Noradrenergic activation in the central and peripheral nervous systems is a putative mechanism explaining the link between hypertension and affective disorders.

We investigated whether these stress-sensitive comorbidities may be dependent on basal noradrenergic activity and whether vascular responses to centrally acting stimuli vary according to noradrenergic activity.

We examined the relation of affective disorders and stress-mediated vascular responses to plasma concentrations of normetanephrine, a measure of noradrenergic activity, in subjects with primary hypertension (n = 100, mean ± s.d. age 43 ± 11 years, 54% male). The questionnaires Patient Health Questionnaire-9 (PHQ-9), 16-item Quick Inventory of Depressive Symptomatology-Self Report (QIDSSR-16) and Generalized Anxiety Disorder-7 (GAD-7) were used for evaluation of symptoms of depression and anxiety. Forearm blood flow (strain gauge plethysmography) was used to assess vascular responses to mental stress and to device-guided breathing (DGB), interventions that respectively increase or decrease noradrenergic activity in the prefrontal cortex and locus coeruleus.

Low mood and high anxiety were two- to threefold higher for hypertensive subjects in the highest compared with the lowest normetanephrine tertiles (each P < 0.005). Forearm vasodilator responses to mental stress and vasoconstrictor responses to DGB were attenuated in those with high compared with low normetanephrine (28.3 ± 21% v. 47.1 ± 30% increases for mental stress and 3.7 ± 21% v. 18.6 ± 15% decreases for DGB for highest versus lowest tertiles of normetanephrine, each P ≤ 0.01).

A hyperadrenergic state in hypertension is associated with mood disturbance and impaired stress-modulated vasomotor responses. This association may be mediated by chronic stress impinging on pathways regulating central arousal and peripheral sympathetic nerve activity.

Literature has shown that a significant minority of bereaved people are at risk of prolonged grief disorder (PGD). However, studies on its prevalence and correlates within Italian samples remain scarce.

This study aimed to explore the prevalence and correlates of PGD symptom severity among 1603 bereaved Italian adults.

Self-reported data on PGD, suicidal ideation, depression, anxiety and stress were gathered. Descriptive characteristics and bereavement-related information were also collected.

Among participants who lost a close other person at least 12 months prior, the prevalence of probable PGD and severe suicidal ideation was 7.7% (n = 104) and 0.7% (n = 9), respectively. The overall prevalence of severe suicidal ideation in the sample was 4.5%, rising to 18.2% among those with probable PGD. The probable PGD diagnosis showed minimal agreement with reported depression (phi = 0.25), anxiety (phi = 0.19), and stress (phi = 0.26), suggesting potentially limited overlap and supporting their distinctiveness. The severity of PGD symptoms was significantly positively associated with older age and suicidal ideation, and negatively associated with lower educational background and time since loss. PGD severity also varied by kinship, cause of death and place of residence. Specifically, bereaved individuals who lost a grandparent due to natural causes associated with ageing and lived in small- to medium-sized cities reported lower PGD symptom severity relative to others.

These findings contribute to the understanding of PGD symptomatology in bereaved individuals in Italy, although the results may not generalise to the entire Italian population.

Depressive symptoms are highly prevalent in first-episode psychosis (FEP) and worsen clinical outcomes. It is currently difficult to determine which patients will have persistent depressive symptoms based on a clinical assessment. We aimed to determine whether depressive symptoms and post-psychotic depressive episodes can be predicted from baseline clinical data, quality of life, and blood-based biomarkers, and to assess the geographical generalizability of these models.

Two FEP trials were analyzed: European First-Episode Schizophrenia Trial (EUFEST) (n = 498; 2002–2006) and Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) (n = 404; 2010–2012). Participants included those aged 15–40 years, meeting Diagnostic and Statistical Manual of Mental Disorders IV criteria for schizophrenia spectrum disorders. We developed support vector regressors and classifiers to predict changes in depressive symptoms at 6 and 12 months and depressive episodes within the first 6 months. These models were trained in one sample and externally validated in another for geographical generalizability.

A total of 320 EUFEST and 234 RAISE-ETP participants were included (mean [SD] age: 25.93 [5.60] years, 56.56% male; 23.90 [5.27] years, 73.50% male). Models predicted changes in depressive symptoms at 6 months with balanced accuracy (BAC) of 66.26% (RAISE-ETP) and 75.09% (EUFEST), and at 12 months with BAC of 67.88% (RAISE-ETP) and 77.61% (EUFEST). Depressive episodes were predicted with BAC of 66.67% (RAISE-ETP) and 69.01% (EUFEST), showing fair external predictive performance.

Predictive models using clinical data, quality of life, and biomarkers accurately forecast depressive events in FEP, demonstrating generalization across populations.

About one-third of South African women have clinically significant symptoms of postpartum depression (PPD). Several socio-demographic risk factors for PPD exist, but data on medical and obstetric risk factors remain scarce for low- and middle-income countries and particularly in sub-Saharan Africa. We aimed to estimate the proportion of women with PPD and investigate socio-demographic, medical and obstetric risk factors for PPD among women receiving private medical care in South Africa (SA).

In this longitudinal cohort study, we analysed reimbursement claims from beneficiaries of an SA medical insurance scheme who delivered a child between 2011 and 2020. PPD was defined as a new International Classification of Diseases, 10th Revision diagnosis of depression within 365 days postpartum. We estimated the frequency of women with a diagnosis of PPD. We explored several medical and obstetric risk factors for PPD, including pre-existing conditions, such as HIV and polycystic ovary syndrome, and conditions diagnosed during pregnancy and labour, such as gestational diabetes, pre-term delivery and postpartum haemorrhage. Using a multivariable modified Poisson model, we estimated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for factors associated with PPD.

Of the 47,697 participants, 2,380 (5.0%) were diagnosed with PPD. The cumulative incidence of PPD increased from 0.8% (95% CI 0.7–0.9) at 6 weeks to 5.5% (5.3–5.7) at 12 months postpartum. PPD risk was higher in individuals with history of depression (aRR 3.47, 95% CI [3.14–3.85]), preterm delivery (1.47 [1.30–1.66]), PCOS (1.37 [1.09–1.72]), hyperemesis gravidarum (1.32 [1.11–1.57]), gestational hypertension (1.30 [1.03–1.66]) and postpartum haemorrhage (1.29 [0.91–1.85]). Endometriosis, HIV, gestational diabetes, foetal stress, perineal laceration, elective or emergency C-section and preeclampsia were not associated with a higher risk of PPD.

The PPD diagnosis rate was lower than anticipated, based on the PPD prevalence of previous studies, indicating a potential diagnostic gap in SA’s private sector. Identified risk factors could inform targeted PPD screening strategies.

Lesbian, gay, and bisexual (LGB) individuals are more than twice as likely to experience anxiety and depression compared with heterosexuals. Minority stress theory posits that stigma and discrimination contribute to chronic stress, potentially affecting clinical treatment. We compared psychological therapy outcomes between LGB and heterosexual patients by gender.

Retrospective cohort data were obtained from seven NHS talking therapy services in London, from April 2013 to December 2023. Of 100,389 patients, 94,239 reported sexual orientation, 7,422 identifying as LGB. The primary outcome was reliable recovery from anxiety and depression. Secondary outcomes were reliable improvement, depression and anxiety severity, therapy attrition, and engagement. Analyses were stratified by gender and employed multilevel regression models, adjusting for sociodemographic and clinical covariates.

After adjustment, gay men had higher odds of reliable recovery (OR: 1.23, 95% CI: 1.13–1.34) and reliable improvement (OR: 1.16, 95% CI: 1.06–1.28) than heterosexual men, with lower attrition (OR: 0.88, 95% CI: 0.80–0.97) and greater reductions in depression (MD: 0.51, 95% CI: 0.28–0.74) and anxiety (MD: 0.45, 95% CI: 0.25–0.65). Bisexual men (OR: 0.67, 95% CI: 0.54–0.83) and bisexual women (OR: 0.84, 95% CI: 0.77–0.93) had lower attrition than heterosexuals. Lesbian and bisexual women, and bisexual men, attended slightly more sessions (MD: 0.02–0.03, 95% CI: 0.01–0.04) than heterosexual patients. No other differences were observed.

Despite significant mental health burdens and stressors, LGB individuals had similar, if not marginally better, outcomes and engagement with psychological therapy compared with heterosexual patients.

Auditory hallucinations (hearing voices in the absence of physical stimuli) are present in clinical conditions, but they are also experienced less frequently by healthy individuals. In the non-clinical population, auditory hallucinations are described more often as positive and not intrusive; indeed, they have received less attention.

The present study explores the phenomenology of non-clinical auditory hallucinations and their possible relationship with religiosity.

Starting from previous findings suggesting that non-clinical auditory hallucinations are often described as a gift or a way to be connected with ‘someone else’, we administered standardised questionnaires to quantify proneness to experiencing auditory hallucinations, religiosity and anxiety/depression scores.

Regression analysis carried out using an auditory hallucinations, index as the dependent variable on a final sample of 680 responders revealed that a total of 31% of the variance was explained by a five-steps model including demographic characteristics (i.e. being young, a woman and a non-believer) and negative (e.g. being afraid of otherworldly punishments) and positive (e.g. believing in benevolent supernatural forces) components of religiosity, anxiety and depression. Crucially, compared with believers, non-believers revealed higher scores in depression, anxiety and in a specific questionnaire measuring proneness to auditory hallucinations.

Results suggests that religiosity acts as a potential protective factor for proneness to paranormal experiences, but a complex relationship emerges between religious beliefs, mood alterations and unusual experiences.

Previous studies have found substantial costs to be associated with depression and insomnia (as separate entities).

To estimate healthcare service use and costs associated with insomnia in Australian adults experiencing subthreshold depression or major depressive disorder (MDD).

Healthcare service use and productivity loss were extracted from the cross-sectional 2020–2022 National Survey of Mental Health and Wellbeing data. Insomnia and depression were assessed using questions aligned with DSM-IV criteria. Weighted two-part models were used to calculate average annual costs (presented as 2021–2022 Australian dollars).

The analytical sample meeting subthreshold depression or MDD criteria consisted of 1331 adults (aged 40.5 ± 16.1 years; 59% female; insomnia prevalence: 84%). Healthcare service use and healthcare costs between individuals with insomnia and those without insomnia were similar in the MDD group. For subthreshold depression, healthcare costs were significantly higher for those with insomnia compared with those without insomnia (Δ = A$990, 95% CI: 234 to 1747), but healthcare resource use was not significantly different. Productivity loss among employed people and reduced employment were much greater (although the difference did not reach statistical significance) in adults with insomnia compared with those without insomnia.

Healthcare resource use among adults with depression was similar in those with and without insomnia. However, higher healthcare costs associated with insomnia were observed in adults with subthreshold depression. Further studies are encouraged to understand the nature of the increased healthcare cost associated with insomnia in individuals with subthreshold depression and to optimise healthcare service use in people with comorbid depression and insomnia.

There are few economic evaluations of adjunctive psychosocial therapies for bipolar disorder.

Estimate the cost–utility of in-person psychosocial therapies for adults with bipolar disorder added to treatment as usual (TAU), from an Australian Government perspective.

We developed an economic model, estimating costs in 2021 Australian dollars (A$) and outcomes using quality-adjusted life-years (QALYs) gained and disability-adjusted life-years (DALYs) averted. The model compared psychoeducation, brief psychoeducation, carer psychoeducation, cognitive–behavioural therapy (CBT) and family therapy when added to TAU (i.e. pharmacotherapy) over a year for adults (18–65 years) with bipolar disorder. The relative risk of relapse was sourced from two network meta-analyses and applied to the depressive phase in the base case. Probabilistic sensitivity analysis and one-way sensitivity analyses were conducted, assessing robustness of results.

Carer psychoeducation was preferred in the base case when the willingness-to-pay (WTP) threshold is below A$1000 per QALY gained and A$1500 per DALY averted. Brief psychoeducation was preferred when WTP is between A$1000 and A$300 000 per QALY gained and A$1500 and A$450 000 per DALY averted. Family therapy was only preferred at WTP thresholds above A$300 000 per QALY gained or A$450 000 per DALY averted. In sensitivity analyses, brief psychoeducation was the preferred therapy. Psychoeducation and CBT were dominated (more costly and less effective) in base-case and sensitivity analyses.

Carer and brief psychoeducation were found to be the most cost-effective psychosocial therapies, supporting use as adjunctive treatments for adults with bipolar disorder and their families in Australia.

Depression is closely associated with abnormalities in brain function. Traditional static functional connectivity analyses offer limited insight into the temporal variability of brain activity. Recent advances in dynamic analyses enable a deeper understanding of how depression relates to temporal fluctuations in brain activity.

This study utilized a large resting-state functional magnetic resonance imaging dataset (N = 696) to examine the association between brain dynamics and depression. Two complementary approaches were employed. Hidden Markov modeling (HMM) was used to identify discrete brain states and quantify their temporal switching patterns; temporal variability was computed within and between large-scale functional networks to capture time-varying fluctuations in functional connectivity.

Depression scores were positively associated with switching rate and negatively associated with maximum fractional occupancy. Furthermore, depression scores were significantly associated with greater temporal variability both within and between networks, with particularly strong effects observed in the default mode network, ventral attention network, and frontoparietal network. Together, these findings suggest that individuals with higher depression scores exhibit more unstable brain dynamics.

Our findings reveal that individuals with higher depression levels exhibit greater instability in brain state transitions and increased temporal variability in functional connectivity across large-scale networks. This instability in brain dynamics may contribute to difficulties in emotion regulation and cognitive control. By capturing whole-brain temporal patterns, this study offers a novel perspective on the neural basis of depression.