Tag: statistics

Actas Esp Psiquiatr. 2026 Aug 15;54(4):1287-1296. doi: 10.62641/aep.v54i4.2138.

ABSTRACT

BACKGROUND: This study aimed to evaluate the effectiveness of digital cognitive behavioural therapy (dCBT) in reducing pain intensity, pain interference, depression, and anxiety symptoms in adults with co-occurring chronic pain, anxiety and depression.

METHODS: We systematically searched in PubMed, PsycINFO, Cochrane Library and Web of Science for randomized controlled trials (RCTs) published up to October 2025. Included studies comparing dCBT with control conditions in adults with chronic pain (≥3 months), co-occurring anxiety and depression. Primary outcomes were pain intensity and depressive symptoms. Secondary outcomes were pain interference and anxiety symptoms. Pooled standardized mean difference (Hedges’ g) were calculated using fixed-effects or random-effects models depending on heterogeneity.

RESULTS: We included 6 RCTs involving 737 participants with chronic pain, co-occurring anxiety and depression. Compared with control groups, dCBT did not significantly reduce pain intensity (g = -0.43, 95% confidence interval (CI) [-0.98, 0.11], p = 0.12; I² = 91%), but it significantly reduced depressive symptoms (g = -0.51, 95% CI [-0.66, -0.36], p < 0.00001; I² = 35%), pain interference (g = -0.70, 95% CI [-1.18, -0.21], p = 0.005; I² = 89%), and anxiety symptoms (g = -0.59, 95% CI [-0.74, -0.44], p < 0.00001; I² = 37%).

CONCLUSIONS: dCBT effectively improves depressive symptoms, anxiety symptoms, and pain interference in patients with co-occurring chronic pain, anxiety and depression, but its direct effect on pain intensity did not reach statistical significance in this meta-analysis. dCBT is convenient and scalable, with confirmed efficacy in emotional and functional domains, making it a valuable adjunctive treatment option. Future research should investigate its true effect on pain intensity, long-term outcomes and personalized treatment approaches.

PMID:42633528 | DOI:10.62641/aep.v54i4.2138

Actas Esp Psiquiatr. 2026 Aug 15;54(4):1055-1065. doi: 10.62641/aep.v54i4.2219.

ABSTRACT

BACKGROUND: Suicidal behaviour in children and adolescents has increased significantly over the last decade, generating growing concern among healthcare professionals. However, clinical and evolutionary differences between minors and adults after a suicide attempt are not sufficiently defined. This study analyses the differential profile of minors treated for suicide attempts in a large provincial cohort to identify specific vulnerabilities and risk patterns.

METHODS: Retrospective cohort study (MCOSUL Cohort) that included all suicide attempts treated in provincial psychiatric emergency services between 2010 and 2024. Sociodemographic variables, psychiatric diagnoses, substance use, method and lethality of the index attempt, recurrence, and mortality were collected. High lethality was defined according to Beautrais criteria. χ², Fisher, Student’s t, Kruskal-Wallis tests, and survival analyses for recurrence were applied.

RESULTS: Minors represented 8% of the cohort, with a female predominance (83%). They presented a higher prevalence of neurodevelopmental disorders and eating disorders (EDs), as well as a differential consumption pattern dominated by tetrahydrocannabinol (THC). They used more violent methods, especially cutting, without an increase in lethality. The Cox model shows that being a minor is significantly associated with earlier recurrence of suicidal behaviour (HR = 1.36), even after adjusting the analysis for sex, neurodevelopmental disorders, THC use, and the method employed. Adults showed higher lethality, mortality, and more frequent use of sedative medications as a suicide method. Recurrence of subsequent suicidal behaviour was similar but occurred earlier in minors.

CONCLUSIONS: Adolescent suicidal behaviour appears to present a distinct clinical phenotype, characterized by a predominance of female adolescents, frequent neurodevelopmental vulnerabilities, THC use, low-lethality violent methods, and relatively rapid recurrence, highlighting the need for tailored prevention strategies.

PMID:42633521 | DOI:10.62641/aep.v54i4.2219

Actas Esp Psiquiatr. 2026 Aug 15;54(4):1141-1149. doi: 10.62641/aep.v54i4.2228.

ABSTRACT

BACKGROUND: This study aimed to investigate the relationship between the duration of social media use and the prevalence and severity of depressive and anxiety symptoms among adolescents in the real-world settings, thereby providing data support to inform mental health support and guide appropriate social media use.

METHODS: This retrospective study analysed clinical data from 156 adolescents admitted to the Mental Health Service Centre of The Second People’s Hospital of Hunan Province (Brain Hospital of Hunan Province) between January 2022 and December 2023. Data were extracted from electronic medical record system and structured survey forms. Baseline demographic characteristics, social media use related data, and mental health assessment results were collected. Pearson correlation analysis was used to examine relationship between social media use duration and scores on the 9-item Patient Health Questionnaire (PHQ-9) and 7-item Generalized Anxiety Disorder scale (GAD-7). Multivariate logistic regression was performed to identify factors independently associated with depression and anxiety symptoms.

RESULTS: Univariate analysis revealed statistically significant differences in parenting style, academic performance, weekly exercise frequency, and depression and anxiety symptoms across different durations of social media use (p < 0.05). Correlation analysis demonstrated significant positive correlations between average daily social media use duration and PHQ-9 score (r = 0.352, p < 0.001) and GAD-7 score (r = 0.308, p < 0.001). Multivariate logistic regression identified longer social media use as an independent risk factor for positive depressive symptoms (odds ratio (OR) = 1.794, 95% confidence interval (CI): 1.261-2.547), along with authoritative parenting (OR = 2.485, 95% CI: 1.253-4.922), permissive parenting (OR = 3.427, 95% CI: 1.503-7.816), medium academic performance (OR = 2.867, 95% CI: 1.286-6.396), and poor academic performance (OR = 6.118, 95% CI: 2.534-14.779). For positive anxiety symptoms, independent risk factors included longer social media use (OR = 1.624, 95% CI: 1.169-2.267), authoritative parenting (OR = 2.278, 95% CI: 1.171-4.425), permissive parenting (OR = 2.863, 95% CI: 1.317-6.256), medium academic performance (OR = 2.564, 95% CI: 1.176-5.614), poor academic performance (OR = 4.575, 95% CI: 1.975-10.614), and reduced weekly exercise frequency (1-2 times/week: OR = 1.927, 95% CI: 1.027-3.608; <1 time/week: OR = 3.825, 95% CI: 1.896-7.736).

CONCLUSIONS: Social media use duration is significantly associated with depressive and anxiety symptoms in adolescents. These findings underscore the importance of monitoring adolescent social media use and implementing targeted health guidance to reduce mental health risks.

PMID:42633519 | DOI:10.62641/aep.v54i4.2228

Actas Esp Psiquiatr. 2026 Aug 15;54(4):1088-1097. doi: 10.62641/aep.v54i4.2250.

ABSTRACT

BACKGROUND: To retrospectively analyze the clinical efficacy of escitalopram combined with low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) in treating anxiety and depression in ischemic stroke patients.

METHODS: Eighty ischemic stroke patients with concurrent depression and anxiety who received treatment at Jiangbin Hospital of Guangxi Zhuang Autonomous Region from January 2025-December 2025 were retrospectively collected. Patients were divided into a conventional treatment group and a combined treatment group, with 40 patients in each group. The conventional treatment group received routine treatment combined with oral escitalopram, while the combined treatment group received the same treatment as the conventional treatment group, combined with LF-rTMS. To evaluate clinical efficacy, Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA) scores were collected before and at the end of treatment in both groups. Transcranial ultrasound imaging of the brainstem raphe (BR) region was also performed, and adverse reactions during treatment were recorded.

RESULTS: The total effective rate in the combined treatment group was significantly higher than that in the conventional treatment group. After adjusting for baseline scores, post-treatment HAMD and HAMA scores in the combined treatment group were significantly lower than those in the conventional treatment group. The proportion of patients with abnormal echogenicity decreased in both groups, and the number of patients with abnormal echogenicity in the combined treatment group was less than that in the conventional treatment group. There was no statistically significant difference in the incidence of adverse reactions between the two groups.

CONCLUSIONS: Escitalopram combined with LF-rTMS can effectively alleviate anxiety and depression in ischemic stroke patients and show beneficial changes in BR echogenicity as an exploratory imaging finding. It may serve as a potential and promising treatment option for post-ischemic stroke depression and anxiety, although further validation is needed.

PMID:42633513 | DOI:10.62641/aep.v54i4.2250

Actas Esp Psiquiatr. 2026 Aug 15;54(4):1269-1286. doi: 10.62641/aep.v54i4.2301.

ABSTRACT

BACKGROUND: This study aimed to systematically evaluate the combined improvement effects of virtual reality (VR)-assisted exercise training on motor function and psychiatric symptoms in patients with Parkinson’s disease (PD), and to provide more scientific evidence-based support for precise clinical rehabilitation.

METHODS: This study searched China National Knowledge Infrastructure (CNKI), Wanfang, China Science and Technology Journal Database (VIP Database), PubMed, Web of Science and Scopus for randomized controlled trials (RCTs) examining VR interventions in patients with idiopathic PD covering the period from database inception to 1 March 2026. Two investigators independently performed literature screening and data extraction. Methodological quality was assessed using the Cochrane Risk of Bias Tool 2.0. Meta-analysis was conducted using Review Manager 5.4 and R 4.6.0 software.

RESULTS: A total of 37 RCTs involving 1749 patients with PD were included. Meta-analysis results showed that, compared with conventional rehabilitation training, VR-assisted training significantly improved motor outcomes, as reflected by the Berg Balance Scale (BBS; mean difference (MD) = 3.96), Timed Up and Go Test (TUGT; MD = -2.48), and Unified Parkinson’s disease Rating Scale Part III (UPDRS-III; MD = -2.94). Regarding psychiatric symptoms, VR training significantly enhanced specific cognitive function (Montreal Cognitive Assessment (MoCA); MD = 1.94), alleviated subjective depressive mood (Beck Depression Inventory (BDI); MD = -1.75), and improved activity-specific balance confidence (Activities-specific Balance Confidence Scale (ABC); MD = 12.03). However, no statistically significant between-group differences were found in global cognition (MiniMental State Examination (MMSE)) and observer-rated depression (Hamilton Depression Rating Scale (HAMD)).

CONCLUSIONS: VR-assisted exercise training effectively improves comprehensive motor function, specific cognition and depressive mood in patients with PD. Therapeutic efficacy may be influenced by the immersion level of equipment and intervention duration. VR confers shortterm improvements, but its long-term effects remain unknown. It may serve as a promising adjunctive therapy; however, routine clinical recommendation requires further evidence from extended follow-up studies. High-quality RCTs with prolonged follow-up periods are still warranted to clarify the long-term effects of VR interventions with varying immersion levels.

PMID:42633503 | DOI:10.62641/aep.v54i4.2301

Actas Esp Psiquiatr. 2026 Aug 15;54(4):1257-1268. doi: 10.62641/aep.v54i4.2313.

ABSTRACT

BACKGROUND: Observational studies have reported associations between antidepressant use and thyroid dysfunction; however, confounding precludes firm causal inference. This study aimed to evaluate the potential causal association between genetically predicted antidepressant use and the risks of Hashimoto’s thyroiditis, hypothyroidism and thyroid cancer using Mendelian randomisation (MR).

METHODS: Publicly available genome-wide association study (GWAS) summary statistics were used, with genetically predicted antidepressant use as the exposure and Hashimoto’s thyroiditis, hypothyroidism and thyroid cancer as the outcomes. Following data harmonisation, 13 single nucleotide polymorphisms (SNPs) meeting the prespecified significance threshold were selected as instrumental variables. The mean F statistic was 24.12 (range, 20.96-29.98), indicating that weak-instrument bias was unlikely. Inverse variance weighted (IVW) was used for the primary analysis, with MR-Egger regression, weighted-median and mode-based methods used in sensitivity analyses. Cochran’s Q test was used to assess heterogeneity, and the MREgger intercept was used to assess directional horizontal pleiotropy.

RESULTS: Genetically predicted antidepressant use was positively associated with the risk of Hashimoto’s thyroiditis (IVW: odds ratio [OR] = 1.483, 95% confidence interval [CI]: 1.176-1.871; p = 0.001). A weak but statistically significant positive association was also observed for hypothyroidism (IVW: OR = 1.012, 95% CI: 1.002-1.023; p = 0.025). The directions of effect were generally consistent across sensitivity analyses. No evidence of an association with thyroid cancer was identified (IVW: p = 0.407). No evidence of bias was found in the heterogeneity test and the horizontal pleiotropy (p > 0.05), and the leave-one-out analysis confirmed the robustness of the results.

CONCLUSIONS: This study provides genetic evidence of potential associations between antidepressant use and increased risks of Hashimoto’s thyroiditis and hypothyroidism. These findings support consideration of thyroidfunction monitoring in patients receiving antidepressant treatment, particularly those with pre-existing thyroid risk factors.

PMID:42633501 | DOI:10.62641/aep.v54i4.2313

Actas Esp Psiquiatr. 2026 Aug 15;54(4):1066-1076. doi: 10.62641/aep.v54i4.2325.

ABSTRACT

BACKGROUND: To investigate the effects of evidence-based nursing combined with computer-assisted cognitive remediation on cognitive function and quality of life in patients with schizophrenia.

METHODS: A retrospective analysis was conducted on the clinical data of 120 patients with schizophrenia admitted between March 2023 and March 2025. Patients were divided into an observation group (n = 60, receiving evidencebased nursing combined with computer-assisted cognitive remediation) and a control group (n = 60, receiving routine nursing combined with routine cognitive training) according to their treatment and nursing protocols. Continuous treatment included in-hospital and post-discharge 12 weeks. Cognitive function, including the Wisconsin Card Sorting Test (WCST), Digit Symbol Substitution Test (DSST), Semantic Verbal Fluency (sVF) task, and the Schizophrenia Patient Quality of Life Scale (SQLS), was compared between the two groups before and 12 weeks after treatment.

RESULTS: Before treatment, there were no statistically significant differences in the scores of WCST, DSST, sVF, and SQLS dimensions between the two groups (p > 0.05). After 12 weeks of treatment, all cognitive indices showed significant within-group improvements for both groups (all p < 0.001), while each SQLS dimension and total score were significantly reduced within each group (observation group: all p < 0.01; control group: all p < 0.05). After Bonferroni correction for multiple comparisons, all cognitive and SQLS outcomes showed significantly larger improvements in the observation group relative to the control group (all corrected between-group p < 0.001).

CONCLUSIONS: Evidence-based nursing combined with computer-assisted cognitive correction therapy is associated with better cognitive performance and higher quality of life in patients with schizophrenia, showing promising clinical application value.

PMID:42633499 | DOI:10.62641/aep.v54i4.2325

Actas Esp Psiquiatr. 2026 Aug 15;54(4):963-970. doi: 10.62641/aep.v54i4.2328.

ABSTRACT

BACKGROUND: Mechanical restraint (MR) remains one of the most controversial interventions in psychiatry, particularly in involuntarily admitted patients. This study examined the prevalence and clinical predictors of MR in an open-door psychiatric unit in Spain, a context where national MR rates remain among the highest in Europe.

METHODS: A retrospective descriptive study of all involuntarily admitted patients (n = 81) was conducted in a 20-bed open-door acute psychiatric unit between June and December 2024. Sociodemographic, diagnostic, and treatment variables were extracted from electronic health records. Bivariate analyses based on exact tests and Firth penalized-likelihood logistic regression were used to identify independent correlates of MR.

RESULTS: MR was applied in 14.8% of patients. In Firth penalized-likelihood multivariable analysis, schizophrenia was the strongest independent correlate of MR (odds ratio [OR] = 9.58, 95% confidence interval [CI]: 1.71-65.89, p = 0.010). Male gender showed a significant bivariate association but lost significance after adjustment. MR co-occurred with intramuscular psychotropic medication in 91.7% of cases.

CONCLUSIONS: Within this single-centre, exclusively involuntary cohort, care delivered in an open-door setting with structured de-escalation interventions was associated with a comparatively low rate of MR. Schizophrenia emerged as the strongest correlate of MR and may represent a priority target for prevention strategies. The results align with convergent evidence from German, Swiss, and Norwegian studies supporting the safety and effectiveness of open-door approaches, and provide the first Spanish data on MR in this model of care. These findings are preliminary and require confirmation in larger, multicentre samples.

PMID:42633498 | DOI:10.62641/aep.v54i4.2328

Braz J Psychiatry. 2026 Aug 22. doi: 10.47626/1516-4446-2026-5019. Online ahead of print.

ABSTRACT

OBJECTIVES: Hyperglycemia during pregnancy is related to adverse obstetric, neonatal, and long-term health outcomes for both mothers and the offspring. This study aimed to conduct a systematic review and meta-analysis of the global literature evaluating the association between maternal diabetes (DM) during pregnancy and the incidence of schizophrenia in the offspring.

METHODS: Following PRISMA guidelines and registered in PROSPERO (CRD42024545505), a comprehensive search was conducted across major databases up to November 2024. Three retrospective cohort studies, including 2,603,889 individuals, met the inclusion criteria.

RESULTS: Three studies were included in the quantitative synthesis. Meta-analysis of hazard ratios showed that maternal DM during pregnancy was associated with an increased risk of schizophrenia in the offspring (HR = 1.58; 95% CI: 1.22-2.03; P = 0.0004), with no heterogeneity (I² = 0%). Analysis based on odds ratios showed a similar trend but did not reach statistical significance (OR = 2.15; 95% CI: 0.13-34.69; P = 0.59).

CONCLUSION: Maternal DM during pregnancy may be associated with an increased risk of schizophrenia in the offspring. Although maternal hyperglycemia may influence fetal neurodevelopment through inflammatory and metabolic mechanisms, the observational nature and limited number of included studies preclude causal inference, and these findings should be interpreted with caution.

PMID:42633496 | DOI:10.47626/1516-4446-2026-5019

ADMET DMPK. 2026 Jul 26;14:3328. doi: 10.5599/admet.3328. eCollection 2026.

ABSTRACT

BACKGROUND AND PURPOSE: Mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) have emerged as a promising cell-free therapy for osteoarthritis (OA). However, their transition into clinical therapeutics is constrained by unstandardized pharmacokinetics and heterogeneous preclinical reporting.

EXPERIMENTAL APPROACH: A meta-analysis of preclinical in vivo OA models evaluating MSC-EV therapy was conducted. Study quality was rigorously assessed using MISEV 2023 (Minimal Information for Studies of Extracellular Vesicles, 2023) criteria and the SYRCLE (Systematic Review Centre for Laboratory animal Experimentation) risk-of-bias tool. Quantitative synthesis was performed for the Osteoarthritis Research Society International (OARSI) histological score, reporting pooled mean differences (MDs) and 95 % confidence intervals (95% CIs), along with heterogeneity (I ² statistic) and microRNA (miRNA) cargo analysis.

KEY RESULTS: MSC-EV administration conferred robust structural protection against cartilage degradation. Quantitative synthesis of human-derived MSC-EVs (26 studies) significantly reduced OARSI scores (MD -3.27, 95% CI -4.66 to -1.88; p < 0.0001). Similarly, quantitative synthesis of animal-derived MSC-EVs (8 studies) demonstrated an even more profound effect (MD -5.58, 95% CI -7.13 to -4.03; p < 0.0001). Non-parametric Trim-and-Fill analysis estimated zero missing studies in both datasets, confirming that these effect sizes are highly robust to publication bias. Despite these robust efficacy signals, significant heterogeneity (I ² > 84 %) persisted. Meta-regression revealed that arbitrary dosage metrics, whether reported by particle count or protein concentration, failed to reliably predict treatment efficacy, highlighting severe gaps in dose-exposure standardization.

CONCLUSION: MSC-EVs demonstrate highly potent, cross-species efficacy in attenuating OA progression. However, clinical translation is critically bottlenecked by a lack of ADMET (absorption, distribution, metabolism, excretion and toxicity) compliance. Future research must prioritize standardized particle-based dosing, in vivo pharmacokinetic tracking, and rigorous cargo-function validation to enable regulatory approval.

PMID:42633484 | PMC:PMC13499667 | DOI:10.5599/admet.3328