BackgroundCochlear implantation is a common treatment for adults with single-sided deafness (SSD), but patient-reported benefits vary. The relationships among tinnitus burden, perceived hearing ability, psychological distress, disease-specific health-related quality of life, and whether early postoperative outcomes predict later results are not well understood.ObjectiveThis study explores how disease-specific quality of life relates to tinnitus burden, hearing, stress, depression, and anxiety after cochlear implantation in SSD. It also seeks early markers linked to 2-year outcomes.MethodsThis secondary complete-case analysis was based on a previously reported prospective longitudinal SSD cohort. Of 70 adults with postlingual SSD, 36 (51.4%) had complete Nijmegen Cochlear Implant Questionnaire (NCIQ) data at baseline and at 6 months, 1 year, and 2 years after unilateral cochlear implantation and were included. Additional measures included the Tinnitus Questionnaire (TQ), Oldenburg Inventory (OI), PerceivFed Stress Questionnaire (PSQ), General Depression Scale (ADS-L), Generalized Anxiety Disorder 7-item scale (GAD-7), and Freiburg Monosyllable Test (FMT) at 65 dB. Timepoint-specific correlations with the NCIQ were analyzed using Spearman’s rank correlations. Exploratory multivariable analyses employed linear regression on rank-transformed variables to assess whether baseline and 6-month patient-reported profiles were associated with 2-year NCIQ outcomes. Longitudinal within-patient comparisons were conducted as a secondary descriptive analysis.ResultsHigher NCIQ scores were linked to lower tinnitus burden and better hearing across all assessments. Associations with depression and anxiety persisted, while connections with perceived stress emerged after surgery. At baseline, higher tinnitus burden was associated with lower 2-year NCIQ scores. At 6 months, higher tinnitus is still associated with lower 2-year NCIQ scores, whereas better hearing is associated with higher 2-year NCIQ scores. Early postoperative improvement was followed by stabilization over 2 years.ConclusionImprovement in health-related quality of life after cochlear implantation in adults with SSD is complex and extends beyond hearing alone. Tinnitus was the most consistent negative factor, while improved subjective hearing at 6 months was associated with better outcomes at 2 years. These results support a structured, multidimensional approach to patient-reported follow-up after cochlear implantation in SSD and suggest that early postoperative patient-reported status may serve as an early candidate marker for later quality-of-life outcomes.
Direct and indirect associations of hypochondriasis with suicidality in psychiatric outpatients: mediating roles of anxiety and depression
IntroductionAlthough both hypochondriasis and suicidality are common in psychiatric patients and related to anxiety and depression, their association in psychiatric patients remains unclear. This study investigated the direct association of hypochondriasis with suicidality and the indirect associations via anxiety and depression in psychiatric patients.MethodsClinical records of 5484 psychiatric outpatients were reviewed. Hypochondriasis, Suicidality, Anxiety, and Depression were evaluated using the hypochondriasis item of the Hamilton Depression Rating Scale, the suicidality item of the 17-item Hamilton Depression Rating Scale (HAM-D17), the Hamilton Anxiety Rating Scale (HAM-A), and the 6-item subscale of the Hamilton Depression Rating Scale (HAM-D6), respectively. The associations among Hypochondriasis, Suicidality, Anxiety, and Depression were examined using a parallel mediation model. The model was estimated using the lavaan package in R with 10, 000 bootstrap resamples, adjusted for age and sex. Moderation by age and sex was also investigated.ResultsSignificant positive indirect associations via Anxiety (point estimate = 0.05, 95% CI [0.03, 0.06]) and Depression (point estimate = 0.17, 95% CI [0.15, 0.19]) were observed between Hypochondriasis and Suicidality. Conversely, the direct association between Hypochondriasis and Suicidality was also significant but in a negative direction (B = −0.16, p <.001). As the total indirect association was stronger than the direct association, the total association of Hypochondriasis with Suicidality was significantly positive (B = 0.05, p = 0.002). The negative direct association of Hypochondriasis with Suicidality was significantly stronger in younger patients (interaction term = 0.004, p <.001).ConclusionAnxiety and depression mediated the association between hypochondriasis and increased suicidality. In contrast, hypochondriasis was associated with decreased suicidality after accounting for the mediators. As the indirect association was stronger than the direct association, hypochondriasis was associated with increased suicidality overall. The direct association between hypochondriasis and decreased suicidality was stronger in younger patients.
Preoperative anxiety and depression symptoms are associated with poorer clinical outcomes following corrective surgery for adult equinocavovarus foot
PurposeThis study aimed to investigate the preoperative psychological status of adult patients with equinocavovarus foot deformity and to examine the association between preoperative anxiety/depressive symptoms and the clinical outcomes of corrective surgery in this population.MethodsA retrospective analysis was conducted on 103 adult patients who underwent corrective surgery for equinocavovarus foot at Xi’an Honghui Hospital between March 2014 and July 2023. Baseline data were collected. Patient psychological status, ankle-hindfoot function, pain, and quality of life were assessed preoperatively and at the final follow-up using the Hospital Anxiety and Depression Scale (HADS), the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, the Visual Analog Scale (VAS), and the 36-Item Short Form Health Survey (SF-36). Based on preoperative HADS scores, patients were categorized into an anxiety/depression group (Group A) and a non-anxiety/depression group (Group B). The two groups were compared with respect to baseline characteristics (gender, age, disease duration, BMI, follow-up duration), clinical outcomes, and the degree of improvement in all assessment metrics.ResultsA total of 83 patients completed the follow-up, among whom 38 (45.78%) exhibited preoperative anxiety/depression symptoms. No significant differences were found in baseline characteristics between the two groups (all P > 0.05). At the final follow-up, both groups showed significant improvement in VAS, AOFAS, SF-36 (PCS/MCS), and HADS (A/D) scores compared to their preoperative baselines (all P < 0.001). Intergroup comparisons revealed that Group A had significantly lower AOFAS and SF-36 (PCS/MCS) scores, and significantly higher VAS and HADS (A/D) scores than Group B, both preoperatively and at the final follow-up (all P < 0.001). Regarding the degree of improvement, Group A demonstrated a smaller magnitude of improvement in VAS (P < 0.01), AOFAS (P < 0.01), and SF-36 PCS (P < 0.001) compared to Group B. Conversely, Group A showed a greater improvement in SF-36 MCS and HADS (A/D) scores (all P < 0.001).ConclusionsWhile surgery improved all outcomes, patients with preoperative anxiety/depression exhibited persistently worse clinical scores. Their improvement profile was distinct: smaller gains in pain and physical function but greater mental health improvement. Addressing preoperative psychological status may optimize comprehensive outcomes.
Effectiveness of Behavioral Activation Group Therapy for Patients With Depression at the Community in Thanh Hoa
Conditions: Depression – Major Depressive Disorder
Interventions: Behavioral: Behaviral activation group therapy
Sponsors: Hanoi Medical University
Completed
Interventions: Behavioral: Behaviral activation group therapy
Sponsors: Hanoi Medical University
Completed
Symptoms of Anxiety and/or Depression and SDM in Older Patients With CLTI
Conditions: Critical Limb Threatening Ischaemia; Depression Disorder; Anxiety
Sponsors: Guy’s and St Thomas’ NHS Foundation Trust; University Hospitals, Leicester
Not yet recruiting
Sponsors: Guy’s and St Thomas’ NHS Foundation Trust; University Hospitals, Leicester
Not yet recruiting
Efficacy and Safety of a Theta Burst Stimulation Protocol of Repetitive Transcranial Magnetic Stimulation in Treatment-Resistant Depression
Conditions: Major Depressive Disorder (MDD); Depression – Major Depressive Disorder
Interventions: Drug: antidepressant therapy; Device: Active rTMS Theta Burst Stimulation; Device: Sham Stimulation
Sponsors: Jung-Sun Lee; Korea Health Industry Development Institute; Seoul National University Hospital; Nowon Eulji Medical Center, Eulji University; Seoul St. Mary’s Hospital, The Catholic University
Not yet recruiting
Interventions: Drug: antidepressant therapy; Device: Active rTMS Theta Burst Stimulation; Device: Sham Stimulation
Sponsors: Jung-Sun Lee; Korea Health Industry Development Institute; Seoul National University Hospital; Nowon Eulji Medical Center, Eulji University; Seoul St. Mary’s Hospital, The Catholic University
Not yet recruiting
Early Brainwave Biomarkers for Personalized Neuromodulation in Treatment-resistant Depression
Conditions: Major Depressive Disorder; Treatment Resistant Depression
Interventions: Device: Personalized iTBS; Device: Non-Personalized iTBS; Device: Sham iTBS
Sponsors: Stanford University; National Institute of Mental Health (NIMH)
Not yet recruiting
Interventions: Device: Personalized iTBS; Device: Non-Personalized iTBS; Device: Sham iTBS
Sponsors: Stanford University; National Institute of Mental Health (NIMH)
Not yet recruiting
User Experience and Early Clinical Outcomes of a Mental Wellness Chatbot for Depression and Anxiety: Pilot Evaluation Mixed Methods Study
Background: Artificial intelligence–powered conversational agents (ie, chatbots) are increasingly popular outlets for users seeking psychological support, yet little is known about how users experience early-stage prototypes or which therapeutic processes contribute to clinical improvement. A transparent evaluation of emerging chatbot prototypes is needed to clarify if, how, and why artificial intelligence companions work and to guide their continued development. Objective: This mixed methods pilot study evaluated user experience, acceptability, and preliminary clinical signals for an early-stage mental wellness chatbot. We also examined whether baseline symptom severity moderated clinical improvement. Methods: Three sequential cohorts (n=125) completed a 2-week, incentivized chatbot exposure (approximately 60 min per week). Participants provided first-impression ratings, qualitative feedback, and pre–post assessments of depressive symptoms (PHQ-8 [Patient Health Questionnaire-8]), anxiety symptoms (GAD-7 [Generalized Anxiety Disorder-7]), psychological distress, well-being, and loneliness. Statistical models estimated symptom change and tested interactions with baseline symptom severity. Mixed methods analysis integrated quantitative outcomes with large language model–assisted qualitative content analysis of open-ended responses. Results: Participants described the chatbot as accessible, easy to use, and emotionally validating, while citing limitations in personalization and conversational depth. Qualitative responses consistently highlighted early therapeutic processes such as emotional validation, goal setting, and perceived attunement. Regression models showed significant pre–post reductions in depressive (Hedges =–0.32) and anxiety (=–0.32) symptoms, alongside modest improvements in distress and well-being. Baseline severity moderated improvement, with marginal effects indicating larger predicted reductions at higher PHQ-8 and GAD-7 baseline scores (eg, PHQ-8=15: =–0.84; GAD-7=15: =–0.62). Conclusions: This pilot provides a comprehensive view of early chatbot development and suggests promising user experiences and preliminary symptom improvements under structured pilot conditions. By integrating experiential and exploratory clinical data, the study identifies candidate process targets to inform ongoing refinement. Findings support continued development and demonstrate procedural feasibility for progression to larger, longer-term trials evaluating engagement and clinical outcomes under more naturalistic conditions.
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Development of Virtual Mental Health Stepped Care Service for a Heart Failure Remote Management Program: Qualitative Descriptive Study
Background: Depression is highly prevalent yet undertreated among people living with heart failure, indicating barriers to mental health services. Although various digital mental health interventions have been developed to detect, treat, and manage depression in this population, these interventions have seen limited integration into clinical care and a lack of implementation research. Stepped care is a service innovation that may promote the implementation of these technologies into clinical settings, but few studies have examined how these services are designed in clinical settings. Objective: This study aimed to identify strategies to address health system barriers to accessing mental health care from the perspective of people living with heart failure, clinicians, and researchers, and to incorporate these strategies into the design of a virtual mental health stepped care service within a heart failure remote management program. Methods: A qualitative description study was conducted using purposive recruitment of people living with heart failure, clinicians, and researchers from a heart failure remote patient management program. As part of a service design approach, semistructured interviews explored potential strategies to address barriers to accessing mental health services. Two researchers coded the data descriptively and constructed themes to guide the development of a virtual stepped care service. Results: A total of 22 participants were interviewed, comprising 13 people living with heart failure and 9 clinicians and researchers. Six themes were identified, comprising 4 requirements and 2 foundational principles. The requirements were to (1) adopt a collective approach to identify distress across methods, people, and time points; (2) maintain a referral-based approach; (3) rely on existing mental health human resources; and (4) offer patient choice among various mental health care options. These requirements were supported by two principles: (1) building on organizational strengths and (2) reducing treatment burden. Based on these findings, a virtual stepped care service was developed, incorporating a depression screening module, referral-based workflows, and, where clinically appropriate, patient choice in treatment selection. Conclusions: The stakeholder-informed design of this virtual stepped care service contributes to the limited literature on stepped care service design and demonstrates how such models can be tailored to their intended contexts. Although each component was designed to address health system barriers to mental health care for people living with heart failure, resource limitations may constrain the balance between feasibility and quality of care. Future research should evaluate the acceptability of this model among people living with heart failure and clinicians.
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Self images: an empirical enquiry into Rembrandt’s self-portraits
Many have speculated that events of personal and financial loss in the life of Rembrandt van Rijn (Rembrandt) caused depression and that this is revealed by examination of his work particularly self-portraits painted in old age. Some report detecting various physiological diseases associated with aging, including vision impairment, which may have affected his mood and work. Aging and neurodegenerative disease which often accompanies it, are both associated with depression. Depression is characterised by visual deficits including perception of reduced contrast and colour. Age-related neurological disorders are associated in artists with reduced complexity. Recent advances in imaging and computer technology make it possible to empirically examine changes in artistic style which can contribute to understanding artists’ physical and mental health. Previous studies have identified associations between adverse events in artists’ lives and altered contrast and colour in their self-portraits. In the current study changes in contrast, colour and fractal dimension were measured in the entire corpus of Rembrandt’s painted self-portraits and portraits to determine whether changes in style indicate depression, cognitive decline, or neurological disease and whether differences in style can be detected between self-portraits and portraits of related and unrelated others. Productivity was also examined as an indirect indicator. The results suggest that it is unlikely that Rembrandt suffered from unipolar or bipolar depression, age-related cognitive decline, or neurodegenerative disease. The data are consistent with someone experiencing episodes of low mood associated with normal grieving and adversity followed by resilient recovery. There is evidence of a gradient in saliency and complexity between self-portraits and related and unrelated portraits and of a ‘late’ style identified by leading art historians consistent with macular degeneration.