1.09–1.34; P  = .003), suggesting greater care burden beyond the elevated incidence risk. Conclusions and Relevance In this cohort study, convergent clinical and genetic evidence revealed ADHD was associated with a markedly increased risk of late-life cognitive impairment. Among those who develop cognitive impairment, an ADHD diagnosis was associated with worse health outcomes and greater health care utilization, supporting the need for targeted monitoring and integrated care in this population.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"57 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal, Geographic, and Polysubstance Patterns in Orphine Analogue Detections","authors":"David T. Zhu,Nicole D. Fitzgerald,Joseph J. Palamar,Alex J. Krotulski","doi":"10.1001/jamapsychiatry.2026.3129","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.3129","url":null,"abstract":"This cross-sectional study examines the temporal, geographic, and polysubstance patterns in orphine analogue detections.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"26 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Should We Interpret the Association Between Abortion and Mild Psychiatric Illness?","authors":"Krista F Huybrechts, Kenneth J Rothman, Katherine L Wisner","doi":"10.1001/jamapsychiatry.2025.3561","DOIUrl":"10.1001/jamapsychiatry.2025.3561","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"1005-1006"},"PeriodicalIF":18.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}