Secondary Analyses Research Articles

Risk of Ventricular Arrhythmia and Sudden Cardiac Arrest Among Older Patients Using Lamotrigine for Epilepsy.

Lamotrigine, an antiseizure medication, blocks the activation of voltage-gated sodium channels and reduces the excitability of cardiomyocytes in vitro. Based on concerns for QT prolongation and case reports of arrhythmias among lamotrigine users, the US Food and Drug Administration placed a safety warning on lamotrigine's label in 2020. However, limited evidence exists on the cardiac risk of lamotrigine in patients with epilepsy. This study assessed whether lamotrigine users with epilepsy had an increased risk of ventricular arrhythmia and sudden cardiac arrest (VA/SCA) compared with users of levetiracetam. This was a retrospective cohort study among Medicare-insured individuals aged 65 years or older with epilepsy (2007-2019). We identified new users of lamotrigine and levetiracetam without inpatient or emergency VA/SCA diagnosis in the 12-month continuous enrollment baseline period before initiation of treatment. Using inverse probability of treatment weighting derived from propensity scores based on baseline covariates, we compared adjusted incidence rates of inpatient or emergency VA/SCA events in lamotrigine vs levetiracetam users and estimated adjusted hazard ratios (HRs) with 95% CIs using Cox proportional hazard regression. The study cohort (mean age 77.6 years and 60.5% female) consisted of 11,786 new lamotrigine users and 147,130 new levetiracetam users. At baseline, lamotrigine users were younger and less likely to have cardiovascular and noncardiovascular comorbidities than the levetiracetam users. The incidence and HR of VA/SCA were not statistically higher among lamotrigine users (7.0 vs 8.2 per 1,000 person-years for the lamotrigine and levetiracetam users, respectively; HR 0.84, 95% CI 0.67-1.06). Secondary analyses stratified by baseline cardiac abnormalities showed significantly reduced risk among lamotrigine users in subgroups with baseline arrhythmia (HR 0.51, 95% CI 0.32-0.80) or use of antiarrhythmic drugs (HR 0.67, 95% CI 0.50-0.91). In older adults with epilepsy, lamotrigine was not associated with an increased risk of VA/SCA compared with levetiracetam, including among those with underlying heart disease. Our findings do not support the reported cardiac risks associated with lamotrigine or the recent changes to its safety label.

The effects of Transcendental Meditation on emotional intelligence, stress, fatigue, and sleep quality among Ayurvedic medical students in India

IntroductionEmotional intelligence (EI) is essential for resilience and adaptability in high-pressure environments such as medical education. Transcendental Meditation (TM) has been shown to enhance emotional regulation, reduce stress, and improve wellbeing. This quasi-experimental, longitudinal observational study evaluated the effects of TM on emotional intelligence, perceived stress, fatigue, and sleep quality among Ayurvedic medical students over a 6-month period.MethodsThis study included 176 Ayurvedic medical students at D. Y. Patil College of Ayurved and Research Center of Dr. D. Y. Patil Vidyapeeth (Deemed to be University) in India, comprising a TM group (n = 97) and a control group (n = 79). Global Emotional Intelligence (Global EI) and its subdomains (Wellbeing, Emotionality, Self-Control, and Sociability) were assessed using the Trait Emotional Intelligence Questionnaire, Short Form (TEIQue-SF). Secondary outcomes included perceived stress (Perceived Stress Scale; PSS), fatigue (PROMIS Fatigue Short Form), and insomnia severity (Insomnia Severity Index; ISI). Assessments were conducted at baseline, 3 months, and 6 months. Linear mixed-effects models (LMMs) were used to evaluate Group × Time interactions for each outcome, controlling for age. An autoregressive [AR(1)] covariance structure was specified to account for repeated measures. Pairwise comparisons based on estimated marginal means were used to assess between-group differences at each timepoint.ResultsSignificant Group × Time interactions were observed for Global Emotional Intelligence (EI) (p < 0.001), perceived stress (p < 0.001), fatigue (p < 0.001), and insomnia severity (p < 0.001), indicating that the TM and control groups showed different patterns of change over time. Specifically, the TM group demonstrated substantial improvements in Global EI and significant reductions in perceived stress, fatigue, and insomnia severity by 6 months compared to the control group. Secondary analyses also revealed significant Group × Time interactions across all four Global EI subdomains (Wellbeing, Emotionality, Self-Control, and Sociability; all p < 0.001).ConclusionRegular practice of Transcendental Meditation (TM) led to meaningful improvements in emotional intelligence, reductions in perceived stress and fatigue, and enhanced sleep quality among Ayurvedic medical students. These findings support integrating TM into student wellness programs as an effective strategy for promoting psychological resilience in high-stress academic environments.

Evidence for a Somatic and Non-Somatic Factor Structure in the Patient Health Questionnaire-8 in a Military Sexual Assault Sample.

The Patient Health Questionnaire-8 (PHQ-8) is a measure of depression symptom severity that is the 8-item version of the more widely used Patient Health Questionnaire-9 (PHQ-9). However, the PHQ-8 lacks the question about suicide ideation and is often used when questions about suicide ideation cannot be administered. A recent review of the literature on the PHQ-9 indicates mixed findings on factor structure, with evidence for both a unidimensional model and a 2-factor model of somatic and non-somatic symptoms. To date, few studies have explored the factor structure of the PHQ-8, and none to our knowledge have examined this in military samples. This secondary analysis examined this in a sample of military sexual assault survivors given their heightened risk for depression. Service members and veterans who experienced assault (N = 346; 49.1% female) completed the PHQ-8 in a previously published study. The parent study was approved by the Utah State University Institutional Review Board (IRB) and secondary analyses were exempted from IRB review by the Arizona State University IRB. Five structural models were tested using confirmatory factor analysis, including 1 unidimensional factor model and 4 2-dimensional factor models. The following goodness of fit statistics were compared between models: Chi-squared testing, Comparative Fit Index (CFI), Tucker Lewis Index (TLI), root mean square error of approximation (RMSEA), Bayesian Information Criterion (BIC) and standardized root mean square residual (SRMR). Strong model fit was determined by a CFI and TLI ≥ .95, RMSEA ≤ .06, and SRMR ≤ .08. The 2-dimensional model with anhedonia, depressed mood, feelings of worthlessness, concentration difficulties, and psychomotor agitation/retardation specified on the non-somatic factor, and sleep difficulties, fatigue, and appetite changes specified on the somatic factor had the most optimal fit (X2 [df] = 46.19 [19], CFI = 0.98, TLI = 0.97, RMSEA = 0.06, SRMR = 0.03, BIC = 6,130.98). Other models had adequate fit, though the fit for the unidimensional model was statistically inferior. The use of 2-factor models of depression might be superior compared to the unidimensional model in samples of military sexual assault survivors which may provide clinical utility in treating specific depression symptom clusters. Studies that wish to examine potential differences in outcomes as a function of somatic and non-somatic depressive symptoms may consider this model. Future studies should examine model fit in samples that may not have been exposed to military sexual assault.

Comparing recovery community centers (RCCs) serving Black, Hispanic/Latino, and other communities: an exploratory secondary data analysis of a nationwide survey of RCC directors

ObjectiveRacial and ethnic disparities exist in opioid-related overdose death rates and engagement with substance use disorder (SUD) treatment. Emerging peer recovery support services (PRSS) show promise in engaging and supporting marginalized populations. Recovery community centers (RCCs) are an important and growing source of community-based PRSS. Our goal was to examine if RCCs serving Black, Hispanic/Latino, or other racial/ethnic communities successfully engage marginalized populations in their community and if there are differences in the service models and functioning of RCCs serving different racial/ethnic communities.MethodsWe conducted exploratory secondary analyses of a nationwide survey of RCC directors (n = 122), in which directors described their RCC in terms of logistics, footprints, service model, linkages, services, and attitudes toward medication treatment. Analysis of variance and chi-square tests were used to compare RCCs serving different communities (i.e., Black, Hispanic/Latino, Other) on these variables, where “serving a Black/Hispanic/Latino community” was operationally defined as being in a ZIP code with more than double the national prevalence of Black (13.6%) and Hispanic/Latino (19.1%) individuals in the United States.ResultsOn average, the median [IQR] percentage of Black participants within RCCs serving Black communities was 45% [30–63%] (51% of residents in the RCCs' ZIP codes were Black); in RCCs serving Hispanic/Latino communities, 50% [28–60%] of RCC participants were Hispanic/Latino (57% of residents in the RCCs' ZIP codes were Hispanic/Latino). Across 70 variables describing the RCCs' service model and functioning, only two statistically significant differences emerged between RCCs serving Black, Hispanic/Latino, and other communities, using an alpha of 0.05. RCCs differed in offering 12-step mutual aid groups (lowest in RCCs serving Hispanic/Latino communities; p = 0.03) and the existence of direct collaboration with clinical sites providing medications for opioid use disorder (MOUD, most common in RCCs serving Black communities; p = 0.03).ConclusionThe overall RCC model appears to be consistent across racial/ethnic settings in terms of footprints, model of care, services offered, connection to relevant systems and organizations, and attitudes toward medications. Given the commonly observed racial/ethnic disparities in SUD care, the robustness of the RCC model across communities is promising.

Association of the ICH Score With Withdrawal of Life-Sustaining Treatment Over a 10-Year Period.

The intracerebral hemorrhage (ICH) score was developed to enhance provider communication and facilitate early severity assessment. We examined the association of the ICH score with mortality and withdrawal of life-sustaining treatment (WLST) in a large, multicenter stroke registry, and evaluated temporal trends in these associations. We identified ICH patients from the Florida Stroke Registry from 2013 to 2022. Outcomes were WLST and in-hospital mortality. ICH scores were grouped as 0-2, 3-4, and 5-6. Importance plots identified key predictors of WLST. Model performance was assessed using AUC-ROC for logistic regression and random forest, adjusted for relevant confounders. Secondary analyses compared outcomes between 2015-2018 and 2019-2022 using stratified univariate logistic regression. In total, 12,426 patients were included (mean age 69, 55% male, 56% white). The most predictive factors associated with WLST were ICH score, age, state region, presenting level of consciousness, insurance status, and race (RF AUC = 0.94, LR AUC = 0.82). Mortality was 6.6%, 41.5%, and 66% for ICH score 0-2, 3-4, and 5-6. WLST occurred more frequently in higher ICH score groups (OR 9.35 [95% CI: 8.5-10.3] for scores 3-4; OR 18.64 [95% CI: 15.28-22.74] for scores 5-6). Early WLST (< 48 h) was more common in higher score groups (OR 2.97 [95% CI: 2.48-3.55] for 3-4; OR 9.51 [95% CI: 7.33-12.35] for 5-6). Higher ICH scores were strongly associated with mortality and WLST, including early withdrawal decisions. These associations remained largely consistent over time. These observational findings underscore the need for continued attention to how prognostic scores may influence WLST decisions.

Associations Between Serum Sodium, Peritoneal Dialysis-Associated Peritonitis, and Mortality in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS).

Associations Between Serum Sodium, Peritoneal Dialysis-Associated Peritonitis, and Mortality in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS).

Smartphone monitoring and digital phenotyping apps for schizophrenia: A review of the academic literature.

Smartphone monitoring and digital phenotyping apps for schizophrenia: A review of the academic literature.

Synthetic neurosurgical data generation with generative adversarial networks and large language models:an investigation on fidelity, utility, and privacy.

Use of neurosurgical data for clinical research and machine learning (ML) model development is often limited by data availability, sample sizes, and regulatory constraints. Synthetic data offer a potential solution to challenges associated with accessing, sharing, and using real-world data (RWD). The aim of this study was to evaluate the capability of generating synthetic neurosurgical data with a generative adversarial network and large language model (LLM) to augment RWD, perform secondary analyses in place of RWD, and train an ML model to predict postoperative outcomes. Synthetic data were generated with a conditional tabular generative adversarial network (CTGAN) and the LLM GPT-4o based on a real-world neurosurgical dataset of 140 older adults who underwent neurosurgical interventions. Each model was used to generate datasets at equivalent (n = 140) and amplified (n = 1000) sample sizes. Data fidelity was evaluated by comparing univariate and bivariate statistics to the RWD. Privacy evaluation involved measuring the uniqueness of generated synthetic records. Utility was assessed by: 1) reproducing and extending clinical analyses on predictors of Karnofsky Performance Status (KPS) deterioration at discharge and a prolonged postoperative intensive care unit (ICU) stay, and 2) training a binary ML classifier on amplified synthetic datasets to predict KPS deterioration on RWD. Both the CTGAN and GPT-4o generated complete, high-fidelity synthetic tabular datasets. GPT-4o matched or exceeded CTGAN across all measured fidelity, utility, and privacy metrics. All significant clinical predictors of KPS deterioration and prolonged ICU stay were retained in the GPT-4o-generated synthetic data, with some differences observed in effect sizes. Preoperative KPS was not preserved as a significant predictor in the CTGAN-generated data. The ML classifier trained on GPT-4o data outperformed the model trained on CTGAN data, achieving a higher F1 score (0.725 vs 0.688) for predicting KPS deterioration. This study demonstrated a promising ability to produce high-fidelity synthetic neurosurgical data using generative models. Synthetic neurosurgical data present a potential solution to critical limitations in data availability for neurosurgical research. Further investigation is necessary to enhance synthetic data utility for secondary analyses and ML model training, and to evaluate synthetic data generation methods across other datasets, including clinical trial data.

Association Between Symptomatic Knee Osteoarthritis and Blood Glucose Control in Persons with Type 2 Diabetes

ObjectivesThere is a high prevalence of knee osteoarthritis (OA) in people with type 2 diabetes (T2D), and knee OA increases risk for diabetes complications. Our objective was to assess the association between symptomatic knee OA and attainment of target blood glucose levels in individuals with T2D.MethodsIn this cross-sectional study, we recruited individuals with T2D aged ≥45 years from diabetes clinics at 3 academic hospitals in Toronto. Participants completed standardized online questionnaires that assessed demographics, comorbidities, height and weight, and joint symptoms. From clinic records we abstracted participants’ most recent HbA1c (within 3 months). Knee OA was defined as fulfilling NICE criteria. We considered blood glucose control at target if HbA1c was ≤7.0%. We used multivariable logistic regression to assess the association between knee OA and being at blood glucose target, adjusting for age and gender. We then examined the effect of further adjusting for body mass index (BMI). In secondary analyses, we repeated modeling with exposure of interest knee OA with knee pain ≥20/100 on pain numeric rating scale (NRS) (yes/no).ResultsWe included 351 participants. Mean age was 66.9 (SD 9.8) years, 50.7% women, mean BMI 29.1 (SD 6.8) kg/m2, and 28.5% fulfilled NICE criteria for knee OA. Mean HbA1c was 7.4 (SD 1.2); 44% had HbA1c at target (≤7.0%). In univariable analysis, those with knee OA had lower odds of being at target (OR 0.60, 95% CI 0.37 to 0.97). Results were similar after adjusting for age and gender (OR 0.59, 95% CI 0.36 to 0.95). When further adjusting for BMI the effect of knee OA was attenuated and was not statistically significant (OR 0.65, 95% CI 0.39 to 1.06). When exposure of interest was knee OA with self-reported pain ≥20/100, we found a stronger negative association; this met statistical significance even after adjusting for BMI (OR 0.59, 95% CI 0.35 to 0.997) (Figure 1).Figure 1.Effect of (A) knee osteoarthritis overall and (B) knee osteoarthritis with pain ≥20/100 on meeting glyeemic target (HbAlc ≤7.0%).ConclusionIndividuals with T2D with knee OA are less likely to be at the recommended target for glycemic control. This association was stronger for those who currently reported pain and remained significant even after adjusting for BMI. This suggests that symptomatic knee OA may increase the risk of diabetes complications through worse glycemic control, and symptom severity is likely important. Further studies are needed to better understand this relationship, as well as the role of additional mechanisms by which knee OA could lead to diabetes complications such as cardiorespiratory fitness and/or systemic inflammation.Best Abstract on Research by Early Career Faculty Award

Expanding the scope of the withdrawal syndrome: Anhedonia as a core nicotine withdrawal symptom.

Some evidence suggests that anhedonia is a component of nicotine withdrawal, but additional research is needed to support this conclusion and establish its clinical relevance. Secondary analyses were conducted for a comparative effectiveness smoking cessation clinical trial of combination nicotine replacement therapy, nicotine patches, and varenicline (N = 1,084). Self-reported consummatory anhedonia was assessed at multiple time points pretarget quit day (TQD) and post-TQD, and biochemically confirmed 7-day point-prevalence smoking abstinence was assessed at 4, 12, and 26 weeks post-TQD. Data collection occurred from May 2012 to November 2015. Analyses were conducted using hierarchical linear modeling, logistic regression, and general linear models. Anhedonia demonstrated a prototypical inverted-U pattern from pre- to post-TQD consistent with withdrawal, which was not moderated by medication condition (ps > .83). Greater postquit anhedonia was associated with lower odds of biochemically confirmed abstinence at 4 weeks (odds ratio [OR] = 0.96, 95% confidence interval [CI] = [0.94, 0.98], p < .001), 12 weeks (OR = 0.96, 95% CI = [0.94, 0.99], p = .001), and 26 weeks (OR = 0.95, 95% CI = [0.93, 0.98], p < .001) post-TQD. These effects remained even after controlling for other withdrawal symptoms and individual characteristics. Gold standard smoking pharmacotherapies had comparable statistical effects on anhedonia's trajectory and association with abstinence during treatment. The results replicate and extend previous research supporting anhedonia as a motivationally significant symptom of nicotine withdrawal. The results suggest anhedonia not only conforms to features of a tobacco withdrawal symptom but is associated with difficulty stopping smoking. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Immune dysregulation in psychiatric disorders with and without exposure to childhood maltreatment: A transdiagnostic stratified meta-analysis.

Immune dysregulation in psychiatric disorders with and without exposure to childhood maltreatment: A transdiagnostic stratified meta-analysis.

Incidence of Stroke in Adults With Congenital Heart Disease: A Systematic Review and Meta-Analysis.

Incidence of Stroke in Adults With Congenital Heart Disease: A Systematic Review and Meta-Analysis.

Differences and similarities in psychological characteristics between cultural groups circum Mediterranean.

We examined differences and similarities between groups sampled from the Mediterranean region in social orientation, cognitive style, self-construal, and honor, face, dignity values, and concerns using a large battery of tasks and measures. We did this by conducting secondary data set analyses focusing on comparisons between nine pairs of samples recruited from the Mediterranean region (Spain, Italy, Greece, Turkey, Cyprus [Greek and Turkish Cypriot communities], Lebanon [Muslim Lebanese and Christian Lebanese], Egypt) that have overlapping and divergent features in terms of religious, ethnic, national, and linguistic factors as well as various physical and socioecological characteristics. Across 38 different psychological characteristics, comparisons between Turkish and Turkish Cypriot samples and between Christian and Muslim samples from Lebanon revealed that they were most similar to each other. In contrast, Greek and Turkish samples were the least similar. Our analyses of intercorrelations between variables, variability, and size of differences provide additional insights into the within-region variation in social orientation, cognitive style, self-construal indicators, as well as honor, face, and dignity values and concerns. Our research contributes to the growing literature on regional variation of psychological processes while raising important pointers for the role of background and socioecological characteristics in cultural group similarities and differences. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Effect of Antihypertensive Agents on the Risk of New-Onset and Recurrent Atrial Fibrillation: A Bayesian Network Meta-Analysis of Randomized Controlled Trials.

The comparative effectiveness of specific antihypertensive agents in preventing new-onset or recurrent atrial fibrillation (AF) remains under debate. This study aimed to evaluate the impact of different antihypertensive agents on AF risk. Medline, Cochrane, EMBASE, and ClinicalTrials.gov databases were searched for randomized controlled trials (RCTs) reporting AF events as a pre-defined outcome. Angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), dihydropyridine calcium channel blockers (CCBs), β-blockers, mineralocorticoid antagonists (MRAs), and thiazide diuretics (TDs) were analyzed. The risk ratio (RR) with a 95% credible interval (CrI) was calculated within a Bayesian random-effects network meta-analysis (NMA). Treatments were ranked using the surface under the cumulative ranking (SUCRA). Twenty-two RCTs randomizing 66,156 patients with hypertension, diabetes, or AF were included. ACE inhibitors plus TD (RR 0.44; 95% CrI 0.23-0.82), ACE inhibitors (RR 0.66; 95% CrI 0.44-0.95), and ARBs (RR 0.52; 95% CrI 0.38-0.70) were associated with lower rates of new-onset or recurrent AF compared with CCBs. SUCRA ranked ACE inhibitors plus TD (0.86) as the best, followed by ARBs (0.77), MRAs (0.75), and ACE inhibitors (0.53) for preventing AF events. These findings were consistent across secondary and sensitivity analyses. In this NMA comparing multiple antihypertensive regimens in patients with hypertension, diabetes, or AF, ACE inhibitors plus TD, ACE inhibitors, and ARBs were the most effective in reducing AF events, outperforming CCBs.

Beta-band power modulation in the human amygdala during a Direct Reach arm reaching task.

Beta-band power modulation in the human amygdala during a Direct Reach arm reaching task.

Postpartum care in the neonatal intensive care unit, PeliCaN: a randomized controlled trial.

Postpartum care in the neonatal intensive care unit, PeliCaN: a randomized controlled trial.

Ultrasound-measured cutaneous-epiglottic distance for predicting difficult laryngoscopy: an observational study.

Ultrasound (US) allows for rapid bedside airway assessment. We aimed to evaluate the US-measured cutaneous-epiglottic distance (CED) in predicting difficult laryngoscopy (Cormack-Lehane grades 3‒4). We also evaluated the potential association between CED, sex, patient's body mass index (BMI), and the independent associations between CED and increased odds for Cormack-Lehane grades 3‒4 (secondary outcomes). Patients aged 18‒70 years scheduled for elective surgeries under general anesthesia with tracheal intubation were included. Those with a BMI > 35 kg.m-2 and/or previous history of difficult intubation were excluded. CED was measured with patients anesthetized before tracheal intubation. Age, sex, BMI, type of surgery, and number of attempts until successful tracheal intubation were recorded. Receiver operator characteristic (ROC) curve analysis was performed to evaluate CED's clinical relevance. Secondary analyses compared the association between CED and BMI in patients with Cormack-Lehane grades 1‒2 versus those with grades 3‒4. The relationship between CED and BMI was assessed using multiple linear regression. Binary logistic regression was employed for predicting Cormack-Lehane grades 3‒4 as a dichotomous outcome with CED and BMI as a covariate. ROC curve analysis revealed an area under the curve of 0.899 (p < 0.001). The maximum CED cut-off point (by Youden index) was 25.6 mm. CED and BMI were positively correlated, and both were independently associated with an increased odds for difficult laryngoscopy [odds ratio for CED = 1.81, 95% confidence interval (CI) 1.35‒2.41; BMI = 1.30, 95% CI 1.05‒1.59]. US-measured CED has a high discriminatory capability for predicting lower (1‒2) and higher (3‒4) Cormack-Lehane grades during direct laryngoscopy. CED was positively correlated with BMI and was independently associated with higher odds for difficult laryngoscopy.

Changes in health-related quality of life following an exercise intervention for alcohol use disorder: Secondary analyses of a randomized controlled trial (FitForChange)

Changes in health-related quality of life following an exercise intervention for alcohol use disorder: Secondary analyses of a randomized controlled trial (FitForChange)

Vision Loss and Blindness in the United States: An Age-Adjusted Comparison by Sex and Associated Disease Category.

Vision Loss and Blindness in the United States: An Age-Adjusted Comparison by Sex and Associated Disease Category.

LIBERAL AND COMMUNITARIAN MODELS OF CIVIC EDUCATION IN LITHUANIA AND ITS PRACTICAL IMPLICATIONS

In the face of evolving geopolitical tensions, digital transformations, and the emergence of new civic challenges – such as Russia’s military aggression and the arrival of refugee communities – civic education in Lithuania has become a matter of renewed urgency. While traditionally centered on transmitting political knowledge, civic education increasingly plays a critical role in shaping civic virtues, values, and participatory attitudes. This research is dedicated to a question: how different models of civic education - liberal and communitarian - have influenced Lithuania’s civic landscape since independence, and how these frameworks respond to current societal needs? The study employs a comparative historical analysis of Lithuanian educational policies, civic participation trends, and socio-political contexts, tracing civic education’s evolution from the communitarian mobilization of the Sąjūdis era to a liberal emphasis on individual autonomy and legal-rational governance. Data is drawn from policy documents, curriculum reforms, and secondary analyses of civic engagement indicators in Lithuania from 1990 to the present. Findings reveal that while liberal models have institutionalized civic norms through rights-based education, they often fall short in fostering emotional engagement and community belonging. Conversely, communitarian models encourage solidarity and active citizenship but risk marginalizing individual freedoms. An integrative approach is proposed, combining liberal and communitarian elements to develop a civic education model aligned with Lithuania’s present context, aimed at enhancing democratic resilience, social cohesion, and a participatory civic culture. Keywords: civic education, communitarian model, individual autonomy, liberal model, Lithuania, social cohesion