Judith Harbertson, Cynthia A LeardMann, Toni Rose T Geronimo-Hara, Isabel G Jacobson, Felicia R Carey, Crystal L Lewis, Neika Sharifian, Sheila F Castañeda, Erin L Richard, Nicole Riedel, Aaron I Schneiderman, Edward J Boyko, Rudolph P Rull
{"title":"Posttraumatic stress disorder and depression trends from 2001 to 2021 among post-9/11 veterans in the U.S. Millennium Cohort Study.","authors":"Judith Harbertson, Cynthia A LeardMann, Toni Rose T Geronimo-Hara, Isabel G Jacobson, Felicia R Carey, Crystal L Lewis, Neika Sharifian, Sheila F Castañeda, Erin L Richard, Nicole Riedel, Aaron I Schneiderman, Edward J Boyko, Rudolph P Rull","doi":"10.1016/j.jad.2026.122338","DOIUrl":"10.1016/j.jad.2026.122338","url":null,"abstract":"<p><p>Approximately one in five veterans may develop a mental health condition, though longitudinal prevalence estimates among post-9/11 veterans are limited. This study examined two decades (2001-21) of posttraumatic stress disorder (PTSD) and depression data from the Millennium Cohort Study. Eligible participants were actively serving at baseline and separated before the 2019-21 follow-up survey (n = 133,575). Probable PTSD (PTSD Checklist) and depression (Patient Health Questionnaire) were assessed. Age- and sex-standardized prevalence estimates for PTSD, depression, and co-occurring PTSD/depression (a four-level, mutually exclusive variable) were calculated for six time points. PTSD increased approximately five-fold (5.2 to 25.2 cases/100 persons) and depression four-fold (3.6 to 15.5 cases/100 persons). For the co-occurring PTSD/depression outcome, a two-fold increase was observed for depression only (1.5 to 2.7 cases/100 persons), while increases for PTSD only (3.1 to 12.4 cases/100 persons), and comorbid PTSD/depression (2.0 to 12.7 cases/100 persons) were four- and six-fold, respectively. In this population-based study, prevalence estimates of PTSD and depression increased over time, with larger increases attributable to PTSD and co-occurring PTSD/depression. These pronounced increases in prevalence estimates warrant consideration for expansion of mental health screening and treatment services among post-9/11 veterans.</p>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":" ","pages":"122338"},"PeriodicalIF":5.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Qingwen Ding, Divyangana Rakesh, Siya Peng, Xinying Li, Sarah Whittle
{"title":"Bridging brain structures and adolescent depression and anxiety symptoms: A symptom-oriented approach.","authors":"Qingwen Ding, Divyangana Rakesh, Siya Peng, Xinying Li, Sarah Whittle","doi":"10.1016/j.jad.2026.122396","DOIUrl":"10.1016/j.jad.2026.122396","url":null,"abstract":"<p><strong>Background: </strong>Anxiety and depression show substantial heterogeneity and often emerge in adolescence. However, their brain structural associations from a symptom-oriented perspective remain unclear. This study investigated the symptom structures of adolescent anxiety and depression and identified key brain regions linking brain structure to symptoms.</p><p><strong>Methods: </strong>A total of 1568 adolescents with elevated depressive symptoms and 413 adolescents with elevated anxiety symptoms were identified from the Adolescent Brain Cognitive Development study. Participants completed symptom assessments and underwent Magnetic Resonance Imaging scanning. A total of ten symptom-only networks and symptom-brain networks were constructed to identify the central symptoms and the key brain structure associated with depression and anxiety symptoms.</p><p><strong>Results: </strong>In the symptom-only networks, concentration difficulties emerged as the shared central symptom, while self-hatred and irritability were the unique central symptoms for depression and anxiety, respectively. In the symptom-brain networks, left- and right-pallidum volumes exhibited the highest bridge centrality in connection with depressive symptoms, whereas left-nucleus accumbens volume showed the highest bridge centrality in connection with anxiety symptoms. Cortical structures showed sparse connections with both depressive and anxiety symptoms.</p><p><strong>Conclusion: </strong>Our findings highlight the pallidum and nucleus accumbens as key brain regions linking brain structure to adolescent depressive and anxiety symptoms. These results provide insights into the neural mechanisms of depression and anxiety from a symptom-oriented perspective and may inform targeted interventions for at-risk youth.</p>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":"414 ","pages":"122396"},"PeriodicalIF":5.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Penelope A Lind, Ian B Hickie, Enda M Byrne, Nicholas G Martin, Sarah E Medland
{"title":"Burden of health comorbidities and associated health care costs in the Australian Genetics of Depression Study using the medication-based Rx-Risk Comorbidity Index.","authors":"Penelope A Lind, Ian B Hickie, Enda M Byrne, Nicholas G Martin, Sarah E Medland","doi":"10.1016/j.jad.2026.122397","DOIUrl":"10.1016/j.jad.2026.122397","url":null,"abstract":"<p><p>Depression is associated with substantial multimorbidity and elevated healthcare utilization. This study characterised treated comorbidities and healthcare costs in participants of the Australian Genetics of Depression Study (AGDS) using pharmaceutical claims data. Linked Pharmaceutical Benefits Scheme (PBS) records from 01/07/2013-31/12/2017 were available for 15,890 AGDS participants. Forty-six chronic conditions were inferred using the validated pharmacy-based Rx-Risk Comorbidity Index based on Anatomical Therapeutic Chemical Classification System codes and PBS item codes. Prevalence estimates were compared with a 4:1 matched non-depressed Australian representative population sample (10PCT) with PBS claims data available from 01/07/2010-31/12/2014. AGDS participants had a higher mean number of inferred comorbidities (4.6 ± 2.9) than individuals in the 10PCT sample (2.0 ± 2.1). Excluding depression, 89.1% of AGDS participants had at least one inferred comorbidity, most commonly pain (51.0%), inflammation/pain (40.3%), and anxiety (32.3%). Metabolic and cardiovascular conditions frequently co-occurred (13.2%). Within AGDS, comorbidity burden was higher among women and increased with age, body mass index, number of depressive episodes and symptoms, and annual healthcare costs. Median annual healthcare costs were approximately 65% higher among AGDS participants with 2-3 inferred comorbidities compared with those with none. This study provides a detailed description of treated comorbidities and associated healthcare costs among Australians living with depression. The findings highlight the substantial multimorbidity burden in this cohort and its association with increased healthcare costs to both the individual and health system.</p>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":"414 ","pages":"122397"},"PeriodicalIF":5.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shilei Wang, Shuling Ye, Ming Feng, Zhifeng Zhou, Yuting Yang, Qinqin Zhang, KuangChing Lin, Sisi Chen, Fan Lu, Meixiao Shen, Zi Jin
{"title":"Retinal microstructural alterations as early phenotypes of depression in radiogenomics analysis.","authors":"Shilei Wang, Shuling Ye, Ming Feng, Zhifeng Zhou, Yuting Yang, Qinqin Zhang, KuangChing Lin, Sisi Chen, Fan Lu, Meixiao Shen, Zi Jin","doi":"10.1016/j.jad.2026.122413","DOIUrl":"10.1016/j.jad.2026.122413","url":null,"abstract":"<p><strong>Background: </strong>With the increasing prevalence of depression, there is an urgent clinical need for early screening in depression. The retina offers a promising window for early screening in depression due to its rapid, non-invasive, objective, eye-brain correlated characteristics, but previous research has yielded conflicting alterations in retinal microstructure in depression.</p><p><strong>Methods: </strong>We screened retinal optical coherence tomography and brain magnetic resonance imaging data in the UK Biobank to enroll 23,225 participants for retinal study of depression occurrence, and 1475 participants for the eye-brain association study. We also used genetic data (ID: ebi-a-GCST90014267 and ukb-d-20,448) from the Integrative Epidemiology Unit Open Genome-Wide Association Study for Mendelian randomization analysis. We used Cox regression to assess the association between retinal microstructure and depression risk, Mendelian randomization to infer causality, and mediation analysis to explore retina-brain pathway association.</p><p><strong>Results: </strong>The Cox regression analysis showed that retinal ganglion cell-inner plexiform layer (GCIPL) thickness remained a significant predictor of depression. The Mendelian randomization analysis indicated a positive statistical association between GCIPL thickness and depression. Moreover, there was a significant positive correlation (all p < 0.001) between the volume of specific depression-related brain regions and the GCIPL thickness. Adjusting for age, sex, and head size, the mediation analysis provided preliminary evidence for a potential anatomical pathway linking retinal GCIPL thickness to depression-related brain regions through primary visual cortex and secondary visual cortex volumes.</p><p><strong>Conclusion: </strong>Thickened retinal GCIPL is a potential early phenotype of depression and has a potential association pathway with depression-related brain regions using a radiogenomics approach.</p>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":" ","pages":"122413"},"PeriodicalIF":5.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Viktor T H Wahner, Toni Lange, Inga Stonner, Pasquale Paribello, Martina Contu, Marco Pinna, Dobrochna Kopeć, Ewa Ferensztajn-Rochowiak, Filip Rybakowski, Mara Dierssen, Massimo Gennarelli, Mirko Manchia, Alessandra Minelli, Marie-Claude Potier, Claudia Pisanu, Ferran Sanz, Alessio Squassina, Júlia Perera-Bel, Silke Jörgens, Bernhard T Baune
{"title":"Comparing trajectories of cognitive functioning in treatment-resistant and non-resistant depression: a multicentre linear mixed-effects analysis.","authors":"Viktor T H Wahner, Toni Lange, Inga Stonner, Pasquale Paribello, Martina Contu, Marco Pinna, Dobrochna Kopeć, Ewa Ferensztajn-Rochowiak, Filip Rybakowski, Mara Dierssen, Massimo Gennarelli, Mirko Manchia, Alessandra Minelli, Marie-Claude Potier, Claudia Pisanu, Ferran Sanz, Alessio Squassina, Júlia Perera-Bel, Silke Jörgens, Bernhard T Baune","doi":"10.1016/j.jad.2026.122380","DOIUrl":"10.1016/j.jad.2026.122380","url":null,"abstract":"<p><strong>Background: </strong>Impaired cognitive functioning is a severe symptom in major depressive disorder (MDD). Recent evidence suggests it may be a central characteristic in its treatment resistant form (TRD), potentially constituting a clinical marker for treatment resistance and a target amenable to intervention. To date, cognitive functioning in TRD remains poorly understood and longitudinal investigations are scarce.</p><p><strong>Methods: </strong>This observational prospective cohort study, including 320 patients diagnosed with MDD from the multicentre PROMPT study, examined differences in cognitive functioning between 118 TRD and 202 non-TRD patients over a period of twelve weeks in a real-world setting, using linear mixed modelling. Patients that failed to respond to at least two prior antidepressants trials at baseline were classified as TRD.</p><p><strong>Results: </strong>TRD patients showed significantly poorer baseline performances than non-TRD patients in attention/processing speed (β = -0.45; 95%CI[-0.70, -0.19]; FDR-p = 0.003) and verbal memory (β = -0.45; 95%CI[-0.72, -0.18]; FDR-p = 0.003). Significant time × group interactions were observed in motor speed and verbal fluency tasks. Post-hoc-analyses revealed stagnation in TRD patients and significant improvement in non-TRD patients. Across all other tasks improvement was observed in both groups, and random effects showed large heterogeneity between patients, indicating notable individual differences in cognitive performances.</p><p><strong>Conclusions: </strong>The results suggest distinct recovery patters between non-TRD and TRD patients, and diminished functioning in TRD patients at the domain level. However, intact and diminished performances likely occur in both groups, warranting further investigation of cognitive heterogeneity. These short-term findings highlight the need for more comprehensive longitudinal research on cognition in TRD.</p>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":" ","pages":"122380"},"PeriodicalIF":5.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Network structure of psychological resilience, cognitive reappraisal, and social problem-solving in relation to non-suicidal self-injury in a sample of Chinese university freshmen.","authors":"Chengfei Ruan, Xin Chen, Mingyue Wu, Jiangtao Dong, Wei Cui, Dongjun Zhang","doi":"10.1016/j.jad.2026.122387","DOIUrl":"10.1016/j.jad.2026.122387","url":null,"abstract":"<p><strong>Objective: </strong>Non-suicidal self-injury (NSSI) is prevalent among university students and represents a critical public health concern. This cross-sectional study investigated the prevalence of NSSI and its associated factors among freshmen at a university in central China. Using network analysis, we further examined the interrelationships among NSSI and three protective psychological constructs: resilience, cognitive reappraisal, and social problem-solving.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted among 3616 freshmen. After data screening, 2862 valid responses were included in the final analysis. Participants completed validated scales measuring NSSI, cognitive reappraisal, psychological resilience, and social problem-solving. SPSS 27.0 was used to perform logistic regression and group comparisons. Network analysis was performed in R to examine the interrelations and centrality of psychological constructs.</p><p><strong>Results: </strong>The prevalence of NSSI among freshmen was 24.1%. Psychological resilience, cognitive reappraisal, and social problem-solving ability showed a significant stepwise decrease across NSSI severity groups (p < 0.001). Logistic regression showed that cognitive reappraisal, psychological resilience, social problem-solving ability, and rural household registration were negatively associated with NSSI, whereas male gender was positively associated with NSSI. Network analysis further revealed that cognitive reappraisal exhibited relatively high betweenness centrality within the network comprising resilience and social problem-solving subsystems. Within this network, toughness, strength, and avoidant problem-solving showed the highest node strength, whereas strength and negative problem orientation exhibited elevated betweenness centrality.</p><p><strong>Limitations: </strong>The cross-sectional design and the single-institution sample preclude causal inferences and limit the generalizability of the present findings.</p><p><strong>Conclusion: </strong>Cognitive reappraisal, psychological resilience, and social problem-solving ability were independently and negatively correlated with NSSI severity. Network analysis provided complementary insights into the structural relationships among these variables, identifying cognitive reappraisal as a central node within this network.</p>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":" ","pages":"122387"},"PeriodicalIF":5.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Paternal versus maternal depressive symptoms and child internalizing/externalizing problems: a comparative threshold analysis.","authors":"Minna Liu, Hongli Sun, Jiahua Liu, Jie Mi","doi":"10.1016/j.jad.2026.122419","DOIUrl":"10.1016/j.jad.2026.122419","url":null,"abstract":"<p><strong>Background: </strong>Parental depression is a well-established risk factor for child psychopathology, yet most studies focus on mothers. Whether nonlinear patterns with thresholds exist, especially for fathers, remains unclear. This study examines these associations and identified optimal thresholds comparing mothers and fathers.</p><p><strong>Methods: </strong>This cross-sectional study included 21,366 parents (16,258 mothers and 5108 fathers) of children aged 3-6 years in western China. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CESD). Child internalizing and externalizing problems were measured with the Strengths and Difficulties Questionnaire (SDQ). Piecewise logistic regression with grid search identified thresholds, adjusting for demographic and socioeconomic covariates.</p><p><strong>Results: </strong>Higher CES-D scores were associated with increased odds of child problems (all P < 0.001). The gender by CES-D interaction was significant for externalizing problems (P = 0.019), indicating a stronger association in fathers. For internalizing problems, the optimal threshold was a CES-D score of 17 for both mothers and fathers. For externalizing problems, the threshold was lower in fathers (16) than in mothers (21). Below these thresholds, each one-point increase in CES-D score was associated with 10-16% higher odds of child problems. Above the thresholds, the associations were attenuated. Piecewise models fitted significantly better than linear models (all P < 0.001).</p><p><strong>Conclusions: </strong>Fathers' depressive symptoms were associated with child externalizing problems at a lower severity level compared with mothers, suggesting that screening for paternal depression even at subclinical levels may help identify families at elevated risk. The identified thresholds may help generate hypotheses for future longitudinal and clinical validation studies.</p>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":" ","pages":"122419"},"PeriodicalIF":5.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mette Bliddal, Sofie Egsgaard, Carolyn E Cesta, Dorthe A Pedersen, Sören Möller, Kaare Christensen, Trine Munk-Olsen
{"title":"Heritability of postpartum depression in female twin pairs: A Danish population-based cohort study.","authors":"Mette Bliddal, Sofie Egsgaard, Carolyn E Cesta, Dorthe A Pedersen, Sören Möller, Kaare Christensen, Trine Munk-Olsen","doi":"10.1016/j.jad.2026.122432","DOIUrl":"10.1016/j.jad.2026.122432","url":null,"abstract":"<p><strong>Objective: </strong>Postpartum depression (PPD) is a common but severe psychiatric condition following childbirth, and its underlying causes and degree of heritability remain unclear. We aimed to examine the heritability of PPD among parous female twin pairs.</p><p><strong>Method: </strong>We linked data from the Danish Twin Register to nationwide health registers. Zygosity was defined as monozygotic (MZ) or dizygotic (DZ) based on validated questionnaires, and PPD was defined using hospital diagnosis of depressive disorders or filled prescriptions of antidepressant medication during the first year postpartum. We used a classic twin design to estimate genetic variance in PPD liability, applying probandwise concordance rates, tetrachoric correlations, and biometric modeling to decompose phenotypic variance into genetic and environmental components.</p><p><strong>Results: </strong>The study included 10,418 female twins (5209 pairs) born from January 1949 to December 2000. There were 68 PPD-discordant and 10 PPD-concordant MZ pairs and 85 PPD-discordant and 5 PPD-concordant DZ pairs. The probandwise concordance rates were 0.22 (95% confidence interval (CI) 0.13-0.35) for MZ twins and 0.11 (95% CI 0.05-0.23) for DZ twins. The heritability (additive genetic effect) of PPD was 0.60 (95% CI 0.46-0.75) with a corresponding unique environment variance of 0.40 (95% CI 0.25-0.54).</p><p><strong>Conclusion: </strong>The results indicate that heritability explains a substantial part of PPD risk. This knowledge is pivotal to understanding the role of genetics and to reducing the stigma of PPD among new mothers. However, the contribution of environmental and other possible modifiable factors emphasizes the importance of targeted prevention initiatives.</p>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":" ","pages":"122432"},"PeriodicalIF":5.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sabrina Berens, Sebastian Dietsche, Chrysovalandis Schwale, Johannes C Ehrenthal, Jonas Tesarz, Rainer Schaefert
{"title":"Psychodynamic characteristics associated with DSM-5 somatic symptom disorder in patients with persistent physical symptoms: A cross-sectional analysis.","authors":"Sabrina Berens, Sebastian Dietsche, Chrysovalandis Schwale, Johannes C Ehrenthal, Jonas Tesarz, Rainer Schaefert","doi":"10.1016/j.jad.2026.122375","DOIUrl":"10.1016/j.jad.2026.122375","url":null,"abstract":"<p><strong>Background: </strong>Persistent physical symptoms (PPS) are distressing bodily complaints that persist irrespective of underlying etiology and represent a descriptive, transdiagnostic umbrella concept. Psychodynamic models highlight attachment-related affect-regulation difficulties and impaired mentalizing as potentially relevant mechanisms. With the introduction of DSM-5, somatic symptom disorder (SSD) was conceptualized as a subgroup within the PPS spectrum characterized by excessive symptom-related thoughts, feelings, and behaviors, requiring re-evaluation of previous psychodynamic findings.</p><p><strong>Methods: </strong>This cross-sectional study (Germany, 02-12/2017) compared three matched groups (96 PPS patients with a positive SSD screen, 96 PPS patients without a positive SSD screen, and 96 healthy controls (HC)) using standardized self-report measures of psychological burden, adverse childhood experiences, attachment, mentalizing, and personality functioning. Symptom-related thoughts, feelings, and behaviors were additionally examined dimensionally across the PPS spectrum.</p><p><strong>Results: </strong>Compared with patients with PPS without SSD, those screening positive for SSD showed higher attachment anxiety (η<sup>2</sup> = 0.054; small-to-moderate effect), greater impairments in mentalizing (η<sup>2</sup> = 0.047; small-to-moderate effect), and personality functioning (η<sup>2</sup> = 0.069; moderate effect). Both PPS groups reported higher attachment avoidance than HC, whereas elevated attachment anxiety was specific to the SSD group. Across the PPS spectrum, psychodynamic impairments were most pronounced at high levels of symptom-related thoughts, feelings, and behaviors.</p><p><strong>Conclusions: </strong>Among patients with PPS, those screening positive for SSD showed higher attachment anxiety and impairments in mentalizing and personality functioning. These psychodynamic impairments appear to show a threshold pattern at high levels of symptom-related thoughts, feelings, and behaviors, suggesting that assessment of psychodynamic characteristics may help identify patients for more targeted interventions.</p><p><strong>Trial registry: </strong>[DRKS00011685].</p>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":" ","pages":"122375"},"PeriodicalIF":5.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}