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BackgroundRisk factors for depressive disorders (DD) change substantially over time, but the prognostic value of these changes remains unclear. Two basic types of dynamic effects are possible. The ‘Risk Escalation hypothesis’ posits that worsening of risk levels predicts DD onset above average level of risk factors. Alternatively, the ‘Chronic Risk hypothesis’ posits that the average level rather than change predicts first-onset DD.MethodsWe utilized data from the ADEPT project, a cohort of 496 girls (baseline age 13.5–15.5 years) from the community followed for 3 years. Participants underwent five waves of assessments for risk factors and diagnostic interviews for DD. For illustration purposes, we selected 16 well-established dynamic risk factors for adolescent depression, such as depressive and anxiety symptoms, personality traits, clinical traits, and social risk factors. We conducted Cox regression analyses with time-varying covariates to predict first DD onset.ResultsConsistently elevated risk factors (i.e. the mean of multiple waves), but not recent escalation, predicted first-onset DD, consistent with the Chronic Risk hypothesis. This hypothesis was supported across all 16 risk factors.ConclusionsAcross a range of risk factors, girls who had first-onset DD generally did not experience a sharp increase in risk level shortly before the onset of disorder; rather, for years before onset, they exhibited elevated levels of risk. Our findings suggest that chronicity of risk should be a particular focus in screening high-risk populations to prevent the onset of DDs. In particular, regular monitoring of risk factors in school settings is highly informative.

Perfectionistic cognitions are thinking patterns that reflect excessive striving and are associated with emotional disorders in nonclinical samples. Despite literature connecting trait perfectionism with psychological disorders, much remains unknown about how perfectionistic cognitions relate to anxiety disorder symptoms in clinical populations. This is the first study to our knowledge that investigates how symptoms of anxiety and related symptoms are influenced by the frequency of perfectionistic cognitions when controlling for well documented correlates of anxiety. Perfectionistic cognitions, depressive symptoms, emotion regulation, anxiety sensitivity, and anxiety symptom severity were assessed prior to starting treatment in 356 treatment-seeking patients diagnosed with an anxiety or anxiety-related disorder at a specialty anxiety clinic. Perfectionistic cognitions were significantly correlated with all anxiety symptom measures as well as measures of depression, emotion regulation and anxiety sensitivity (range of rs =.22-.68). Hierarchical regression analyses revealed that when controlling for depressive symptoms, anxiety sensitivity, and emotion regulation, perfectionistic cognitions significantly and uniquely contribute to the variance of GAD (p .01) and PTSD (p .05) symptoms but not other anxiety-related symptoms (all ps.05). Regardless of specific diagnoses, treatment-seeking individuals reporting frequent perfectionistic thoughts are more likely to report more severe symptoms of PTSD and GAD.

OBJECTIVE Machine learning algorithms in electronic medical records can classify patients by suicide risk, but no research has explored clinicians' perceptions of suicide risk flags generated by these algorithms, which may affect algorithm implementation. The objective of this study was to evaluate clinician perceptions of suicide risk flags. METHODS Participants (n = 139; 68 with complete data) were mental health clinicians recruited to complete online surveys from October 2018 to April 2019. RESULTS Most participants preferred to know which features resulted in a patient receiving a suicide flag (94.12%) and reported that knowing those features would influence their treatment (88.24%). Clinicians were more likely to report that some algorithm features (increased thoughts of suicide) would alter their clinical decisions more than others (age, physical health conditions; χ² = 270.84, P < .001). Clinicians were more likely to report that they would create a safety/crisis response plan in response to a suicide risk flag compared to other interventions (χ² = 227.02, P < .001), and 21% reported that they would complete a no-suicide contract following a suicide risk flag. CONCLUSIONS Clinicians overwhelmingly reported that suicide risk flags in electronic medical records would alter their clinical decision making. However, clinicians' likelihood of acting in response to a suicide risk flag was tied to which features were highlighted rather than the presence of the risk flag alone. Thus, the utility of a suicide risk algorithm will be reduced if clinical features underlying the algorithm are hidden from clinicians or if clinicians do not view the clinical features as intuitively meaningful predictors of suicide risk.

While psychiatric disorder prevalence is higher among patients living with HIV (PLWH), there are no prior studies on rates of psychiatric diagnosis documentation in electronic medical records (EMRs) of PLWH, which was the goal of this study. Participants (n = 2,336) were enrolled in the Center for AIDS Research (CFAR) Longitudinal Database study. Diagnostic codes were extracted to assess the prevalence rates of depressive, alcohol/substance use, PTSD, sleep, and adjustment disorders. Prevalence rates for psychiatric disorders were extracted from national epidemiological studies for comparison. Rates of Major Depressive Disorder in the EMR were comparable to prior epidemiological reports in PLWH. In contrast, rates of PTSD, substance use, alcohol use, adjustment, and insomnia disorders were all markedly lower compared to epidemiological studies. While clinicians appropriately documented depression, other psychiatric comorbidities were largely overlooked. This indicates a potential bias in the detection or documentation of psychiatric disorders in PLWH.

Background Prior research has demonstrated the efficacy of internet-based cognitive behavioral therapy (ICBT) for social anxiety disorder (SAD). However, it is unclear how shame influences the efficacy of this treatment. Objective This study aimed to investigate the role shame played in the ICBT treatment process for participants with SAD. Methods A total of 104 Chinese participants (73 females; age: mean 24.92, SD 4.59 years) were randomly assigned to self-help ICBT, guided ICBT, or wait list control groups. For the guided ICBT group, half of the participants were assigned to the group at a time due to resource constraints. This led to a time difference among the three groups. Participants were assessed before and immediately after the intervention using the Social Interaction Anxiety Scale (SIAS), Social Phobia Scale (SPS), and Experience of Shame Scale (ESS). Results Participants’ social anxiety symptoms (self-help: differences between pre- and posttreatment SIAS=−12.71; Cohen d=1.01; 95% CI 9.08 to 16.32; P Conclusions The findings of this study suggest that participants’ engagement in the exposure module in ICBT alleviates social anxiety symptoms by reducing the levels of shame proneness. Our study provides a new perspective for understanding the role of shame in the treatment of social anxiety. The possible mechanisms of the mediation effect and clinical implications are discussed. Trial Registration Chinese Clinical Trial Registry ChiCTR1900021952; http://www.chictr.org.cn/showproj.aspx?proj=36977

The Na+ /H+ antiporter SOS1 enhances the salinity tolerance of a number of plant species, but its involvement in the response to hypoxia is less well known. We presented chrysanthemum homologs CmSOS1 and CmRCD1 coordinately mediate waterlogging tolerance by maintaining membrane integrity and minimizing the level of reactive oxygen species.

IntroductionStrong evidence establishes a close relationship between personality traits and mental illness; where personality can be said to influences the likelihood, severity and longevity of a mental disorder. Personality is usually seen as fixed, yet there is a growing body of evidence for the changeability of personality, though this has rarely been studied in relation to mental disorders.ObjectiveTo study the longitudinal interplay between personality and eating disorders (EDs), particularly the associations between personality, recovery and treatment modality.AimsTo investigate changes in the five domains and thirty lower-level facets of personality in non-underweight EDs, and its associations to intervention and outcome.MethodsTwo hundred and nine adults with EDs enrolled either in a four-month multimodal psychodynamic group-therapy (DAY) or four-six month internet-based supported cognitive behavioural therapy (iCBT). ED diagnosis and personality (by the five-factor model) were assessed at baseline, termination and 6-month follow up. Structural equation modeling was used to analyze domain-level development, and reliable change (RCI) for facet-level development.ResultsRemission rate at end of treatment was 71% in DAY and 55% in iCBT. Over time, Neuroticism decreased significantly while Extraversion, Openness and Conscientiousness increased (P < 0.01). Treatment and outcome had little influence on domain-level change. At the facet-level, 28% of patients reliably changed in any given facet, and there were several differences in pattern based on treatment and outcome.ConclusionsThis study lends support for the possibility of personality change and its relevance for recovery from EDs.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Consistent with affect regulation models of eating-related psychopathology, prior research indicates that trait-like shame and state self-conscious emotion are associated with maladaptive eating-related attitudes/behaviors. The present investigation extended past research on shame and maladaptive eating-related attitudes/behaviors by examining the role of shame aversion — the perception of shame as an especially unwanted and painful emotion — in these attitudes/behaviors over and above shame-proneness, general distress, and experiential avoidance. In 488 female undergraduates, shame aversion was positively associated with dieting, self-perceptions of body shape, awareness of food content, and food preoccupation even after taking into account other possible explanatory variables. Additionally, shame aversion moderated shame-proneness' associations with dieting, awareness of food content, and food preoccupation, such that shame-proneness was positively associated with these attitudes/behaviors only when shame aversion was high. Future directions for research and clinical implications of the present findings are discussed.