Journal of psychiatric research最新文献

{"title":"Trends in anticholinergic drug exposure and associated risk factors in older Australian patients with dementia","authors":"Woldesellassie M. Bezabhe ,&nbsp;Jan Radford ,&nbsp;Mohammed S. Salahudeen ,&nbsp;Ivan Bindoff ,&nbsp;Tristan Ling ,&nbsp;Peter Gee ,&nbsp;Gregory M. Peterson","doi":"10.1016/j.jpsychires.2026.01.048","DOIUrl":"10.1016/j.jpsychires.2026.01.048","url":null,"abstract":"<div><h3>Background</h3><div>Awareness of anticholinergic drug exposure and its harm in people with dementia has been increasing. We investigated whether this had transpired into reduced use and determined factors associated with high anticholinergic burdens.</div></div><div><h3>Methods</h3><div>We used the anticholinergic cognitive burden (ACB) scale to measure the mean daily ACB score from 135 medicines in patients with dementia using data from 400 general practices across Australia from 2013 to 2020. We determined factors associated with exposure to high anticholinergic burden.</div></div><div><h3>Results</h3><div>Included patients with dementia (1:1 matched controls) ranged from 3989 in 2013 to 6278 in 2020. The proportion of patients with a mean total daily ACB score ≥3 declined from 26.1% (95% CI 24.7–27.5%) in 2013 to 19.2% (95% CI 18.3–20.2%) in 2020 in the dementia groups (p &lt;0.001). Schizophrenia (adjusted odds ratio [aOR], 3.51; 95% CI, 2.62–4.78), depression (aOR, 2.31; 95% CI, 2.11–2.54) and anxiety (aOR, 1.41; 95% CI, 1.26–1.57) were associated with a high daily mean ACB score in patients with dementia. Living in outer regional, remote and very remote areas (compared with major cities) (aOR, 1.43; 95% CI, 1.22–1.68) and living in disadvantaged areas, compared with most advantaged areas (aOR 1.25; 95% CI, 1.07–1.46), were also associated with a higher ACB score.</div></div><div><h3>Conclusions</h3><div>While the use of anticholinergic medicines had significantly reduced, nearly one-fifth of the patients with dementia had high anticholinergic exposure at the end of the study period. The findings support the rationale for efforts to deprescribe antidepressants, antipsychotics, and opioids, especially in relatively disadvantaged areas.</div></div>","PeriodicalId":16868,"journal":{"name":"Journal of psychiatric research","volume":"195 ","pages":"Pages 212-218"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118954","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":"Exploring the relationship between ADHD symptoms and suicide risk through the lens of the Integrated Motivational-Volitional Model of suicidal behaviour","authors":"Seonaid Cleare,&nbsp;Rory C. O'Connor","doi":"10.1016/j.jpsychires.2026.01.036","DOIUrl":"10.1016/j.jpsychires.2026.01.036","url":null,"abstract":"<div><h3>Introduction</h3><div>Attention Deficit-Hyperactivity Disorder (ADHD) is associated with increased vulnerability to suicide. However, understanding of the psychological factors associated with increased risk is limited. Therefore, we investigated the extent to which psychological factors from the Integrated Motivational–Volitional (IMV) model of suicidal behaviour were associated with suicide risk.</div></div><div><h3>Methods</h3><div>696 adults who were recruited to a study on ADHD, mental health and suicide risk completed validated measures that assessed components of the IMV model, ADHD symptoms and mental health history.</div></div><div><h3>Results</h3><div>642 (92.2 %) participants scored 4 or more on the Adult ADHD Self-Report screener (ASRS; Kessler et al., 2005), indicating recent ADHD symptoms. Analyses of IMV model factors were conducted in this subgroup. More than nine out of ten (93 %) participants reported lifetime suicidal thoughts (n = 597), and 41.7 % (n = 268) reported a history of suicide attempts. Multivariable analyses showed higher defeat, internal entrapment and perceived burdensomeness were associated with recent suicidal thoughts, while mental imagery distinguished those with suicide attempt from suicidal thought histories. Perceived burdensomeness moderated the entrapment-to-suicidal thoughts relationship. Exploratory mediation analysis indicated entrapment may mediate the defeat-to-suicidal thoughts relationship.</div></div><div><h3>Conclusions</h3><div>This is the first study to apply the IMV model to understanding the ADHD-suicide risk relationship. Psychological factors from the IMV model warrant investigation longitudinally as potentially targets for suicide prevention in people with ADHD.</div></div>","PeriodicalId":16868,"journal":{"name":"Journal of psychiatric research","volume":"195 ","pages":"Pages 142-152"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105727","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":"Neurobiological, molecular, and systemic mechanisms of exercise in the treatment of mental health disorders","authors":"Tony R. Montgomery Jr.,&nbsp;DeMond M. Grant","doi":"10.1016/j.jpsychires.2026.01.043","DOIUrl":"10.1016/j.jpsychires.2026.01.043","url":null,"abstract":"<div><div>Exercise is a potent modulator of mental health, with accumulating evidence highlighting its ability to produce structural and functional changes in the brain. This review synthesizes findings across neurobiological, molecular, and systemic domains to explain how exercise improves outcomes in mood, anxiety, and stress-related disorders. We examine how exercise stimulates brain-derived neurotrophic factor (BDNF), regulates monoaminergic systems (serotonin, dopamine, norepinephrine), modulates inflammatory and oxidative stress pathways, and promotes neurogenesis and synaptic plasticity. The review also explores systemic mechanisms including the gut–brain axis, myokine signaling (e.g., irisin, cathepsin B), and the regulation of the hypothalamic–pituitary–adrenal (HPA) axis. Furthermore, we discuss how exercise influences key psychological mechanisms, including emotion regulation, self-efficacy, and cognitive reappraisal, offering a translational bridge between physiology and psychotherapy. Understanding these overlapping mechanisms can guide clinicians in prescribing exercise as an evidence-based adjunct or standalone therapy for mental health disorders. This model of exercise as medicine has the potential to enhance both accessibility and efficacy of mental health care. Implications for clinical integration, mechanistic research, and policy development are discussed.</div></div>","PeriodicalId":16868,"journal":{"name":"Journal of psychiatric research","volume":"195 ","pages":"Pages 113-122"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080478","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":"Opioid use disorder of any severity is associated with increased suicidality","authors":"William H. Craft ,&nbsp;Keith Humphreys ,&nbsp;Michael J. Ostacher ,&nbsp;Claudia B. Padula","doi":"10.1016/j.jpsychires.2026.01.049","DOIUrl":"10.1016/j.jpsychires.2026.01.049","url":null,"abstract":"<div><h3>Background</h3><div>Suicide represents an underappreciated contributor to drug-related mortality, with 20%–30% of opioid overdoses estimated to be intentional. However, suicide risk relative to opioid use disorder (OUD) severity has not been well characterized. Understanding suicidality risk across the OUD severity spectrum will inform which healthcare providers should be screening and treating self-harm.</div></div><div><h3>Methods</h3><div>We estimated the odds of past-year suicidal thoughts, plans, and attempts relative to OUD severity using data from the National Survey on Drug Use and Health (NSDUH), a cross-sectional, nationally representative, population-based survey study of noninstitutionalized individuals. Data were analyzed for adults (18+) from 2021 to 2023 (N = 139,524). Past-year DSM-5 OUD, OUD severity, and past-year suicidal thoughts, plans, and attempts were estimated, and logistic regression was utilized to assess the association of OUD severity with suicidality measures.</div></div><div><h3>Results</h3><div>Among individuals with OUD, 62.9% (95% CI, 60.1%–65.6%) had mild, 15.9% (95% CI, 13.5%–18.6%) had moderate, and 21.2% (95% CI, 19.1%–23.6%) had severe OUD. Individuals with OUD were at increased odds of reporting suicidal thoughts compared to individuals without OUD: mild OUD was associated with 2.18-fold greater odds (95% CI, 1.61–2.95), moderate OUD was associated with 1.88-fold greater odds (95% CI, 1.08–3.28), and severe OUD was associated with 4.17-fold greater odds (95% CI, 2.99–5.82). Individuals with OUD were also at increased odds of reporting a suicide plan relative to no OUD: mild OUD was associated with 3.35-fold greater odds (95% CI, 2.07–5.41), moderate OUD was associated with 4.66-fold greater odds (95% CI, 2.66–8.17), and severe OUD was associated with 6.70-fold greater odds (95% CI, 4.59–9.75). Lastly, across OUD severities, there was an increased odds of reporting a suicide attempt relative no OUD: mild OUD was associated with 2.80-fold greater odds (95% CI, 1.53–5.13), moderate OUD was associated with 8.45-fold greater odds (95% CI, 3.28–21.8), and severe OUD was associated with 9.96-fold greater odds (95% CI, 5.52–18.0).</div></div><div><h3>Conclusions</h3><div>These findings suggest OUD of any severity is associated with markedly increased risk of suicidal thoughts, plans, and suicide attempts. This highlights a continued need to integrate suicide screening and prevention into OUD treatment and clinical settings where opioids are frequently prescribed, such as primary care.</div></div>","PeriodicalId":16868,"journal":{"name":"Journal of psychiatric research","volume":"195 ","pages":"Pages 177-180"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113070","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":"Metabolic shifts, a consequence of hyperosmolarity, are a hallmark of mental disorders","authors":"Laurent Schwartz ,&nbsp;Ashraf Bakkar ,&nbsp;Frederic Bouillaud ,&nbsp;Romain Attal ,&nbsp;Marion Leboyer","doi":"10.1016/j.jpsychires.2026.01.047","DOIUrl":"10.1016/j.jpsychires.2026.01.047","url":null,"abstract":"<div><div>Mental and neurodevelopmental disorders are heterogeneous, complex, and overlapping entities. Despite progress, their neurobiological underpinnings are not well understood, and current treatments have limited efficacy. However, a growing number of studies have shown impaired brain and systemic energy metabolism evidenced by low-grade inflammation, metabolic syndrome, mitochondrial dysfunction, and abnormal glucose utilization, although their underlying mechanisms remain poorly understood.</div><div>This paper reviews metabolic shifts in mental disorders, examines the underlying mechanisms driving these metabolic abnormalities in patient subgroups, and explores targeted therapeutic strategies. We argue here that this inflammation results in hyperosmolarity because of increased protein concentration in the extracellular fluid, resulting from vascular leakages. Hyperosmolarity exerts pressure on the capillaries resulting in altered blood flow (hypoperfusion and/or hyper perfusion). Another consequence of hyperosmolarity is metabolic shifts such as aerobic glycolysis. Hyperosmolarity is also responsible for releasing neurotransmitters such as serotonin, dopamine, glutamate, or gamma-aminobutyric acid (GABA). Drugs known to interfere with metabolism such as methylene blue and lipoic acid have been found to have antidepressant, anxiolytic, and neuroprotective effects (both in animals and in humans) in a large array of mental disorders.</div><div>We suggest that metabolic shifts are a hallmark of mental disorders and that treatments aiming to alleviate these metabolic shifts may improve patients' prognoses. Mechanisms-based treatments should be tested in future clinical trials, where subgroups of patients characterized as having the most profoundly impaired metabolism should be included, following the rules of precision psychiatry.</div></div>","PeriodicalId":16868,"journal":{"name":"Journal of psychiatric research","volume":"195 ","pages":"Pages 160-168"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105656","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":"Lifetime prevalence of hoarding disorder symptoms in adults with an eating disorder: A systematic review and meta-analysis","authors":"Brad A. MacNeil ,&nbsp;Michael Montross ,&nbsp;Samantha Re ,&nbsp;Samantha Schultz ,&nbsp;Alexandra Robey ,&nbsp;Charlotte Bolch","doi":"10.1016/j.jpsychires.2026.01.031","DOIUrl":"10.1016/j.jpsychires.2026.01.031","url":null,"abstract":"<div><div>Hoarding disorder has been found to co-occur with eating disorders. However, no prior systematic reviews or meta-analyses have examined the pooled lifetime prevalence of hoarding disorder symptoms in adults with an eating disorder. Based on PRISMA guidelines, 4 electronic databases (MEDLINE, PubMed, PsycINFO, and Cochrane) were searched on September 17, 2025. A total of 539 articles were identified for screening using a combination of search terms. The effect size is the pooled lifetime prevalence of hoarding disorder symptoms among adults with an eating disorder. A total of 5 studies were included in the overall meta-analysis for hoarding disorder symptom prevalence. The results revealed that the pooled lifetime prevalence of hoarding disorder symptoms in adults with an eating disorder was 24 % (95 % CI: 0.23–0.25) with low heterogeneity between studies (<em>I</em>² = 12.0 %). Results suggest that hoarding disorder symptoms co-occur often with eating disorders. Based on these findings, clinicians should consider screening for comorbid hoarding disorder when assessing for eating disorders.</div></div>","PeriodicalId":16868,"journal":{"name":"Journal of psychiatric research","volume":"195 ","pages":"Pages 153-159"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105632","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":"‘Touch hunger’: trajectory and predictors of longing for physical contact during the COVID-19 pandemic in people with and without depressive, anxiety, or obsessive-compulsive disorders","authors":"Sarah E. Mann ,&nbsp;Almar A.L. Kok ,&nbsp;Nathaly Rius Ottenheim ,&nbsp;Brenda W.J.H. Penninx ,&nbsp;Erik J. Giltay","doi":"10.1016/j.jpsychires.2026.01.046","DOIUrl":"10.1016/j.jpsychires.2026.01.046","url":null,"abstract":"<div><h3>Background</h3><div>Little is known about ‘touch hunger’ (longing for physical contact) during the COVID-19 pandemic, particularly for people with pre-existing mental health disorders. We aimed to 1) explore whether touch hunger differs between people with and without depressive, anxiety, or obsessive-compulsive disorders during the COVID-19 pandemic, 2) study the development of touch hunger in relation to loneliness, and 3) examine its predictors during lockdown.</div></div><div><h3>Methods</h3><div>Data were aggregated from three Dutch ongoing prospective cohorts with similar methodology for data collection. We included participants with pre-pandemic data gathered during 2006–2016, and who completed up to 9 online questionnaires between October 2020 and February 2022. Touch hunger trajectories were analyzed using linear mixed models. Sociodemographics, personality traits, (chronicity of) mental health disorders, and COVID-19-related factors were analyzed as predictors of touch hunger using multivariate linear regression analyses.</div></div><div><h3>Results</h3><div>We included 1061 participants with (n = 811) and without (n = 250) mental health disorders. In all chronicity groups, touch hunger increased during lockdown and decreased after lockdown. Extraversion (β = 0.256, P &lt; 0.001), social distancing due to COVID-19 anxiety (β = 0.122, P = 0.001), and death of a close contact from COVID-19 (β = 0.073, P = 0.02) predicted higher touch hunger, while living with a partner (β = −0.109, P = 0.004) or with a partner and children (β = −0.147, P &lt; 0.001) were protective factors for touch hunger. Remarkably, pre-pandemic psychiatric diagnosis did not predict touch hunger during lockdown.</div></div><div><h3>Conclusions</h3><div>Touch hunger rose during the lockdown and was widespread regardless of mental health conditions, indicating a fundamental human need for physical contact, especially among extroverts.</div></div>","PeriodicalId":16868,"journal":{"name":"Journal of psychiatric research","volume":"195 ","pages":"Pages 133-141"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080477","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":"Insular cortex-lateral habenula circuit mediates chronic itch-associated affective comorbidities","authors":"Zhiqiang Chen ,&nbsp;Shuaibo Wang ,&nbsp;Yifei Wang","doi":"10.1016/j.jpsychires.2026.01.026","DOIUrl":"10.1016/j.jpsychires.2026.01.026","url":null,"abstract":"<div><div>Pruritus triggers scratching-induced skin damage and anxiety/depression, forming a vicious cycle that exacerbates inflammatory skin diseases. The insular cortex (IC) integrates itch and emotional processing, while the lateral habenula (LHb) regulates depression.Using acute (3-day) and chronic (14-day) histamine-induced murine itch models combined with chemogenetic manipulation, we demonstrate that the insular cortex (IC) bidirectionally regulates acute itch and anxiety-like behaviors, whereas chronic itch engages the IC-lateral habenula (LHb) circuit to drive comorbid depression. These results establish the IC–LHb circuit as a critical mechanistic driver of chronic itch–associated affective comorbidities. They further highlight serotonergic modulation of this pathway as a promising therapeutic strategy for neuroinflammatory itch.</div></div>","PeriodicalId":16868,"journal":{"name":"Journal of psychiatric research","volume":"195 ","pages":"Pages 63-73"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080481","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":"Microglial, astrocytic, oligodendrocyte, B-/T-cell and neutrophil dysregulation in neuroinflammation of Alzheimer's disease and related dementias","authors":"Asem Surindro Singh ,&nbsp;Afsar Raza Naqvi ,&nbsp;Machathoibi Takhellambam Chanu","doi":"10.1016/j.jpsychires.2026.01.050","DOIUrl":"10.1016/j.jpsychires.2026.01.050","url":null,"abstract":"<div><div>Wide number of basic, preclinical and clinical research have led to increase our knowledge on understanding the potential roles of neuroinflammation in neurodegenerative diseases such as Alzheimer's disease (AD). In fact, neuroinflammation is considered as one of the key pathological factors of neuronal dysfunction leading to dementia in AD and other forms of dementias or related dementias (RD). Central nervous system (CNS) network communicates and control the immune system signaling pathways within the brain as well as peripheral part of the body. Hence, disturbance in the physiological immune system regulation is susceptible to the etiology or pathogenesis of the diseases. Microglia, astrocytes, oligodendrocytes, B-/T-cells and neutrophils are potential regulatory cells in keeping our immune system in balance. The imbalance in the regulatory function of these cells results to inflammatory consequences and has direct or indirect influence in the AD trajectory. In the brain, neuroinflammation is strongly linked to the accumulation of Aβ plaques and tau tangles which lead to pathogenesis underlying dementia of AD. Currently, neuroinflammation is considered as one of the pathological hallmarks of AD, alongside Aβ plaques and tau tangles. Various research and review articles have described the dysregulation of immune system cells leading to neuroinflammation in AD and RD pathogenesis. However, how these immune cells become coordinately imbalanced in the disease pathogenesis has been rarely reported, which is necessary for deeper understanding of the disease pathology and therapeutic development. In this review, we intend to highlight and discuss the neuroinflammatory pathways mediated via dysregulation of microglia, astrocyte, oligodendrocyte, neutrophil, B-cell and T-cell functions, which leads to neuronal dysfunction, dementia or cognitive decline in AD and RD. We believe that the narrative in this review will be helpful in the future basic/clinical research and therapeutic development for AD and RD.</div></div>","PeriodicalId":16868,"journal":{"name":"Journal of psychiatric research","volume":"195 ","pages":"Pages 225-243"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118860","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":"Predicting suicide in patients who have received acute psychiatric inpatient treatment - the longitudinal and prospective SIPEA study","authors":"Desiré Furnes ,&nbsp;Lars Mehlum ,&nbsp;Fredrik A. Walby ,&nbsp;Kristin J. Fredriksen ,&nbsp;Ketil J. Oedegaard ,&nbsp;Rolf Gjestad","doi":"10.1016/j.jpsychires.2026.01.053","DOIUrl":"10.1016/j.jpsychires.2026.01.053","url":null,"abstract":"<div><div>Suicidality (suicidal ideation and -plans (SI) and deliberate self-harm (DSH)), has been extensively studied in different patient populations. Fewer studies have examined predictors of <em>suicide</em> within an extensive longitudinal frame, which is problematic since findings from studies including participants with non-lethal suicidal behavior are not easily generalizable to patients that complete suicide. We aimed to address this gap by examining demographic and clinical factors as predictors of suicide in a longitudinal prospective cohort study of 7,000 consecutively admitted patients. Mean observation time was 4.1 years. Male gender, more frequent admissions during the follow-up period, and having SI, DSH and substance-induced psychosis at the final admission before suicide, <em>directly</em> predicted <em>shorter</em> time to suicide. Shorter time to suicide was <em>indirectly</em> predicted by borderline personality disorder (BPD) via DSH and by psychotic depression and neurotic disorders via SI. In contrast, <em>longer</em> time to suicide was <em>indirectly</em> predicted by substance-induced psychosis and psychotic disorders via reduced probability of SI and DSH at the final admission. Patients diagnosed with BPD had more frequent admissions and higher levels of SI and DSH across admissions, which predicted shorter time to suicide via increased risk of DSH at the final admission. Similarly, patients diagnosed with neurotic disorders had a higher level of SI and DSH across admissions, with shorter time to suicide via SI and DSH at the final admission. Findings suggest different pathways to suicide for different clinical subgroups, and this is discussed in relation to current theoretical models that emphasize suicide as a transdiagnostic phenomenon.</div></div>","PeriodicalId":16868,"journal":{"name":"Journal of psychiatric research","volume":"195 ","pages":"Pages 257-263"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146125251","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}