Journal Articles
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Item The associations of childhood adversities and mental disorders with suicidal thoughts and behaviors - Results from the World Mental Health International College Student Initiative(Elsevier B V, 2025-08-01) Mortier P; Yang X; Altwaijri YA; Holdcraft JA; Lee S; Sampson NA; Albor Y; Alhadi AN; Alonso J; Al-Saud NK; Andersson C; Atwoli L; Auerbach RP; Muaka CA; Báez-Mansur PM; Ballester L; Bantjes J; Baumeister H; Bendtsen M; Benjet C; Berman AH; Bruffaerts R; Carrasco P; Chan SCN; Cohut I; Covarrubias Díaz Couder MA; Crockett MA; Cuijpers P; David OA; Dong D; Ebert DD; Gaete J; Felez-Nobrega M; García Forero C; Gili M; Gutiérrez-García RA; Haro JM; Hasking P; Hunt X; Husky MM; Jaguga F; Jansen L; Langer ÁI; Liu Y; Mac-Ginty S; Martínez V; Mason A; Mathai M; McLafferty M; Miranda-Mendizabal A; Murray EK; Musyoka CM; O'Neill SM; Papasteri CC; Piqueras JA; Popescu CA; Rapsey C; Robinson K; Rodriguez-Jimenez T; Scarf D; Siu O-L; Stein DJ; Struijs SY; Tomoiaga CT; Valdés-García KP; Vereecke S; Vigo DV; Wang AY; Wong SYS; Kessler RC; World Mental Health International College Student collaboratorsObjective: To investigate the associations of demographic variables, childhood adversities (CAs), and mental disorders (MDx) with onset, transition, and persistence of suicidal thoughts and behaviors (STB) among first-year university students. Method: Poisson regression models within a discrete-time survival framework were constructed using web-based self-report survey data from 72,288 incoming university students across 18 countries (response rate=20.9%; median age=19 years, 57.9% female, 1.4% transgender, 21.0% non-heterosexual). These models examined the associations of four demographic variables, five CAs, and eight MDx with STB outcomes. Results: Lifetime prevalence of suicidal ideation, plans, and attempts was 47.0%, 26.0%, and 9.6%, respectively; 12-month estimates were 30.6%, 14.0%, and 2.3%. In unadjusted analyses, associations were strongest between lifetime onset of suicidal ideation and CAs (RR range 4.4–7.0), particularly parental psychopathology (relative risk [RR]=7.0 [95% CI 6.5–7.7]), followed by MDx (RR range 1.3–3.0). Of the demographic subgroups, transgender students had highest risk of STB (lifetime ideation onset RR=2.4 [2.3–2.6]; ideation-to-attempt transition RR=1.5 [1.3–1.8]). In fully adjusted models, strongest predictors of lifetime ideation onset were emotional abuse (RR=2.1 [1.9–2.2]), major depressive disorder (RR=2.0 [1.9–2.1]), and bipolar disorder (RR=1.8 [1.6–2.0]). Ideation-to-attempt transition remained most strongly associated with panic disorder (RR=1.5 [1.3–1.7]), bipolar disorder (RR=1.4 [1.2–1.7]), and sexual abuse (RR=1.4 [1.2–1.7]). Most predictors were significantly but weakly associated with persistence of ideation and plan, while only physical abuse remained associated with repeated suicide attempts (RR=1.3 [1.0–1.8]). Conclusion: CAs and MDx are strong predictors of both onset of and transition within the STB spectrum, underscoring the importance of implementing early-life prevention interventions.Item Exposure to Traumatic Events and Shame in Adolescent Surf Lifesavers: An Australian Perspective(Springer Nature Switzerland AG, 2024-10-10) Fien S; Lawes JC; Ledger J; de Terte I; Drummond M; Simon P; Joseph N; Daw S; Kelly S; Hillman W; Stanton R; Best TEmergency service personnel experience high levels of psychological distress, with increasing evidence of associations with shame and trauma. Additionally, adolescence is a critical time in social and cognitive development, in which shame plays an important role. In Australia, adolescent volunteer surf lifesavers (SLS) are particularly vulnerable due to exposure to potentially traumatic experiences (PTEs) such as rescues and resuscitation of human lives. The aim of this study was to investigate the association between direct or indirect PTEs, and the relationship PTSS and shame may have in adolescent surf lifesavers. This cross-sectional study surveyed patrolling adolescent SLS, aged 13–17 years, recruited via internal communications and social media groups. Complete responses from patrolling adolescents (n = 118; 59% female; mean age 15.4 years) were used to determine exposure to PTEs across global, direct, and within SLS trauma domains. Associations between demographics, PTEs, post-traumatic stress symptoms (PTSS), with shame as a moderator were assessed for each trauma domain. PTEs and PTSS were positively associated across trauma domains. Shame was identified as a significant predictor of PTSS and as an important moderator of PTSS for experiences within SLSA, but not global or direct trauma. By exploring links between PTEs, PTSS, and shame, these findings contribute to the development of strategies and interventions for adolescents during stressful times. Responsiveness to adolescents via feedback and genuine, reassuring relationships that acknowledge the complexity of coping with stressful situations, may be potentially effective approaches to support coping with experiences of shame following PTE’s in adolescent surf lifesavers.Item Prepare Romania: study protocol for a randomized controlled trial of an intervention to promote pre-exposure prophylaxis adherence and persistence among gay, bisexual, and other men who have sex with men(BMC, part of Springer Nature, 2024-07-10) Lelutiu-Weinberger C; Filimon ML; Zavodszky AM; Lixandru M; Hanu L; Fierbinteanu C; Patrascu R; Streinu-Cercel A; Luculescu S; Bora M; Filipescu I; Jianu C; Heightow-Weidman LB; Rochelle A; Yi B; Buckner N; Golub SA; van Dyk IS; Burger J; Li F; Pachankis JEBACKGROUND: Gay, bisexual, and other men who have sex with men (GBMSM) represent a high-risk group for HIV transmission in Romania, yet they possess few resources for prevention. Despite having no formal access to pre-exposure prophylaxis (PrEP) through the health system, GBMSM in Romania demonstrate a high need for and interest in this medication. In anticipation of a national rollout of PrEP, this study tests the efficacy of a novel strategy, Prepare Romania, that combines two evidence-based PrEP promotion interventions for GBMSM living in Romania. METHODS: This study uses a randomized controlled trial design to examine whether GBMSM living in Romania receiving Prepare Romania, a culturally adapted counseling and mobile health intervention (expected n = 60), demonstrate greater PrEP adherence and persistence than those assigned to a PrEP education control arm (expected n = 60). Participants from two main cities in Romania are prescribed PrEP and followed-up at 3 and 6 months post-randomization. PrEP adherence data are obtained through weekly self-report surveys and dried blood spot testing at follow-up visits. Potential mediators (e.g., PrEP use motivation) of intervention efficacy are also assessed. Furthermore, Prepare Romania's implementation (e.g., proportion of enrolled participants attending medical visits, intervention experience) will be examined through interviews with participants, study implementers, and healthcare officials. DISCUSSION: The knowledge gained from this study will be utilized for further refinement and scale-up of Prepare Romania for a future multi-city effectiveness trial. By studying the efficacy of tools to support PrEP adherence and persistence, this research has the potential to lay the groundwork for PrEP rollout in Romania and similar contexts. Trial registration This study was registered on ClinicalTrials.gov, identifier NCT05323123 , on March 25, 2022.Item Child abuse and neglect and mental health outcomes in adulthood by ethnicity: Findings from a 40-year longitudinal study in New Zealand/Aotearoa.(Elsevier B.V., 2023-11-01) Telfar S; McLeod GFH; Dhakal B; Henderson J; Tanveer S; Broad HET; Woolhouse W; Macfarlane S; Boden JMBACKGROUND: Longitudinal studies consistently report adverse long-term outcomes of childhood maltreatment. Little is known about the impact of childhood maltreatment on mental health among a marginalized population (New Zealand Māori); therefore, we cannot assume the effects of maltreatment are the same across the population. OBJECTIVE: Associations were examined between childhood sexual abuse (CSA), childhood physical punishment (CPP) and childhood neglect (CN) (<16 years) and mental health outcomes 18-40 years, by ethnicity (Māori/non-Māori). PARTICIPANTS AND SETTING: Data from the Christchurch Health and Development Study, a study of a birth cohort of 1265 children born in Christchurch in 1977. By age 40, 17.8 % (n = 191) reported New Zealand Māori ethnic identity; 82.2 % (n = 883) were non-Māori. METHODS: CSA, CPP (<16 years) were measured at 18, 21 years; CN was measured at 40 years. Major depression, anxiety disorder, suicidal ideation, alcohol abuse/dependence and cannabis abuse/dependence were measured at ages 21, 25, 30, 35 and 40 years. Childhood confounding variables controlled. Analyses were extended to include Māori ethnicity. RESULTS: After statistical adjustment, experience of severe childhood maltreatment increased odds of mental health problems 1.8-2.6×, compared to no maltreatment; the effects of maltreatment were similar for males and females. For Māori, some higher rates of mental health problems were seen among those maltreated, no statistically significant associations were detected after Bonferroni correction (among severe maltreatment vs. no maltreatment). Limitations should be considered when interpreting results. CONCLUSIONS: Exposure to childhood maltreatment has long-term effects into middle-age. Further research employing culturally-sensitive approaches may help clarify Māori childhood maltreatment outcomes.Item A Framework for the Empirical Investigation of Mindfulness Meditative Development(Springer Science+Business Media, LLC, 2023-05) Galante J; Grabovac A; Wright M; Ingram DM; Van Dam NT; Sanguinetti JL; Sparby T; van Lutterveld R; Sacchet MDMillions of people globally have learned mindfulness meditation with the goal of improving health and well-being outcomes in both clinical and non-clinical contexts. An estimated half of these practitioners follow mindfulness teachers’ recommendations to continue regular meditation after completion of initial instruction, but it is unclear whether benefits are strengthened by regular practice and whether harm can occur. Increasing evidence shows a wide range of experiences that can arise with regular mindfulness meditation, from profoundly positive to challenging and potentially harmful. Initial research suggests that complex interactions and temporal sequences may explain these experiential phenomena and their relations to health and well-being. We believe further study of the effects of mindfulness meditation is urgently needed to better understand the benefits and challenges of continued practice after initial instructions. Effects may vary systematically over time due to factors such as initial dosage, accumulation of ongoing practice, developing skill of the meditator, and complex interactions with the subjects’ past experiences and present environment. We propose that framing mindfulness meditation experiences and any associated health and well-being benefits within integrated longitudinal models may be more illuminating than treating them as discrete, unrelated events. We call for ontologically agnostic, collaborative, and interdisciplinary research to study the effects of continued mindfulness meditation and their contexts, advancing the view that practical information found within religious and spiritual contemplative traditions can serve to develop initial theories and scientifically falsifiable hypotheses. Such investigation could inform safer and more effective applications of mindfulness meditation training for improving health and well-being.Item Volitional mental absorption in meditation: Toward a scientific understanding of advanced concentrative absorption meditation and the case of jhana(Elsevier Ltd, 2024-05-30) Yang WFZ; Sparby T; Wright M; Kim E; Sacchet MDMeditation has been integral to human culture for millennia, deeply rooted in various spiritual and contemplative traditions. While the field of contemplative science has made significant steps toward understanding the effects of meditation on health and well-being, there has been little study of advanced meditative states, including those achieved through intense concentration and absorption. We refer to these types of states as advanced concentrative absorption meditation (ACAM), characterized by absorption with the meditation object leading to states of heightened attention, clarity, energy, effortlessness, and bliss. This review focuses on a type of ACAM known as jhana (ACAM-J) due to its well-documented history, systematic practice approach, recurring phenomenological themes, and growing popularity among contemplative scientists and more generally in media and society. ACAM-J encompasses eight layers of deep concentration, awareness, and internal experiences. Here, we describe the phenomenology of ACAM-J and present evidence from phenomenological and neuroscientific studies that highlight their potential applications in contemplative practices, psychological sciences, and therapeutics. We additionally propose theoretical ACAM-J frameworks grounded in current cognitive neuroscientific understanding of meditation and ancient contemplative traditions. We aim to stimulate further research on ACAM more broadly, encompassing advanced meditation including meditative development and meditative endpoints. Studying advanced meditation including ACAM, and specific practices such as ACAM-J, can potentially revolutionize our understanding of consciousness and applications for mental health.Item Altered States of Consciousness are Prevalent and Insufficiently Supported Clinically: A Population Survey(Springer Science+Business Media, LLC, 2024-05-17) Wright MJ; Galante J; Corneille JS; Grabovac A; Ingram DM; Sacchet MDObjectives: Adoption of potentially consciousness-altering practices may be leading to a rise in emergent phenomena (EP): sudden unusual mental or somatic experiences often interpreted as spiritual, mystical, energetic, or magical in nature. It is unclear how frequently these altered states of consciousness occur and what the clinical implications may be. Anecdotal accounts and prior literature suggest that EP may be common, under-reported, and followed by either positive or negative changes to well-being. We sought to supplement prior evidence on the prevalence and effects of EP among general populations with large-scale quantitative measurements. Method: We measured the prevalence of EP, while not on mind-altering substances, through completion of online surveys by representative samples from three international communities (n = 3135). The communities sampled were UK Qualtrics online panelists, US-based MTurk workers, and the readers of a popular rationalist blog. Samples were broadly representative of underlying populations. Results: Forty-five percent of participants reported experiencing non-pharmacologically induced EP at least once in their lives, including derealization (17%), unitive experiences (15%), ecstatic thrills (15%), vivid perceptions (11%), changes in perceived size (10%), bodily heat or electricity (9%), out-of-body experiences (8%), and perception of non-physical lights (5%). Respondents reported a mix of positive and negative well-being outcomes following EP, with 13% claiming moderate or greater suffering and 1.1% claiming life-threatening suffering. Of those who experienced suffering, 63% did not seek help. Conclusions: EP are widespread among the studied populations with potential for both positive and negative outcomes, the latter of which do not appear to be adequately addressed through recourse to clinical practice.Item A preliminary study investigating the neglected domain of mental health in Australian lifesavers and lifeguards.(Springer Nature Limited, 2023-05-31) Fien S; Lawes JC; Ledger J; Drummond M; Simon P; Joseph N; Daw S; Best T; Stanton R; de Terte IBACKGROUND: Surf lifesavers and lifeguards have provided essential education, preventative, and rescue services to the Australian community for over 110 years. In this first responder role, surf lifesavers and lifeguards are inadvertently exposed to high risk and trauma related experiences, which may negatively impact mental well-being. To date however, there has been limited research into the mental health of surf lifesavers and lifeguards, and no studies at all on the mental health of adolescent surf lifesavers. The preliminary study aimed to measure the exposure of potentially traumatic events (PTEs), post-traumatic stress symptoms (PTSS), self-efficacy, social support, and attitudes towards mental health problems in Surf Life Saving (SLS) members. METHODS: An anonymous, online survey was developed (adolescent and adult versions) and created to measure the domain of mental health in surf lifesavers and lifeguards. Pearson's correlations investigated relationships between PTEs, PTSS, self-efficacy, social support, attitudes towards mental health problems, age, years as a SLS member, and years patrolling. Spearman's Rank was used for violations of normality. RESULTS: A total of 57 surf lifesavers/lifeguards aged 13-59 years were included in the final analysis. There was a significant positive relationship between exposure to direct trauma and PTSS, which in turn, were associated with greater negative attitudes towards mental health problems towards the mental health of others, and lower levels of self-efficacy. Male and female adults with PTSS reported lower social support, whereas for adolescent males, a positive relationship between direct trauma and PTSS was observed. CONCLUSION: This research is the first to explore the mental health of Australian surf lifesavers and lifeguards. The results highlight the potential risks to mental health and well-being associated with this first responder role. More research to protect the vulnerability of this population is warranted.Item Coping with stress during the COVID-19 pandemic in the oldest-old population(Springer Nature B.V., 2022-12) Gerhards SK; Pabst A; Röhr S; Luppa M; Riedel-Heller SGThe aim of the study is to investigate psychosocial factors that are associated with positive and negative coping with stress, as well as with worries about and perceived threat by COVID-19 to enable us to provide adequate support for oldest-old individuals. A paper–pencil-based survey assessed COVID-19 worries and perceived threat, depression, anxiety, somatization, social support, loneliness, resilience, positive and negative coping in a sample of n = 197 oldest-old individuals (78–100 years). Linear multivariate and binary logistic regression analyses were conducted. Individuals with high levels of resilience were more likely to feel self-efficient when coping with stress. High levels of depression, anxiety and loneliness were associated with feeling more helpless when coping with stress. However, oldest-old individuals who felt lonely also experienced situations where they felt competent in stress coping. Being male and experiencing high levels of social support was more likely associated with high levels of worries due to COVID-19. Increased age and higher levels of depression were associated with lower levels of perceived personal threat, whereas higher somatization scores were more likely associated with higher perceived personal threat. Findings suggest that mental health factors may shape the way oldest-old individuals cope with pandemic-related stress. Resilience might be an important factor to take into account when targeting an improvement in positive coping with stress. Oldest-old individuals who have higher levels of depression, anxiety and feel lonely may be supported by adapting their coping skill repertoire to reduce the feeling of helplessness when coping with stress.Item AgeWell.de – study protocol of a pragmatic multi-center cluster-randomized controlled prevention trial against cognitive decline in older primary care patients(BioMed Central Ltd, 2019-08-01) Zülke A; Luck T; Pabst A; Hoffmann W; Thyrian JR; Gensichen J; Kaduszkiewicz H; König H-H; Haefeli WE; Czock D; Wiese B; Frese T; Röhr S; Riedel-Heller SGBackground In the absence of treatment options, the WHO emphasizes the identification of effective prevention strategies as a key element to counteract the dementia epidemic. Regarding the complex nature of dementia, trials simultaneously targeting multiple risk factors should be particularly effective for prevention. So far, however, only few such multi-component trials have been launched, but yielding promising results. In Germany, comparable initiatives are lacking, and translation of these complex interventions into routine care was not yet done. Therefore, AgeWell.de will be conducted as the first multi-component prevention trial in Germany which is closely linked to the primary care setting. Methods AgeWell.de will be designed as a multi-centric, cluster-randomized controlled multi-component prevention trial. Participants will be older community-dwelling general practitioner (GP) patients (60–77 years; n = 1,152) with increased dementia risk according to CAIDE (Cardiovascular Risk Factors, Aging, and Incidence of Dementia) Dementia Risk Score. Recruitment will take place at 5 study sites across Germany. GP practices will be randomized to either intervention A (advanced) or B (basic). GPs will be blinded to their respective group assignment, as will be the statistician conducting the randomization. The multi-component intervention (A) includes nutritional counseling, physical activity, cognitive training, optimization of medication, management of vascular risk factors, social activity, and, if necessary, further specific interventions targeting grief and depression. Intervention B includes general health advice on the intervention components and GP treatment as usual. We hypothesize that over the 2-year follow-up period the intervention group A will benefit significantly from the intervention program in terms of preserved cognitive function/delayed cognitive decline (primary outcome), and other relevant (secondary) outcomes (e.g. quality of life, social activities, depressive symptomatology, cost-effectiveness). Discussion AgeWell.de will be the first multi-component trial targeting risk of cognitive decline in older adults in Germany. Compared to previous trials, AgeWell.de covers an even broader set of interventions suggested to be beneficial for the intended outcomes. The findings will add substantial knowledge on modifiable lifestyle factors to prevent or delay cognitive decline. Trial registration German Clinical Trials Register (reference number: DRKS00013555).