Journal of Clinical Psychiatry最新文献

{"title":"Placebo Effects in Alcohol, Cocaine, and Methamphetamine Use Disorder: A Systematic Review and Meta-Analysis.","authors":"Pim B van der Meer, Jan W Schoones, Jurjen Luykx, Olaf M Dekkers, Marta Fiocco, Cornelis Kees Kramers, Arnt Schellekens, Albert Batalla","doi":"10.4088/JCP.25r16118","DOIUrl":"10.4088/JCP.25r16118","url":null,"abstract":"<p><p></p><p><p><b>Objective:</b> The placebo effect is established in psychiatry, yet its role in substance use disorders (SUDs) treatment remains unclear. The aim of this study was to evaluate changes in craving scores in placebo groups in randomized controlled trials (RCTs) across different SUDs in adults.</p><p><p><b>Data sources:</b> Eight different databases (PubMed, Embase, Web of Science, Cochrane Library, Emcare, MEDLINE, PsycINFO, and Academic Search) were systematically searched up to October 28, 2024, by 2 independent researchers.</p><p><p><b>Study selection:</b> Placebo-controlled, double-blind RCTs assessing craving in patients with SUDs were included based on predefined eligibility criteria, published in English, Dutch, Spanish, or German language. Search terms were a combination and synonyms of \"craving,\" \"addiction,\" and \"placebo.\" From a total of 1945 unique records identified, 9 articles met our eligibility criteria.</p><p><p><b>Data extraction:</b> Data on demographic characteristics, study design, and outcome results were extracted. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated for pre-post craving scores within each placebo group; a positive difference point towards improvement in the postplacebo period.</p><p><p><b>Results:</b> A total of n=495 placebo-treated participants were included from nine RCTs in three different SUDs (n=300 in alcohol, n=88 in cocaine, and n=107 in methamphetamine use disorder). Craving scores significantly decreased over time (meaning symptom improvement) in the placebo treatment group in alcohol use disorder (5 studies, SMD=0.93 [95% CI=0.33 to 1.54]) but did not reach statistical significance in cocaine use disorder (2 studies, SMD=0.61 [95% CI=-1.41 to 2.62]) or in (meth)amphetamine use disorder (2 studies, SMD=0.44 [95% CI=-3.43 to 4.32]).</p><p><p><b>Conclusions:</b> Placebo treatment led to reductions in craving scores across all three SUDs, although statistical significance was achieved only in alcohol use disorder. Given the low number of studies for cocaine and (meth)amphetamine use disorder, these estimates were captured with much uncertainty. These findings may inform the design of future RCTs and support the development of more individualized treatment approaches in clinical settings.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148228981","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":"County-Level Variation in Substance Use Disorder Service Utilization by Insurance Payers and Self-Pay in the United States.","authors":"Beth Han, Wilson M Compton, Christopher M Jones, Daniel T Stimson, Elizabeth T Barfield, Julie Frost Bellgowan, Jennifer A Hobin, Nora D Volkow","doi":"10.4088/JCP.26m16340","DOIUrl":"10.4088/JCP.26m16340","url":null,"abstract":"<p><p><b>Objectives:</b> To examine county-level variations in and correlates of substance use disorders (SUDs) health service utilization by insurance payers (Medicaid, private insurance, and Medicare) and self-pay.</p><p><p><b>Methods:</b> Service utilization (the number of health care encounters, visits, admissions, or prescriptions) for SUDs was extracted from the Disease Expenditure 2017-2019 Project. We linked county-level data to drug overdose mortality rates and County Health Rankings, Area Health Resources Files, and Opioid Environment Policy Scan datasets. Descriptive and regression analyses were applied.</p><p><p><b>Results:</b> During 2017-2019, Medicaid (52.7%) and private insurance (32.3%) financed 85.0% of annual average SUD service expenditures examined, accounting for 50.6% of SUD service utilizations (in number). Across 3,143 counties, the average annual county-level number of SUD service utilizations was 5.2 (95% CI =5.1-5.3) per 1,000 county residents. Self-pay individuals had the highest average county-level number of SUD service utilizations (8.6, 95% CI =8.4-8.6 per 1,000 county residents), followed by Medicaid beneficiaries (6.9, 95% CI =6.6-7.1 per 1,000 county Medicaid enrollees) and those paid by private insurance (2.8, 95% CI =2.7-2.8 per 1,000 privately insured county residents). County-level percentage of uninsured adults was negatively associated with SUD service utilization overall (standardized β = -.45, the highest across examined variables, <i>P</i><.0001), accounting for 23.0% of its variance. SUD-related health care resource indicators explained 2.3%.</p><p><p><b>Conclusions:</b> Across all examined payers, Medicaid funded a disproportionate share-over 50%-of SUD service expenditures. Findings quantified the substantial impact of county-level adult uninsured rates on SUD health service utilization, highlighting the pivotal role of health insurance in supporting access to and utilization of SUD services.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13352591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inhaled Mebufotenin (GH001) for Adult Patients With Postpartum Depression: A Phase 2a Open-Label Clinical Trial.","authors":"Martin Johnson, Pau Aceves Baldo, Emilio Arbe, Brian Brennan, Sem E Cohen, Kelly Doolin, William Gann, David Gregory, Sarah Keady, Katerina Kriger, Rachael MacIsaac, Stuart Ratcliffe, David R Rubinow, Claus Bo Svendsen, Theis H Terwey, Dan Tully, Velichka Valcheva, Jasper B Zantvoord, Kristina M Deligiannidis","doi":"10.4088/JCP.25m16284","DOIUrl":"10.4088/JCP.25m16284","url":null,"abstract":"<p><p></p><p><p><b>Objective:</b> Postpartum depression (PPD) is a debilitating mood disorder with peripartum onset. Current treatment options are limited in PPD. GH001 is a synthetic inhalation formulation of the psychoactive molecule mebufotenin (5-MeO-DMT). This trial investigated the preliminary efficacy and safety of GH001 in adult females with PPD.</p><p><p><b>Methods:</b> This phase 2a, proof-of-concept, open-label trial enrolled women aged 18-45 years (March 2023 to August 2024) with a Mini-International Neuropsychiatric Interview-confirmed diagnosis of major depressive disorder with peripartum onset. Patients had Montgomery-Asberg Depression Rating Scale (MADRS) scores of ≥28 at baseline. GH001 was administered as an individualized dosing regimen of up to 3 escalating doses (6, 12, and 18 mg) on day 1. The primary end point was the change in MADRS total score from baseline to day 8. Secondary end points included antidepressant response (≥50% reduction), remission (MADRS total score ≤10), and safety and tolerability of GH001.</p><p><p><b>Results:</b> Ten patients were enrolled. Mean baseline MADRS total score was 36.7 (SD = 4.8). Mean MADRS total score change from baseline to day 8 was -35.4 points (SD = 5.5; <i>P</i> < .0001). All patients achieved response and were in remission on day 8, which was first observed 2 hours after their final dose on day 1. Inhalation of GH001 was well tolerated, and no serious adverse events (AEs) were reported. All treatment-emergent AEs were mild or moderate, with headache as the most frequently reported AE.</p><p><p><b>Conclusion:</b> GH001 demonstrated rapid and significant improvements in depressive symptoms and remission of PPD with an acceptable safety profile and parallel improvements across secondary end points.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT05804708; EudraCT identifier: 2021-006879-42.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148177086","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":"Prescribing GLP-1 Receptor Agonists for Persons With Mental Disorders: Evidence-Based and Aspirational Targets.","authors":"Roger S McIntyre","doi":"10.4088/JCP.26com16484","DOIUrl":"https://doi.org/10.4088/JCP.26com16484","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148177082","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":"Prevalence of GLP-1 Receptor Agonist Use Among Privately Insured Individuals With Mood Disorders.","authors":"Mason T Breitzig, Tyler R Trippetti, Lan Kong, Erika F H Saunders, Andrew A Nierenberg, Guodong Liu","doi":"10.4088/JCP.26br16352","DOIUrl":"https://doi.org/10.4088/JCP.26br16352","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148177111","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":"Viloxazine Extended Release in Adults With Attention-Deficit/Hyperactivity Disorder and Depression and/or Anxiety Symptoms: Results From a Decentralized, Open-Label, Phase 4 Trial.","authors":"Lenard A Adler, V Rose Lieberman, Leslie Brijbasi, Greg W Mattingly, Ilmiya Yarullina, Yuan Li, Jami Earnest, Jonathan Rubin","doi":"10.4088/JCP.25m16234","DOIUrl":"10.4088/JCP.25m16234","url":null,"abstract":"<p><p><b>Objective:</b> Adult attention-deficit/hyperactivity disorder (ADHD) is commonly associated with comorbidities, including depression and anxiety; however, most ADHD treatment studies exclude people with these conditions. This phase 4, open-label, decentralized clinical trial (conducted March 25, 2024-December 11, 2024) evaluated viloxazine ER (extended-release capsules, an FDA-approved nonstimulant medication for ADHD) in adults with ADHD (based on <i>DSM-5-TR</i>) and comorbid depression and/or anxiety symptoms.</p><p><p><b>Methods:</b> Participants received viloxazine ER (200-600 mg/d) for 14 weeks added to existing medications (including stimulant, antidepressant, or anxiolytic medications). Efficacy and safety measures (assessed via televisit, mobile phone app, and home monitoring devices) included clinician-and patient-reported scales evaluating ADHD, depression, and anxiety symptoms, treatment-emergent adverse events, blood pressure, pulse rate, weight, and suicidality assessment. The primary end point was change from baseline in Adult ADHD Investigator Symptom Rating Scale (AISRS) total score.</p><p><p><b>Results:</b> Among participants receiving viloxazine ER (n=161; mean age, 39.4 years; female, 75.8%), almost all (99.4%) had substantial depression and anxiety symptoms. AISRS total score was significantly reduced (improved) from baseline (mean [SD], 37.5 [6.53]; n=150) at week 14/end of study (EOS) (mean [SD] change, -17.3 [11.34]; <i>P</i><.0001); similar results were observed for patient-reported ADHD symptoms. Depression and anxiety rating scales were significantly improved from baseline to week 14/EOS (all <i>P</i><.0001). Safety outcomes were consistent with previous viloxazine ER studies; 24 participants (14.9%) had adverse events leading to study discontinuation.</p><p><p><b>Conclusions:</b> Viloxazine ER was well tolerated and associated with improvements in ADHD, depression, and anxiety symptoms in this real-world study of adults with ADHD and comorbid symptoms.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT06185985.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148058081","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":"National Trends in Posttraumatic Stress Disorder Among US Military Veterans: Results From the 2025-2026 National Health and Resilience in Veterans Study.","authors":"Robert H Pietrzak, Ian C Fischer, Peter J Na, Ilan Harpaz-Rotem, Ismene L Petrakis, John H Krystal","doi":"10.4088/JCP.26m16378","DOIUrl":"10.4088/JCP.26m16378","url":null,"abstract":"<p><p><b>Background:</b> Posttraumatic stress disorder (PTSD) is a prevalent and disabling condition among US military veterans. Prior waves of the National Health and Resilience in Veterans Study (NHRVS; 2011-2020) have estimated the lifetime and past-month prevalence of PTSD at 8.0%-9.4% and 4.7%-5.0%, respectively. Updated national surveillance data are needed given demographic changes in the veteran population and evolving patterns of trauma exposure.</p><p><p><b>Methods:</b> Data were drawn from the 2025-2026 NHRVS, a nationally representative, web-based survey of 2,636 US veterans. Weighted prevalence estimates of lifetime and past-month PTSD were compared with estimates from prior NHRVS waves (2011, 2013, and 2019-2020). Linear regression assessed associations among trauma burden, PTSD, and functional disability.</p><p><p><b>Results:</b> In 2025-2026, the weighted prevalence of lifetime PTSD was 14.4% (95% CI, 12.6%-16.4%), and the prevalence of past-month PTSD was 7.3% (95% CI, 6.0%-8.9%), both significantly higher than those observed in prior NHRVS waves. Compared with 2019-2020, the prevalence of past-month PTSD was higher among men, white and racial/ethnic minority veterans, and veterans aged 18-59 years. Sudden loss, life-threatening illness or injury, and witnessed violence were the most frequently identified index traumas, whereas forced sexual experiences were associated with the highest conditional risk of PTSD. Greater cumulative trauma burden and PTSD were each strongly associated with increased functional disability.</p><p><p><b>Conclusions:</b> PTSD affects a substantial and growing proportion of US veterans. Cumulative trauma burden and PTSD are strongly associated with functional disability, underscoring the importance of assessing lifetime trauma exposure alongside PTSD symptoms in clinical care and population surveillance.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148058034","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":"Insomnia, Sleep, and the Use of Sedative-Hypnotic Drugs: Practical Notes.","authors":"Chittaranjan Andrade","doi":"10.4088/JCP.26f16467","DOIUrl":"10.4088/JCP.26f16467","url":null,"abstract":"<p><p>Sleep is an important biological function. This article considers practical matters related to the prescription of sedative-hypnotic drugs to patients with insomnia. This article also presents practical suggestions for the management of excessive sedation in patients who need pharmacologic treatments with sedating adverse effects when dose reduction is not an option. Issues examined include the choice of drug for sleep-onset insomnia and for sleep-maintenance insomnia; the choice of drug for insomnia in patients with psychiatric disorders; sedative-hypnotic dosing in contexts such as perturbation of multiple neurotransmitter systems; metabolic drug interactions with sedative-hypnotic drugs; gastrointestinal absorption of hypnotic drugs and time to onset of drowsiness; the effect of food on absorption and time to onset of drowsiness; the effect of glucagon-like peptide-1 receptor agonist (GLP-1RA) drugs on absorption and time to onset of drowsiness; the importance of half-life for the duration of action of the sedative-hypnotic drug; strategies to address oversedation with sedating psychotropic drugs; treating insomnia with classical monoamine oxidase inhibitors, especially tranylcypromine; optimization of sedative-hypnotic therapy; provision of patient guidance; and related matters. Readers are also reminded that sleep hygiene and cognitive-behavioral approaches should routinely be combined with sedative-hypnotic drug therapy to optimize insomnia care and improve treatment outcomes.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148057916","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":"Differential Impact of Cholecystokinin and Ghrelin on 2-Year Avoidant/Restrictive Food Intake Disorder Symptoms.","authors":"Vittoria Trolio, Sophie Scharner, Nassim Tabri, Hang Lee, Helen Burton-Murray, Kendra R Becker, P Evelyna Kambanis, Lauren Breithaupt, Julia Gydus, Laura Holsen, Madhusmita Misra, Kamryn T Eddy, Nadia Micali, Elizabeth A Lawson, Jennifer J Thomas","doi":"10.4088/JCP.25m16046","DOIUrl":"10.4088/JCP.25m16046","url":null,"abstract":"<p><p><b>Objective:</b> Individuals with avoidant/restrictive food intake disorder (ARFID) commonly endorse lacking interest in eating/food, difficulties recognizing hunger, and early satiation. Cholecystokinin (CCK) and ghrelin may be important biologic mechanisms in ARFID given their role in appetite signaling. We investigated whether youth with ARFID-<i>lack of interest</i> had greater CCK and lower ghrelin levels compared to youth without this presentation across timepoints and whether greater reductions in CCK and increases in ghrelin were associated with ARFID symptom improvement over a two-year period.</p><p><p><b>Methods:</b> One hundred youth (49% female, mean [SD] age=15.87 [3.89] years, mean [SD] body mass index percentile=37.71 [35.16]) recruited from a single-center clinic and surrounding community, initially meeting <i>DSM-5</i> criteria for full/subthreshold ARFID completed the Pica, ARFID, and Rumination Disorder Interview at baseline and follow-up over two years (July 2016-September 2022) to determine ARFID diagnosis, presentation type, and severity scores. We obtained fasting plasma levels of CCK and ghrelin at each timepoint.</p><p><p><b>Results:</b> Youth with ARFID-<i>lack of interest</i> had higher CCK than those without this presentation, though there were no differences in fasting ghrelin. Greater decreases in CCK from Baseline to Years 1 and 2 were associated with decreases in lack of interest severity at Years 1 and 2, whereas greater increases in ghrelin from Baseline to Years 1 and 2 were associated with decreases in ARFID severity at Years 1 and 2.</p><p><p><b>Conclusion:</b> In the first longitudinal study of neuroendocrine abnormalities in individuals with ARFID, we found that decreases in CCK and increases in ghrelin were associated with improvements in ARFID symptomology.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 2","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13348274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of a Nationwide Aftercare Program for Self-Harm Presentations on the Risk of Self-Harm Repetition and Suicide: A Cohort Study.","authors":"Chien-Yu Lin, Yi-Han Chang, Chia-Yueh Hsu, Ying-Yeh Chen, Chi-Shin Wu, Chau-Shoun Lee, Shu-Sen Chang","doi":"10.4088/JCP.25m16173","DOIUrl":"10.4088/JCP.25m16173","url":null,"abstract":"<p><p><b>Objective:</b> Aftercare interventions following self-harm may prevent subsequent self-harm and suicide deaths. However, previous research into the effectiveness of aftercare services on self-harm repetition and suicide mostly comprised a small sample size and showed inconsistent findings. We investigated the effectiveness of Taiwan's national self-harm aftercare program on self-harm repetition and suicide among self-harm patients.</p><p><p><b>Methods:</b> A cohort study of 90,413 index self-harm episodes (ie, the first episode during the study period) presented to hospitals and registered in the National Suicide Surveillance System (2012-2016) was performed. Cox regression models were used to evaluate the risk of self-harm repetition or suicide after receiving the aftercare, which was modeled as a time-varying variable.</p><p><p><b>Results:</b> The aftercare was associated with a 17% (adjusted hazard ratio [aHR]=1.17, 95% confidence interval [CI] 1.14-1.21) increase in self-harm repetition risk and a 20% (aHR=0.80, 95% CI 0.74-0.86) decrease in suicide risk. The association of the aftercare with increased self-harm repetition risk was most marked in patients aged 45-64 years (aHR=1.34) and more marked in those with a history of psychiatric disorders (aHR=1.26). The association of aftercare with decreased suicide risk was most marked in patients aged 10-24 years (aHR=0.64) and more marked in those without a history of psychiatric disorders (aHR=0.76) than their counterparts.</p><p><p><b>Conclusion:</b> The aftercare following self-harm was associated with an increased risk of repeat self-harm hospital presentation and decreased risk of suicide. The findings suggest that the aftercare intervention may increase help-seeking behaviors after self-harm and decrease suicide deaths, especially in specific subgroups.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"87 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976718","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}