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Yunosuke Usui,1 Miki Ono,1 Rintaro Nibuya,1 Masayuki Kikkawa,1 Shunichiro Ito,1 Chihiro Morishita,1 Mina Honyashiki,1 Yu Tamada,1,2 Takeshi Inoue,1 Jiro Masuya1 1Department of Psychiatry, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan; 2Department of Psychiatry, Tokyo Medical University Hachioji Medical Center, Hachioji-shi, Tokyo, JapanCorrespondence: Jiro Masuya, Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan, Tel +81-(0)3-3342-6111, Email j-masuya@tokyo-med.ac.jpBackground: Prior research has shown that inappropriate childhood nurturing experiences (low care and high overprotection), trait anxiety, and depressive rumination are risk factors for depression. However, no studies to date have analyzed the overall association between these factors and depressive symptoms. In the present study, we hypothesized that depressive rumination mediates the impacts of inappropriate childhood nurturing experiences on depressive symptoms, and that these mediating effects are moderated by trait anxiety, and tested these hypotheses in adult volunteers.Methods: The subjects were adult volunteers who were investigated between April 2017 and April 2018. A self-report questionnaire on demographic data, childhood nurturing experiences, trait anxiety, depressive rumination, and depressive symptoms was distributed to conduct the survey, and written informed consent and valid responses were obtained from 585 subjects. Mediation and moderated-mediation analyses were performed by SPSS 28 and macro PROCESS 4.0 software. This study was approved by the Ethics Committee of Tokyo Medical University.Results: Parental care showed a significant negative indirect effect on depressive symptoms via its effect on depressive rumination (p < 0.01), whereas parental overprotection showed the opposite effect (p < 0.01). Furthermore, the mediation effect of depressive rumination on depressive symptoms was increased by trait anxiety (p < 0.05).Conclusion: Our present study demonstrated that the main factor affecting depressive symptoms is inappropriate childhood nurturing experiences, which indirectly enhance depression by intensifying depressive rumination, and that depressive rumination and trait anxiety mutually reinforce each other to enhance depressive symptoms. These findings may be useful for the prevention of depressive symptoms. Large-scale prospective studies are needed to confirm the causal associations among these factors in the future.Keywords: childhood parenting experiences, depressive rumination, trait anxiety, depressive symptoms, moderated-mediation analysis

Yoshio Iwata,1 Miki Ono,1 Yoshitaka Ishii,1 Shunichiro Ito,1 Masayuki Kikkawa,1 Chihiro Morishita,1 Yu Tamada,1,2 Mina Honyashiki,1 Takeshi Inoue,1 Jiro Masuya1 1Department of Psychiatry, Tokyo Medical University, Tokyo, Japan; 2Department of Psychiatry, Tokyo Medical University Hachioji Medical Center, Tokyo, JapanCorrespondence: Jiro Masuya, Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan, Tel +81-3-3342-6111, Email j-masuya@tokyo-med.ac.jpBackground: The experience of peer victimization in childhood increases the risk of developing anxiety disorders and depression, risk of suicide, as well as sensitivity to stress, in adulthood. Various personality traits are known to be associated with these effects. However, the influence of trait anxiety on job stress has not yet been reported. In the present study, we tested the hypothesis that the experience of peer victimization in childhood and trait anxiety influence job stress in adulthood.Methods: A questionnaire survey, including State-Trait Anxiety Inventory, Childhood Victimization Rating Scale, and Brief Job Stress Questionnaire, was administered to 566 adult workers. The interrelationship between multiple variables was analyzed by multiple regression analysis and path analysis.Results: In the path model, childhood peer victimization had a positive direct effect on trait anxiety and the psychological and physical stress response (PPSR). Trait anxiety had a positive direct effect on job stressors and PPSR, and job stressors had a positive direct effect on PPSR. Regarding indirect effects, childhood peer victimization had a significant adverse effect on job stressors and PPSR via trait anxiety.Conclusion: Our results showed that childhood peer victimization has a negative impact on job stress in adulthood, which is influenced by trait anxiety. Interventions to address peer victimization in childhood and trait anxiety may reduce job stress in adulthood, and thus contribute to improved occupational mental health and productivity in the workplace.Keywords: job stress, peer victimization, trait anxiety, path analysis, mediation effect

Misaki Endo,1,2 Miki Ono,1 Ayaka Deguchi,1 Yoshio Iwata,1 Yu Tamada,1,3 Jiro Masuya,1 Hajime Tanabe,4 Naoki Hashimoto,5 Takeshi Inoue,1 Mina Honyashiki1 1Department of Psychiatry, Tokyo Medical University, Tokyo, Japan; 2Department of Psychiatry, Saitama Prefectural Psychiatric Hospital, Saitama, Japan; 3Department of Psychiatry, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan; 4Faculty of Humanities and Social Sciences, Shizuoka University, Shizuoka, Japan; 5Department of Psychiatry, Hokkaido University, Sapporo, JapanCorrespondence: Miki Ono, Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan, Tel +81-3-3342-6111, Email mikky@tokyo-med.ac.jpBackground: Subjective social status influences anxiety, but at present, the mechanism is not fully understood. It has been reported that negative childhood experiences, such as abuse, can influence depressive symptoms through subjective social status and personality traits, such as self-esteem. A similar mechanism is presumed to underlie anxiety symptoms in adulthood. Therefore, we hypothesized that subjective social status and self-esteem are intermediate factors in the indirect effects of childhood abuse on state anxiety in adulthood, and analyzed the indirect effects via these factors using a path analysis.Subjects and Methods: Child Abuse and Trauma Scale, Subjective Social Status, Rosenberg Self-Esteem Scale, and State-Trait Anxiety Inventory Form Y questionnaires were administered in a self-report format to 404 adult volunteers from January 2014 to August 2014. In addition, a path analysis was conducted to determine whether subjective social status and self-esteem are associated with the indirect effects of childhood abuse on anxiety symptoms in adulthood.Results: Childhood abuse did not directly affect state anxiety in adulthood, but affected state anxiety via subjective social status and self-esteem. Subjective social status affected state anxiety via self-esteem. This model explained 25.2% of the variation in state anxiety in adult volunteers.Conclusion: The present study demonstrated that childhood abuse affects anxiety in adulthood through subjective social status and self-esteem. Therefore, interventions that enhance subjective social status and self-esteem for adults who experienced childhood abuse may help reduce their anxiety.Keywords: childhood abuse, subjective social status, self-esteem, anxiety

Shunichiro Ito,1 Chihiro Morishita,1 Jiro Masuya,1 Miki Ono,1 Mina Honyashiki,1 Shinji Higashi,1,2 Yu Tamada,1,3 Yota Fujimura,1,3 Takeshi Inoue1 1Department of Psychiatry, Tokyo Medical University, Tokyo, 160-0023, Japan; 2Department of Psychiatry, Ibaraki Medical Center, Tokyo Medical University, Ibaraki, 300-0395, Japan; 3Department of Psychiatry, Tokyo Medical University Hachioji Medical Center, Tokyo, 193-0998, JapanCorrespondence: Chihiro Morishita, Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan, Tel +81 3 3342 6111, Fax +81 3 3340 4499, Email mchihiro@tokyo-med.ac.jpBackground: Parenting quality experienced in childhood affects depressive symptoms in adulthood, and neuroticism and resilience are attracting attention as personality traits that mediate the effects of parental rearing quality experienced in childhood on adulthood depressive symptoms. However, the interaction between neuroticism and resilience remains unclear. In this study, we hypothesized that resilience and neuroticism are mediators between parental rearing quality experienced in childhood and depressive symptoms in adulthood, and furthermore, that resilience and neuroticism interact with each other in their effects on depressive symptoms. To test these hypotheses, we conducted structural equation modeling and hierarchical multiple regression analysis including interactions in adult volunteers.Methods: A self-administered questionnaire survey was conducted on 528 adult volunteers recruited at Tokyo Medical University for 1 year from April 2017 to April 2018. The Parental Bonding Instrument (PBI), Eysenck Personality Questionnaire-revised short version, Connor-Davidson Resilience Scale, and Patient Health Questionnaire-9 were used as questionnaires, and their scores were analyzed using structure equation modeling. The interaction between resilience and neuroticism was analyzed using hierarchical multiple regression analysis.Results: Structural equation modeling showed that parenting quality (care and overprotection) experienced in childhood had a significant indirect effect on the severity of depressive symptoms in adulthood, mediated by both neuroticism and resilience. Among the subscores of the PBI, “care” showed opposite effects to “overprotection”. Structural equation modeling of “care” and “overprotection” explained 36.9% and 36.6% of the variability in depressive symptoms in adulthood, respectively. Hierarchical multiple regression analysis showed that the negative interaction between neuroticism and resilience had a significant effect on depressive symptom severity in adulthood.Conclusion: The results of this study show that resilience and neuroticism are mediators of the effects from parental child-rearing to depressive symptoms in adulthood. Furthermore, resilience antagonizes the effect of neuroticism on adulthood depressive symptoms.Keywords: parenting, resilience, neuroticism, depressive symptoms, structure equation modeling, hierarchical multiple regression analysis

Jiro Masuya,1,&ast; Masahiko Ichiki,1,&ast; Chihiro Morishita,1 Motoki Higashiyama,1 Miki Ono,1 Mina Honyashiki,1 Yoshio Iwata,1 Hajime Tanabe,2 Takeshi Inoue1 1Department of Psychiatry, Tokyo Medical University, Shinjuku-ku, Tokyo, 160-0023, Japan; 2Faculty of Humanities and Social Sciences, Shizuoka University, Suruga-ku, Shizuoka, 422-8529, Japan&ast;These authors contributed equally to this workCorrespondence: Jiro Masuya, Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan, Tel +81-3-3342-6111, ext. 5754, Fax +81-3-3340-4499, Email j-masuya@tokyo-med.ac.jpBackground: When assessing patients with depressive and anxiety disorders in psychiatric clinical practice, it is common to encounter children and adolescents who have experienced abuse and victimization. To date, it has been clarified that experiences of “childhood abuse” and “childhood victimization” lead to “neuroticism”, and that neuroticism leads to “adult depressive symptoms”. In this study, we analyzed how these four factors are interrelated.Subjects and Methods: The following self-administered questionnaire surveys were conducted in 576 adult volunteers: Patient Health Questionnaire-9, Eysenck Personality Questionnaire-revised shortened version, Child Abuse and Trauma Scale, and Childhood Victimization Rating Scale. For statistical analysis, Pearson correlation coefficient analysis, t-test, multiple regression analysis, and covariance structure analysis (path analysis) were performed.Results: Path analysis showed that the indirect effects of childhood abuse and childhood victimization on depressive symptoms through neuroticism were statistically significant. In addition, the indirect effects of childhood abuse on neuroticism through childhood victimization were statistically significant. Finally, the indirect effects of childhood abuse on depressive symptoms through the combined paths of childhood victimization and neuroticism were statistically significant.Conclusion: Our results suggest that “childhood abuse (A)” induces changes in the personality trait of “neuroticism (C)” with “childhood victimization (B)” as a mediator, and that these adversities affect the expression of “depressive symptoms in adulthood (D)” through “neuroticism (C)” as a mediator. In other words, to our knowledge, this is the first study to clarify that these four factors are not only individually associated with each other but also cause a chain reaction of A to B to C to D.Keywords: childhood abuse, childhood victimization, neuroticism, depressive symptoms, path analysis

Introduction: Assertive Community Treatment (ACT), which was developed in the 1970s in the USA, is a programme that supports people with severe mental illness living in the community through a multidisciplinary team, individual care and outreach approach. It is widely known that ACT effectively decreases hospital stays and improves Global Assessment of Functioning scores. In Japan, empirical studies on ACT were conducted in the late 2000s. Through the introduction of the standardised programme and domestic network, its implementation nationwide was anticipated. However, to date, the implementation of ACT is limited. There has been no comprehensive research in Japan on what inhibits and promotes the implementation of ACT in community mental health settings. Therefore, in this study, we aimed to systematically and comprehensively investigate the factors influencing the implementation of ACT in Japan using implementation research., Methods and Analysis: A qualitative study will be conducted using semistructured interviews with key stakeholders in the ACT team. Interviews will be conducted face-to-face or online, using an interview guide. The inclusion criteria are present and past ACT teams. Recruitment will be in two steps. A preinterview questionnaire will be sent to the members of the Community Mental Health Outreach Association regarding their basic characteristics and fidelity to the ACT model, and purposive sampling will be performed based on it. The Consolidated Framework for Implementation Research will be used to collect and analyse the interview data according to the qualitative content analysis, with reference to the fidelity category, because this will help to find influencing factors by identifying constructs that appear to distinguish between high-fidelity and low-fidelity teams., Ethics and Dissemination: This study has been approved by the Tokyo Medical University Ethics Approval Committee (approval number: T2022-0175). The findings will be shared via peer-reviewed journal publications and presentations to policymakers and service users., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: Various risk factors, such as childhood nurturing experiences and subjective social status, have been identified to be involved in the onset of depression. However, the mechanism of depression is not yet fully understood. In this study, we hypothesized that nurturing experienced in childhood affects subjective social status and current personality traits, which in turn influence depressive symptoms in adulthood, and verified this hypothesis through structural equation modeling., Methods: A questionnaire survey was conducted on 404 adults. Multiple regression analysis and structural equation modeling were conducted using demographic information and scores for the Patient Health Questionnaire-9, Parental Bonding Instrument, and NEO Five-Factor Inventory., Results: Subjective social status was found to mediate the association between nurturing experiences and neuroticism (0.029 for Overprotection and -0.034 for Care). On the other hand, neuroticism was found to mediate the association between subjective social status and depressive symptoms (-0.097 in Care model and -0.103 in Overprotection model), as well as the association between nurturing experiences and depressive symptoms (0.144 for Overprotection and -0.134 for Care). Furthermore, it was also shown that complex paths, in which the association of nurturing experiences with depressive symptoms was mediated by two factors, namely, subjective social status and neuroticism, were statistically significant as indirect effects (0.016 for Overprotection and -0.018 for Care)., Conclusion: In this study, we clarified that nurturing experienced in childhood affects neuroticism in adulthood, which is mediated by subjective social status, and furthermore, the effects of nurturing on neuroticism lead to varying levels of depressive symptoms in adulthood. The mediation effects demonstrated in the present study may contribute towards unraveling the causes of depression and developing effective treatments for depressive symptoms., Competing Interests: The authors have read the journal's policy and the authors of this manuscript have the following competing interests: Yu Tamada has received personal fees from Otsuka Pharmaceutical, Sumitomo Pharma, Eisai, MSD, and Meiji Seika Pharma. Yota Fujimura has received personal compensation from Sumitomo Pharma, and grants from Otsuka Pharmaceutical, Sumitomo Pharma, and Shionogi. Shinji Higashi has received personal fees from Dainippon Sumitomo Pharma, Eisai, Takeda Pharmaceutical, Shionogi, Viatris, and MSD. Naoki Hashimoto has received personal fees from Janssen Pharmaceutical, Yoshitomiyakuhin, Otsuka Pharmaceutical, Sumitomo Pharma, Takeda Pharmaceutical, and Meiji Seika Pharma. Takeshi Inoue has received personal fees from Mochida Pharmaceutical, Takeda Pharmaceutical, Eli Lilly, Janssen Pharmaceutical, MSD, Taisho Toyama Pharmaceutical, Yoshitomiyakuhin, and Daiichi Sankyo; grants from Shionogi, Astellas, Tsumura, and Eisai; and grants and personal compensation from Otsuka Pharmaceutical, Sumitomo Pharma, Mitsubishi Tanabe Pharma, Kyowa Pharmaceutical Industry, Pfizer, Novartis Pharma, and Meiji Seika Pharma; and is a member of the advisory boards of Pfizer, Novartis Pharma, and Mitsubishi Tanabe Pharma. Jiro Masuya has received personal fees from Otsuka Pharmaceutical, Eli Lilly, Astellas, and Meiji Yasuda Mental Health Foundation, and grants from Pfizer. The remaining authors declare no conflict of interest., (© 2024 The Author(s). Psychiatry and Clinical Neurosciences Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Psychiatry and Neurology.)

Background: Stressors induce depression together with parenting experienced in childhood, personality traits, and sleep. In this study, we investigated factors associated with the development of depression in a long-term stressful environment, namely, the Antarctic Research Expedition wintering party, by comparing 2 groups, the depression and nondepression groups., Methods: A self-administered questionnaire was used to survey 91 members of the Japanese Antarctic Research Expedition who spent winters in the Antarctic base. Psychological evaluations of depression, anxiety, and sleep were performed using a questionnaire every 3 months during the participants' stay in Antarctica. The primary endpoint was the occurrence of minor or major depression, as evaluated by the PHQ-9 score., Results: Participants with a PHQ-9 score of 5 or more during their stay in Antarctica were defined as the depression group (25 subjects), and participants with a PHQ score of 4 or less were defined as the nondepression group (43 subjects). Compared with the nondepression group, the depression group had significantly higher scores for predeparture PHQ-9, state and trait anxiety, sleep disturbance, and neuroticism. Multivariable logistic regression analyses showed that higher predeparture scores of subthreshold depressive symptoms and neuroticism were found to be significant predictors of the occurrence of depression during their stay in Antarctica., Conclusions: This study prospectively showed that subthreshold depressive symptoms and neuroticism, which were suggested as risk factors in previous studies, were confirmed to be risk factors for depression. The results of our study are expected to contribute to the understanding of depression in harsh environments., (© 2024 The Author(s). Neuropsychopharmacology Reports published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Neuropsychopharmacology.)

Background: Previously, we demonstrated that childhood maltreatment could worsen depressive symptoms through neuroticism. On the one hand, some studies report that sleep disturbances are related to childhood maltreatment and neuroticism and worsens depressive symptoms. But, to our knowledge, no reports to date have shown the interrelatedness between childhood maltreatment, neuroticism, and depressive symptoms, and sleep disturbance in the one model. We hypothesized that sleep disturbance enhances the influence of maltreatment victimization in childhood or neuroticism on adulthood depressive symptoms and the mediation influence of neuroticism between maltreatment victimization in childhood and adulthood depressive symptoms., Subjects and Methods: Total 584 Japanese volunteer adults recruited through convenience sampling from 4/2017 to 4/2018 were assessed regarding their characteristics of demographics, history of childhood maltreatment, sleep disturbance, neuroticism, and depressive symptoms with questionnaires self-administered. Survey data were analyzed using simple moderation models and a moderating mediation model., Results: The interaction of sleep disturbance with childhood maltreatment or neuroticism on depressive symptoms was significantly positive. Furthermore, the moderating effect of sleep disturbance on the indirect effect of childhood maltreatment to depressive symptoms through neuroticism was significantly positive., Limitations: Because this was a cross-sectional study, a causal relationship could not be confirmed., Conclusions: Our findings indicate that individuals with milder sleep disturbance experience fewer depressive symptoms attributable to neuroticism and childhood maltreatment. Additionally, people with less sleep disturbance have fewer depressive symptoms arising from neuroticism owing to childhood maltreatment. Therefore, improvement of sleep disturbance will buffer the aggravating effect of childhood maltreatment, neuroticism caused by various factors, and neuroticism resulting from childhood maltreatment on depressive symptoms., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Jiro Masuya has received personal compensation from Otsuka Pharmaceutical, Eli Lilly, Astellas, MSD, Janssen Pharmaceutical, Takeda Pharmaceutical, Shionogi Pharmaceutical, and Meiji Yasuda Mental Health Foundation, as well as grants from Pfizer, and Mitsubishi Tanabe Pharma. Yu Tamada received honoraria from Otsuka Pharmaceutical, Sumitomo Pharma, Eisai, MSD and Meiji Seika Pharma. Takeshi Inoue has received personal fees from Mochida Pharmaceutical, Takeda Pharmaceutical, Eli Lilly, Janssen Pharmaceutical, MSD, Taisho Toyama Pharmaceutical, Yoshitomiyakuhin, and Ono Pharmaceutical; a grant from Astellas; and grants and personal fees from Otsuka Pharmaceutical, Sumitomo Dainippon Pharma, Mitsubishi Tanabe Pharma, Kyowa Pharmaceutical Industry, Pfizer, Shionogi, Tsumura, Novartis Pharma, Eisai, Daiichi Sankyo, and Meiji Seika Pharma; and is a member of the advisory boards of Pfizer, Novartis Pharma, and Mitsubishi Tanabe Pharma. All other authors declare that they have no actual or potential conflicts of interest associated with this study. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Masuya et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Aim: Various factors are thought to be involved in the development of depression, but the mechanisms are not yet clear. Although several reports have demonstrated that parental attitude experienced in childhood, depressive rumination, and sleep disturbances each influence depressive symptoms, and the association between two of these four variables, to our knowledge, no reports to date have investigated the association among the four variables., Methods: A questionnaire survey was administered to 576 adults who agreed to participate in this study between April 2017 and April 2018. Questionnaires assessed parental attitudes experienced in childhood, depressive rumination, sleep disturbances, and depressive symptoms in adulthood. The associations among the four variables were tested by structural equation modeling., Results: Regarding the direct effects, the parental attitude of "care" had a negative influence on depressive rumination and depressive symptoms, whereas "overprotection" had a positive influence on depressive rumination. Depressive rumination had a positive influence on sleep disturbance and depressive symptoms, whereas sleep disturbances had a positive influence on depressive symptoms. Regarding indirect effects, depressive rumination mediated the association between parental attitudes and sleep disturbances or depressive symptoms. Furthermore, sleep disturbances mediated the association between depressive rumination and depressive symptoms. Care and overprotection showed opposite effects. The goodness of fit of this model was high., Conclusion: The results of this study demonstrated that there were associations among the four variables. Clinical assessment and intervention of depressive rumination and sleep disturbances that are closely associated with previous parental attitudes may lead to an improvement of depressive symptoms., Competing Interests: The authors have read the journal's policy and the authors of this manuscript have the following competing interests: Yu Tamada has received personal fees from Otsuka Pharmaceutical, Sumitomo Pharma, Eisai, MSD, and Meiji Seika Pharma. Takeshi Inoue has received personal fees from Mochida Pharmaceutical, Takeda Pharmaceutical, Eli Lilly, Janssen Pharmaceutical, MSD, Taisho Toyama Pharmaceutical, Yoshitomiyakuhin, and Daiichi Sankyo; grants from Shionogi, Astellas, Tsumura, and Eisai; and grants and personal compensation from Otsuka Pharmaceutical, Sumitomo Pharma, Mitsubishi Tanabe Pharma, Kyowa Pharmaceutical Industry, Pfizer, Novartis Pharma, and Meiji Seika Pharma; and is a member of the advisory boards of Pfizer, Novartis Pharma, and Mitsubishi Tanabe Pharma. Jiro Masuya has received personal fees from Otsuka Pharmaceutical, Eli Lilly, Astellas, and Meiji Yasuda Mental Health Foundation, and grants from Pfizer. All other authors declare that they have no actual or potential conflicts of interest associated with this study., (© 2024 The Author(s). Psychiatry and Clinical Neurosciences Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Psychiatry and Neurology.)

Abstract: The aim of this study was to analyze whether interpersonal sensitivity mediates the effect of qualitative parenting characteristics experienced during childhood on the appraisal of life experiences and depression severity during adulthood in adult community volunteers. A total of 404 Japanese adult volunteers answered the following four self-report questionnaires: Parental Bonding Instrument, Interpersonal Sensitivity Measure, Life Experiences Survey, and Patient Health Questionnaire-9. Structural equation modeling was performed to analyze whether childhood parenting quality increases depressive symptom severity through interpersonal sensitivity, which then affects the appraisal of recent life events. In the two structural equation models, inadequate care and excessive overprotection received during childhood were associated with the negative evaluation of life experiences and depression severity in adulthood through high interpersonal sensitivity. Our findings indicate interpersonal sensitivity as a mediator of the effect of inadequate care and excessive overprotection experienced in childhood on the negative evaluation of life experiences and depression severity in adulthood., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Aim: We aimed to illustrate and compare the processes of mental health policies aiming at a service delivery shift from the hospital to the community using implementation science, and to identify important implementation strategies., Methods: This study had a comparative case study design. The cases were the Belgian mental health reform, and the person-centered model of mental health in Hong Kong, China. Several documentary sources were reviewed, including the published literature and websites. Data on policy processes were extracted, analyzed using directed content analysis, and categorized into constructs of the conceptual model for evidence-informed policy formulation and implementation arranged for the mental health policy., Results: Several similarities were identified in the strategies for active implementation and dissemination; official staff allocation, and training to the community psychiatric services, an approach to adjust the number of psychiatric hospital beds, and promoting collaboration between health care sectors and social welfare sectors. Under distinct social contexts, differences were found in all processes., Conclusions: Each of the described policy processes can serve as a model for countries in similar social contexts seeking to shift their psychiatric service delivery. Furthermore, our findings suggest widely applicable implementation strategies for policies aiming at a service delivery shift., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Aim: Understanding the appropriate prescription of psychotropics for hospitalized patients in terms of preventing falls is an important issue. The aim of this study was to assess the associations between the occurrence of falls and the use of various individual psychotropics in hospitalized patients., Methods: A retrospective matched case-control study was conducted on adult patients admitted to every department of Tokyo Medical University Hospital, with the outcome being in-hospital falls. A total of 447 hospitalized patients who had had in-hospital falls at some point in their hospitalization between January 2016 and December 2016 were included as cases. A total of 447 hospitalized patients who did not have in-hospital falls, and were individually matched to the cases by sex, age, and clinical department, were included as controls. All data were extracted from electronic medical records. Conditional logistic regression analyses were conducted to assess the association between the exposure to 16 psychotropic medications and the occurrence of in-hospital falls. The multivariable logistic regression model adjusted sex, age, clinical department, body mass index, fall risk score on the fall risk assessment measure, and use of psychotropic medications., Results: The multivariable conditional logistic regression model showed a significant association between the use of risperidone (odds ratio [OR] = 3.730; 95% confidence interval [CI] = 1.229-11.325) and flunitrazepam (OR = 4.120; 95% CI = 1.105-15.364) and an increased OR of falls among hospitalized patients., Conclusion: The use of risperidone and flunitrazepam were identified as risk factors for falls among hospitalized patients., Competing Interests: Jiro Masuya has received personal fees from Otsuka Pharmaceutical, Eli Lilly, Astellas, MSD, Janssen Pharmaceutical, Takeda Pharmaceutical, Shionogi Pharmaceutical, and Meiji Yasuda Mental Health Foundation, as well as grants from Pfizer, and Mitsubishi Tanabe Pharma. Yu Tamada has received honoraria from Otsuka Pharmaceutical, Dainippon Sumitomo Pharma, and Eisai. Yota Fujimura has received honoraria and a research grant from Sumitomo Pharma, and research grants from Otsuka Pharmaceutical, and Shionogi. Takeshi Inoue is a member of the advisory boards of Pfizer, Novartis Pharma, and Mitsubishi Tanabe Pharma, and has received personal fees from Mochida Pharmaceutical, Takeda Pharmaceutical, Eli Lilly, Janssen Pharmaceutical, MSD, Taisho Toyama Pharmaceutical, Yoshitomiyakuhin, and Daiichi Sankyo; grants from Shionogi, Astellas, Tsumura, and Eisai; and grants and personal fees from Otsuka Pharmaceutical, Dainippon Sumitomo Pharma, Mitsubishi Tanabe Pharma, Kyowa Pharmaceutical Industry, Pfizer, Novartis Pharma, and Meiji Seika Pharma. The other authors have no actual or potential conflicts of interest to declare., (© 2023 The Authors. Psychiatry and Clinical Neurosciences Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Psychiatry and Neurology.)

Aim: Productivity loss in the workplace due to physical or mental health problems, which is called presenteeism, leads to large financial losses. Personal and work environment factors, as well as physical and mental illnesses are associated with presenteeism, but the detailed underlying mechanism remains unclear. In this study, we analyzed the effects of perceived childhood rearing on the presenteeism of adult workers, and the mediating effects of trait anxiety and depressive rumination., Methods: In 2017 and 2018, a cross-sectional paper-based survey was conducted, and written consent from 447 adult workers was obtained. Demographic information and results from the Parental Bonding Instrument, trait anxiety of State-Trait Anxiety Inventory Form Y, Ruminative Responses Scale, and Work Limitations Questionnaire were surveyed. Multiple regression analyses and structural equation modeling were conducted., Results: The low perceived quality of rearing from parents in childhood, i.e., low care and high overprotection, indirectly worsened current presenteeism via trait anxiety and depressive rumination. Presenteeism was directly worsened by trait anxiety and depressive rumination, and the low perceived quality of rearing from parents directly affected trait anxiety and depressive rumination, and trait anxiety affected depressive rumination., Conclusion: The results of this study clarified the long-term influences of the low perceived quality of rearing experienced in childhood on adulthood presenteeism via trait anxiety and depressive rumination. Therefore, assessing the quality of childhood rearing, trait anxiety, and depressive rumination of individuals may help to elucidate the causes of presenteeism in the workplace, and how to manage it effectively., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Yota Fujimura has received personal compensation from Sumitomo Pharma, and grants from Otsuka Pharmaceutical, Sumitomo Pharma, and Shionogi. Takeshi Inoue has received personal compensation from Mochida Pharmaceutical, Takeda Pharmaceutical, Eli Lilly, Janssen Pharmaceutical, MSD, Taisho Toyama Pharmaceutical, Yoshitomiyakuhin, and Daiichi Sankyo; grants from Shionogi, Astellas, Tsumura, and Eisai; and grants and personal compensation from Otsuka Pharmaceutical, Sumitomo Pharma, Mitsubishi Tanabe Pharma, Kyowa Pharmaceutical Industry, Pfizer, Novartis Pharma, and Meiji Seika Pharma; and is a member of the advisory boards of Pfizer, Novartis Pharma, and Mitsubishi Tanabe Pharma. Jiro Masuya has received personal compensation from Otsuka Pharmaceutical, Eli Lilly, Astellas, and Meiji Yasuda Mental Health Foundation, and grants from Pfizer. All other authors declare that they have no actual or potential conflicts of interest associated with this study. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2023 Shimasaki et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Personality traits, such as neuroticism, that results in vulnerability to stress, and resilience, a measure of stress coping, are closely associated with the onset of depressive symptoms, whereas regular physical activity habits have been shown to reduce depressive symptoms. In this study, the mediating effects of neuroticism and resilience between physical activity duration and depressive symptoms were investigated by a covariance structure analysis., Methods: Between April 2017 and April 2018, 526 adult volunteers were surveyed using self-administered questionnaires. Demographic information, habitual physical activity duration (PAD), neuroticism, and resilience were investigated. The effects of these factors on depressive symptoms were analyzed by a covariance structure analysis. This study was conducted with the approval of the Medical Ethics Committee of Tokyo Medical University., Results: The dose-response curves of physical activity duration and depression scores were U-shaped: the optimal physical activity duration for the lowest depression score was 25.7 h/week. We found that the greater the difference from the optimal PAD, the higher the neuroticism and the lower the resilience, and the more severe the depressive symptoms. Covariance structure analysis demonstrated that neuroticism and resilience significantly and completely mediated the effects of the difference from the optimal PAD on depressive symptoms (coefficient of determination R 2 = 0.349)., Conclusion: Our study suggests that there is an optimal PAD that reduces depressive symptoms, and that a greater difference from the optimal PAD increases depressive symptoms through neuroticism and resilience.

Background: Prior studies have reported that childhood victimization experiences substantially augment the risk of depression and suicide in adulthood. Several of our previous studies suggested that childhood experiences of victimization interact with the quality of parenting experienced in childhood, childhood experiences of abuse, neuroticism, and other factors to influence depressive symptoms in adulthood. In this study, it was hypothesized that "childhood victimization" worsens "trait anxiety" and "depressive rumination", and that "trait anxiety" and "depressive rumination" are mediators that worsen "depressive symptoms in adulthood"., Subjects and Methods: The following self-administered questionnaires were completed by 576 adult volunteers: Patient Health Questionnaire-9, State-Trait Anxiety Inventory form Y, Ruminative Responses Scale, and Childhood Victimization Rating Scale. Statistical analyses were performed by Pearson correlation coefficient analysis, t-test, multiple regression analysis, path analysis, and covariance structure analysis., Results: Path analysis demonstrated that the direct effect was statistically significant for the paths from childhood victimization to trait anxiety, depressive rumination, and depressive symptom severity. Moreover, the indirect effect of childhood victimization on depressive rumination mediated by trait anxiety was statistically significant. The indirect effects of childhood victimization on depressive symptom severity mediated by trait anxiety and depressive rumination were statistically significant. Furthermore, the indirect effect of childhood victimization on depressive symptom severity mediated by both trait anxiety and depressive rumination was statistically significant., Conclusions: We found that childhood victimization directly and adversely influenced each of the above factors, and indirectly worsened adulthood depressive symptoms with trait anxiety and depressive ruminations as mediating factors. The present study is the first to clarify these mediation effects. Therefore, the results of this study suggest the importance of preventing childhood victimization and the importance of identifying and addressing childhood victimization in patients with clinical depression., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Jiro Masuya has received personal compensation from Otsuka Pharmaceutical, Eli Lilly, Astellas, MSD, Janssen Pharmaceutical, Takeda Pharmaceutical, Shionogi Pharmaceutical, and Meiji Yasuda Mental Health Foundation, as well as grants from Pfizer, and Mitsubishi Tanabe Pharma. Takeshi Inoue has received personal fees from Mochida Pharmaceutical, Takeda Pharmaceutical, Eli Lilly, Janssen Pharmaceutical, MSD, Taisho Toyama Pharmaceutical, Yoshitomiyakuhin, and Ono Pharmaceutical; a grant from Astellas; and grants and personal fees from Otsuka Pharmaceutical, Sumitomo Dainippon Pharma, Mitsubishi Tanabe Pharma, Kyowa Pharmaceutical Industry, Pfizer, Shionogi, Tsumura, Novartis Pharma, Eisai, Daiichi Sankyo, and Meiji Seika Pharma; and is a member of the advisory boards of Pfizer, Novartis Pharma, and Mitsubishi Tanabe Pharma. All other authors declare that they have no actual or potential conflicts of interest associated with this study. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2023 Masuya et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Aim: The association of parenting experiences in childhood with anxiety symptoms in adulthood has yet to be clarified. We hypothesized that interpersonal sensitivity (IPS) mediates the impacts of parenting experiences in childhood on anxiety symptoms and negative assessment of life events in adulthood., Methods: An observational cross-sectional study was carried out from January 2014 to August 2014 on 853 adults. Participants provided their demographic information and answered the following four self-administered questionnaires: Parental Bonding Instrument (PBI), Interpersonal Sensitivity Measure (IPSM), Life Experiences Survey (LES), and State-Trait Anxiety Inventory Form Y (STAI-Y). The data of a total of 404 participants who agreed to take part in this study were analyzed., Results: Multiple regression analysis with the State Anxiety subscale of STAI-Y as the dependent variable identified the following five out of the 15 independent variables as being statistically significant: IPSM total, LES positive and negative, PBI paternal overprotection, and employment status. This model explains 17.8% of the State Anxiety subscale score. In the structural equation models, the Care subscale showed significant indirect negative effects on State Anxiety subscale and LES negative score through a decrease in IPSM total score ( β  = -0.061 and -0.042, respectively). The former indirect effect accounted for 31.6%, and the latter accounted for 56.8% of the total effects. In contrast, Overprotection subscale had opposite effects to Care subscale., Conclusion: These results suggest that parenting experiences in childhood are related to adult anxiety symptoms and the negative assessment of life events indirectly through IPS., Competing Interests: Jiro Masuya has received personal compensation from Otsuka Pharmaceutical, Eli Lilly, Astellas, and Meiji Yasuda Mental Health Foundation, and grants from Pfizer. Ichiro Kusumi has received personal compensation from Astellas, Chugai Pharmaceutical, Daiichi Sankyo, Dainippon Sumitomo Pharma, Eisai, Eli Lilly, Janssen Pharmaceutical, Kyowa Hakko Kirin, Meiji Seika Pharma, MSD, Nippon Chemiphar, Novartis Pharma, Ono Pharmaceutical, Otsuka Pharmaceutical, Pfizer, Tanabe Mitsubishi Pharma, Shionogi, and Yoshitomiyakuhin, and has received research grants from AbbVie GK, Asahi Kasei Pharma, Astellas, Boehringer Ingelheim, Chugai Pharmaceutical, Daiichi Sankyo, Dainippon Sumitomo Pharma, Eisai, Eli Lilly, GlaxoSmithKline, Kyowa Hakko Kirin, Meiji Seika Pharma, MSD, Novartis Pharma, Ono Pharmaceutical, Otsuka Pharmaceutical, Pfizer, Takeda Pharmaceutical, Tanabe Mitsubishi Pharma, Shionogi, and Yoshitomiyakuhin, and is a member of the advisory board of Dainippon Sumitomo Pharma and Tanabe Mitsubishi Pharma. Takeshi Inoue has received personal compensation from Mochida Pharmaceutical, Takeda Pharmaceutical, Eli Lilly, Janssen Pharmaceutical, MSD, Taisho Toyama Pharmaceutical, Yoshitomiyakuhin, and Daiichi Sankyo; grants from Shionogi, Astellas, Tsumura, and Eisai; and grants and personal compensation from Otsuka Pharmaceutical, Dainippon Sumitomo Pharma, Mitsubishi Tanabe Pharma, Kyowa Pharmaceutical Industry, Pfizer, Novartis Pharma, and Meiji Seika Pharma; and is a member of the advisory boards of Pfizer, Novartis Pharma, and Mitsubishi Tanabe Pharma. The other authors declare that they have no actual or potential conflicts of interest associated with this study., (© 2023 The Authors. Psychiatry and Clinical Neurosciences Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Psychiatry and Neurology.)

Background: Previous studies have reported that physical activity can prevent the onset of depression and reduces anxiety. In the present study, the hypothesis that total physical activity time influences depressive symptoms via state and trait anxiety was tested by a path analysis., Methods: Self-administered questionnaires were used to survey 526 general adult volunteers from April 2017 to April 2018. Demographic information, physical activity, and state and trait anxiety were investigated., Results: The association between physical activity time and depressive symptoms was expressed as a U-shape curve. The results of the covariance structure analysis showed that differences from the optimal physical activity time (DOT) had direct positive effects on state and trait anxiety. DOT affected depressive symptoms only via trait anxiety, and this was a complete mediation model., Conclusion: The present study suggests that an optimal physical activity time exists for depressive symptoms. The path model demonstrated an association between the three factors of optimal physical activity time, trait anxiety, and depressive symptoms, and the effect was fully mediated by trait anxiety.

Depressive symptoms (DepS) associated with major depressive disorder (MDD) are influenced by affective temperaments (ATs), behavioral inhibition system (BIS), and behavioral activation system (BAS). However, the effect of interactions between ATs and BIS/BAS on DepS in MDD remains poorly understood. Herein, we aimed to investigate the effects of these interactions. The Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A), BIS/BAS questionnaire, and Patient Health Questionnaire-9 (PHQ-9) were used to evaluate ATs, BIS/BAS, and DepS, respectively, in 90 participants with MDD. Data were analyzed using hierarchical multiple regression analysis to assess the interaction effect. The interaction ( β = 0.199, p < 0.05) between depressive temperament (DepT) ( β = 0.319, p < 0.01) and BIS scores ( β = 0.300, p < 0.01) exhibited a significant positive effect on DepS (Δ R 2 = 0.038, p < 0.05). However, the interaction between ATs and BAS scores did not exhibit a significant effect on DepS. Our findings suggest that interactions between BIS sensitivity and DepT worsen DepS in individuals with MDD. Hence, to manage DepS associated with BIS sensitivity and DepT, evaluating their interaction may be useful in daily clinical practice. This study presents important insights into MDD psychopathology.

Background: In 2021, the US Food and Drug Administration granted an accelerated approval to aducanumab for patients with mild cognitive impairment (MCI) and mild dementia caused by Alzheimer's disease (AD); however, the cost of aducanumab is high, at approximately $28,000 for one year per person. On the other hand, lithium is much cheaper at $40 a year, and has been reported to be effective for the cognitive decline observed in both patients with MCI and AD. In contrast to acetylcholinesterase inhibitors and N-methyl D-aspartate receptor antagonists, aducanumab and lithium may be disease-modifying drugs. Therefore, we focused on aducanumab and lithium and compared the effects of these drugs on the cognitive decline in MCI and AD patients using a network meta-analysis., Methods: PubMed, the Cochrane Library, CINHAL, and ClinicalTrials.gov were searched for randomized controlled trials testing lithium or aducanumab for the treatment of cognitive decline in patients with MCI or AD, up to January 31, 2022. A frequentist fixed-effect network meta-analysis was performed to estimate direct and indirect effects. The primary outcome was change scores in cognitive decline measured by Mini-Mental State Examination. This study has been registered with PROSPERO (number CRD42022304807)., Results: Network meta-analysis demonstrated that lithium was significantly more effective than aducanumab in the primary outcome., Conclusion: Although there were various limitations in this study, lithium may be a more cost-effective treatment than aducanumab for MCI and AD., Competing Interests: Conflicts of interest Takeshi Inoue has received personal compensation from Mochida Pharmaceutical, Takeda Pharmaceutical, Eli Lilly, Janssen Pharmaceutical, MSD, Taisho Toyama Pharmaceutical, Yoshitomiyakuhin, and Daiichi Sankyo; grants from Shionogi, Astellas, Tsumura, and Eisai; and grants and personal compensation from Otsuka Pharmaceutical, Dainippon Sumitomo Pharma, Mitsubishi Tanabe Pharma, Kyowa Pharmaceutical Industry, Pfizer, Novartis Pharma, and Meiji Seika Pharma; and is a member of the advisory boards of Pfizer, Novartis Pharma, and Mitsubishi Tanabe Pharma. The other authors declare that they have no actual or potential conflicts of interest associated with this study., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Long working hours are detrimental to physical and mental health. However, the association between long working hours and psychosomatic symptoms have remained controversial, possibly because of the existence of mediators between working hours and psychosomatic stress responses. We hypothesized that lifestyle habits, regarding sleep and mealtimes, act as mediators, and analyzed the associations between long working hours, sleep duration, mealtime regularity, and psychosomatic stress responses in office workers., Methods: From April 2017 to March 2018, an online cross-sectional survey regarding overtime work hours, work-related stress, sleep, and eating habits was conducted with employees of 17 companies located in Tokyo, Japan. Answers were obtained from 3559 employees, and 3100 provided written consent for the academic use of their answers, and were included in the analysis. A path analysis was conducted to assess the effect of overtime work on psychosomatic stress via shortened sleep or irregular mealtimes., Results: Overtime work hours had no direct effect on psychosomatic stress responses and depressive symptoms. However, overtime work hours affected sleep duration and the regularity of mealtimes. The effects of overtime work hours on psychosomatic stress responses and depressive symptoms were completely mediated by sleep duration and the regularity of mealtimes., Conclusion: Long working hours do not affect mental health directly; however, shortened sleep duration and irregular mealtimes mediate the effect of long working hours on psychosomatic stress responses and depressive symptoms.

Background: About 3% to 8% of women of fertile age are thought to have premenstrual dysphoric disorder (PMDD), which is regarded as a serious form of premenstrual syndrome (PMS), although the details of this common condition remain unclear. The aim of this study was to analyze the interrelations of childhood maltreatment, personality traits, and life stress in the etiology of PMS/PMDD., Methods: A total of 240 adult female volunteers from a community in Japan were investigated, using the following 5 questionnaires: Patient Health Quesstionaire-9, Child Abuse and Trauma Scale, Temperament and Character Inventory (TCI), Life Experiences Survey, and premenstrual dysphoric disorder (PMDD) scale. The questionnaire data were subjected to path analyses to clarify the association between childhood maltreatment and the severity of premenstrual symptoms, mediated by personality traits and life stress., Results: The 2 path analysis models showed that high harm avoidance (HA) on the TCI and low self-directedness (SD) on the TCI had significant direct effects on the severity of premenstrual symptoms. Moreover, childhood maltreatment was associated with the severity of premenstrual symptoms, both directly and indirectly through personality traits., Conclusion: Our findings suggest that HA on the TCI might be a risk factor for severe premenstrual symptoms among general women and furthermore that SD on the TCI may be a protective factor. In addition, childhood maltreatment is associated with severe premenstrual symptoms both directly and indirectly through personality traits., (© 2022. The Author(s).)

The fear of cancer recurrence (FCR) is the most common and most severe unmet need among cancer survivors. Safe treatments for the FCR that are easily disseminated are greatly needed. Our primary aim is a preliminary evaluation of the efficacy and effect size of perilla oil, which is rich in omega-3 fatty acids, and Bifidobacterium , a probiotic, on FCR in breast cancer survivors after the completion of chemotherapy. This study has been planned as an exploratory clinical study (phase II) and will be conducted as a three-arm, 12-week parallel group, masked-rater randomized controlled trial. Fifteen participants will be randomized with 1:1:1 allocation to receive Bifidobacterium plus perilla oil, Bifidobacterium alone, or no intervention (control). Interventions will end within 12 weeks after the random allocation of each participant. The participants will be outpatients with invasive breast cancer aged 20 years or older whose chemotherapy was completed at least 6 months before registration; hormone therapy may be ongoing. The primary outcome will be severity of FCR at 12 weeks assessed by masked raters using the 4-item Concerns about Recurrence Scale concerning overall fear of recurrence. The study protocol for the current study is registered in the Japan Registry of Clinical Trials (jRCTs031200029).

Background: Over the years randomized controlled trials (RCTs) of various psychotherapies for treating depression have provided evidence to demonstrate the interventions' efficacy/effectiveness. However, recent researches suggest that the quality of some RCTs were actually less than ideal, which could hence have biased their results. The present study aims to assess (1) the changes in characteristics of RCTs of psychotherapies for treating adult depression; (2) the temporal changes in their trial quality, and (3) the quality differences among different therapeutic approaches., Methods: We included 135 RCTs of psychotherapies treating adult depression published from year 1969 to 2011. Temporal changes in trials' characteristics including their quantity and quality were assessed at study-level and arm-level. Quality differences among different schools of psychotherapy were assessed at arm-level., Results: Changes in quantity and improvements in methodological quality were found at study-level. Positive changes in trial quality at arm-level were observed in most aspects. Comparisons made across different schools of psychotherapy revealed statistically significant differences among them, with earlier behavior therapy trials doing worst and more recent third wave cognitive-behavior therapy doing best., Limitations: We could not determine whether the observed changes in quality resulted from actual improvement in trial quality and/or from improved reporting. The relatively smaller number of arms for several types of interventions could weaken the representativeness when making comparisons across psychotherapeutic approaches., Conclusion: Our study revealed positive temporal changes in both trial quantity and quality over the past five decades and has also spotted possible areas for further improvement., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: So-called 'third wave' cognitive and behavioural therapies represents a new generation of psychological therapies that are increasingly being used in the treatment of psychological problems. However, the effectiveness and acceptability of third wave cognitive and behavioural therapy (CBT) approaches as a treatment for depression compared with other psychological therapies remain unclear., Objectives: 1. To examine the effects of all third wave CBT approaches compared with all other psychological therapy approaches for acute depression.2. To examine the effects of different third wave CBT approaches (ACT, compassionate mind training, functional analytic psychotherapy, extended behavioural activation and metacognitive therapy) compared with all other psychological therapy approaches for acute depression.3. To examine the effects of all third wave CBT approaches compared with different psychological therapy approaches (psychodynamic, behavioural, humanistic, integrative, cognitive-behavioural) for acute depression., Search Methods: We searched the Cochrane Depression, Anxiety and Neurosis Group Specialised Register (CCDANCTR to 01/01/12), which includes relevant randomised controlled trials from The Cochrane Library (all years), EMBASE (1974-), MEDLINE (1950-) and PsycINFO (1967-). We also searched CINAHL (May 2010) and PSYNDEX (June 2010) and reference lists of the included studies and relevant reviews for additional published and unpublished studies. An updated search of CCDANCTR restricted to search terms relevant to third wave CBT was conducted in March 2013 (CCDANCTR to 01/02/13)., Selection Criteria: Randomised controlled trials that compared various third wave CBT with other psychological therapies for acute depression in adults., Data Collection and Analysis: Two review authors independently identified studies, assessed trial quality and extracted data. Study authors were contacted for additional information where required. We rated the quality of evidence using GRADE methods., Main Results: A total of three studies involving 144 eligible participants were included in the review. Two of the studies (56 participants) compared an early version of acceptance and commitment therapy (ACT) with CBT, and one study (88 eligible participants) compared extended behavioural activation with CBT. No other studies of third wave CBT were identified. The two ACT studies were assessed as being at high risk of performance bias and researcher allegiance. Post-treatment results, which were based on dropout rates, showed no evidence of any difference between third wave CBT and other psychological therapies for the primary outcomes of efficacy (risk ratio (RR) of clinical response 1.14, 95% confidence interval (CI) 0.79 to 1.64; very low quality) and acceptability. Results at two-month follow-up showed no evidence of any difference between third wave CBT and other psychological therapies for clinical response (2 studies, 56 participants, RR 0.22, 95% CI 0.04 to 1.15). Moderate statistical heterogeneity was indicated in the acceptability analyses (I(2) = 41%)., Authors' Conclusions: Very low quality evidence suggests that third wave CBT and CBT approaches are equally effective and acceptable in the treatment of acute depression. Evidence is limited in quantity, quality and breadth of available studies, precluding us from drawing any conclusions as to their short- or longer-term equivalence. The increasing popularity of third wave CBT approaches in clinical practice underscores the importance of completing further studies to compare various third wave CBT approaches with other psychological therapy approaches to inform clinicians and policymakers on the most effective forms of psychological therapy in treating depression.

Background: Behavioural therapies represent one of several categories of psychological therapies that are currently used in the treatment of depression. However, the effectiveness and acceptability of behavioural therapies for depression compared with other psychological therapies remain unclear., Objectives: 1. To examine the effects of all BT approaches compared with all other psychological therapy approaches for acute depression.2. To examine the effects of different BT approaches (behavioural therapy, behavioural activation, social skills training and relaxation training) compared with all other psychological therapy approaches for acute depression.3. To examine the effects of all BT approaches compared with different psychological therapy approaches (CBT, third wave CBT, psychodynamic, humanistic and integrative psychological therapies) for acute depression., Search Methods: We searched the Cochrane Depression Anxiety and Neurosis Group Trials Specialised Register (CCDANCTR, 31/07/2013), which includes relevant randomised controlled trials from The Cochrane Library (all years), EMBASE, (1974-), MEDLINE (1950-) and PsycINFO (1967-). We also searched CINAHL (May 2010) and PSYNDEX (June 2010) and reference lists of the included studies and relevant reviews for additional published and unpublished studies., Selection Criteria: Randomised controlled trials that compared behavioural therapies with other psychological therapies for acute depression in adults., Data Collection and Analysis: Two or more review authors independently identified studies, assessed trial quality and extracted data. We contacted study authors for additional information., Main Results: Twenty-five trials involving 955 participants compared behavioural therapies with one or more of five other major categories of psychological therapies (cognitive-behavioural, third wave cognitive-behavioural, psychodynamic, humanistic and integrative therapies). Most studies had a small sample size and were assessed as being at unclear or high risk of bias. Compared with all other psychological therapies together, behavioural therapies showed no significant difference in response rate (18 studies, 690 participants, risk ratio (RR) 0.97, 95% confidence interval (CI) 0.86 to 1.09) or in acceptability (15 studies, 495 participants, RR of total dropout rate 1.02, 95% CI 0.65 to 1.61). Similarly, in comparison with each of the other classes of psychological therapies, low-quality evidence showed better response to cognitive-behavioural therapies than to behavioural therapies (15 studies, 544 participants, RR 0.93, 95% CI 0.83 to 1.05) and low-quality evidence of better response to behavioural therapies over psychodynamic therapies (2 studies, 110 participants, RR 1.24, 95% CI 0.84 to 1.82).When compared with integrative therapies and humanistic therapies, only one study was included in each comparison, and the analysis showed no significant difference between behavioural therapies and integrative or humanistic therapies., Authors' Conclusions: We found low- to moderate-quality evidence that behavioural therapies and other psychological therapies are equally effective. The current evidence base that evaluates the relative benefits and harms of behavioural therapies is very weak. This limits our confidence in both the size of the effect and its precision for our key outcomes related to response and withdrawal. Studies recruiting larger samples with improved reporting of design and fidelity to treatment would improve the quality of evidence in this review.

Background: People who suffer from severe mental disorder experience high rates of unemployment. Supported employment is an approach to vocational rehabilitation that involves trying to place clients in competitive jobs without any extended preparation. The Individual placement and support (IPS) model is a carefully specified form of supported employment., Objectives: 1. To review the effectiveness of supported employment compared with other approaches to vocational rehabilitation or treatment as usual.2. Secondary objectives were to establish how far:(a) fidelity to the IPS model affects the effectiveness of supported employment,(b) the effectiveness of supported employment can be augmented by the addition of other interventions., Search Methods: We searched the Cochrane Schizophrenia Group Trials Register (February 2010), which is compiled by systematic searches of major databases, handsearches and conference proceedings., Selection Criteria: All relevant randomised clinical trials focusing on people with severe mental illness, of working age (normally 16 to 70 years), where supported employment was compared with other vocational approaches or treatment as usual. Outcomes such as days in employment, job stability, global state, social functioning, mental state, quality of life, satisfaction and costs were sought., Data Collection and Analysis: Two review authors (YK and KK) independently extracted data. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated mean difference (MD) between groups and its 95% (CI). We employed a fixed-effect model for analyses. A random-effects model was also employed where heterogeneity was present., Main Results: A total of 14 randomised controlled trials were included in this review (total 2265 people). In terms of our primary outcome (employment: days in competitive employment, over one year follow-up), supported employment seems to significantly increase levels of any employment obtained during the course of studies (7 RCTs, n = 951, RR 3.24 CI 2.17 to 4.82, very low quality of evidence). Supported employment also seems to increase length of competitive employment when compared with other vocational approaches (1 RCT, n = 204, MD 70.63 CI 43.22 to 94.04, very low quality evidence). Supported employment also showed some advantages in other secondary outcomes. It appears to increase length (in days) of any form of paid employment (2 RCTs, n = 510, MD 84.94 CI 51.99 to 117.89, very low quality evidence) and job tenure (weeks) for competitive employment (1 RCT, n = 204, MD 9.86 CI 5.36 to 14.36, very low quality evidence) and any paid employment (3 RCTs, n = 735, MD 3.86 CI -2.94 to 22.17, very low quality evidence). Furthermore, one study indicated a decreased time to first competitive employment in the long term for people in supported employment (1 RCT, n = 204, MD -161.60 CI -225.73 to -97.47, very low quality evidence). A large amount of data were considerably skewed, and therefore not included in meta-analysis, which makes any meaningful interpretation of the vast amount of data very difficult., Authors' Conclusions: The limited available evidence suggests that supported employment is effective in improving a number of vocational outcomes relevant to people with severe mental illness, though there appears to exist some overall risk of bias in terms of the quality of individual studies. All studies should report a standard set of vocational and non-vocational outcomes that are relevant to the consumers and policy-makers. Studies with longer follow-up should be conducted to answer or address the critical question about durability of effects.

Background: This is the first study to investigate the associations between chronic health conditions of older people and their impact on co-resident psychological morbidity using population-based samples in low and middle income countries (LAMICs)., Methods: Single-phase cross-sectional catchment area surveys were undertaken in urban sites in Cuba, Dominican Republic and Venezuela, and in rural and urban catchment areas in Mexico, Peru, India and China. All residents aged 65 years and over were interviewed with a co-resident key informant. Exposures were structured clinical diagnoses (10/66 and DSM-IV dementia and ICD-10 depression), self-reported diagnosis (stroke) and physical impairments. Mediating variables were dependence and disability (WHODAS 2.0), and the outcome was co-resident psychological morbidity assessed using SRQ-20., Results: Poisson regression analysis was used to estimate the prevalence ratios (PRs) for the associations between health conditions and psychological morbidity in each site, and meta-analysis was used to pool the estimates. 11,988 pairs comprising a participant and a co-resident informant were included in the analysis. After meta-analysis, independent effects were noted for depression (PR2.11; 95% CI 1.82-2.45), dementia (PR 1.98; 95% CI 1.72-2.28), stroke (PR 1.42; 95% CI 1.17-1.71) and physical impairments (PR 1.17; 95% CI 1.13-1.21). The effects were partly mediated through disability and dependence. The mean population attributable fraction of total chronic conditions was 30.1%., Conclusion: The prevalence of co-resident psychological morbidity is higher among co-residents of older people with chronic conditions. This effect was prominent for, but not confined to, depression and dementia. Attention needs to be directed to chronic conditions.