JAMA Psychiatry最新文献

{"title":"Suicide Risk Models Are Ready—Our Health Systems Are Not","authors":"Yunyu Xiao, Colin G. Walsh, Hadi Kharrazi, J. John Mann","doi":"10.1001/jamapsychiatry.2026.2397","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.2397","url":null,"abstract":"This Viewpoint argues that suicide risk prediction models are advancing faster than the shared infrastructure health systems need to evaluate, select, and sustain them and proposes a federated framework for closing that gap.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"12 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766719","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":"Racial and Ethnic Disparities in Treatment Discontinuation in Pregnant Females With Opioid Use Disorder","authors":"Heidi Zakoul, Chih-Wan Grace Lin, Loreen Straub, Seanna Vine, Sonia Hernandez-Diaz, Brian T. Bateman, Krista F. Huybrechts","doi":"10.1001/jamapsychiatry.2026.2506","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.2506","url":null,"abstract":"This cohort study examines racial and ethnic disparities in retention in buprenorphine and methadone treatment among pregnant females with opioid use disorder (OUD) in the US.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"36 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766716","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":"Predicting US Army Soldier Suicide-Related Behaviors at the Time of Periodic Health Assessments","authors":"Emily R. Edwards, Shelby Borowski, Matthew K. Nock, David M. Benedek, Kate H. Bentley, Joseph Geraci, Sarah M. Gildea, Marianne Goodman, Amit Gupta, Chris J. Kennedy, Andrew J. King, Evan M. Kleiman, Howard Liu, Alex Luedtke, Sarah Maggio, James A. Naifeh, Thomas H. Nassif, Chris Paine, Nancy A. Sampson, Nur Hani Zainal, James Wagner, Murray B. Stein, Vincent F. Capaldi, Robert J. Ursano, Ronald C. Kessler","doi":"10.1001/jamapsychiatry.2026.2410","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.2410","url":null,"abstract":"Importance Suicide is the leading cause of death among active-duty US Army soldiers. Evidence-based preventive interventions exist but need to be targeted to be cost-effective. Objectives To develop machine learning models using administrative data available during periodic health assessments (PHAs) to determine eligibility for a remote group dialectical behavior therapy-based skills training intervention for soldiers with elevated risk of suicide or nonfatal suicide attempt. Design, Setting, and Participants From regular US Army soldier PHAs completed from 2015 to 2019, separate 70% training samples were created for suicides and SAs. Each training sample contained all cases and a stratified equal-probability sample of 10 times as many controls, with inverse-probability of selection weights applied to controls. Model performance was evaluated in the remaining 30% test sample. Data analysis was conducted September 2025 through January 2026. Main Outcomes and Measures Suicides were recorded in the National Death Index for soldiers either still in or out of active service. SAs were recorded in US Army records only for soldiers still in active service. A 24-month risk horizon was used because successive PHAs, though designed to occur annually, are sometimes separated by this much time. A loss to follow-up weight was used in the SA model to adjust for leaving service within 24 months. Results PHA data were available from 668 684 regular US Army soldiers. A total of 1 932 243 PHAs (including 85.5% by male soldiers, 46.7% by soldiers aged 28 years or older, and 58.1% by married soldiers) completed during the 2015 to 2019 period were included in analyses. Over 24 months, suicide prevalence was 66.7 per 100 000 (SE = 3.6) and SA prevalence was 704.1 per 100 000 (SE = 14.7) adjusted for loss to follow-up. Test sample area under the receiver operating characteristic curve (AUROC) for suicide was 0.72 (SE = 0.17), with Integrated Calibration Index (ICI) of 0.0003 and Brier score of 0.0007. Test sample AUROC for SA was 0.81 (SE = 0.02), with ICI of 0.0014 and Brier score of 0.0070. Suicide prevalence was meaningfully elevated (at least twice that expected by chance) only in the 5% of PHAs with highest predicted risk (sensitivity = 18.6%; SE = 2.0%). SA risk was elevated only in the 10% of PHAs with highest predicted risk (sensitivity = 46.5%; SE = 1.0%). Predicted probabilities of suicide and SA were correlated (Pearson <jats:italic toggle=\"yes\">r</jats:italic> = 0.29; <jats:italic toggle=\"yes\">t</jats:italic> = 233.8; <jats:italic toggle=\"yes\">P</jats:italic> < .001). Overall, 11.9% of PHAs revealed US Army soldiers at elevated risk of either suicide or SA, and 3.1% were at elevated risk of both outcomes. Conclusions and Relevance Results of this prognostic study suggest that as suicides and SAs have distinct predictors, an attempt to optimize resource allocation will require thoughtful postintervention considerations of costs and benefits of inte","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"15 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148709517","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":"Focused Ultrasound Neuromodulation in Psychiatry—Promises and Challenges","authors":"Noah S. Philip, Mascha van ‘t Wout-Frank, Amanda R. Arulpragasam","doi":"10.1001/jamapsychiatry.2026.2401","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.2401","url":null,"abstract":"This article explores the therapeutic potential of low-intensity focused ultrasound to modulate focal brain regions for noninvasive and reversible deep brain stimulation.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"1 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148709566","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":"Depression and SSRI Treatment During Pregnancy—Prioritizing Maternal Mental Health","authors":"Katherine L. Wisner, Tim F. Oberlander, Lauren M. Osborne, Krista F. Huybrechts","doi":"10.1001/jamapsychiatry.2026.2405","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.2405","url":null,"abstract":"Importance In the US, 5% to 6% of pregnant patients are treated with selective serotonin reuptake inhibitors (SSRI), primarily for major depressive disorder (MDD), which has a prevalence of about 12%. Psychiatric conditions are a leading cause of maternal morbidity and mortality. MDD is a common disorder that must be treated during pregnancy to improve outcomes for the mother, infant, family, and community. Observations MDD is a complex, multifactorial brain disease arising from genetic, environmental, and epigenetic factors. Factors unique to the perinatal period are associated with additional pathophysiologic changes specific to MDD. Maternal stress and psychiatric illnesses adversely affect fetal and infant outcomes. SSRI are an essential component of perinatal mental health care. Studies that define the benefits of SSRI treatment in pregnancy are fewer than those defining risks; however, several describe adverse effects with drug discontinuation in women with moderate to severe MDD. Evaluating the safety of SSRI treatment during pregnancy has been challenging due to the potential for confounding in observational studies by the underlying indication and associated factors. Once the impact of the drug is disentangled from that of MDD and its sequelae, accumulated evidence suggests that SSRI carry little or no risk for serious adverse outcomes. The thrust of the field has shifted to prioritize treatment of MDD to optimize maternal health. Conclusions and Relevance Meaningful advances in the treatment of perinatal MDD require coordinated attention to multiple aspects of clinical care delivery and research, informed by a perspective accounting for the health needs of 2 generations. Expanding access to care—particularly in maternity, child health, and psychiatric care deserts—is a public health imperative. A structured decision-making process facilitates the provision of balanced information on the potential maternal and fetal risks of untreated or undertreated illness, the benefits of treatment, and the risks associated with SSRI exposure.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"35 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148709518","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":"Deconstructing Social Functioning in Psychosis Risk—From Prediction to Recovery","authors":"Ricardo E. Carrión, Benson S. Ku, Christoph U. Correll","doi":"10.1001/jamapsychiatry.2026.2226","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.2226","url":null,"abstract":"This Viewpoint recommends viewing recovery from social functioning deficits as a co–primary outcome among individuals at clinical high risk for developing psychosis alongside the traditional primary outcome of reducing transition to schizophrenia and other psychotic disorders.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"263 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148675336","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":"Blinding Integrity and Psychedelic Drug Trials.","authors":"Michael Elliott, Olga Chernoloz","doi":"10.1001/jamapsychiatry.2026.2293","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.2293","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":""},"PeriodicalIF":18.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148678696","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":"Psychotherapy for Impact of Killing During War","authors":"Shira Maguen, Rebecca Gloria, Amy Lehrner, Jean C. Beckham, Stephanie Y. Wells, Laura Pratchett, Jamil Davis, Deborah E. Barnes, Kristine Burkman","doi":"10.1001/jamapsychiatry.2026.2307","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.2307","url":null,"abstract":"Importance Killing in war is associated with multiple adverse outcomes, including posttraumatic stress disorder (PTSD), moral injury (MI), and suicide. Impact of killing (IOK) is an individual psychotherapy developed to treat the mental health impact of killing in war. Objective To determine whether IOK improves veterans’ mental health symptoms and functioning at posttreatment and 6-month follow-up. Design, Setting, and Participants This multisite, superiority, randomized clinical trial was conducted from August 2018 to November 2023. Participants were veterans randomized to IOK or present-centered therapy (PCT). Diagnostic assessments were administered at screening and posttreatment by blinded evaluators. Self-report measures were collected at baseline, midtreatment, posttreatment, and 6-month follow-up at 3 Veterans Affairs health care systems in California, New York, and North Carolina via in-person and remote appointments. Participants were a sample of veterans with PTSD who reported distress related to killing in war or feeling responsible for the death of others. Primary exclusion criteria were a psychotic disorder diagnosis, moderate or severe alcohol or substance use disorder, untreated mania, or recent suicidal or homicidal behavior. Interventions IOK, an individual psychotherapy that focuses on killing cognitions, acceptance, self-forgiveness, and moral repair, and PCT, which addresses current functional issues due to moral distress with related problem-solving. Main Outcomes and Measures The primary outcomes were psychosocial functioning assessed by the World Health Organization Quality of Life Scale–Brief (WHOQOL-BREF) and the Sheehan Disability Scale (SDS). Secondary outcomes included PTSD and MI measures. Results A total of 100 individuals (98 male; mean [SD] age, 48.4 [13.7] years) were randomized. Linear mixed models revealed that psychosocial functioning improved for both groups at posttreatment (WHOQOL-BREF and SDS) and the IOK group had a significantly greater improvement than those in PCT on the SDS (−3.50; <jats:italic>z</jats:italic> score, −2.42; Cohen <jats:italic>d</jats:italic> , −0.51; <jats:italic>P</jats:italic> = .02; 95% CI, −5.65 to −0.59). There was no significant difference between treatments on the WHOQOL-BREF at posttreatment. Compared to PCT participants, IOK participants also reported significantly greater improvement in PTSD and MI symptoms. Conclusions and Relevance Individuals in both treatments improved on measures of psychosocial functioning (WHOQOL-BREF and SDS). Those who received IOK evidenced greater improvements in work or school, social life, and home or family life (as measured by the SDS) compared to those in PCT at posttreatment. IOK participants also reported improved PTSD and MI symptoms. The findings suggest that IOK may improve several outcomes for those who experience distress due to killing in war. Trial Registration ClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"35 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148675368","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":"Optimizing Study Design for Clinically Useful Peripheral Molecular Biomarker Discovery in Psychiatry","authors":"Chloe X. Yap, Anjali K. Henders, Naomi R. Wray, Rachel Upthegrove","doi":"10.1001/jamapsychiatry.2026.2299","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.2299","url":null,"abstract":"Importance Psychiatric diagnosis, prognosis, and management currently rely on subjective assessments. There is hope that peripheral (eg, blood) biomarkers or combinations thereof could transform clinical care by bringing objectivity and patient stratification while being accessible and scalable. The time is ripe to find molecular biomarkers: omics technologies can now profile hundreds to millions of molecules across thousands of individuals, while funders recognize the clinical need and have responded with ambition. However, this enthusiasm will likely be finite, and there is no guarantee that a biomarker will be found. Observations It is essential to design and perform studies that are most likely to deliver robust peripheral biomarkers with a clear path to translation. This narrative review provides recommendations to optimize peripheral psychiatric biomarker study design. The review first introduces conceptual grounding illustrating how biomarker study design must triangulate clinical utility, technological fit, and biological plausibility. Biomarker studies should optimize for signal-to-noise ratio via careful phenotype selection and minimization of biological and technical noise. However, feasibility issues—in collecting sufficient data on enough representative participants for an adequately powered and clinically translatable analysis—constrain study design. Conclusions and Relevance Study design is the single most influential and controllable factor for future psychiatric biomarker discovery. This is because many years elapse between study design and data analysis (particularly for biobanked samples held for future use) and because no technological or analytical advances can answer questions that the dataset was not designed for, or overcome unmeasured confounding. Moreover, the direction of biomarker research is constrained by what is possible to design. Many clinical questions and contexts need biomarkers, but realistically, some are better primed for biomarker discovery than others. In this generation of peripheral psychiatric biomarker studies, designs most likely to demonstrate proof-of-principle should be prioritized to ensure the long-term sustainability of the field.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"54 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148675279","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":"Blinding Integrity and Psychedelic Drug Trials-Reply.","authors":"Wieslaw J Cubala, Velichka Valcheva, Michael E Thase","doi":"10.1001/jamapsychiatry.2026.2296","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2026.2296","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":""},"PeriodicalIF":18.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148678664","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}