IntroductionThe association between cognitive functioning and mental health symptoms across the lifespan remains poorly understood. Understanding the directional associations between mental health and cognition is important as most gold-standard psychological therapies, such as cognitive-behaviour therapy, are cognitively demanding. Here, we examined the directionality of the association between cognitive and affective control with symptoms of depression and anxiety across the lifespan. Methods1002 participants (87.2 % female, age range: 11–89 years) completed self-report measures of depressive and anxiety symptoms and an affective backward digit span task thrice at 3-month intervals. Cross-lagged panel models (CLPMs) were used to model the longitudinal relationships between affective and cognitive control with depressive and anxiety symptoms. Multiple-group CLPMs were applied to test the model invariance between adolescents and adults. ResultsThe results supported a unidirectional relationship, where symptoms of depression and anxiety predicted impaired affective control across time points, over and above cognitive control. There was no evidence for affective or cognitive control capacity predicting emotional disorder symptomatology. In addition, multiple-group analysis revealed that depressive symptoms also predicted impaired cognitive control among adolescents only. There were no age-related differences in the associations between cognitive and affective control with anxiety symptoms. ConclusionsOur findings support depression and anxiety as antecedents, but not consequences, of impaired affective control, suggesting that timely management of emotional disorders, in particular for adolescents, is essential to prevent deterioration in cognitive functioning. The results further signal that practitioners should consider impaired affective control capacity in therapeutic contexts.

ObjectiveTo examine whether patients with obsessive-compulsive disorder (OCD) are adequately treated with pharmacotherapy before referral to a specialized center for OCD. MethodsWe performed a retrospective chart review of patients with OCD who were seen for intake at an academic outpatient center in The Netherlands between 2016 and 2023. We collected data on age, gender, illness severity using the Yale-Brown Obsessive-Compulsive Scale, duration of illness, comorbidity and past pharmacotherapy and psychotherapy. Following the international treatment guidelines, we calculated percentages of patients treated with one SSRI, two or more SSRIs, clomipramine and/or antipsychotic augmentation treatments. Using multiple regression, we analyzed if patient and illness characteristics influenced the adequacy of treatment. ResultsWe included 673 patients with an average YBOCS score of 27. 76 % had taken at least one SSRI, and 35 % at least two SSRIs before admission. Only 29 % received a high SSRI-dose and 4 % had taken at least two SSRIs in high dose. Clomipramine and antipsychotics augmentation had been taken by less than one-third of patients. Only 3 % of referred patients followed all guideline-recommended treatment steps. Although the vast majority of patients had received some form of psychotherapy, a minority had received exposure and response prevention treatment. Multiple regression showed that illness duration and having received psychotherapy were independent moderators of the adequacy of pharmacological treatment. ConclusionPatients with OCD are not being treated adequately according to the pharmacological guidelines. Poor pharmacological treatment may lead to increased duration of illness, suboptimal recovery and unnecessary societal costs. Further research could clarify barriers for patients and caregivers, and facilitate improvement of pharmacological treatment for OCS.

BackgroundIn response to the inherent critical incident exposures experienced by firefighters, various mental health education programs have been developed. The purpose of this study was to explore the perceptions of firefighters who took such programs to understand differences/similarities across these programs. MethodsWe recruited 14 participants, who had taken or delivered two or more programs for firefighters (Resilient Minds (RM), Road to Mental Readiness (R2MR), and Before Operational Stress (BOS)). Participants participated in semi-structured interviews, which explored information that they learned, recalled, used, and their preferences. Data was analysed using thematic analysis. ResultsParticipants believed that all programs had some shared teaching methods, goals, skills, and topics; however, each program had key focuses/distinctive features. RM was said to be largely group participation and focused on assisting yourself, peers, and citizens. R2MR and BOS was said to be largely lecture style with a focus on the self. 70 % of participants who took RM (n = 7) and one other course preferred RM due to the specificity of training to firefighters, more active teaching methods, and focus on practical skill development. Others (43 %) had no program preference. Participants suggest that a tiered approach to mental health education would benefit firefighters. ConclusionsAll programs were seen as helpful. Despite some congruency in goals and content, most firefighters preferred RM because the content was fire-specific, and the pedagogical approach was seen as more active and engaging. Program characteristics are important to facilitate appropriate program selection, as such, programs should be explicit about these aspects.

BackgroundThe BRIGhTMIND study was a double-blind RCT comparing repetitive transcranial magnetic stimulation at a standard simulation site (the “F3” location given by the International 10–20 system, F3-rTMS) versus connectivity-guided intermittent theta burst stimulation (cgiTBS) for treatment-resistant depression. This present study reports the acceptability, safety, and tolerability of F3-rTMS versus cgiTBS. MethodsThe present study used quantitative and qualitative methods. Two hundred fifty-four participants were included in the quantitative BRIGhTMIND acceptability and safety analysis (n = 126 F3-rTMS, n = 128 cgiTBS). Qualitative analysis included interviews for 15 participants (n = 7 F3-rTMS, n = 8 cgiTBS) and 582 written comments made by any participant randomised to the BRIGhTMIND trial regarding their experience of TMS and the study. Statistical analyses were used to explore differences between F3-rTMS and cgiTBS, as well as associations between acceptability, impression of change and safety. Qualitative data was analysed using an inductive thematic framework approach. OutcomesAcceptability, TMS benefits/negative effects and impression of improvement ratings did not differ across the two treatment protocols, with ratings maintained long-term (71.4 % rated TMS acceptable, 48.8 % indicated benefits of TMS outweighed negative effects and 52.2 % feeling somewhat or much better at 26 week follow-up n = 203). Impression of improvement was positively associated with acceptability and TMS benefits. Qualitative themes included participants' TMS experience, TMS response variability, and lay theories of effectiveness. Safety profiles were comparable between F3-rTMS and cgiTBS, with 74.5 % of participants (n = 190/254) experiencing at least one adverse event possibly, probably, or definitely related to TMS. The majority of adverse events were transient and mild, with a sizeable number requiring simple treatments or small adjustments to TMS intensity and coil positioning. The F3-rTMS group had a significantly greater proportion of participants that required small adjustments to TMS to tolerate treatment compared to the cgiTBS group. Serious adverse events were rare, with one serious event in each treatment arm possibly related to TMS (F3-rTMS- psychotic episode, cgiTBS-manic episode). ConclusionF3-rTMS and cgiTBS are comparably safe, tolerable and highly acceptable interventions for treatment-resistant depression. BRIGhTMIND systematically collected data from a large sample, providing evidence to meet the information needs of patients, clinicians and policy makers.

Individuals with eating disorders (EDs) often engage in exercise no matter potential negative long-term outcomes (e.g., weight loss, injury). Yet exercising may temporarily attenuate ED symptoms, but whether exercise also affects network structure and pairwise associations of ED symptoms remained unclear. We used a novel approach called Moderated Multilevel Graphical Vector Autoregression to estimate changes in psychopathology networks from before to after exercising in ecological momentary assessment data from 102 individuals with EDs across multiple days (M = 22.14, SD = 5.40; range: 6–22 days) at 4 times daily. Between-person and within-person temporal networks were computed, obtaining stable centrality coefficients for temporal networks only. In those, autoregressive effects of several symptoms, including binge-eating, overeating, or weighing oneself, were attenuated when participants previously exercised. Exercise mostly downregulated temporal effects of ED symptoms on other symptoms, including effects of binge eating and other compensatory behaviors on feeling guilty after the most recent meal, vomiting on weighing oneself, and overeating on fear of weight gain. Our study highlights the complex dynamic effects of exercise on ED symptoms in daily life and calls for novel studies investigating mechanisms of exercise to inform treatments targeting detrimental long-term effects of exercise in EDs.

Deer mice (Peromyscus maniculatus bairdii), a wildtype species native to North America, have been investigated for their spontaneous compulsive-like behaviour. The repetitive and persistence nature of three unique compulsive-like phenotypes in deer mice, i.e., high stereotypy (HS), large nesting behaviour (LNB) and high marble burying (HMB), are characterized by behavioural and cognitive rigidity. In this narrative review, we summarize key advances in the model's application to study obsessive-compulsive disorder (OCD), emphasizing how it may be used to investigate neurobiological and neurocognitive aspects of rigidity. Indeed, deer mice provide the field with a unique naturalistic and spontaneous model system of behavioural and cognitive rigidity that is useful for investigating the psychobiological mechanisms that underpin a range of compulsive-like phenotypes. Throughout the review, we highlight new opportunities for future research.

IntroductionMost studies on recovery of psychotic disorders focus on first-episode populations using premorbid and baseline data to predict recovery. However, many patients experience a long duration of illness and many factors are dynamic and change during life. AimsTo investigate factors strongest associated with clinical, societal and personal recovery, and recovery change scores in people with a long duration of illness using current data measured at the same assessment. MethodsLeast absolute shrinkage and selection operator regression analyses with cross-validation were used to identify the correlates of (changes in) clinical (N = 1054), societal (N = 1145) and personal recovery (N = 1187) in people with psychotic disorders. Subsequently, the identified associated factors were included in separate linear regression models, examining the associative strength of the identified variables and overall fit of the models. ResultsBetter clinical recovery was associated with better societal and personal recovery, experiencing fewer problems with daily functioning and social relations. Participants had a better societal recovery when they were employed, had fewer problems in daily life, less negative symptoms, had a life partner and better clinical recovery. Personal recovery was associated with greater satisfaction with life in general, no depressive mood and increased clinical recovery. Change scores were small with minimal fluctuation and no significant associations with change scores were detected. ConclusionsRecovery domains strongly influence each other in people with a long illness duration of psychosis and should therefore have an equally important focus during treatment.

In an era of high need for humanitarian assistance, humanitarian aid workers face increased exposure to potentially traumatic events and, correspondingly, a greater risk of psychological distress (e.g., anxiety, depression, posttraumatic stress disorder [PTSD], and burnout). Less studied among humanitarian workers, however, are other known correlates of trauma-exposure: complex PTSD, risk-taking behaviours, and suicidality. The current study examined levels of trauma exposure and rates of trauma-related mental health disorders, risk-taking behaviour, and levels of suicidality among a sample (N = 232) of humanitarian workers located across 52 countries. Multiple linear regression analysis was used to determine which demographic (i.e., sex, age, cadre, years working as an aid worker), psychological (i.e., social support, personality traits), and trauma-related (trauma exposure, complex posttraumatic stress disorder [CPTSD] symptoms, and dissociation) variables were uniquely associated with risk-taking behaviours and suicidality. Overall, 12.9 % (95 % CI = 8.5 %, 17.2 %) of humanitarian workers met the diagnostic requirements for PTSD, and 8.6 % (95 % CI = 5.0 %, 12.2 %) met requirements for CPTSD. Higher risk-taking behaviours were significantly associated with being male, an international worker, greater trauma exposure, extraversion, neuroticism, and CPTSD symptoms. Suicidality was significantly associated with being an international staff member and higher levels of dissociation. Results are consistent with previous studies citing a high risk of psychological distress among humanitarian workers. Humanitarian aid agencies have a duty of care to their workers - both professional and volunteer - and greater safeguarding measures are necessary to mitigate the risk to mental health brought on by humanitarian work-related stressors.