IntroductionMajor Depressive Disorder (MDD) is a burdensome behavioral health condition that is costly and difficult to treat, particularly for patients with severe cases. The Collaborative Care Model (CoCM) has been shown to be effective for moderate depression treatment but less is known about its effectiveness for severe depression. This study analyzes the impact of CoCM treatment on outcomes for depression patients across all ranges of MDD severity at Concert Health.Materials and methodsAnalysis was completed utilizing all closed patient treatment episodes (N = 30,162) at Concert Health between 2018 and 2025. Of these patients, 5,693 began treatment with severe depression. We compare effect sizes for change between baseline and final screener scores across severity levels. Additionally, we utilize logistic regression to complete analyses to understand treatment factors and patient characteristics that are associated with treatment response and remission, as measured by changes in PHQ-9 scores.ResultsThe primary analysis showed that patients with severe depression (PHQ-9 > 20) had slightly lower odds of achieving response compared to patients with moderate depression (OR: 0.93). The treatment factors of insurance type, suicide risk, anxiety presence, and touchpoints also had significant effects on the odds of achieving response and remission.DiscussionThe results suggest that CoCM may be effective for patients with severe depression in achieving treatment response. Patients on Medicaid or with more complex conditions such as anxiety presence or elevated risk for suicide may need higher levels of engagement from the care team to achieve response and remission.
Smoking as a correlate of suicidal behavior and self-harm in adolescents with depressive disorders
Suicidal behavior and self-harm are major public health concerns among adolescents, particularly those with depressive disorders. While smoking has been linked to suicidality in general populations, its independent role in both suicidal behavior and self-harm within well-characterized clinical samples of youth with depressive disorders remains understudied. This study consecutively enrolled 2,343 adolescents (aged 12–18 years) diagnosed with unipolar depression, bipolar disorder, or depressive episode according to DSM-5 criteria at Nanhai Public Health Hospital of Foshan City and The Third People’s Hospital of Foshan between January 2025 and December 2025. Suicidal behavior (≥1 suicide attempt) and self-harm (intentional self-injury or poisoning regardless of intent) were assessed via clinical interviews. Multivariable binary logistic regression models were constructed to identify factors independently associated with each outcome, adjusting for age, sex, education, income, parental education, psychiatric diagnosis, family history of mental illness, physical disease, and smoking status. Among 2,343 participants (mean age 14.99 ± 1.65 years; 77.8% female), the prevalence of self-harm was 76.0% and suicidal behavior was 44.2%. In fully adjusted models, smoking status was the only variable significantly associated with suicidal behavior after adjustment for measured covariates: current smokers (OR = 2.74, 95% CI: 1.81–4.22, P<0.001) and past quitters (OR = 2.32, 95% CI: 1.66–3.28, P<0.001) had higher odds compared to never smokers. For self-harm, current smoking was significantly associated with increased risk (OR = 2.31, 95% CI: 1.33–4.37, P = 0.006). Education level showed a borderline association with self-harm, with each additional year of schooling corresponding to a 10% lower odds (OR = 0.90, 95% CI: 0.81–1.00, P = 0.050); however, this finding should be interpreted cautiously given the exploratory nature of the analysis. No other demographic or clinical variables, including age, sex, or psychiatric diagnosis, were independently associated with either outcome. Smoking was strongly associated with both suicidal behavior and self−harm after adjustment for measured demographic and clinical covariates. These findings underscore the importance of assessing tobacco use as a potential clinical marker of vulnerability in youth mental health settings.
Dose–response relationship of exercise interventions on sleep quality in patients with depression: a systematic review and meta-analysis
BackgroundThis meta-analysis aimed to systematically evaluate the effects of exercise interventions on sleep quality in patients with depression and to explore the dose–response relationships of key intervention parameters.MethodsA comprehensive search was conducted in PubMed, Web of Science, Embase, Scopus, and the Cochrane Library to identify randomized controlled trials (RCTs). Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup and sensitivity analyses were performed to examine potential dose–response relationships.ResultsA total of 17 publications, including 19 randomized controlled trial comparisons and 1,457 participants, were included in this systematic review and meta-analysis. Pooled estimates indicated that exercise interventions significantly improved sleep quality [SMD = −0.37, 95% CI: −0.48 to −0.27]. Dose–response modeling suggested that exercise doses around 312.75 MET·min/week may be associated with greater improvements [Hedges’ g = −0.51, 95% CI: −0.71 to −0.31]. Subgroup analyses suggested that mind–body exercise [SMD = −0.49, 95% CI: −0.63 to −0.35], durations of 9–12 weeks [SMD = −0.49, 95% CI: −0.74 to −0.24], fewer than two sessions per week [SMD = −0.47, 95% CI: −0.65 to −0.29], and sessions longer than 90 minutes [SMD = −0.42, 95% CI: −0.66 to −0.18] may be associated with favorable changes.ConclusionsExercise interventions may improve sleep quality in individuals with depression, with potential benefits at low doses. These findings support individualized exercise prescriptions, but larger multicenter RCTs with long-term follow-up are needed to confirm the dose–response pattern and subgroup findings.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251105568, identifier PROSPERO (CRD420251105568).
Post-intracerebral hemorrhage depression comorbid with obstructive sleep apnea and REM sleep behavior disorder: a case report and literature review
We report a 63-year-old male with post-cerebral hemorrhage depressive disorder. Previous adequate-dose, full-course antidepressant treatment yielded no significant improvement in depression, anxiety, or sleep disturbance. Detailed history taking and polysomnography (PSG) confirmed comorbid severe obstructive sleep apnea hypopnea syndrome (OSAHS) and rapid eye movement sleep behavior disorder (RBD). Without adjusting antidepressants, the patient first received continuous positive airway pressure (CPAP) for OSAHS, followed by individualized pharmacotherapy for RBD. With the improvement of sleep architecture and respiratory events, obvious remission of depressive and anxiety symptoms and substantial recovery of daytime function were observed. This case emphasizes the bidirectional relationship between sleep and mood disorders. For post-stroke depression (PSD) poorly responsive to antidepressants, active sleep evaluation, multidisciplinary collaboration, and targeted management of comorbid sleep disorders may be crucial to enhance therapeutic efficacy.
<![CDATA[Track latest neuropsychiatry breakthroughs: phase 3 narcolepsy study launches, new depression and PTSD therapies advance, and FDA approvals reshape care.]]>
<![CDATA[Largest real-world analysis shows Deep TMS cuts PTSD and depression symptoms in comorbid patients; promising but not FDA-cleared yet.]]>
Association between objective sleep structure and suicidal ideation in patients with depression: a study based on polysomnographic regression and cluster analysis
BackgroundDepression is a common mental disorder, and current suicidal ideation (SI) is a clinically important symptom. Sleep disturbance is common in depression, but the relationship between objective sleep architecture and current SI remains unclear. This study examined associations between objective sleep structure and current SI and explored whether sleep-clinical clustering could support exploratory SI stratification.Methods287 patients meeting DSM-5 criteria for depressive disorder underwent clinical assessment and overnight polysomnography (PSG). Current SI was assessed using item 3 of the HAMD-17. Binary logistic regression evaluated factors associated with current SI. K-Means clustering (K = 3) was performed using standardized HAMD score, PSQI score, AHI, total awakenings, N3%, R%, and sleep efficiency. Quantitative cluster validation, sensitivity analyses excluding HAMD from clustering, and ROC-based performance metrics were additionally conducted.ResultsCurrent SI was present in 50.52% (145/287) of patients. In the individual-variable regression model, only HAMD total score was independently associated with current SI (OR = 1.683, p < 0.001). Cluster analysis identified three subgroups with distinct current SI rates: Cluster 1 (deep-sleep dominant, 37.04%), Cluster 2 (high-arousal-apnea, 70.37%), and Cluster 3 (low-arousal-subjective insomnia, 60.80%). The K = 3 solution showed WSS = 1450.71, mean silhouette = 0.204, and Davies-Bouldin index = 1.679. In the demographic-adjusted model, membership in Clusters 2 + 3 was associated with current SI (OR = 3.152, 95% CI: 1.883-5.274, p < 0.001; AUC = 0.700, 95% CI: 0.639-0.760). When HAMD was excluded from clustering, the association remained (OR = 2.669, 95% CI: 1.598-4.458, p < 0.001), whereas additional adjustment for HAMD total score attenuated the primary cluster association (OR = 0.842, 95% CI: 0.411-1.725, p = 0.639).ConclusionsDepression severity was the primary factor associated with current SI. PSG-derived sleep-clinical clusters may help characterize heterogeneous presentations of current SI, but their incremental value beyond depressive severity should be interpreted as exploratory and validated in larger longitudinal samples.
Rhythm-Based Video Games: Exploring the Cognitive and Learning Potential
By Florencia Assaneo, PhD, Research Fellow, Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute
Educational challenges for Latin American children
Primary education in Latin America has faced a steady decline over recent decades, contributing to what many organizations now describe as an educational crisis. International institutions such as the Economic Commission for Latin America and the Caribbean (ECLAC), the United Nations Educational, Scientific and Cultural Organization (UNESCO), as well as the World Bank Group have all called for urgent action to address worsening learning outcomes across the region. The situation is particularly concerning in Mexico. Results from the 2022 Programme for International Student Assessment showed that Mexico scored well below the Organization for Economic Co-operation and Development (OECD) average in reading, mathematics, and science — placing the country among the lower-performing educational systems evaluated globally.
The consequences of this crisis extend far beyond the classroom. Educational difficulties during childhood are closely linked to long-term social and mental health outcomes. Research has shown that additional years of basic education are associated with lower rates of depression and anxiety (Kondirolli & Sunder, 2022), as well as higher levels of resilience and perceived control over one’s life (Niemeyer et al. 2019). In this sense, poor academic performance in primary school can have lasting effects that continue into adulthood, limiting employment opportunities, increasing vulnerability, and negatively affecting overall well-being.
Can rhythm-based video games improve learning?
Open-access interventions that strengthen children’s cognitive and academic abilities could have enormous value in low- and middle-income countries, where educational resources are often limited. Our work explores whether the ability to coordinate movements with rhythmic sounds — such as clapping, tapping, or dancing to music — can be leveraged to support children’s learning and cognitive development through engaging digital tools.
Over the last decade, multiple studies have shown that children who are better at synchronizing their movements to rhythm also tend to perform better on a wide range of cognitive and language-related tasks. These include reading, phonological awareness, processing speed, rapid naming, and other foundational abilities linked to academic success. Researchers have assessed these rhythmic coordination skills in multiple ways, from walking to the beat of music to tapping along with a steady rhythm or coordinating movements while playing musical instruments. Across these different approaches, one result consistently emerges: children who are better at aligning movement with sound also tend to show stronger cognitive performance.
Building on these study findings, my current fellowship project, supported by the Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute, seeks to better understand how these rhythm synchronization abilities develop during childhood and whether they could eventually be strengthened through interactive digital interventions. Specifically, we are studying the developmental stage at which these abilities become established in children, and whether individuals with stronger rhythmic coordination also show advantages in attention and language-related skills. Understanding when these abilities emerge is particularly important because it may help identify the developmental window during which they are most malleable and therefore most responsive to training or intervention.
In parallel, we are using functional magnetic resonance imaging (fMRI) — a non-invasive brain imaging technique that allows us to observe which brain regions become active during different tasks — to explore the relationship between rhythmic synchronization and the brain’s reward system. Importantly, these same reward-related regions are also strongly engaged during video game play. If the pathways within this reward system are similarly activated during rhythmic coordination, this could mean that children who initially struggle to synchronize movements with sound may be able to strengthen these abilities through a carefully designed video game experience. One possible future application could involve an open-access mobile game in which children synchronize taps or hand movements to musical rhythms while progressing through increasingly challenging levels and unlocking rewards or visual customizations.
Overall, the current project seeks to generate the scientific evidence necessary to determine whether rhythm-based digital interventions could become a viable tool for supporting children’s cognitive development. This work has the potential to contribute to the future development of accessible and scalable tools that can strengthen foundational cognitive skills linked to academic performance in children. These tools can be applied to children in Mexico and, more broadly, across low- and middle-income countries (LMICs), expanding access to education resources and interventions.
The power of collaboration between the SNF Global Center and UNAM
Our laboratory at Universidad Nacional Autónoma de México (UNAM) is primarily dedicated to basic neuroscience research. Based at UNAM’s campus in Querétaro, our team brings together researchers and students from different disciplines — including neuroscience, psychology, physics, engineering, and data analysis — united by a shared interest in understanding how rhythm and brain dynamics shape human cognition and behavior. Here, we have access to excellent infrastructure for fundamental research, including neuroimaging facilities and high-performance computational resources. However, translating basic scientific discoveries into interventions capable of improving people’s daily lives is often much more challenging and requires strong cross-sector collaboration.
The work I’m conducting as part of the SNF Global Center Research Fellowship has encouraged us to begin thinking beyond the laboratory. This current fellowship has given us the opportunity to test the core scientific assumptions behind our proposed open-access intervention. If the pilot project proves successful, the next stages of the work will become considerably more ambitious, involving both the technological development of the intervention and its large-scale implementation and evaluation in school settings. Advancing toward those goals will likely require the support of larger international organizations and cross-sector collaborations. In this context, the opportunities provided by the SNF Global Center at the Child Mind Institute to share, disseminate, and give visibility to our work are extremely valuable, helping create the connections and momentum necessary to move from foundational research toward real-world impact.
More broadly, this kind of collaboration highlights the importance of building bridges between global institutions and local research communities. By combining international support with local expertise and close engagement with schools and communities, it becomes possible to develop solutions that are both scientifically rigorous and genuinely connected to the realities of the populations they aim to serve.
Learn more about the Research Fellowship
The post Rhythm-Based Video Games: Exploring the Cognitive and Learning Potential appeared first on Child Mind Institute.
Elevated NHHR at admission is independently associated with elevated post-stroke depressive symptoms
BackgroundElevated post-stroke depressive symptoms are common among acute ischemic stroke (AIS) survivors and are associated with poor functional recovery. However, readily available biomarkers reflecting lipid–inflammation status remain limited. The ratio of non–high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (NHHR) may integrate atherogenic burden and inflammatory status and thus be associated with depressive symptom burden after stroke.MethodsWe retrospectively analyzed a cohort of 518 Chinese AIS patients. Admission NHHR was calculated from routine lipid panels. Depressive symptoms at 90 days were assessed using the Hamilton Depression Rating Scale (HAMD), and elevated post-stroke depressive symptoms were defined according to the prespecified HAMD threshold. Multivariable logistic regression, restricted cubic spline (RCS) analysis, and subgroup analyses were conducted to examine the association between NHHR and elevated depressive symptoms.ResultsAmong the 518 patients, 179 exhibited elevated post-stroke depressive symptoms at 90 days. Higher NHHR levels were independently associated with increased odds of elevated depressive symptoms after adjustment for demographics, stroke severity, cognitive function, inflammatory markers, and coagulation parameters (OR = 1.35, P = 0.029). Dose–response trends were observed, and RCS analysis suggested a linear relationship without significant nonlinearity. No significant interactions were found across sex, smoking, alcohol use, hypertension, or diabetes subgroups.ConclusionsElevated NHHR at admission was independently associated with elevated post-stroke depressive symptoms at 90 days in Chinese AIS patients. As a simple, cost-effective, and readily obtainable biomarker, NHHR may facilitate early risk stratification and guide individualized interventions.
Young Adults’ Perspectives on an Ecological Momentary Intervention for Drinking to Cope: Qualitative Study
<strong>Background:</strong> Young adults have high rates of mental health problems, such as mood or anxiety symptoms, and high rates of problematic drinking. Many young adults who undergo psychiatric hospitalization to address depression and anxiety symptoms also engage in risky drinking and tend to drink to cope with negative emotions. However, in many cases, treatment programs focusing on mood and anxiety symptoms often fail to adequately address problematic alcohol use in young adults. <strong>Objective:</strong> This study aimed to address this treatment gap by investigating patient perspectives on a potential ecological momentary intervention mobile app. Researchers used qualitative methods to gather perspectives of young adults hospitalized for psychiatric care on their use of drinking to cope with negative emotions and their feedback for a prospective app designed to suggest healthy coping strategies when participants report low mood and cravings to drink. <strong>Methods:</strong> We recruited a total of 12 young adults admitted to a partial hospitalization program to participate in a qualitative interview. To be eligible, participants needed to be aged 18-25 years and report drinking at least once weekly, binge drinking at least once monthly, drinking to cope with negative emotions, and depression and/or anxiety symptoms. <strong>Results:</strong> Qualitative analysis of our data resulted in 4 major themes. These included (1) motivations to use substances, (2) healthy coping, (3) general reactions to the proposed app, and (4) suggestions for the app. Participants generally had insight about their use of alcohol to cope and were able to identify several motivations for drinking; the most frequent motivations were to alleviate anxiety and depression, although many participants noted drinking to cope with other emotions, such as guilt or loneliness. Participants overall had positive responses to the prospective intervention and reported that they would appreciate the portability of a digital intervention in helping them “step down” from higher levels of psychiatric care. Participants also made several valuable suggestions about content, features, and usability, such as suggesting ways to “gamify” the app to increase use. <strong>Conclusions:</strong> This feedback will be crucial in designing and testing an ecological momentary intervention designed to reduce drinking to cope in young adults hospitalized for psychiatric care.
