Psychological Medicine最新文献

{"title":"Normative amygdala fMRI response during emotional processing as a trait of depressive symptoms in the UK Biobank.","authors":"Jerke J van den Berg, Henricus G Ruhé, Henk A Marquering, Liesbeth Reneman, Matthan W A Caan","doi":"10.1017/S0033291725101797","DOIUrl":"https://doi.org/10.1017/S0033291725101797","url":null,"abstract":"<p><strong>Background: </strong>Heightened reactivity in the amygdala measured by functional magnetic resonance imaging during emotional processing is considered a potential biomarker for clinical depression. Still, it is unknown whether this is also true for depressive symptoms in the general population, and - when in remission after recurrent depressive episodes - it is associated with future episodes.</p><p><strong>Methods: </strong>Using the UK Biobank population study (<i>n</i> = 11,334), we investigated the association of amygdala reactivity during negative facial stimuli, focusing on lifetime depression (trait), depressive symptoms (state), and the modulating effect of antidepressant (AD) treatment thereof. We employed normative modeling (NM) to better incorporate population heterogeneity of the amygdala activity.</p><p><strong>Results: </strong>In line with a previous study, depressive symptoms (state) over the last 2 weeks were not associated with the amygdala reactivity signal. Rather, our results indicate a significant positive association (<i>p</i> = 0.03, <i>ω</i>² = 0.001) between amygdala response and the recurrence of depressive episodes (trait). Longitudinal analysis revealed that the group that had experienced a single depressive episode before showed a significantly increased amygdala response after additional episodes (<i>p</i> = 0.03, <i>ω</i>² = 0.017). ADs were not associated with amygdala response directly, but decreased associations within episode recurrence severity.</p><p><strong>Conclusions: </strong>The amygdala response to negative stimuli was associated with an individual's risk of recurrence of depressive episodes, and AD treatment reduced these associations. This study highlights the relevance of amygdala reactivity as a trait, but not a state biomarker for (recurrent) depression. Moreover, it demonstrates the benefit of applying NM in the context of population data.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":"55 ","pages":"e304"},"PeriodicalIF":5.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252461","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":"The relationship between recreational cannabis use, psychotic-like experiences, and the salience network in adolescent and young adult twins.","authors":"Hande Atmaca-Turan, Didenur Şahin-Çevik, Serenay Çakar, Fulya Gökalp-Yavuz, Martijn van den Heuvel, Fruhling Rijsdijk, Francesca Filbey, Timothea Toulopoulou","doi":"10.1017/S0033291725101773","DOIUrl":"https://doi.org/10.1017/S0033291725101773","url":null,"abstract":"<p><strong>Background: </strong>The use of cannabis in adolescence and early adulthood, critical phases for brain development, is linked to psychotic-like experiences (PLEs). The underlying mechanisms, however, remain unclear. This research examined the relationship between recreational cannabis use and PLEs, emphasizing the connectivity of the salience network (SN), which plays a role in salience processing and psychosis. To determine whether this relationship reflects shared genetic or environmental contributions, twin modeling was used.</p><p><strong>Methods: </strong>We included 232 healthy adolescent Turkish twins who underwent diffusion MRI and psychometric assessment. SN connectivity was quantified using graph theory metrics. Linear mixed models were used to examine the associations among cannabis use, SN factors, and PLEs. Mediation analyses assessed whether SN parameters explained the cannabis-PLEs association. Twin models disentangle genetic and environmental contributions to these traits and their covariation.</p><p><strong>Results: </strong>Cannabis use was significantly associated with higher overall PLE frequency. A specific SN factor predicted both total and positive PLEs. However, SN connectivity did not mediate the cannabis-PLEs relationship. Twin modeling showed that cannabis use and PLEs were mainly influenced by unique environmental factors. No significant phenotypic covariations were found among cannabis use, PLEs, and SN parameters.</p><p><strong>Conclusions: </strong>Recreational cannabis use during adolescence and young adulthood is associated with heightened PLEs, although this association is not mediated by SN connectivity. The environment plays an important role during adolescence in shaping these traits independently. The findings underscore the need for longitudinal and genetically informed studies to clarify the mental health effects of adolescent cannabis use.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":"55 ","pages":"e300"},"PeriodicalIF":5.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239578","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":"The effects of intermittent escitalopram treatment on impulsivity and inattention in women with premenstrual irritability and anger.","authors":"Maria Gröndal, Christin Englund, Jakob Näslund, Karl Ask, Elias Eriksson, Stefan Winblad","doi":"10.1017/S0033291725102055","DOIUrl":"https://doi.org/10.1017/S0033291725102055","url":null,"abstract":"<p><strong>Background: </strong>Women diagnosed with premenstrual dysphoric disorder (PMDD) report significant symptom relief when treated with selective serotonin reuptake inhibitors, but few studies have addressed the possibility of capturing this effect in behavioral, laboratory-based tests. This study examined the effects of intermittent treatment with escitalopram (vs. placebo) on a behavioral measure of impulsivity and inattentiveness in women reporting high levels of premenstrual irritability and anger.</p><p><strong>Methods: </strong>Participants (<i>N</i> = 27) rated cardinal PMDD mood symptoms over three menstrual cycles using Visual Analogue Scales. In Cycles 2 and 3, participants displaying cyclicity with respect to the irritability/anger item received escitalopram (20 mg) or placebo in a randomized, single-blind, crossover design. The participants completed the Conners Continuous Performance Test (CPT 3) in the luteal phase of the intervention cycles. Additionally, they filled out the UPPS Impulsive Behavior Scale, once in the luteal phase and once in the follicular phase of the placebo cycle.</p><p><strong>Results: </strong>In line with previous reports, escitalopram caused a significant reduction in self-rated irritability and anger in the luteal phase. When on escitalopram, the participants demonstrated a lower frequency of anticipatory responses and greater consistency in response speed in the CPT 3. With respect to self-reported impulsivity, participants reported higher levels of urgency and lower levels of sensation seeking in the luteal placebo phase versus the follicular phase.</p><p><strong>Conclusions: </strong>The finding that escitalopram impacted the outcome of the CPT 3 test in women with premenstrual irritability highlights the possible role of impulsivity in this condition.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":"55 ","pages":"e301"},"PeriodicalIF":5.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239535","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":"The efficacy and safety of pharmacological treatment for major depressive episode with mixed features specifier: a systematic review and meta-analysis.","authors":"Sirui Gao, Yanjun Chen, Jin Liu, Qianqian Zhang, Xiaotian Zhao, Bangshan Liu, Yan Zhang, LingJiang Li, Gang Wang","doi":"10.1017/S0033291725101955","DOIUrl":"https://doi.org/10.1017/S0033291725101955","url":null,"abstract":"<p><strong>Background: </strong>With the increased prevalence of major depressive episodes with mixed features specifier (MDE-MFS), the pharmacological treatment for MDE-MFS has attracted great clinical attention. This study aimed to investigate the efficacy and safety of medication use for MDE-MFS.</p><p><strong>Methods: </strong>Commonly used databases were searched for the meta-analysis. Primary efficacy outcomes included response rate and the change in the Young Mania Rating Scale scores; the primary safety outcome was the rate of treatment-emergent hypomania/mania. Effects were expressed as relative risk (RR) or standardized mean difference (SMD).</p><p><strong>Results: </strong>In patients with MDE-MFS, antipsychotics significantly improved depressive (RR = 1.46 [95% CI: 1.31, 1.61]) and manic (SMD = -0.35 [95% CI: -0.53, -0.17]) symptoms without increasing the risk of manic switch (RR = 0.91 [95% CI: 0.53, 1.55]). However, subgroup analysis of bipolar disorder (BD) patients with MDE-MFS indicated that antipsychotics had limited effects on manic symptoms. Mood stabilizers, especially valproate, demonstrated significant effects in BD patients with MDE-MFS by relieving depressive and manic symptoms. For MDE-MFS in patients with major depressive disorder, trazodone has shown potential effectiveness in retrospective studies, while the effectiveness of antidepressants on BD patients with MDE-MFS lacked evidence.</p><p><strong>Conclusions: </strong>While antipsychotics are first options for MDE-MFS, their effect on manic symptoms in BD patients with MDE-MFS is still unclear. Mood stabilizers may also be considered, and the use of antidepressants remains a topic of controversy. Since our findings are mostly based on post-hoc analyses, the evidence remains preliminary, highlighting the need for further research to produce more conclusive evidence.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":"55 ","pages":"e294"},"PeriodicalIF":5.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239569","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":"Facilitators of and barriers to patient and public involvement in mental health research within university settings: a systematic review and meta-synthesis.","authors":"Jo Evans, Caroline Da Cunha Lewin, Hannah Fabian, Mahveen Alam, Pamela Calder, Rosie Hill, Ezekiel Khayri, Sarah Markham, Angela Sweeney, Til Wykes","doi":"10.1017/S0033291725101748","DOIUrl":"https://doi.org/10.1017/S0033291725101748","url":null,"abstract":"<p><p>Patient and public involvement (PPI) increasingly features in the shaping, design, and conduct of mental health research. This review identifies and synthesizes evidence of barriers and facilitators of PPI in mental health research within university settings. The search strategy followed PRISMA guidance and involved keyword searches in eight peer reviewed databases, grey literature, hand searching two journals, requests to national mental health organizations, and backwards and forwards citation searching. We included primary mental health studies on patient and public involvement, with data on facilitators and barriers. Data were extracted capturing author, date and country of publication, study aim, participant and research team composition, data collection and analysis methods, and levels of PPI. Quality appraisal was conducted using the CASP Checklist for Qualitative Research, with an additional item on intersectionality. We conducted an inductive thematic analysis, before holding a peer-debriefing session with a lived experience working group. The final dataset included 51 articles that were either of a qualitative design or contained analyzed qualitative data. Barriers and facilitators were grouped around the following themes: the structure of the research environment, organizational culture, and individual needs. Good practice exists, but the wider research environment and power imbalances within universities constrain PPI. For PPI in mental health research to reach its full potential, the redistribution of power, building capacity for all, the provision of safe working environments, and widening inclusion in the research process are necessary. This review involved researchers with lived experience of mental ill health.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":"55 ","pages":"e297"},"PeriodicalIF":5.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239620","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":"The role of psychological strengths in positive life outcomes in adults with ADHD.","authors":"Luca D Hargitai, Emma L M Laan, Lessa M Schippers, Lucy A Livingston, Graeme Fairchild, Punit Shah, Martine Hoogman","doi":"10.1017/S0033291725101232","DOIUrl":"https://doi.org/10.1017/S0033291725101232","url":null,"abstract":"<p><strong>Background: </strong>Strength-based approaches are increasingly common in neurodevelopmental research, but the positive characteristics that may be features of attention-deficit/hyperactivity disorder (ADHD) remain underexplored. The extent to which people with ADHD recognize and use their personal strengths, and whether these play a role in their life outcomes, is also unknown. Tackling these gaps in the literature, we conducted the first study of self-reported strengths, strengths knowledge, and strengths use in ADHD.</p><p><strong>Methods: </strong>Adults with (<i>n</i> = 200) and without (<i>n</i> = 200) ADHD were recruited online and rated their endorsement of 25 putative ADHD-related strengths. Participants also completed self-report measures assessing strengths knowledge, strengths use, subjective wellbeing, quality of life, and mental health. Using both Frequentist and Bayesian methods, we compared the groups and explored the associations of strengths knowledge and use with outcomes across both groups.</p><p><strong>Results: </strong>The ADHD group endorsed 10 strengths more strongly than the non-ADHD group, including hyperfocus, humor, and creativity, but reported similar endorsement for 14 of the strengths. Adults with and without ADHD did not differ on their strengths knowledge and use but, in both groups, increased strengths knowledge and, to some extent, greater strengths use were associated with better wellbeing, improved quality of life, and fewer mental health symptoms.</p><p><strong>Conclusions: </strong>We conclude that, while adults with and without ADHD may have both similarities and differences in strengths, interventions that focus on enhancing people's strength knowledge and promoting the everyday use of their personal strengths could have universal applications to improve wellbeing in adulthood.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":"55 ","pages":"e278"},"PeriodicalIF":5.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233351","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":"Complex temporal dynamics of mental health indicators: A longitudinal network approach perspective.","authors":"Matúš Adamkovič, Benjamin Simsa, Bibiána Jozefiaková, Gabriela Mikulášková, Peter Babinčák, Gabriel Baník, Jaroslava Bočanová, Denisa Fedáková, Klára Kačmariková, Pavol Kačmár, Michal Kentoš, Viktória Majdáková, Lenka Vargová, Ľubica Zibrínová, Ivan Ropovik","doi":"10.1017/S0033291725102080","DOIUrl":"https://doi.org/10.1017/S0033291725102080","url":null,"abstract":"<p><strong>Background: </strong>Although mental disorders have long been considered complex dynamic systems, our understanding of the mutual interactions and temporal patterns of their symptoms remains limited.</p><p><strong>Methods: </strong>In this longitudinal study, we examined the structure and dynamics of four key mental health indicators - depression, anxiety, post-traumatic stress disorder, and insomnia - in a representative sample of the Slovak population (effective <i>N</i> = 3,874) over 10 waves spanning 3.5 years. For each construct, a longitudinal panel network model was estimated.</p><p><strong>Results: </strong>The temporal relationships between symptoms were mostly weak, with the autoregressive effects typically being stronger. In depression, anxiety, and insomnia, some causal chains and feedback loops were identified. In all constructs, both contemporaneous and between-person networks showed dense connections.</p><p><strong>Conclusions: </strong>The findings provide critical insights into the complexity of mental health development, offering potential targets for intervention and prevention strategies.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":"55 ","pages":"e295"},"PeriodicalIF":5.5,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213536","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":"Behavioral and neural dysfunctions in reward-related cognitive control among adolescents with major depressive disorder.","authors":"Yiwen Qiu, Haoran Dou, Benjamin Becker, Zongling He, Ying Mei, Yi Lei","doi":"10.1017/S003329172510202X","DOIUrl":"https://doi.org/10.1017/S003329172510202X","url":null,"abstract":"<p><strong>Background: </strong>Reward can influence cognitive control; however, dysfunctional interactions between reward and cognitive control in adolescents with major depressive disorder (MDD) remain unclear.</p><p><strong>Methods: </strong>We recruited 35 adolescents with MDD and 29 healthy controls (HC) who completed the AX version of the Continuous Performance Test (AX-CPT) under reward and non-reward conditions, while undergoing functional Near-Infrared Spectroscopy (fNIRS).</p><p><strong>Results: </strong>Adolescents with MDD exhibited slower response times and higher error rates compared to healthy controls. Under reward conditions, they responded more quickly but made more errors. Hierarchical Drift Diffusion Modeling (HDDM) revealed that adolescents with MDD showed a reduced starting bias toward more rewarding responses and a broader decision threshold in reward contexts. Neuroimaging results indicated that the MDD group showed diminished activation differences in the left dorsolateral prefrontal cortex (DLPFC), left ventrolateral prefrontal cortex (VLPFC), and right VLPFC in response to cues requiring high versus low cognitive control. Additionally, they exhibited weaker functional connectivity between these regions during reward-related cognitive control. Correlation analyses further showed that greater anhedonia severity was associated with poorer behavioral performance and less flexible activation in the prefrontal cortex.</p><p><strong>Conclusions: </strong>Cognitive control impairments in depressed adolescents may be related to dysfunction in the motivational system. Our findings provide behavioral, computational, and neural evidence for the Expected Value of Control (EVC) theory. Diminished reward sensitivity and inflexible cognitive control may jointly contribute to these deficits, highlighting the importance of considering motivational factors in the diagnosis and intervention of cognitive control impairments in adolescents with depression.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":"55 ","pages":"e298"},"PeriodicalIF":5.5,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213472","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":"Alterations of structural-functional connectivity coupling in older adults with depressive symptoms.","authors":"Ting Li, Haishuo Xia, Shaokun Zhao, Jiawen Liu, Biying Peng, Ziyun Li, Birong Ge, Xin Li, Zhanjun Zhang","doi":"10.1017/S0033291725101657","DOIUrl":"https://doi.org/10.1017/S0033291725101657","url":null,"abstract":"<p><strong>Background: </strong>Prior research indicates that both structural and functional networks are compromised in older adults experiencing depressive symptoms. However, the potential impact of abnormal interactions between brain structure and function remains unclear. This study investigates alterations in structural-functional connectivity coupling (SFC) among older adults with depressive symptoms, and explores how these changes differ depending on the presence of physiological comorbidities.</p><p><strong>Methods: </strong>We used multimodal neuroimaging data (dMRI/rs-fMRI) from 415 older adults with depressive symptoms and 415 age-matched normal controls. Subgroups were established within the depressive group based on the presence of hypertension, hyperlipidemia, diabetes, cerebrovascular disease, and sleep disorders. We examined group and subgroup differences in SFC and tracked its alterations in relation to symptom progression.</p><p><strong>Results: </strong>Older adults with depressive symptoms showed significantly increased SFC in the ventral attention network compared with normal controls. Moreover, changes in SFC within the subcortical network, especially in the left amygdala, were closely linked to symptom progression. Subgroup analyses further revealed heterogeneity in SFC changes, with certain physiological health factors, such as metabolic diseases and sleep disorders, contributing to distinct neural mechanisms underlying depressive symptoms in this population.</p><p><strong>Conclusions: </strong>This study identifies alterations in SFC related to depressive symptoms in older adults, primarily within the ventral attention and subcortical networks. Subgroup analyses highlight the heterogeneous SFC changes associated with metabolic diseases and sleep disorders. These findings highlight SFC may serve as potential markers for more personalized interventions, ultimately improving the clinical management of depression in older adults.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":"55 ","pages":"e293"},"PeriodicalIF":5.5,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213499","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":"Examining bidirectional associations between cannabis use and internalizing symptoms among high-risk emerging adults: A prospective cohort study.","authors":"Jillian Halladay, Kyla Belisario, André McDonald, Samuel Acuff, Amanda Doggett, Molly Garber, Andrea Maxwell, James Murphy, James MacKillop","doi":"10.1017/S0033291725101700","DOIUrl":"https://doi.org/10.1017/S0033291725101700","url":null,"abstract":"<p><strong>Background: </strong>The co-occurrence of cannabis use and internalizing symptoms, such as depression and anxiety, during emerging adulthood (18-25 years) is well documented. However, while bidirectional relationships are often assumed, empirical evidence is mixed. This study investigates bidirectional longitudinal relationships between cannabis frequency and consequences and internalizing symptoms (depressive and anxiety) among high-risk emerging adults.</p><p><strong>Methods: </strong>Data came from seven assessments collected over a 2-year period among 961 (54% female) high-risk emerging adults participating in two longitudinal cohorts (Ontario, Canada; Tennessee, USA). Assessments were at 4-month intervals spanning 2018-2020. Latent curve models with structured residuals were used to explore bidirectional between- and within-person relationships between cannabis-related variables and internalizing symptoms.</p><p><strong>Results: </strong>At baseline, higher levels of cannabis frequency and consequences were associated with higher internalizing symptoms. In between-person model components, cannabis-related and internalizing variables decreased across emerging adulthood. Significant within-person bidirectional relationships were observed, partially supporting both symptom-driven and substance-induced pathways, but the findings were specific to negative cannabis consequences, not frequency, and for depressive symptoms, not anxiety symptoms, for symptom-driven pathways. These bidirectional relationships were more pronounced among females and those surpassing clinical thresholds for internalizing symptoms at baseline.</p><p><strong>Conclusions: </strong>This study found evidence of bidirectional relationships between cannabis consequences and internalizing symptoms across emerging adulthood, with the prevailing direction from cannabis-related negative consequences to increases in internalizing symptoms. These findings highlight the importance of cannabis intervention in emerging adults, both to reduce consequences and to prevent internalizing disorders, especially targeting females and those with clinically elevated internalizing symptoms.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":"55 ","pages":"e291"},"PeriodicalIF":5.5,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213558","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}