Mental Disorders Research Articles

Frequency and clinical associations of common mental disorders in adults with high-grade glioma-A multicenter study.

One third of adults with cancer suffer from common mental disorders in addition to their malignant disease. However, it is unknown whether this proportion is the same in patients who have brain tumors and which factors modulate the risk for psychiatric comorbidity. In a multicenter study, patients with high-grade glioma at 13 neurooncology clinics were enrolled consecutively and interviewed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (SCID) to diagnose common mental disorders. Predictors of psychiatric comorbidity were investigated using binary logistic regression. Six hundred ninety-one patients were interviewed. The proportion of patients who had mental disorders was 31% (95% confidence interval [CI], 28%-35%). There was evidence for an association of psychiatric comorbidity with the following factors: younger age (odds ratio [OR], 1.9; 95% CI, 1.1-3.4; p = .04), stable disease versus complete remission (OR, 1.7; 95% CI, 1.1-2.8; p = .04), lower income (OR, 1.7; 95% CI, 1.0-2.8; p = .04), living alone (OR, 1.6; 95% CI, 1.0-2.6; p = .05), fatigue (OR, 1.6; 95% CI, 1.1-2.4; p = .03), and impaired cognitive functioning (OR, 2.3; 95% CI, 1.5-3.6; p < .01). There was no evidence for independent effects of gender, histology, affected lobe, time since diagnosis, or employment status. Approximately one third of adult patients with high-grade glioma may suffer from a clinically relevant common mental disorder, without notable disparity between the genders. In particular, clinicians should pay attention to possible comorbidities for cases in which patients exhibit compromised subjective cognitive function, are younger than 50 years, maintain a state of stable disease, or live alone.

Does becoming amother make you ill?-Frequency of mental health diagnoses in postpartum mothers compared to childless women based on BARMER billing data

Around 700,000 children are born in Germany every year. Many mothers are under great pressure and strain due to prevailing role models and social expectations. Up to 15% of mothers in Germany are said to be affected by postpartum depression. The available studies, however, are mainly based on surveys, are older and vary widely in their results. This study brings another data source into play and asks how frequently diagnoses of mental illness are found in mothers after childbirth compared to childless women in the billing data of alarge health insurance company. Aretrospective matched cohort study was conducted with health insurance data from 2017-2022, comparing mothers and childless women with the same age and the same medical and socioeconomic characteristics with regard to depression, exhaustion and burnout, and anxiety and stress disorder outcomes. The modelling was carried out using Poisson regression. Mothers were less likely than childless women to receive adiagnosis of amental disorder within five years after childbirth. In the long run, however, the frequency of diagnoses equalised. Becoming amother does not lead to more diagnoses of mental disorders compared to childless women, at least in the first five years after giving birth. However, the interpretation of the data is difficult. Possible influence of external factors on making the diagnosis is not seen in the data, such as the social expectation of a"happy mother" or achange in the utilisation of medical care due to maternity.

Predictors and Outcomes of Mental Health Conditions Among Patients with Colorectal Cancer.

Mental health (MH) conditions are common in patients with colorectal cancer (CRC) due to the unique challenges these patients encounter. The primary aim was to investigate predictors of new onset MH conditions after a diagnosis of CRC and determine the association of new MH conditions on survival. A single institution, retrospective study was conducted. A multivariable Fine-Gray competing risks model was used to describe the primary study outcome of new MH diagnosis in patients at least 18years of age with CRC. Survival was modeled using Cox proportional hazards regression with a time-varying covariate for new MH diagnosis. 456 patients were identified for inclusion, with 16% developing a new MH condition and 29% dying during follow-up. A new MH condition was more likely among non-Hispanic white patients compared to non-Hispanic black and were less likely among those who are male or had a pre-cancer MH condition. The onset of a new MH condition was associated with a threefold decrease in survival. In addition, having a pre-cancer MH condition decreased survival nearly twofold. Our findings emphasize the importance of new-onset MH in patients after CRC diagnosis. Standardized screenings may alleviate some of the MH burden that patients with CRC experience in addition to potentially improving the overall health of patients. MH conditions may impact not only CRC outcomes but may direct future studies analyzing the risks of new onset MH conditions in other types of cancers, further expanding the importance of psychiatric support in patients with cancer.

Biomarkers Unveiling the Interplay of Mind, Nervous System, and Immunity.

The field of psychoneuroimmunology has significantly expanded in the last few decades and so has our understanding of the bidirectional communications between the immune and central nervous systems (CNS). There is a preponderance of evidence supporting the fact that immunological pathways and neuroinflammation are involved in the pathophysiology of multiple neurological and mental health conditions. In this chapter, we have explored various neuroimmunological biomarkers involved in these pathways, responsible for developing and perpetuating different neuropsychiatric disorders. This chapter will examine inflammatory biomarkers and those associated with intestinal homeostasis, blood-brain barrier (BBB) permeability, glial cells, and neuronal injury. A range of tests has been developed to evaluate these markers, and we will also explore the existing methods currently employed for these techniques. Further studies of these inflammatory and neurological markers are needed to support their utility as biomarkers for diagnosis and prognosis and to inform treatment strategies for various neuropsychiatric disorders.

Altered expression of Csnk1a1p in Autism Spectrum Disorder in Iranian population: case-control study.

Over the past decade, substantial scientific evidence has showed that long non-coding RNAs (lncRNAs) are extensively expressed and play a crucial role in gene modulation through a diverse range of transcriptional, and post-transcriptional mechanisms. Recent discoveries have emphasized the involvement of lncRNAs in maintaining cellular homeostasis and neurogenesis in the brain. Accumulating reports identified dysregulated lncRNAs associated with psychiatric disorders, including autism. In this study, we examined the expression levels of DISC2, Linc00945, Foxg1-as1, Csnk1a1p, and Evf2 lncRNAs in blood samples from 21 clinically diagnosed autistic patients based on the Diagnostic and Statistical Manual of Mental Disorders criteria-5th edition (DSM-5), compared to age, sex, and ethnically-matched 25 healthy individuals. RNA extraction and cDNA synthesis were performed, followed by real-time PCR for quantification of lncRNAs expression levels. Receiver operating characteristic (ROC) curve analysis was used to evaluate biomarker potential. Additionally, we investigated the correlation between gene expression levels and autism comorbidities. Our results showed a significant decrease in Csnk1a1p expression in patients with autism spectrum disorder (ASD) compared to healthy children (P value = 0.0008). ROC curve analysis indicated that Csnk1a1p expression levels could effectively discriminate patients from healthy controls (AUC = 0.837, P value = 0.000284). No significant differences were observed between Csnk1a1p expression levels and comorbidity with ADHD or intellectual disability (p-value > 0.05). Based on these findings, Csnk1a1p may play a significant role in autistic patients and could serve as a potential biomarker for diagnostic and predictive purposes, as well as a therapeutic target.

Personality, Aging, and Alzheimer's Disease: Implications for Psychoneuroimmunology and Personalized Medicine.

Psychoneuroimmunology (PNI) advancements may revolutionize personalized medicine by identifying systemic biomarkers that enhance diagnosis and treatment. Inflammatory pathways connect personality traits with cognitive performance, aging-related disorders, and mortality risks. Studies have demonstrated the critical interactions between personality and various biological systems like the hypothalamic-pituitary-adrenal (HPA) axis. The gut-brain axis also affects behaviors and psychological states in older adults, with specific gut microbiota influencing cognition, mood, and personality. These findings underscore the practical implications of understanding personality-biology interactions. They can support preventive and personalized medicine for aging-associated disorders. Specifically, personality changes are prevalent in Alzheimer's disease (AD) patients, impacting clinical management and caregiver stress. Non-cognitive factors, such as personality traits and psychiatric symptoms, may serve as early markers of AD. Traits like high Neuroticism and low Openness can predict initial AD stages, often before a formal diagnosis. Personality alterations in AD are also linked to cerebrospinal fluid (CSF) and vascular imaging biomarkers, which can track AD pathology and serve as predictors. Dynamic personality assessment can aid in timely diagnosis, monitoring progression, and evaluating treatmentsof AD. Understanding personality traits is crucial for predicting burnout, lifespan, and intervention success. Integrating personality and PNI biomarkers into patient profiles will support the development of personalized and systems medicine.

Personality and Psychoneuroimmunology: A Systems Biology Perspective.

Research in psychoneuroimmunology (PNI) underscores the intricate connections within the "whole mind-body system." Personality plays a pivotal role, with specific traits linked to stress influencing neural behavior and psychophysiological disorders. Gene expression networks associated with personality affect neuronal plasticity, epigenetic processes, and adaptive behaviors, highlighting the importance of systems biology mechanisms. Systemic inflammation correlates with key personality traits. Understanding the roles of inflammatory and oxidative biomarkers in personality traits and disorders can help identify diagnostic and therapeutic targets for various diseases. Neurobiological features contribute to our understanding of personality disorders and related conditions. Personality traits are linked to distributed neuroendocrine networks, particularly the hypothalamic-pituitary-adrenal (HPA) axis, rather than localized brain areas. Correlations have also been identified between personality traits and thyroid hormones. Disrupted hypothalamic-pituitary-thyroid (HPT) axis functions may be associated with disease severity, depression, and distress, highlighting the need for comprehensive endocrinological and psychopathological evaluations. The gut-brain axis influences personality traits, emotions, stress, and social behaviors. Altered gut microbiota is common in psychiatric conditions, suggesting potential treatments targeting the microbiota. Chronic stress impacts cognitive functions and correlates with personality and mental health, emphasizing the need for comprehensive, multi-dimensional patient profiles for effective prevention and therapy. A biopsychosocial model integrating personality traits will advance personalized and systems medicine.

Alterations of gray matter asymmetry in internet gaming disorder.

Structural asymmetry is a subtle but pervasive property of the human brain, which has been found altered in various psychiatric and neurocognitive disorders. However, little is known regarding potential alterations of structural asymmetry underlying internet gaming disorder (IGD). Therefore, this study aimed to investigate the structural features of gray matter asymmetry in IGD. High-resolution structural magnetic resonance imaging data were collected from 104 individuals with IGD and 104 recreational game users (RGUs). We applied a whole-brain voxel-based asymmetry (VBA) approach to determine the asymmetrical aberrations of gray matter in relation to IGD. Furthermore, the local abnormalities of structural asymmetry were employed as features to examine the effect of classification using a support vector machine (SVM). The results indicated that individuals with IGD as compared to RGUs showed asymmetrical alterations of gray matter in the medial prefrontal cortex (mPFC), orbitofrontal cortex, precuneus, middle temporal gyrus, superior parietal lobule and inferior temporal gyrus, regions implicated in hedonic motivation, self-reflection, information integration and visuospatial attention processing. Moreover, these atypical asymmetrical features can distinguish IGD subjects from RGUs with high accuracy. These results suggested that disrupted structural asymmetry of motivational reward, visuospatial and default mode circuits might be potential biomarkers for identifying pathological gaming dependence. These findings extended our understanding of structural underpinnings of IGD and provided new insights for developing effective interventions to alleviate compulsive gaming usage.

Concepts of Implied Interventions for Treating Depression: A Comprehensive Review

Hence, answering the question how a person is able to secure and maintain lifelong good mood would facilitate in deceiphering depression; a common and etiologically complex multi factorial mental health disorder which affects over 264 m individuals worldwide with tremendous effect on morbidity and economic burden. Here, our study results from more than 100 experimental and observational studies with respect to effective treatments for depression across three main groups such as: Pharmacological interventions, Psychotherapeutic approaches, and Emerging digital health solutions have been effective as implied interventions to tret Depression. While antidepressants, particularly selective serotonergic reuptake inhibitors (SSRIs), continued as the bedrock of therapy; Novel therapies with Ketamine have shown potential for treatment failure cases. Large-scale studies of Psychotherapeutic methods, such as Cognitive Behavioural Therapy (CBT) and Interpersonal Therapy (IPT), show high effectiveness rates in most populations. Digital health interventions, such as e-therapy, were potential alternatives and particularly suitable for patients in rural areas. Integrating these modalities will allow clinicians to offer more individualised and tailored care. This review provided an overview of the mechanisms of each intervention for depression as a clinical aid to inform decisions by clinicians as well as policy makers seeking to improve treatment pathways for individuals with Mood disorders and Depression.

Acute Behavioral and Neurochemical Effects of Sulpiride in Adult Zebrafish.

Affective and psychotic disorders are highly prevalent and severely debilitating mental illnesses that often remain untreated or treatment-resistant. Sulpiride is a common antipsychotic (neuroleptic) drug whose well-established additional (e.g., antidepressant) therapeutic effects call for further studies of a wider spectrum of its CNS effects. Here, we examined effects of acute 20-min exposure to sulpiride (50-200mg/L) on anxiety- and depression-like behaviors, as well as on brain monoamines, in adult zebrafish (Danio rerio). Overall, sulpiride exerted overt anxiolytic-like effects in the novel tank test and showed tranquilizing-like effects in the zebrafish tail immobilization test, accompanied by lowered whole-brain dopamine and its elevated turnover, without affecting serotonin or norepinephrine levels and their turnover. Taken together, these findings support complex behavioral pharmacology of sulpiride in vivo and reconfirm high sensitivity of zebrafish-based screens to this and, likely, other related clinically active neuroleptics.

Sex-specific GABAergic microcircuits that switch vulnerability into resilience to stress and reverse the effects of chronic stress exposure.

Clinical and preclinical studies have identified somatostatin (SST)-positive interneurons as critical elements that regulate the vulnerability to stress-related psychiatric disorders. Conversely, disinhibition of SST neurons in mice results in resilience to the behavioral effects of chronic stress. Here, we established a low-dose chronic chemogenetic protocol to map these changes in positively and negatively motivated behaviors to specific brain regions. AAV-hM3Dq-mediated chronic activation of SST neurons in the prelimbic cortex (PLC) had antidepressant drug-like effects on anxiety- and anhedonia-like motivated behaviors in male but not female mice. Analogous manipulation of the ventral hippocampus (vHPC) had such effects in female but not male mice. Moreover, the activation of SST neurons in the PLC of male mice and the vHPC of female mice resulted in stress resilience. Activation of SST neurons in the PLC reversed prior chronic stress-induced defects in motivated behavior in males but was ineffective in females. Conversely, activation of SST neurons in the vHPC reversed chronic stress-induced behavioral alterations in females but not males. Quantitation of c-Fos+ and FosB+ neurons in chronic stress-exposed mice revealed that chronic activation of SST neurons leads to a paradoxical increase in pyramidal cell activity. Collectively, these data demonstrate that GABAergic microcircuits driven by dendrite targeting interneurons enable sex- and brain-region-specific neural plasticity that promotes stress resilience and reverses stress-induced anxiety- and anhedonia-like motivated behavior. The data provide a rationale for the lack of antidepressant efficacy of benzodiazepines and superior efficacy of dendrite-targeting, low-potency GABAA receptor agonists, independent of sex and despite striking sex differences in the relevant brain substrates.

Endocannabinoid dysregulation and PTSD in urban adolescents: Associations with anandamide concentrations and FAAH genotype.

The endocannabinoid system, which regulates fear- and anxiety-related behaviors, is dysregulated in adults with posttraumatic stress disorder (PTSD), as indicated by higher circulating anandamide (AEA) concentrations. The C385A (rs324420) polymorphism in the fatty acid amide hydrolase (FAAH) gene, which catabolizes AEA, is linked to higher AEA concentrations and greater PTSD symptoms in adults. Given that adolescence is a critical period during which trauma and psychiatric disorders emerge, understanding this relationship in youth is essential. This study examines PTSD symptoms, AEA concentrations, and FAAH genotype in a diverse adolescent sample. This study included 102 Detroit-area adolescents (M ± SD = 13.33 ± 2.21 years, 54.9% female) and their parents/guardians. The sample consisted of 40.2% White Non-Hispanic, 34.3% Black Non-Hispanic, 6.9% White Hispanic, 4.9% Asian/Pacific Islander, and 12.7% Biracial adolescents. Trauma exposure and PTSD symptoms were assessed using the UCLA PTSD Reaction Index for DSM-5. Plasma concentrations of AEA were measured by liquid chromatography-tandem mass spectrometry, and FAAH genotype was determined from saliva samples and high-throughput screening. The majority (90%) of adolescents reported trauma exposure, and 20% met PTSD criteria. Higher AEA concentrations were associated with more severe PTSD symptoms (p = 0.009), especially hyperarousal. The FAAH A-allele (present in 52.5% of participants) was associated with higher AEA concentrations (2.11 ± 0.69 pmol/ml, p = 0.013) and greater PTSD severity (22.65 ± 15.931, p = 0.027), particularly those with the reexperiencing cluster, compared to the CC genotype (1.79 ± 0.66 pmol/ml and 15.87 ±+ 13.043, respectively). Elevated AEA concentrations and the FAAH A-allele were associated with greater PTSD symptom severity in urban adolescents. These findings suggest endocannabinoid dysregulation may play a role in adolescent PTSD, highlighting the need for further research and targeted interventions.

Transcriptome signatures of the medial prefrontal cortex underlying GABAergic control of resilience to chronic stress exposure.

Analyses of postmortem human brains and preclinical studies of rodents have identified somatostatin (SST)-positive, dendrite-targeting GABAergic interneurons as key elements that regulate the vulnerability to stress-related psychiatric disorders. Conversely, genetically induced disinhibition of SST neurons (induced by Cre-mediated deletion of the γ2 GABAA receptor subunit gene selectively from SST neurons, SSTCre:γ2f/f mice) results in stress resilience. Similarly, chronic chemogenetic activation of SST neurons in the medial prefrontal cortex (mPFC) results in stress resilience but only in male and not in female mice. Here, we used RNA sequencing of the mPFC of SSTCre:γ2f/f mice to characterize the transcriptome changes underlying GABAergic control of stress resilience. We found that stress resilience of male but not female SSTCre:γ2f/f mice is characterized by resilience to chronic stress-induced transcriptome changes in the mPFC. Interestingly, the transcriptome of non-stressed SSTCre:γ2f/f (stress-resilient) male mice resembled that of chronic stress-exposed SSTCre (stress-vulnerable) mice. However, the behavior and the serum corticosterone levels of non-stressed SSTCre:γ2f/f mice showed no signs of physiological stress. Most strikingly, chronic stress exposure of SSTCre:γ2f/f mice was associated with an almost complete reversal of their chronic stress-like transcriptome signature, along with pathway changes suggesting stress-induced enhancement of mRNA translation. Behaviorally, the SSTCre:γ2f/f mice were not only resilient to chronic stress-induced anhedonia - they also showed an inversed, anxiolytic-like behavioral response to chronic stress exposure that mirrored the chronic stress-induced reversal of the chronic stress-like transcriptome signature. We conclude that GABAergic dendritic inhibition by SST neurons exerts bidirectional control over behavioral vulnerability and resilience to chronic stress exposure that is mirrored in bidirectional changes in the expression of putative stress resilience genes, through a sex-specific brain substrate.

Psychometric properties of the Maladjustment Inventory in a Spanish clinical and student sample.

The various systems of diagnosis and classification of mental disorders underline the need to evaluate the interference caused by the different disorders in a person's daily life. The Maladjustment Inventory (MI) evaluates the impairment in the individual's functioning in a brief and self-applied way, through six items. The objective of this research was to explore the psychometric properties of the MI scores through two studies, one with a Spanish clinical sample (Study 1) and another with a Spanish university students' sample (Study 2). The total sample was made up of 928 participants (81.1% women, n = 495 clinical sample). Descriptive analyses, exploration of internal structure and reliability, exploratory and confirmatory factor analyses, relationship with other variables (quality of life, anxiety, depression, neuroticism and extraversion), and percentiles and T-scores were performed. The results showed good psychometric properties of the MI, with a good fit model for one factor solution in both samples, Cronbach's alpha coefficient of 0.84-88, and evidence of validity based on the relationship with other variables. The good psychometric properties of the MI, together with its brevity, make it a recommended instrument for the evaluation of interference in both clinical and research contexts.

Semantic-spatial feature-fused cortical surface parcellation: a scale-unified spatial learning network with boundary contrastive loss.

The cortical surface parcellation provides prior guidance for studying mental disorders and human cognition. Graph neural networks (GNNs) have gained popularity in this task to preserve its spatial structure. However, previous GNNs struggled to effectively exploit the information contained in the complex spatial structure of the cortical surface and generally encountered an uneven node distribution issue. Meanwhile, labeling boundary nodes was also identified as a widespread problem in this task. Accordingly, this paper develops a scale-unified spatial learning network with a boundary contrastive loss (SSLNet) for cortical surface parcellation. Its core is the scale-unified spatial learning module. It devises neighbor feature extraction and aggregation strategies by fully integrating spatial coordinates and semantic structure to learn effective spatial features of local neighborhoods. More importantly, spatial scale unification is incorporated into this module to mitigate the negative effect on spatial learning caused by node distribution differences among local areas. Additionally, a universal boundary contrastive loss is constructed, enhancing the feature discriminability of boundary nodes by constraining them to be close to the same class nodes and apart from different class nodes in the feature space. It considerably improves boundary performance without increasing parameters or changing the network structure. Experiments regarding public Mindboggle demonstrate that the dice score and accuracy of SSLNet achieve and , respectively, surpassing existing methods.

Additive effect of clove essential oil combined with hydrogen inhalation improves psychological harm caused by lipopolysaccharide in mice.

Psychological anxiety and depression, as well as memory impairment, are frequently linked to inflammation. Clove essential oil (CEO) administration and hydrogen (H2) inhalation have been proven to have anti-inflammatory and alleviating effects on related psychological disorders in the past. The current study investigated the potential to improve anxiety-like behaviors and cognitive function by a combination of CEO and H2 treatment. The mice were administered lipopolysaccharide (LPS) to induce inflammation and oxidative stress response and cause psychological disorders. Using this animal model, we conducted experiments to test whether essential oil and H2 inhalation could improve the psychological damage in behavior caused by LPS. Subsequently, elevated plus maze (EPM), forced swimming test (FST), and passive avoidance (PA) test were performed for evaluation of mice anxiety, depression, and response to electric shock, respectively. Furthermore, the biochemical analysis was used to examine the expression levels of inflammatory and oxidative stress markers. Our results showed that CEO administration and H2 inhalation alone or in combination positively improved inflammation-induced anxiety, depression, and cognitive memory deficits in the mice. In the single treatment groups, CEO demonstrated better results than H2 inhalation in the elevated plus maze, forced swimming, and passive avoidance tests, while combined treatment with both provided a further improved enhancement effect. Biochemical analysis of the cerebral cortex revealed that CEO and H2 therapy reversed the LPS-induced inflammation and oxidative stress response. Our results suggest that a combination of CEO and H2 has the potential to treat psychological disorders or neuropsychiatric disorders.

On-body sensing technologies and signal processing techniques in addressing safety of human machine collaboration

AbstractSafety is a challenge in human machine collaboration despite of the advantages in achieving efficiency, cost reduction and productivity in a collaborative scenario between human and machine/robot. During collaboration with machines, the user might not be able to follow the collaborative tasks as expected due to the cognitive burden causing potential safety concerns such as collision. Addressing this challenge, the aim of this paper is to explore the potential of on-body sensing systems in study of user experience and the psychological condition during the collaboration between machines and human. As the psychological condition is reflected in physiological signals, sensing technologies and signal processing techniques to extract features from physiological signals are explored with applicability in human machine collaboration scenarios. An experiment is designed utilising an industrial collaborative robot arm while quantitative and qualitative data is gathered for this purpose exploring the problem to study user experience and impact of mental strain and cognitive workload on user performance and experience during human machine collaboration. Results show that an adaptive machine to user experience measured by on-body sensing systems during the collaboration has the potential to address safety in human machine collaboration while improving performance and user experience.

Maternal Mental Health: Addressing Postpartum Depression and Anxiety in Different Socioeconomic Contexts

Maternal mental health, particularly postpartum depression (PPD) and anxiety, is a critical public health concern affecting women globally. The postpartum period presents unique challenges, as new mothers navigate hormonal changes, caregiving responsibilities, and societal pressures. The prevalence of postpartum depression and anxiety is influenced by socioeconomic factors, and women from lower socioeconomic backgrounds often face a higher risk due to limited access to mental health resources, social support, and financial instability. This review highlights recent advances in understanding postpartum mental health disorders, their prevalence across different socioeconomic contexts, and strategies for effective intervention. We explore innovative therapeutic approaches, the role of healthcare policies, and the importance of early detection to reduce the long-term effects of maternal mental health disorders on both mothers and their children.

Linking heart and mind: development and evaluation of online information material on mental health disorders in children and adolescents with CHDs.

Psychiatric comorbidity is common in children and adolescents with CHDs. Early recognition and evidence-based treatments are crucial to prevent long-term consequences. To support early identification and reduce stigma, we 1) developed and 2) tested the usability and acceptability of online information material on common mental health disorders targeted healthcare professionals and affected families. Website content was shaped by insights from interviews with healthcare professionals across sectors, parents, and adolescents. Evaluations demonstrated promising acceptability and usability of the first prototype but indicated the need for improvements in specific aspects of content, navigation, and overall aesthetics.

Health Care Service Utilization Among People with HIV, Chronic Pain, and Depression: Utilization and Cost Outcomes from the HIV-PASS Study.

In the United States (U.S.), 90% of annual health care expenditures are devoted to people with chronic physical and mental health conditions. For people with HIV (PWH), two common, chronic comorbidities are pain and depression. This report assesses the impact of a brief psychotherapy intervention for PWH and comorbid chronic pain and depression on health care service utilization. Data from the HIV Pain and Sadness Study (HIV-PASS) randomized trial were used. Electronic health records were reviewed to tabulate use of the following services: (a) outpatient rehabilitation; (b) outpatient psychiatric; and (c) hospital-based (e.g., emergency department). Estimated average marginal effects were analyzed to determine how many times a participant accessed the service and the charge at each event. The sample consisted of 187 adults recruited from three U.S. sites. Individuals randomized to the three-month, seven session HIV-PASS intervention had average charges for hospital-based services that were significantly less during the post-treatment phase (months 4-12; 95%CI: -$16,612, -$131; p =.046) than those randomized to the comparison condition. On average, comparison condition participants were charged $8,371 more for hospital services in the 8-month period following intervention. No significant differences between treatment conditions were observed in use of outpatient rehabilitation, outpatient psychiatric services, or hospital-based care. Consistent with predictions, lower health care charges among those randomized to the HIV-PASS behavioral intervention were incurred for hospital services, indicating that a brief behavioral intervention could lead to decreased use of more emergent and expensive care services among persons with HIV, depression, and chronic pain.