Tag: Depression

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Psychometric properties of the Chinese version of the school refusal assessment scale–revised in a clinical sample of adolescents and their caregivers with depressive disorders

School refusal behavior (SRB) is a prevalent and functionally heterogeneous problem among children and adolescents that can lead to serious academic, social, and psychological consequences. The School Refusal Assessment Scale–Revised (SRAS-R) is the most widely used instrument for identifying the functional motivations underlying school refusal, yet its psychometric properties have not been examined in Chinese clinical populations. The present study aimed to translate and culturally adapt the SRAS-R into Chinese and to evaluate its psychometric properties in a clinical sample of adolescents with depressive disorders. A total of 171 adolescent outpatients (age range 12–19 years; M = 15.5, SD = 1.90; 67.3% female) diagnosed with DSM-5 depressive disorders and meeting criteria for school refusal behavior completed both child and parent versions of the Chinese SRAS-R. Confirmatory factor analysis (CFA) using diagonally weighted least squares estimation was conducted. After removing Items 20 and 24, the four-factor model yielded strong CFI and RMSEA values for both parent (CFI = 0.99, RMSEA = 0.021, SRMR = 0.094) and child reports (CFI = 0.98, RMSEA = 0.028, SRMR = 0.097), although SRMR values were marginally above the prespecified threshold. Internal consistency reliability ranged from marginal to good across subscales (Cronbach’s α: parent = 0.664–0.815; child = 0.700–0.864), with parent-reported Factor 4 showing the weakest reliability. Factor 1 (avoidance of aversive school situations) obtained the highest mean scores for both informants, consistent with the depression-related negative affectivity characteristic of this clinical sample. Cross-informant discrepancy analyses revealed that children reported significantly higher scores than parents on Factor 2 (escape from social/evaluative situations; p = .017, d = 0.18) and Factor 4 (pursuit of tangible reinforcement; p <.001, d = 0.27), suggesting that parents may underestimate internally driven motivations. Intraclass correlation coefficients indicated fair to good parent–child agreement (ICC = 0.45–0.62), with the highest agreement for Factor 1 and the lowest for Factor 4. The findings provide initial internal-structure and reliability evidence for the Chinese SRAS-R in this single-site clinical sample and underscore the need for multi-informant assessment, while future studies should examine convergent, discriminant, criterion-related, and predictive validity in more diverse samples.
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Mobility Patterns and Mental Health During the COVID-19 Pandemic: Longitudinal Observational Study Using Smartphone Mobility Data

<strong>Background:</strong> The COVID-19 pandemic disrupted mobility globally, but its mental health implications remain difficult to characterize because most studies relied on lockdown status, population-level mobility indicators, or self-reported mobility. These approaches may miss individual differences in actual movement patterns and cannot fully examine bidirectional relationships between mobility and mental health. Individual-level smartphone geolocation data may provide a more objective and temporally aligned measure of mobility during periods of societal disruption. <strong>Objective:</strong> This study aimed to use individual-level Google location history (GLH) data and population-level Google community mobility reports (GCMRs) to examine concurrent and longitudinal relationships between pandemic-era mobility patterns and mental health symptoms in Hong Kong. <strong>Methods:</strong> This study analyzed data from the CU-COVID19 cohort study, an online longitudinal survey study of the psychological impact of the pandemic in Hong Kong. Mental health symptoms over the previous 14 days were assessed at baseline, 6 months, and 12 months using the 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder scale, and the 4-item PTSD Checklist for DSM-5. Participants provided retrospective GLH data reflecting their mobility during the corresponding 14-day survey periods. The analytic sample included 145 participants with baseline GLH data, of whom 110 had 6-month follow-up data and 49 had data available at all 3 assessment waves. GLH data were used to derive mobility factors representing journey diversity, immobility, and remoteness. Population-level mobility during the same 14-day periods was measured using Hong Kong GCMR residential stay data. Concurrent mediation models examined whether individual mobility mediated associations between population-level residential stay and mental health symptoms. Longitudinal models examined bidirectional associations between changes in individual mobility and mental health across 6-month intervals. <strong>Results:</strong> Population-level residential stay was not directly associated with mental health. In concurrent mediation models, higher population-level residential stay was associated with lower individual journey diversity (β=–0.36; <i>P</i>&lt;.001), and lower journey diversity was associated with higher depression (β=–0.29; <i>P</i>=.02) and posttraumatic stress disorder (PTSD) (β=–0.35; <i>P</i>=.002). Bootstrapped indirect effects suggested mediation through journey diversity for depressive symptoms (β=0.11, 95% CI 0.02-0.25) and PTSD symptoms (β=0.13, 95% CI 0.05-0.27), although the depression-related indirect effect became less robust after adjustment for local and individual COVID-19 infection indicators. Longitudinally, higher baseline depressive symptoms predicted subsequent reductions in journey diversity (β=–0.15; <i>P</i>=.02), and reductions in journey diversity predicted higher subsequent depressive symptoms (β=–0.43; <i>P</i>=.008). <strong>Conclusions:</strong> Individual-level mobility patterns, particularly lower journey diversity, showed more consistent associations with mental health symptoms than population-level residential stay. Findings suggest bidirectional relationships between mobility and mental health and demonstrate the potential of smartphone geolocation data for digital phenotyping. However, the modest and self-selected sample, limited GCMR availability, and observational design require cautious interpretation.
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<![CDATA[Concussion recovery in teen athletes often masks anxiety or depression; learn warning signs, screening tips, and safer return-to-play steps.]]>
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Historical trauma as a contributor to postpartum depression among Indigenous mothers

IntroductionPostpartum depression (PPD) is a significant public health concern. Moreover, research suggests that American Indian/Alaskan Native (AI/AN) mothers experience postpartum depression at higher rates than the general population (Heck, 2021; Ko et al., 2017). As a result, understanding the potential causes of higher PPD among AI/AN mothers is helpful to the development of better interventions to reduce PPD among AI/AN mothers. A potential cause of higher PPD symptoms among AI/AN mothers is historical trauma (HT). HT refers to the cumulative psychological wounding experienced across generations due to systemic oppression, colonization, slavery, and other traumatic events experienced by a group of individuals.MethodsTo test the theorized relationships between HT and PPD symptoms, we conducted an online survey of adult women who both identified as Indigenous and who give birth in the past five years (N = 56). The survey consisted of the psychometrically suitable measures of the Historical Loss Scale (HLS: Whitbeck at al, 2004) and the Edinburgh Postnatal Depression Scale (EPDS; Cox et al., 1987). .ResultsThe results indicated that a model of HLS scores as a predictor of PPD symptoms over and above the controls of income, mental health diagnosis, and the total number of children of the birth mother fit the data well (χ2 = 13.60; df = 10; p = .192; RMSEA = .081 [90% CI: .000, .178]; CFI = .949). Moreover, of all the predictors, the dimension of the HLS measuring mothers’ endorsement of the presence of oppressive governmental and institutional policies toward AI/AN was the strongest predictor of greater PPD (β = .28, p < .05). A Bollen Stine bootstrap test was also used to confirm the stability of the model. The Bollen Stine operates by comparing the theorized model to a model that perfectly fits the data. The results of the Bollen Stine test indicated that the theorized model was not significantly different than a model of perfect fit. .DiscussionSuch results suggest that a potential explanation of higher PPD symptoms among AI/AN mothers is the effects of HT. Future interventions to reduce PPD symptoms among AI/AN mothers may benefit from an additional focus on treating HT.
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Effectiveness of Clustered Versus Tapered Repetitive Transcranial Magnetic Stimulation (rTMS) as Maintenance Therapy Following Successful Acute rTMS Treatment in Patients With Depressive Syndrome

Conditions: Major Depressive Disorder (MDD); Depressive Episodes; Depressive Syndrome

Interventions: Device: Repetitive Transcranial Magnetic Stimulation (rTMS), Theta Burst Stimulation

Sponsors: Technical University of Munich; Medizinische Universitätsklinik Tübingen

Not yet recruiting
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Randomized Trial Evaluating the Effect of Light Therapy Using Glasses Versus a Sham Device on the Evolution of Self-reported Depressive Disorders in Chronic Hemodialysis Patients

Conditions: End-stage Chronic Kidney Disease Treated With Hemodialysis; Depressive Disorders

Interventions: Other: Light therapy using active glasses; Other: Light therapy using inactive glasses

Sponsors: Centre Hospitalier Annecy Genevois; Direction Générale de la Santé, France; Association France REIN; LUCIMED

Not yet recruiting
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Clinical Outcomes and Predictors of Improvement With Virtual Behavioral Health Care for Gambling Disorder: Retrospective Cohort Study

<strong>Background:</strong> Gambling disorder is associated with substantial psychiatric and functional burden, yet few individuals receive treatment. Limited real-world evidence exists evaluating outcomes of virtually delivered behavioral health care for gambling disorder, particularly among clinically complex patients. <strong>Objective:</strong> The purpose of this study was to evaluate gambling symptom severity outcomes among adults with gambling disorder receiving care from Birches Health. We aimed to (1) characterize the clinical profile of adults seeking treatment for gambling disorder; (2) quantify changes in gambling symptom severity over the initial 12 weeks of treatment and examine whether baseline clinical complexity, such as gambling symptom severity, depression severity, and psychiatric comorbidities, was associated with differences in gambling symptom severity improvement over time; and (3) estimate the timing and likelihood of achieving clinically meaningful improvement in gambling symptom severity. <strong>Methods:</strong> This retrospective cohort study included 1305 adults receiving virtual behavioral health treatment for gambling disorder through Birches Health between June 2024 and April 2026. Gambling symptom severity was assessed using the Gambling Symptom Assessment Scale (G-SAS) weekly. Linear mixed-effects models evaluated changes in gambling symptom severity over 12 weeks and associations with baseline clinical characteristics. Clinically meaningful improvement was defined as a reduction of 4 or more points in the G-SAS score. <strong>Results:</strong> Participants had a mean age of 41.5 (SD 13.1) years, 65.2% (851/1305) were male, and baseline gambling symptom severity was moderate (mean G-SAS score 20.5, SD 11.83). Over half (730/1305, 56%) of participants presented with at least one psychiatric comorbidity, most commonly anxiety disorder (351/1305, 26.9%) and depressive disorder (276/1305, 21.1%). Gambling symptom severity declined significantly over the first 12 weeks of treatment, with G-SAS scores decreasing by approximately 0.099 points per day (<i>P</i>&lt;.001), corresponding to an estimated 8.3-point reduction over 12 weeks. Higher baseline depressive symptom severity was associated with faster improvement in gambling symptoms (<i>P</i>=.01), whereas depressive disorder (<i>P</i>=.03) and attention-deficit/hyperactivity disorder (<i>P</i>=.008) diagnoses were associated with slower improvement trajectories. Among patients with routine follow-up assessments recorded during the initial 12 weeks of treatment (1071/1305, 82.1%), 71.7% (935/1305) achieved clinically meaningful improvement in gambling symptom severity, with a median time to improvement of 14 days. <strong>Conclusions:</strong> A clinically complex population of adults receiving care through a national virtual behavioral health care provider demonstrated rapid and clinically meaningful reductions in gambling symptom severity. These findings highlight the potential of specialized virtual care models to expand access to gambling treatment and support symptom improvement in routine care settings. Future research should evaluate longer-term recovery trajectories and identify factors associated with sustained improvement and ongoing engagement in care.