To Örebro University

OBJECTIVES: Depression is common in the oldest-old population (aged ≥85 years), a population in which research is lacking and the effects of psychopharmacological treatment may be adverse. Electroconvulsive therapy (ECT) appears to be well tolerated by older patients with depression; however, it is used rarely in clinical practice and research concerning the oldest-old is lacking. The objective of this study was to assess response and remission rates, as well as adverse effects, in oldest-old depressed patients treated with ECT.

METHODS: This was a nationwide Swedish register study including 522 oldest-old patients treated with ECT for depression. Two propensity score matched control groups were also included: young patients treated with ECT, and oldest-old depressed patients not treated with ECT. Response and remission rates, clinician-reported adverse events, prognostic factors (including comorbid diseases and treatment parameters), adverse events requiring hospitalization, as well as deaths within 1 week from discharge, were assessed.

RESULTS: The oldest-old receiving ECT reported higher response (81.2%) and remission (53.3%) rates than younger counterparts (67.4% versus 27.4%, respectively). Severe psychotic depression was the only prognostic factor for response and remission. The oldest-old experienced fewer adverse events, most commonly confusion and cardiovascular complications, compared to controls. Compared with oldest-old patients not receiving ECT, the ECT group had fewer hospitalizations following discharge.

CONCLUSION: ECT is a viable treatment option for oldest-old patients with depression, who show higher response and remission rates than younger patients, as well as fewer hospitalizations than oldest-old patients not treated with ECT.

Eating disorders (ED) have a high comorbidity with major depressive disorder (MDD). Antidepressants often lack effect in these patients. While electroconvulsive therapy (ECT) is the most effective treatment for severe MDD, there are no large studies in the ED patient group yet. We aimed to compare the outcome of ECT for MDD in patients with and without eating disorders. We conducted a register-based study for patients with MDD and comorbid ED treated with ECT in Sweden between 2012-2023. The outcomes were compared to a matched control group without comorbid ED. The primary outcome was a response to treatment according to the Clinical Global Impression Improvement Scale (CGI-I). Secondary outcomes were remission according to CGI-I and subjective memory complaint. There were 861 patients in the ED group and 1,722 in the control group; of these 93.2% were female. The response rate was 58.4% in the ED group and 62.4% in the control group (OR 0.8, 95% CI 0.7-0.9, p <0.05). The frequency of subjective memory complaints in the ED versus the control group was 25.9% and 24.8%, respectively (OR 1.1, 95% 0.8-1.3 CI, p = 0.6). High response rates after ECT for MDD were found in the ED group but were significantly lower than in the matched control group. Subjective memory complaints did not differ significantly. Further studies are required comparing the outcome of ECT versus alternative treatments among patients with ED complicated by severe MDD.

Prior research has established that insomnia is predctive of pain in adolescents and that psychological mechanisms have a crucial role in this relationship. Adolescent girls report more insomnia and pain than boys, yet little is known of gender differences in how insomnia influences pain. This study assessed gender differences in levels and trajectories of insomnia and pain during adolescence, and whether rumination and negative mood mediated the effect of insomnia on pain. Longitudinal survey data measured on 5 annual occasions (Nbaseline = 2,767) were analyzed in a multigroup longitudinal serial mediation model. A final model was generated with insomnia as the predictor, rumination and depressed mood as mediators, pain as the outcome, and gender the grouping variable. The results showed that insomnia predicted pain in adolescents, with an effect 3.5 times larger in girls than boys. Depressed mood was the main mediator in boys. In girls, rumination was the only significant mediator. There were significant gender differences in the effects of insomnia on rumination and pain, and in the effects of rumination on depressed mood and pain, with stronger effects in girls. These results highlight that girls and boys should be considered separately when studying the relationship between insomnia and pain. PERSPECTIVE: Levels of insomnia and pain are progressively higher in adolescent girls than boys, across adolescence. The predictive strength of insomnia symptoms for future pain is 3.5 times greater in girls, with distinct gender-specific underlying pathways: rumination partially mediates this effect in girls, while depressed mood does so in boys.

OBJECTIVE: The majority of patients hospitalized for treatment of a manic episode are readmitted within 2 years despite maintenance treatment. Electroconvulsive therapy (ECT) has been associated with lower rehospitalization rates in some psychiatric conditions, but its association with readmission after a manic episode has not been investigated. Therefore, the aim of this study was to determine whether the time to readmission in patients with mania treated with ECT was longer than in patients not treated with ECT and whether there were subgroups of patients that benefited more.

METHODS: This was a nationwide register-based, observational study. All patients diagnosed with bipolar disorder, manic episode, admitted to any hospital in Sweden between 2012 and 2021 were included. Patients contributed data to the study for every admission. All admissions were followed up until psychiatric readmission, death, or the end of the study (December 31, 2021). Association between ECT and time to readmission was analyzed. A paired samples model was performed for 377 patients with at least two admissions for mania, treated with ECT at one admission and without ECT at the other admission. Times to readmission were analyzed.

RESULTS: A total of 12,337 admissions were included; mean (SD) age 47.7 (17.2), 5443 (44.1%) men. Readmission rate within 1 year was 54.6%. ECT was administered in 902 (7.3%) admissions. Within 30 days after admission, 182 out of 894 (20.4%) patients treated with ECT versus 2105 out of 11,305 (18.6%) patients treated without ECT were readmitted. There was no association between ECT and time to readmission (aHR 1.00, 95% CI 0.86-1.16, p = 0.992) in the model with all admissions. The paired samples model included 754 admissions (377 patients), mean (SD) age during admission without ECT was 45.6 (16.5), and with ECT 46.6 (16.4), 147 (39.0%) were men. In that model, readmission rate within 30 days for treatment with ECT was 19.0%, and for treatments without ECT, 24.1% (aHR 0.75, 95% CI 0.55-1.02, p = 0.067).

CONCLUSION: Readmission rates after inpatient treatment of mania were high. ECT was not significantly associated with longer time to readmission, but there was a trend toward a protective effect of ECT when admissions with and without ECT were compared within the same patients.

Introduction: Psychiatric disorders are common during pregnancy, affecting up to 16% of pregnant women. Severe depression and anxiety have significant negative effects on the health of both the mother and the developing fetus. Electroconvulsive therapy (ECT) is considered a treatment option for pregnant women with severe psychiatric disorders when other treatments have been ineffective or pose risks to the fetus. Knowledge of the safety and efficacy of ECT during pregnancy, however, remains limited.

Methods: Data were obtained from nationwide registries of pregnant women in Sweden who received ECT for a severe psychiatric disorder from January 2008 to December 2021. ECT-related outcomes in pregnant women were compared by propensity score matching with a group of non-pregnant women who also received ECT. Pregnancy-related outcomes were compared with two additional control groups: one consisting of the same group of women who did not receive ECT during another pregnancy and the other composed of pregnant women admitted to inpatient psychiatric care but who did not receive ECT, matched based on propensity score.

Results: Ninety-five pregnant women received ECT during the study period, accounting for 97 pregnancies. The response rate to ECT in pregnant women (n = 54) was similar to the matched control group of non-pregnant women (74% vs. 65%; OR 1.61; 95% CI 0.79-3.27). Rates of adverse events related to ECT were similar to those in the control group. There were no pre-term births or severe adverse outcomes related to the pregnancy, that were close in time to ECT. Therefore, no adverse outcomes related to pregnancy and childbirth could be directly attributed to ECT. The likelihood of premature birth and a 5-min Apgar score <7 in the newborn were both significantly higher in the ECT group, compared with the matched non-ECT group (OR 2.33, 95% CI 1.15-4.73, p = 0.008, and OR 3.68, 95% CI 1.58-8.55, p < 0.001, respectively). By contrast, no significant differences were observed when women in the pregnant ECT group were compared with the same group lacking ECT during another pregnancy.

Conclusions: ECT was associated with a positive treatment response in pregnant women with severe psychiatric disorders. The response rate to ECT was similar in pregnant and non-pregnant women. Nevertheless, the risks of premature birth and of a slightly poorer condition in newborns were higher in women who did than did not receive ECT, emphasizing the need for increased attention to severe psychiatric disorders during pregnancy.

Introduction

Sleep problems are increasingly recognized as a significant health concern among youth, with insufficient sleep affecting the majority of adolescents worldwide. Emerging research challenges the traditional view that sleep disturbances are merely symptoms of underlying mental disorders, suggesting instead a bidirectional relationship where sleep issues may also contribute to the development of psychopathology. Despite this growing evidence in adults, the role of sleep disturbances as predictors of mental illness in children and adolescents remains inconclusive. 

Aim

This study aims to systematically review and synthesize existing research to better understand how sleep problems in children and adolescents may predict future mental health issues.

Methods

* Conducted per PRISMA and SYMBALS guidelines, combining active learning machine learning and backwards snowballing.

* Titles and abstracts were screened by multiple authors using ASReview software.

* The databases Embase, MEDLINE, Web of Science and PsychINFO were searched. * Inclusion criteria: Primary studies in English language, Participants 0-18 years at baseline, Sleep disturbance as exposure, Mental illness (diagnosis or symptoms) as outcome, Longitudinal studies with at least 1 month between timepoints.

Results

A total of 136* studies were eligible for inclusion in the systematic review, published between 2000 and 2024.

Of these, 63 concerned adolescents at baseline, 45 school-aged children, and 28 concerned infants, toddlers and pre-school children. 

Some 46 of the studies concerned the broader construct Internalising symptoms, encompassing both depression and anxiety. A total of 59 studies concerned depression as outcome, 26 studies anxiety, 18 studies ADHD, 5 studies GAD, 5 studies social anxiety, 5 studies separation anxiety, and 4 studies psychosis. Rarer outcomes included panic disorder, PTSD, borderline personality disorder, oppositional defiant disorder, mania, OCD, and bipolar disorder. 

A significant association was found in 153 of the analyses (81.8 %), while 34 (18.2 %) did not. The most studied outcome was depression, where 50 studies found an association and 9 did not, followed by internalising symptoms (45 yes, 1 no) and anxiety (24 yes, 2 no). Several additional outcomes were studied, demonstrating more ambiguous results. The information is depicted in Figure 1. 

Conclusions

The preliminary results of this study provide convincing evidence that sleep problems predict later mental illness in children and adolescents: primarily regarding internalising symptoms, anxiety and depression, with more equivocal evidence regarding ADHD, psychosis, GAD, social anxiety and separation anxiety. The majority of studies concern adolescents. More studies on specific mental disorders beyond depression and anxiety are needed.

Introduction: Sleep problems in children and adolescents are common, with a significant majority having less than the recommended 8 h of sleep and/or experiencing suboptimal sleep quality. This issue, worsening with age and more prevalent in females, has been identified as a potentially critical health epidemic. Recent studies challenge the traditional view that sleep problems are merely consequences of mental disorders, suggesting a bidirectional relationship where sleep issues can also predict and exacerbate psychopathology, possibly even more so than the reverse relationship. Growing evidence underlines the urgent need for early interventions aimed at sleep disturbance to prevent future mental illness, highlighting a gap in research and the importance of a systematic review to guide future efforts in addressing this critical issue among children and adolescents.

Method: Prospective, longitudinal studies, where sleep problems were measured during childhood or adolescence, and mental illness either not present at baseline, or controlled for, were eligible for inclusion. Searches from Medline, Embase, Web of science and PsychInfo resulted in a total of 25825 hits, which were screened using ASReview.

Results: Preliminary search results identified approximately 85 studies eligible for inclusion. Of these, nine included infants and pre-school children (age 0–6 years), with eight of these studies focusing on symptoms of depression and anxiety, and one on symptoms of borderline personality disorder or psychotic symptoms. Children (age 7 to 12 years) were the focus in 26 of the studies, 20 of which had depression and/or anxiety as the outcome, two ADHD, two bipolar disorder, and three psychotic experiences. In 39 of the studies, participants were adolescents (age 13–18 years) at baseline. Some 40 of these focused on depression and/or anxiety, four on PTSD, five on bipolar disorder, four on psychosis, three on ADHD, and three on substance use disorder. Apart from a few exceptions, sleep problems in children and adolescents were found to be associated with future mental illness.

Conclusion: Sleep problems during childhood and adolescence are consistently associated with a range of later mental illnesses. This systematic review constitutes a foundation highlighting the need to prioritize sleep problems in youth in prevention efforts.

OBJECTIVE: Individuals with fibromyalgia report alarming levels of suicidal ideation, and comorbidity with other chronic health conditions such as obesity - a risk factor for suicidal ideation per se- could further complicate the clinical picture. The aim of this study is to determine, in a sample of women with fibromyalgia and comorbid obesity, the prevalence of suicidal ideation and to evaluate clinical, pain-related and psychological factors associated with suicidal ideation.

METHODS: 156 female individuals with fibromyalgia and obesity were recruited and completed a series of self-report measures that assessed i) the level of pain intensity, ii) depressive symptomatology, iii) sleep quality, and iv) pain catastrophizing. Suicidal ideation was evaluated by item #9 of the Beck Depression Inventory. In addition, information regarding previous suicide attempts and current opioid use was collected.

RESULTS: 37.8% of participants reported presence of suicidal ideation. According to the results of the multiple logistic regression, depressive symptomatology, sleep quality, and pain catastrophizing were associated with the presence of suicidal ideation.

DISCUSSION: The presence of suicidal ideation in our sample was significantly associated with depressive symptomatology, sleep quality, and pain catastrophizing. Our findings are the first to suggest a unique (i.e., independent of depressive symptomatology, and sleep quality) association between pain catastrophizing and suicidal ideation in the context of fibromyalgia and comorbid obesity. In order to prevent and reduce suicidal ideation, these factors should be assessed and targeted in interventions for pain management. Future research should investigate the extent to which addressing depressive symptoms, sleep quality, and pain catastrophizing reduces suicidal ideation.