European psychiatry : the journal of the Association of European Psychiatrists最新文献

{"title":"Individual- and population-level associations of mental disorders with intentional self-harm.","authors":"Philippe Mortier, Matilde Francisco, Itxaso Alayo, Laura Ballester, Juan Francisco Martínez-Cerdá, Montserrat López, Ana Portillo-Van Diest, Diego Palao, Víctor Pérez-Solà, Lars Mehlum, Ronald C Kessler, Oleguer Plana-Ripoll, Gemma Vilagut, Jordi Alonso","doi":"10.1192/j.eurpsy.2026.10182","DOIUrl":"10.1192/j.eurpsy.2026.10182","url":null,"abstract":"<p><strong>Background: </strong>Registry-based studies can inform suicide prevention by identifying mental disorders with the highest risk. Previous studies focused on severe disorders and suicide, with limited data on non-lethal self-harm or population impact. We quantified individual- and population-level associations of 32 mental disorders with non-lethal intentional self-harm (NLISH) and suicide.</p><p><strong>Methods: </strong>Registry-based cohort study representative for all residents of Catalonia (Spain) aged ≥10 years (2014-2019; <i>n</i> = 645,571). Cause-specific Cox models estimated individual (hazard ratios [HRs]) and population-level (population attributable fractions [PAFs]) associations with NLISH and suicide, stratified by sex and adjusted for age, socioeconomic status, and nationality.</p><p><strong>Results: </strong>Individual-level associations with NLISH were strongest for borderline personality disorder (BPD; females HR = 26.9 [95%CI 24.9-29.0]; males HR = 18.9 [95%CI 16.7-21.4]). Associations with suicide were strongest for BPD in females (HR = 40.9 [95%CI 28.5-58.8]) and obsessive-compulsive disorder in males (HR = 17.4 [95%CI 5.3-56.5]). Associations with suicide were stronger among females, and those aged 10-44 across mood, substance use, dissociative, borderline personality, and psychotic disorders. Substantial proportions of outcomes were associated with common disorders: depressive episodes (PAFs 29.8-49.8%), substance use disorders (PAFs 25.1-48.7%), mixed anxiety-depressive disorders (PAFs 19.7-53.2%), and adjustment disorders (PAFs 10.6-44.6%).</p><p><strong>Conclusions: </strong>Depressive, anxiety, adjustment, and substance use disorders are associated with large shares of self-harm and suicide, whereas BPD confers particularly high individual risk. Our findings support multilevel prevention strategies, especially among young people, including improved risk assessment, collaborative care, and timely access to specialized interventions.</p>","PeriodicalId":520621,"journal":{"name":"European psychiatry : the journal of the Association of European Psychiatrists","volume":" ","pages":"e50"},"PeriodicalIF":6.7,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147392243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of sleep-wake behaviors on the onset of mania in youth: A computational model.","authors":"Kirill Glavatskiy, Ian B Hickie, Jacob J Crouse, William Capon, Ante Prodan, Jan Scott, Kathleen Merikangas, Joanne S Carpenter, Mathew Varidel, Elizabeth M Scott, Frank Iorfino","doi":"10.1192/j.eurpsy.2026.10180","DOIUrl":"10.1192/j.eurpsy.2026.10180","url":null,"abstract":"<p><strong>Background: </strong>Bipolar disorder is a recurrent and disabling condition, with a critical clinical need to prevent transitions from euthymia or depression (normal or low activation states) to mania (a high activation state). This study investigates how disruptions in sleep-wake and circadian rhythms may trigger these high activation states, to inform more effective relapse prevention strategies.</p><p><strong>Methods: </strong>We developed a computational agent-based model integrating empirical evidence, clinical expertise, and lived experience to simulate how 24-hour sleep-wake behaviors (SWBs) influence manic episodes. Individual characteristics were drawn from the Brain and Mind Youth Cohort (<i>N</i> = 2,330), and multiple scenarios were simulated to assess how SWB dynamics affect the emergence and course of mania.</p><p><strong>Results: </strong>In the absence of all irregularities, no individuals experienced a manic episode. Removing behavioral feedback loops resulted in a substantial reduction in manic episodes and delayed onset. In contrast, eliminating light-dark entrainment slightly increased the frequency of manic episodes, suggesting that seasonal adaptation plays a stabilizing role. When examining components of SWB separately, removing sleep irregularities alone had only a modest effect on mania rates, whereas reducing activity irregularities led to the largest benefit: a significant drop in mean manic episodes, a delay in onset, and preventing mania in 65% of the simulated agent population.</p><p><strong>Conclusions: </strong>Our findings highlight the value of computational modeling for uncovering causal dynamics in mental health. These specific findings demonstrate how daily irregularities in sleep-wake behavior may be a necessary condition for mania. Targeting behavioral regularity may offer a powerful pathway for prevention and early intervention.</p>","PeriodicalId":520621,"journal":{"name":"European psychiatry : the journal of the Association of European Psychiatrists","volume":" ","pages":"e49"},"PeriodicalIF":6.7,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147380486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External validation and recalibration of the psychosis metabolic risk calculator (PsyMetRiC) in young adults with chronic psychotic disorders in the Netherlands.","authors":"D M C Quadackers, B I Perry, S S Gangadin, E Visser, H Riese, D C Cath","doi":"10.1192/j.eurpsy.2026.10179","DOIUrl":"10.1192/j.eurpsy.2026.10179","url":null,"abstract":"<p><strong>Background: </strong>People with psychotic disorders have high cardiometabolic risk, yet prediction tools are rarely validated outside early-intervention settings. We externally validated and recalibrated the UK Psychosis Metabolic Risk Calculator (PsyMetRiC) in a Dutch cohort of young adults with psychotic disorders in long-term care.</p><p><strong>Methods: </strong>We used data from the PHAMOUS registry. Individuals aged 16-35 years, without metabolic syndrome (MetS) at baseline (prevalence 21.2%), were included. MetS incidence over approximately 6 years (last assessment 1-6 years; cumulative incidence 29.1%) was defined using international criteria. Full (biochemical + clinical) and partial (clinical only) PsyMetRiC models were applied to 10 multiply imputed datasets. Discrimination, calibration, and decision-curve analysis (DCA) were assessed before and after logistic recalibration of intercept and slope.</p><p><strong>Results: </strong>In external validation, <i>C</i>-statistics were about 0.69 for the full and 0.67 for the partial model. Both systematically underpredicted MetS risk; recalibration yielded calibration intercepts near 0 and slopes near 1, while discrimination was unchanged. DCA suggested that, across risk thresholds of 0.10-0.35, using recalibrated PsyMetRiC could provide higher net benefit than \"treat all\" or \"treat none.\"</p><p><strong>Conclusions: </strong>In this chronic-care cohort, PsyMetRiC showed moderate discrimination and improved calibration after logistic recalibration. The recalibrated models may support more targeted metabolic monitoring and prevention, but interpretation is limited by registry design, variable follow-up times, reliance on multiple imputation, and modest power for subgroup analyses.</p>","PeriodicalId":520621,"journal":{"name":"European psychiatry : the journal of the Association of European Psychiatrists","volume":" ","pages":"e44"},"PeriodicalIF":6.7,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147380472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stable structure, shifting links: How depression-anxiety symptom networks reconfigure from pregnancy to postpartum.","authors":"Alberto Stefana, Fiorino Mirabella, Antonella Gigantesco, Gemma Calamandrei, Laura Camoni","doi":"10.1192/j.eurpsy.2026.10181","DOIUrl":"10.1192/j.eurpsy.2026.10181","url":null,"abstract":"<p><strong>Background: </strong>Network analysis was employed to test whether the overall pattern of depressive-anxious symptom connections remains stable or whether specific symptom-to-symptom links shift from pregnancy to postpartum.</p><p><strong>Methods: </strong>In a perinatal sample (n = 4,461 pregnant women, n = 5,711 postpartum women), depressive and anxiety symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS) and Generalized Anxiety Disorder-7 (GAD-7). Phase-specific polychoric Gaussian graphical models were estimated with EBICglass. We examined strength and bridge centrality, community structure, and nodewise predictability, and compared networks using the network comparison test.</p><p><strong>Results: </strong>Depression and anxiety formed four reproducible communities (one GAD-7 worry/arousal and three EPDS affective/anhedonic, anxious-cognitive distress, and depressed affect/sleep-suicidality modules) with identical partitions across phases. Global strength was similar, but postpartum networks showed higher edge density and more negative partial correlations, suggesting localized changes in which symptom pairs were directly linked-and how strongly-across phases. Across phases, Sadness, Crying, Uncontrollable worrying, and Trouble relaxing were most central and predictable. Worry-, arousal-, and sleep-related symptoms (e.g., hard to sleep) showed the strongest bridge centrality postpartum, and Self-harm was a prominent bridge during pregnancy; several edges shifted between phases, including stronger Enjoyment-Self-harm and weaker Hard to sleep-Self-harm postpartum.</p><p><strong>Conclusions: </strong>Perinatal depression and anxiety organize into cohesive yet partially distinct symptom networks that remain globally stable but show localized shifts in direct symptom-to-symptom connections from pregnancy to postpartum. Central affective and arousal nodes, particularly sadness, pathological worry, and sleep disturbance, may be high-yield targets for phase-tailored screening and intervention.</p>","PeriodicalId":520621,"journal":{"name":"European psychiatry : the journal of the Association of European Psychiatrists","volume":" ","pages":"e40"},"PeriodicalIF":6.7,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147380456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review of specialized psychosocial and complex psychosocial interventions for early psychosis, early depression, early bipolar disorder, and early borderline personality disorder.","authors":"Andreas Bechdolf, Hendrik Müller, Daniel Richter, Stefan Weinmann, Thomas Becker, Steffi G Riedel-Heller, Uta Gühne","doi":"10.1192/j.eurpsy.2026.10158","DOIUrl":"10.1192/j.eurpsy.2026.10158","url":null,"abstract":"<p><strong>Background: </strong>This systematic review evaluates specialized psychosocial and complex interventions for early bipolar disorder (BD), early borderline personality disorder (BPD), early depression, early psychosis, and first-episode mental illness in general (FEMI).</p><p><strong>Methods: </strong>We included systematic reviews and randomized controlled trials (RCTs) of interventions with psychosocial components, excluding trials that focused on pharmacological-only interventions and stand-alone psychotherapies. Searches were conducted in January 2023 across five databases. Review quality was assessed using AMSTAR-2 and risk of bias for RCTs using the Cochrane tool.</p><p><strong>Results: </strong>Ten studies met the inclusion criteria: seven reviews and three RCTs. High-to moderate-quality evidence supports complex psychosocial interventions combined with pharmacotherapy for early psychosis. The most robust effects were reductions in relapse and improvements in psychosocial functioning; additional benefits were observed for symptom burden, remission, treatment discontinuation, and hospital admissions. Benefits were most sustained in longer-duration, community-based programs. For early BD, limited evidence suggests that combining pharmacotherapy with family-focused therapy or structured psychoeducation may improve the course of illness and treatment satisfaction. One RCT in early BPD reported improved engagement with a developmentally tailored program. Two FEMI RCTs found that nurse-led psychoeducation and psychosocial programs improved in-patient duration, symptoms, insight, self-efficacy, quality of life, and engagement. No eligible studies addressed early-stage depression, indicating a notable evidence gap for multimodal psychosocial interventions.</p><p><strong>Conclusions: </strong>Complex psychosocial interventions are strongly supported for early psychosis. Preliminary data in BD, BPD, and FEMI suggest consistent benefits for engagement, but further rigorous trials - especially in early depression - focusing on different outcomes - are required.</p>","PeriodicalId":520621,"journal":{"name":"European psychiatry : the journal of the Association of European Psychiatrists","volume":" ","pages":"e47"},"PeriodicalIF":6.7,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How alexithymia shapes functional networks: Insights from a general population study.","authors":"Elischa Krause, Johanna Klinger-König, Katharina S Goerlich, Stefan Frenzel, Robin Bülow, Mark Oliver Wielpütz, Henry Völzke, Hans J Grabe","doi":"10.1192/j.eurpsy.2026.10177","DOIUrl":"10.1192/j.eurpsy.2026.10177","url":null,"abstract":"<p><strong>Background: </strong>Alexithymia is a multifaceted, transdiagnostic trait characterized by challenges in emotion processing. Affecting up to 10% in the general population, it represents a risk factor for various mental and physical health conditions. Recent neuroimaging studies have elucidated the neural substrates of alexithymia, providing initial insight into altered functional connectivity within key emotional, attentional, and interoceptive networks, potentially impairing emotion processing and everyday functioning. However, no large-scale study has yet confirmed these network alterations.</p><p><strong>Methods: </strong>Resting-state functional magnetic resonance imaging from 575 individuals (ages 29-60, 334 women) in the population-based SHIP-TREND cohort, using regions of interest covering major functional networks across the whole brain, was paired with the 20-item Toronto Alexithymia Scale (TAS-20) to investigate the signature of alexithymia. The analysis accounted for technical variables, sociodemographic factors, lifestyle, and current depressive symptoms.</p><p><strong>Results: </strong>Higher TAS-20 scores were associated with altered functional connectivity within the frontoparietal network and between the dorsal attention and salience networks. Specifically, the subscale \"difficulties identifying feelings\" was associated with functional alterations between and within attentional, salience, and sensorimotor networks, indicating a divergent pattern within the salience network.</p><p><strong>Conclusions: </strong>These findings underscore the widespread impact of alexithymia on brain networks involved in emotional attention, interoception, and somatosensory processing. Controlling for lifestyle factors, current depressive symptoms, and other health indicators supports the specificity of these patterns. This supports the view of alexithymia as a personality trait that affects large-scale network functioning, potentially hampering emotional regulation and self-awareness processes, contributing to mental and physical health risks.</p>","PeriodicalId":520621,"journal":{"name":"European psychiatry : the journal of the Association of European Psychiatrists","volume":" ","pages":"e45"},"PeriodicalIF":6.7,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147358448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parental alcohol supply in early childhood and adolescent drinking: Evidence from a prospective cohort.","authors":"Albert J Ksinan, Pavla Brennan Kearns, Zuzana Mohrová, Zsófia Csajbók, Jana Klánová, Hynek Pikhart, Martin Bobák","doi":"10.1192/j.eurpsy.2026.10175","DOIUrl":"10.1192/j.eurpsy.2026.10175","url":null,"abstract":"<p><strong>Background: </strong>Parental alcohol supply in early childhood may increase the risk of alcohol use in late adolescence. This study examined its longitudinal impact and the distinct roles of mothers' and fathers' drinking.</p><p><strong>Methods: </strong>We studied 1,891 mother-child pairs from the Czech European Longitudinal Study of Pregnancy and Childhood. Mothers reported parental alcohol supply at ages 3, 5, 7, and 11 years, while adolescent alcohol use was reported by mothers, pediatricians, and youth at ages 18 and 19 years. Structural equation modeling assessed the longitudinal link between early alcohol supply (three classes: none, occasional, and frequent) and adolescent alcohol use, accounting for parental drinking and covariates, including the child's sex, mother's education, and family structure.</p><p><strong>Results: </strong>Alcohol supply began in early childhood, with 14% of children exposed by age 3 and around 20% by age 11. By age 19, one-third of individuals reported frequent alcohol use. Adolescents' alcohol use was associated with concurrent mothers', but not fathers' alcohol use (<i>β</i> = .24, <i>p</i> < .001). Early alcohol supply predicted higher adolescent use for both occasional (<i>β</i> = .14, <i>p</i> = .041) and frequent (<i>β</i> = .22, <i>p</i> = .005) classes. Mothers' and fathers' alcohol use at 6 months was associated with frequent alcohol supply, and fathers' alcohol use was also associated with occasional alcohol supply. Significant indirect effects were found from early parental drinking to adolescent use via these classes.</p><p><strong>Conclusions: </strong>Public health messaging should emphasize the risks of early alcohol consumption, including its potential harm to the developing brain.</p>","PeriodicalId":520621,"journal":{"name":"European psychiatry : the journal of the Association of European Psychiatrists","volume":" ","pages":"e34"},"PeriodicalIF":6.7,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147329096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term diagnostic and social outcomes after first psychiatric hospitalization.","authors":"Julie Nordgaard, Ditte Saebye, Josef Parnas, Peter Handest, Janne Petersen, Sofie Oersted-Hoeyer, Mads Gram Henriksen","doi":"10.1192/j.eurpsy.2026.10178","DOIUrl":"10.1192/j.eurpsy.2026.10178","url":null,"abstract":"<p><strong>Background: </strong>The early phases of severe mental disorders are often diagnostically challenging, with frequent diagnostic shifts over time. Few studies have combined detailed baseline diagnostic assessment with long-term follow-up to examine both diagnostic and social development.</p><p><strong>Methods: </strong>We conducted a 20-year register-based follow-up of 150 patients with first-time psychiatric hospitalizations. At baseline, all participants underwent a comprehensive diagnostic assessment. Follow-up data were obtained through linkage to national registers, providing information on psychiatric diagnoses, education, family formation, crime, mortality, and suicide. Cumulative incidence functions accounting for competing risks were calculated stratified on baseline diagnoses.</p><p><strong>Results: </strong>Only seven participants (4.6%) had no further contact with hospital-based psychiatry during the 20-year follow-up. During the follow-up period, 37.9% received a diagnosis of schizophrenia, 35% schizotypy, 14.4% depression, 24.6% personality disorder, 11% bipolar disorder, and 6.1% substance use disorder. Participants with a baseline diagnosis of schizophrenia, schizotypy, or depression had a significantly higher probability of receiving the same diagnosis during follow-up (schizophrenia 81.6%, schizotypy 69.4%, and depression 53.3%), whereas this was not the case for participants with a baseline diagnosis of personality disorder. Mortality was elevated (5.9%), with suicide accounting for one-third of all deaths, ten times the national average.</p><p><strong>Conclusions: </strong>A first psychiatric hospitalization in early adulthood marked the beginning of a longer clinical trajectory: 95% of participants re-entered hospital-based care or had prolonged initial hospitalization. The findings emphasize the importance of diagnostic assessment and sustained care to improve prognosis and reduce social impairment and premature death.</p>","PeriodicalId":520621,"journal":{"name":"European psychiatry : the journal of the Association of European Psychiatrists","volume":" ","pages":"e37"},"PeriodicalIF":6.7,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147314495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex differences in the effect of childhood adversity and coping strategies on psychosis expression: A TwinssCan study.","authors":"Melike Karaçam Doğan, Thanavadee Prachason, Laura Fusar-Poli, Claudia Menne-Lothmann, Jeroen Decoster, Ruud van Winkel, Dina Collip, Philippe Delespaul, Marc De Hert, Catherine Derom, Evert Thiery, Nele Jacobs, Marieke Wichers, Bart P F Rutten, Jim van Os, Lotta Katrin Pries, Sinan Guloksuz","doi":"10.1192/j.eurpsy.2026.10173","DOIUrl":"10.1192/j.eurpsy.2026.10173","url":null,"abstract":"<p><strong>Background: </strong>Sex differences in psychosis pathoetiology are insufficiently understood. This study explores how childhood adversity (CA) and coping mechanisms relate to psychosis expression (PE) across males and females in the general population.</p><p><strong>Methods: </strong>Data from the TwinssCan project (males: <i>n</i> = 312; females: <i>n</i> = 478) were used. The Childhood Trauma Questionnaire assessed CA domains. The Utrecht Coping List assessed coping strategies. Psychosis expression was assessed using the Community Assessment of Psychic Experiences (CAPE). Mixed linear regression analyses examined sex-stratified associations of CAPE scores with CA, coping strategies, and their interactions.</p><p><strong>Results: </strong>Emotional abuse (EA) was associated with increased total CAPE scores (T-CAPE), explaining the greatest variance among CA across sexes. Sex-specific effects showed that sexual abuse (SA) and physical abuse (PA) were linked to higher T-CAPE in females, whereas physical neglect (PN) was linked to higher T-CAPE in males. Passive-reacting was associated with increased T-CAPE, explaining the greatest variance among coping styles across both sexes. Sex-specific effects showed that, in females, seeking social support was linked to decreased T-CAPE, while emotional expression increased it. The only sex-shared interaction effect was between reassuring thoughts and emotional neglect (EN), associated with decreased T-CAPE. In females, social support (× PA/PN/EA), reassuring thoughts (× PA/PN), and palliative-reacting (× PN/PA) were associated with decreased T-CAPE, while passive-reacting (× EN) increased it. In males, avoidance (× SA/PA) and passive-reacting (× PN) were associated with increased T-CAPE.</p><p><strong>Conclusions: </strong>Sex differences in the associations of PE with CA and coping underscore the necessity for sex-specific interventions that promote adaptive coping strategies.</p>","PeriodicalId":520621,"journal":{"name":"European psychiatry : the journal of the Association of European Psychiatrists","volume":" ","pages":"e42"},"PeriodicalIF":6.7,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146230370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complete blood count-based inflammatory ratios in people with bipolar disorder: a systematic review and meta-analysis of neutrophil-to-lymphocyte, monocyte-to-lymphocyte, and platelet-to-lymphocyte ratios.","authors":"Daniele Cavaleri, Giorgio Cucchi, Martina Citton, Martina Monti, Cristina Crocamo, Francesco Bartoli, Giuseppe Carrà","doi":"10.1192/j.eurpsy.2026.10174","DOIUrl":"10.1192/j.eurpsy.2026.10174","url":null,"abstract":"<p><strong>Background: </strong>Bipolar disorder (BD) involves immune-inflammatory dysregulation. This systematic review and meta-analysis assessed complete blood count-based inflammatory indices - neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), and platelet-to-lymphocyte (PLR) ratios - in BD versus healthy controls (HCs), major depressive disorder (MDD), and across BD mood states.</p><p><strong>Methods: </strong>Databases were searched through June 2025 for observational studies reporting at least one ratio in adults with BD and including as comparators either HCs, MDD, or within-BD mood-state contrasts (mania, bipolar depression, euthymia). Quality was appraised using BIOCROSS. Random-effects meta-analyses, sensitivity analyses, and meta-regressions were performed. GRADE was adapted to rate evidence certainty.</p><p><strong>Results: </strong>Fifty-one studies (38,309 participants) met the inclusion criteria. Compared to HCs, BD showed higher NLR (SMD = 0.44, <i>p</i> < 0.001) and MLR (SMD = 0.28, <i>p</i> < 0.001). In mania, NLR (SMD = 0.62, <i>p</i> < 0.001), MLR (SMD = 0.51, <i>p</i> < 0.001), and PLR (SMD = 0.18, <i>p</i> = 0.014) were all elevated versus HCs. Depression showed lower PLR (SMD = -0.14, <i>p</i> < 0.001) and euthymia higher NLR (SMD = 0.37, <i>p</i> = 0.002). Compared to MDD, BD had higher NLR (SMD = 0.21, <i>p</i> < 0.001) and MLR (SMD = 0.18, <i>p</i> < 0.001). Similarly, mania showed higher NLR (SMD = 0.53, <i>p</i> < 0.001) and MLR (SMD = 0.41, <i>p</i> < 0.001), while bipolar depression lower PLR (SMD = -0.15, <i>p</i> < 0.001). Mania had higher NLR (SMD = 0.32, <i>p</i> < 0.001), MLR (SMD = 0.32, <i>p</i> < 0.001), and PLR (SMD = 0.14, <i>p</i> = 0.028) than depression and higher MLR than euthymia (SMD = 0.44, <i>p</i> = 0.027), while depression had lower NLR (SMD = -0.28, <i>p</i> = 0.012) and PLR (SMD = -0.22, <i>p</i> < 0.001). Evidence certainty was mixed.</p><p><strong>Conclusions: </strong>NLR, MLR, and PLR emerge as non-specific, group-level correlates of immune-inflammatory dysregulation in BD, however offering limited discrimination between bipolar and unipolar depression. Notwithstanding their potential role as trait- and state-related markers in BD, further studies are needed to support translation into clinically useful biomarkers.</p>","PeriodicalId":520621,"journal":{"name":"European psychiatry : the journal of the Association of European Psychiatrists","volume":" ","pages":"e26"},"PeriodicalIF":6.7,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12978994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146215558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}