BACKGROUND
Depressive and anxiety symptoms (depression and anxiety hereafter), and suicidality are common among psychiatric patients. This study examined the network structure of depressive and anxiety symptoms and suicidality among psychiatric patients across Asia.
METHODS
Data were drawn from the Research on Asian Psychotropic Prescription Patterns for Antidepressants Phase 3 study (REAP-AD3), which included 2,455 psychiatric patients from 11 Asian countries and territories. Depression and anxiety were assessed using the 9-item Patient Health Questionnaire (PHQ-9) and 7-item Generalized Anxiety Disorder Scale (GAD-7), respectively, while suicidality (i.e., suicidal thoughts or acts) was assessed by a clinical interview. Expected Influence (EI) and Bridge EI were used as centrality indices in the symptom network to characterize the structure of the symptoms.
RESULTS
The point prevalence of suicidality was 30.1% (95% confidence interval [CI] = 28.2, 31.9) among the psychiatric patients. The network analysis identified PHQ2 ("Sad mood") as the most central symptom, followed by GAD2 ("Uncontrollable worry"). Additionally, PHQ8 ("Motor disturbances") and S ("Suicidality") were identified as bridge nodes linking depression and anxiety with suicidality. The flow network indicated that PHQ6 ("Guilt") and PHQ2 ("Sad mood") had the strongest positive associations with suicidality.
CONCLUSIONS
Suicidality was common among psychiatric patients across Asia. The central and bridge symptoms might represent potential clinical markers and generate hypotheses for longitudinal and interventional research on depression, anxiety, and suicidality in the future.
L. A, Yuan Feng, Qinge Zhang et al.· International Journal of Soc...· 0 citations
Previous studies suggest that transcranial magnetic stimulation exerts antidepressant effects and is associated with alterations in functional connectivity (FC), but the neural correlates remain unclear. This exploratory sham-controlled trial investigated the effect of continuous theta-burst stimulation (cTBS) over the right dorsolateral prefrontal cortex (DLPFC) on FC in major depressive disorder (MDD). Seventy MDD patients were randomized to receive two-week treatment of personalized cTBS or sham stimulation. Resting-state fMRI was performed at baseline and post-treatment. Ultimately, 31 patients in the active cTBS group and 28 patients in the sham group passed imaging quality control and were included in the final analysis. To identify the FC that may have been influenced by cTBS treatment, two complementary FC analyses were conducted: (1) voxel-wise degree centrality (DC) followed by seed-based FC, and (2) an individual FC analysis based on the stimulation targets. Furthermore, correlations between FC changes and clinical symptoms improvement were examined. Both groups exhibited reductions of depression scores, with greater improvement in the active group. Compared to the sham group, active cTBS showed increased DC in the precuneus and elevated FC between the precuneus (within the para-cingulate network) and the right inferior parietal lobule (IPL) and DLPFC. Further stimulation target-based analysis revealed increased FC between stimulation targets and both the precuneus and visual regions following treatment. Our findings reveal neural changes associated with cTBS over the right DLPFC in MDD, notably involving the precuneus and its connectivity with the right IPL/DLPFC, suggesting alterations within the central executive network. TRIAL REGISTRATION: chictr.org.cn; ChiCTR2300068273.
Yun Wang, Jing Jin, Pengfei Wang et al.· Journal of Affective Disorde...· 0 citations
