The contributors to Actas Españolas de Psiquiatría include leading professionals whose work is known both nationally and internationally. The topics covered are diverse and fall within the fields of psychiatry, clinical psychology, and mental health. Most of the contributions are original articles, although we also publish scientific reviews. Our exhaustive selection process takes the utmost care to guarantee the quality that has become the hallmark of the Journal, whose reputation is based on more than 70 years of history. Actas Españolas de Psiquiatría indexes in: EMBASE, MEDLINE, PMC, SCI, SCOPUS, EBSICO, IBECS.
Pharmacogenes Associated with Suicidal Behavior: Addressing a Potential Therapeutic Window
Suicide rates in Mexico have been rising, and because suicidal behavior has a genetic component, several pharmacogenes potentially linked with suicide risk have been investigated. This review aims to summarize articles addressing pharmacogenes, their relationship with suicidal behavior phenotypes, and their role in pharmacological treatment response. Among the identified pharmacogenes, variants in genes such as ATP-binding cassette subfamily B member 1 Gene (ABCB1) and FKBP Prolyl Isomerase 5 Gene (FKBP5) have been repeatedly observed across suicide attempt and completed suicide phenotypes. With these we could hypothesize that there is a possibility of finding shared genetic mechanisms among suicide phenotypes. When studying the response to treatment, the presence of certain variants may result in reduced drug response, yielding no benefit and possibly worsening symptoms, potentially culminating in suicidal behavior. Moreover, overlapping variants have been identified between suicidal behavior and altered response to psychotropic drugs in pharmacogenes involved in different functional pathways such as neurotransmission, hypothalamic-pituitary-adrenal (HPA) regulation and neuroinflammation, so this combination could lead to an increased genetic vulnerability to suicidal behavior. In summary, although data on pharmacogenes related to suicide exist, further research is required to replicate findings in the Mexican population. The insights presented in this review may support the inclusion of other pharmacogenes or variants in existing pharmacogenomic panels to advance precision medicine approaching suicide prevention.
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The Gut Microbiome in Sleep Disorders: A Review of Recent Evidence
Alterations in the gut microbiome have been shown to influence sleep through gut-brain interactions. However, the interplay between the gut microbiome and sleep disorders remains insufficiently understood. This narrative review provides an overview of recent evidence on the role of the gut microbiome in sleep disorders, examining hostmicrobial regulation of the sleep cycle, the relationship between gut microbiome dysbiosis and sleep disorders, the influence of the gut microbiome on sleep-related breathing disorders, sleep deprivation, and sleep fragmentation, as well as microbial therapeutic approaches to sleep disorders. Through its effects on bacterial metabolites, immune responses, and neuronal signaling, the gut microbiome might be potentially involved in the regulation of sleep-wake cycles. Disturbances in sleep have been associated with shifts in gut microbiome composition, but this relationship remains incompletely understood and it suggests a bidirectional nature. Evidence indicates that interventions targeting the gut microbiome, such as the use of psychobiotics and fecal microbiota transplantation, may have potential for improving sleep outcomes, but further research is needed to determine their actual effectiveness. Understanding the full range of factors influencing the gut microbiome and their interactions with other variables will be essential for elucidating the mechanisms behind gut-sleep interactions. Thus, future studies should focus on clarifying causality, identifying key biomarkers, and developing microbial-based interventions to establish effective therapeutic strategies.
Correlation Between Insecure Attachment Style and Symptomatology in Patients With Bipolar Disorder: A Systematic Review
Background: Attachment style describes the bond between a child and their caregivers, and its effect on subsequent relationships. Bipolar disorder (BD) is a mood disorder characterized by fluctuations in mood and energy levels. The aim of this work is to update the evidence on the relationship between two insecure attachment styles (anxious and avoidant) and the symptomatology of patients with BD. Methods: To achieve the objectives of this systematic review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines were followed. Searches were conducted from inception until July 24, 2025 in the PsycInfo, PubMed, Scopus, and Web of Science databases. A structured process was carried out for study selection, data extraction, and risk of bias assessment of the included studies. Results: A total of six articles were included, five of which were cross-sectional and one was a case-control study. These six studies included a total of 466 patients, with a weighted mean age of 41.4 years old. The weighted mean age was calculated according to the sample size of each of the selected articles. The female-to-male ratio was 1.53:1. Patients with insecure attachment experienced depressive, anxiety, and somatization symptoms, as well as greater symptom severity (increased risk of suicidal behavior, greater number of hospitalizations, higher frequency of affective episodes, and greater substance use). Conclusions: In patients with BD, insecure attachment is associated with greater symptom severity. Future research should investigate the explanatory mechanisms underlying the relationship between insecure attachment and the symptomatology of these patients.
Prevalence and Influencing Factors of Anxiety and Depression in Patients With Breast Cancer: A Meta-Analysis
Background: Breast cancer (BC) patients shoulder considerable psychologicalstrain asthey traverse the illness trajectory. While anxiety and depression among this population have received substantial research attention, comprehensive global estimates that distinguish anxiety from depression remarkably scarce. Even more understudied is the systematic review of factors unique to each condition. Our meta-analysis was designed to redress these gaps by establishing worldwide pooled prevalence figures for both anxiety and depression among BC patients, alongside mapping their associated risk and protective influences. Objective: This study aimed to obtain consolidated global estimates of anxiety and depression prevalence within BC populations, and to explore various risk and protective factors that shape these. Methods: This systematic review and meta-analysis included cross-sectional and cohort studies from multiple databases reporting anxiety/depression prevalence in BC patients. Two investigators independently conducted study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale (NOS). A random-effects model pooled prevalence estimates; heterogeneity was explored via subgroup analysis and meta-regression. Publication bias was assessed with Egger’s test and funnel plots. Results: This meta-analysis included 32 studies comprising 21,507 BC patients. The pooled prevalence of anxiety was 35% (95% confidence intervals (CI): 30%–39%), and that of depression was 26% (95% CI: 23%–30%), with significant heterogeneity for both (p < 0.001). For anxiety, a high Life Orientation Test-Revised (LOT-R) score was protective, whereas low income was a risk factor. For depression, protective factors included older age, higher income, early tumor stage, and a high LOT-R score. Risk factors were low education, rural residence, disrupted marital status, comorbidities, lack of social support, and a history of mental illness. Sensitivity analysis confirmed that the results of this study were robust; although there was bias in anxiety and depression, its effect is limited after correction. Conclusion: Anxiety and depression are highly prevalent in breast cancer patients, influenced by distinct sociodemographic and clinical factors, necessitating targeted psychological assessment and intervention.
Technology-Assisted Interventions for Reducing Risk of Suicide: A Meta-Analysis Focused on Suicidal Ideation
Background: Suicide is a leading cause of death among adolescents worldwide. Suicide is a complex multifactorial issue and, in 2025, became the third-leading cause of death among individuals aged 15–29. We sought to evaluate the effectiveness of technology-assisted interventions (TIs) in reducing both suicidal behaviour and non-suicidal self-injury among adolescents. Methods: For this meta-analysis, we searched the EBSCO (APA PsycArticles, APA PsycInfo, MEDLINE, APA PsycTherapy, Psychology and Behavioral Sciences Collection), PubMed and Cochrane databases from inception until May 2025, seeking out articles featuring data (quantitative outcomes related to suicidal ideation or behaviour) on evaluated suicide or self-harm interventions among children and adolescents (aged 13–18) that incorporated digital technologies in some manner. We used random effects meta-analysis to estimate the effect size for suicidal ideation reduction. We assessed heterogeneity using the I2 statistic, and, due to the small number of considered studies, publication bias was assessed using an adaptation of Cochrane’s guidelines for the assessment of bias risk. The review was registered with INPLASY, with the code INPLASY202570073. Results: After applying the eligibility criteria, six studies were selected for the analysis. Although the initial conceptual aim pertained to suicidal risk and self-harm more broadly, suicidal ideation was the only outcome consistently reported across the eligible studies; therefore, it served as the primary meta-analytic outcome. Conclusions: The results highlight that technologyassisted interventions yield an overall statistically significant moderate reduction in suicidal ideation, providing valuable support for the implementation of such interventions during adolescence, although further rigorous research is needed to strengthen the evidence base.
The Role of Exosome-miRNA as Biomarkers of Alzheimer’s Disease: A Systematic Review of Case-Control and Longitudinal Studies
Alzheimer's disease (AD) is a progressive neurodegenerative disorder, and its diagnosis emains challenging. Exosomal microRNAs (miRNAs), due to their stability, tissue specificity, and ability to cross the blood–brain barrier, show significant promise as ideal biomarkers for AD. The present study aimed to systematically elucidate the relationship between the exosomal miRNA expression changes and AD pathogenesis (including Aβ deposition, Tau protein phosphorylation, and neuroinflammation) and to evaluate their potential utility in clinical screening and therapeutic interventions. A systematic literature search was conducted in the PubMed and Web of Science databases to identify human case–control or cohort studies reporting expressions of mature exosomal miRNAs in the serum, plasma, cerebrospinal fluid, saliva, or central nervous system cells. After evaluating the quality of the studies using the National Institutes of Health quality assessment tool, the identified differentially expressed miRNAs were summarized and functionally integrated. Among the 390 screened records, 48 studies (n = 3046 AD patients) met the inclusion criteria. The analysis identified 120 exosomal miRNAs that are differentially expressed at different ADages. Six miRNAs (miR-125b, miR-146a, miR-193b, miR-185-5p, miR-29b/c, miR-21-5p) were most consistently reported and showed significant correlation with AD pathology.
Observation of the Therapeutic Effect of Washed Microbiota Transplantation on Childhood Autism Spectrum Disorder
Background: This retrospective study evaluated the efficacy and safety of washed microbiota transplantation (WMT) via trans colonic endoscopic administration tube for children with autism spectrum disorder (ASD). Methods: The clinical data of 19 children with ASD treated between November 2021 and December 2023 were analysed. The data included scores on the Autism Behaviour Checklist (ABC), Childhood Autism Rating Scale (CARS) and PedsQL™ 3.0 Gastrointestinal Symptoms Scales (PedsQL-GI) before treatment and one and six months post-WMT, as well as faecal 16S rRNA sequencing results (vs. healthy controls). Results: ABC, CARS and PedsQL-GI scores improved significantly over time (all p < 0.001, large effect sizes). CARS and PedsQL-GI scores decreased notably at one and six months after treatment. ABC scores reduced significantly only at six months posttreatment. PedsQLGI scores at six months posttreatment further declined relative to those atone month posttreatment, whereas ABC and CARS scores remained stable. Subgroup analysis showed greater score reductions in the high-score ASD and constipation subgroups than in other patients. Faecal microbiota analysis revealed structural differences between ASD and healthy children. WMT altered gut flora structure and increased beneficial bacteria (e.g., Faecalibacterium). Conclusions: Preliminary findings suggest that WMT may improve gastrointestinal and core symptoms in children with ASD, especially those in high-score subgroups. Caution is needed given this study’s small sample size, and large prospective studies are required for validation.
Association Between Borderline Personality Traits and Addictive Features of Non-Suicidal Self-Injury in Adolescent Patients With Depressive Disorder
Objective: This study aimed to investigate the association between borderline personality traits and addictive features of non-suicidal self-injury (NSSI) in adolescent patients with depressive disorder, identify independent risk factors for NSSI addictive features and provide evidence for clinical intervention. Methods: A cross-sectional study design was utilised. A total of 320 adolescent patients with depressive disorder (aged 12–18 years, mean ± SD: 15.82 ± 1.74 years; 238 females, 74.38%) admitted to Jingzhou Mental Health Center between January 2024 and October 2025 were enrolled. Assessments were conducted using the 17-item Hamilton Depression Rating Scale, the Borderline Personality Features Scale for Children (BPFS-C), the Adolescent Self-Rating Life Events Checklist (ASLEC), the 20-item Toronto Alexithymia Scale, the Family APGAR Index and the Addiction Subscale of the Ottawa Self-Injury Inventory (OSI-AS). Pearson correlation analysis was conducted to explore the association between borderline personality traits and NSSI addictive features. Binary logistic regression analysis was performed to identify independent influencing factors for NSSI addictive features. Results: Based on the presence or absence of NSSI addictive features, the 201 patients in the NSSI group were further divided into an addictive NSSI subgroup (n = 111) and a non-addictive NSSI subgroup (n = 90). The OSI-AS score was significantly higher in the addictive NSSI subgroup than in the non-addictive subgroup (p < 0.001). The total BPFS-C score and its subscale scores showed significant positive correlations with NSSI addictive features (p < 0.001). Binary logistic regression analysis revealed that, after adjusting for confounders such as age, gender, severity of depression and family function, the total BPFS-C score (odds ratio [OR] = 1.116, 95% confidence interval [CI]: 1.077–1.157, p < 0.001) and the total ASLEC score (OR = 1.051, 95% CI: 1.021–1.082, p = 0.001) were independent risk factors for NSSI addictive features. The overall prediction accuracy of this model was 84.7%. Conclusion: Borderline personality traits are an independent risk factor for NSSI addictive featuresin adolescent patients with depressive disorder and are closely associated with the severity of addictive NSSI. In clinical practice, screening for borderline personality traits should be implemented for adolescents with depression and NSSI. Early psychological interventions targeting core features such as affective instability and impulsivity should be conducted to reduce the risk of NSSI addiction.
Differential Psychological and Social Impact of the COVID-19 Pandemic on Spanish Youth With and Without Non-Suicidal Self-Injury: A Longitudinal Analysis
Background: Non-suicidal self-injury (NSSI) in adolescents and young adults is a serious public health concern. The COVID-19 pandemic significantly impacted mental health worldwide. This longitudinal study aimed to investigate the differential impacts of COVID-19 on psychological health, social support, and academic performance among young adults with and without previous history of NSSI. Methods: From an initial sample of 603 college students, 241 (40%) completed this 2.5-year follow-up study. The first assessment was in January-February/2020 (pre-pandemic) and the second in June-July/2022 (postpandemic). Participants were grouped based on the pres-ence or absence of NSSI at baseline. Variables assessed included sociodemographic data, academic performance, COVID-19-related experiences, clinical characteristics, and perceived social support. Results: A significant reduction in the prevalence of NSSI behaviors was observed over the follow-up period, decreasing from 35% to 8.7%. The NSSI group endorsed worse academic performance post-pandemic. While they maintained stable clinical severity with no observed worsening, during pandemic period they experienced an improvement in perceived social support. In contrast, the Non-NSSI group experienced a decline in perceived social support during the same period. Conclusions: Contrary to previous studies, our findings indicate that young adults with NSSI significantly reduced self-harm behaviors after the COVID-19 pandemic. Although their academic performance was negatively affected, their clinical severity and social support did not worsen compared to those without NSSI. Findings indicate that the COVID-19 outbreak did not increase NSSI behaviors or exacerbate psychopathology in individuals with NSSI.
Effects of Lactate on Improving Cognitive Function and Survival Rate in a Mouse Model of Post-Sepsis Cognitive Impairment
Background: Post-sepsis cognitive impairment (PSCI) represents a prevalent complication observed in survivors of sepsis, manifesting as neurocognitive deficits, including memory impairment and attentional deficits. The precise mechanisms contributing to PSCI are inadequately understood, and there is a notable absence of effective clinical interventions. Lactate, previously considered as a metabolic byproduct, has recently been recognized as a potential energy source and signaling molecule involved in various physiological and pathological processes that are intricately linked to clinical outcomes of sepsis. This study aimed to explore the neuroprotective effects of lactate on PSCI and to elucidate the underlying mechanisms. Methods: Sixty male C57BL/6 mice were randomly assigned to three groups: control, sepsis-induced cognitive impairment, and lactate treatment groups. Sepsisassociated cognitive impairment was induced by cecal ligation and puncture. Lactate was administered via daily intraperitoneal injection (1 mol/L, 10 µL/g) for 10 consecutive days beginning 24 hours after surgery, while control groups received saline. Survival and body weight were monitored for 20 days. Cognitive performance was evaluated between days 10 and 15 using established behavioral paradigms. Brain tissue was subsequently collected for histological and molecular analyses. Results: Lactate administration significantly improved survival rates, promoted body weight gain, and enhanced cognitive performance. Additionally, lactate inhibited the activation of the high mobility group box 1 (HMGB1)/receptor for advanced glycation end products (RAGE) axis, reduced neuronal apoptosis and damage, suppressed glial cell activation, reduced Ca2+ levels, and modulated inflammatory cytokine production. Mechanistically, lactate upregulated the expression of glucose transporter 1 (GLUT1) in brain tissue. This facilitated glucose utilization and diminished pyruvate accumulation, potentially influencing energy metabolism. Concurrently, lactate also reduced Malondialdehyde (MDA) levels and elevated Superoxide Dismutase (SOD) activity to mitigate oxidative damage. Conclusions: Lactate emerges as a promising neuroprotective agent against PSCI potentially influencing cerebral energy metabolism, alleviating oxidative stress, and inhibiting neuroinflammation and neuronal damage.
Association Between Relative Fat Mass and Risk of Cognitive Impairment: The Role of Social Determinants of Health
Objective: This study examined the relationship between relative fat mass (RFM) and the risk of new-onset cognitive impairment and tested the mediating effect of social determinants of health (SDOH). Methods: Data originated from the China Health and Retirement Longitudinal Study. Data from 6147 participants without cognitive impairment at baseline were included. RFM was calculated and categorised into quartiles, whereas a cumulative SDOH score was constructed and grouped into tertiles. The association between RFM and new-onset cognitive impairment was assessed by using Kaplan–Meier curves, multivariable Cox proportional hazards models and restricted cubic splines (with piecewise regression for threshold analysis). Subgroup and joint effect analyses were performed on SDOH and RFM. Results: During a mean follow-up of 7.16 years, 1242 incident cases of cognitive impairment occurred. Elevated RFM was a significant risk factor for cognitive impairment (hazard ratio [HR] = 1.024, 95% confidence interval [CI]: 1.015–1.033, p < 0.001). This correlation was nonlinear, and RFM was estimated to have an inflection point of 26.45. The analysis of interaction effects showed that the risk of cognitive impairment in the population at risk (low SDOH/obesity) was higher by 91% (HR = 1.908, 95% CI: 1.516–2.401, p < 0.001) relative to that in the highSDOH/nonobesity group. Notably, amongst obese individuals, high SDOH/obesity was not associated with a significantly increased risk (HR = 1.047, 95% CI: 0.828–1.325, p = 0.701). Conclusions: Elevated RFM is significantly associated with an increased risk of cognitive impairment. However, this relationship is moderated by socioeconomic context. Low SDOH is a serious aggravating factor for the risk of high RFM, whereas high SDOH may play a massive buffering and protective role. Intervention approaches should be designed by accounting for personal metabolic factors along with the social environment, with particular attention paid to dually disadvantaged groups to avoid cognitive deterioration.
Impact of Sleep Quality on Cognitive Function in Elderly Patients With Alzheimer’s Disease
Objective: This study aimed to analyse the effect of sleep quality on cognitive function in elderly patients with Alzheimer’s disease (AD). Methods: This retrospective study extracted clinical data from the hospital’s electronic medical record system for elderly patients with AD admitted to the Departments of Neurology or Geriatrics between June 2022 and June 2024. Cognitive function was assessed using the MiniMental State Examination (MMSE), subjective sleep quality was evaluated with the Athens Insomnia Scale (AIS) and objective sleep architecture parameters were measured via overnight polysomnography (PSG). Participants were stratified into mild and moderate-to-severe cognitive impairment groups according to their MMSE scores. General characteristics and sleep-related indicators were compared between the two groups. A binary logistic regression model was employed to analyse independent factors influencing cognitive impairment severity. In this model, cognitive impairment severity served as the dependent variable, and PSG parameters and AIS score served as the core independent variables. Adjustments were made for potential confounding factors, including age, gender, years of education, disease duration, Hospital Anxiety and Depression Scale (HADS) scores and Instrumental Activities of Daily Living Scale (IADL) scores. Results: The cohort comprised 61 (40.67%) moderate-to-severe and 89 (59.33%) mild impairment patients. Compared with the mild impairment group, the moderate-to-severe group showed significantly poorer subjective (higher AIS) and objective sleep profiles, including reduced total sleep time, efficiency, and N2/N3 sleep and increased N1 sleep, latency and awakenings (p < 0.05). Adjusted regression identified the N3 stage/total sleep time ratio as a protective factor (odds ratio [OR] = 0.720, 95% CI: 0.576–0.900, p = 0.004) and the AIS score (OR = 1.850, 95% CI: 1.405–2.434, p < 0.001) and number of awakenings (OR = 3.101, 95% CI: 1.879–5.116, p < 0.001) as independent risk factors. Conclusion: In elderly patients with AD, impaired objective sleep architecture and subjective insomnia are significantly associated with poor cognitive function. This study highlighted sleep parameters as potential indicators for cognitive status assessment.
Development and Psychometric Evaluation of the Scale of Externalizing Problem Behaviors in Adults (SEPBA): A Hybrid Dimensional–Categorical Instrument
Background: The Scale of Externalizing Problem Behaviors in Adults (SEPBA) was developed as a hybrid psychometric instrument designed to assess both dimensional traits and categorical diagnoses associated with externalizing psychopathology. Based on an integrative operational framework drawing on Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the Hierarchical Taxonomy of Psychopathology (HiTOP) model, the SEPBA assesses 15 traits/facets and 6 disorders within the domains of antagonism and disinhibition. Methods: The present study analyzed the psychometric properties of the SEPBA in a combined community and prisoner sample (n = 922). The final version of the SEPBA included 144 items rated on a 4-point Likert scale. Reliability (α, ω), item discrimination, convergent/discriminant validity, confirmatory factor analyses, and gender measurement invariance were examined. Results: The results indicated adequate item discrimination and internal consistency across all scales. Confirmatory factor analyses supported the unidimensionality of the individual scales and the hypothesized hierarchical organization of traits and facets. Gender invariance of the measure was demonstrated. In addition, evidence of convergent and discriminant validity was provided through correlations with external measures. Conclusion: The findings support the SEPBA as a suitable assessment instrument. Its hybrid structure offers an integrative approach to transdiagnostic assessment, enhancing both the clinical utility of categorical diagnoses and the empirical applicability of dimensional profiles for assessing externalizing behaviors in adults.
Linking Social Anxiety to Depressive Symptoms in Adolescents: The Dual Mediating Roles of Perceived Social Support and Sleep Quality
Objective: Social anxiety is a key risk factor for adolescent depression, yet its underlying mechanisms and subgroup differences remain unclear. This study explored the mediating roles of perceived social support and sleep quality in their link, and the moderating effects of visit type and gender. Methods: A retrospective observational study enrolled 386 depressed adolescents (12–18 years; 231 outpatients, 155 inpatients) from Xiamen Xianyue Hospital. Social anxiety, depressive symptoms, perceived social support and sleep quality were assessed using the Social Anxiety Scale for Adolescents, Self-Rating Depression Scale, Multidimensional Scale of Perceived Social Support and Pittsburgh Sleep Quality Index, respectively. Pearson’s correlation and Hayes’ PROCESS macro (Model 6) were applied for mediation/moderation analyses, with sensitivity testing via the Montgomery–Åsberg Depression Rating Scale (MADRS). Results: Inpatients and severe cases had higher Social Anxiety Scale for Adolescents (SAS-A), Zung Self-Rating Depression Scale (SDS) and Pittsburgh Sleep Quality Index (PSQI) and lower Multidimensional Scale of Perceived Social Support (MSPSS) scores (all p < 0.001); females had higher social anxiety (p = 0.003). Social anxiety correlated positively with depressive symptoms (r = 0.54, p < 0.001) and negatively with perceived social support (r = –0.49, p < 0.001). Mediation analysis showed a total effect of social anxiety on depressive symptoms (β = 0.304, p < 0.001), with direct effect (57.5%, β = 0.175) and total indirect effect (42.5%, β = 0.130). Key indirect pathways: ‘social anxiety → sleep quality → depressive symptoms’ (27.0%) and a serial mediation pathway via perceived social support and sleep quality (8.2%); perceived social support’s single mediation was marginally non-significant (p = 0.118). Moderation analyses revealed stronger direct effects in inpatients (β = 0.342 vs. 0.097, p < 0.001) and stronger sleep quality effects in females (β = 1.125 vs. 0.619, p = 0.006). MADRS sensitivity analyses confirmed consistency (path coefficient deviations <1%). Conclusions: Social anxiety affects adolescent depressive symptoms directly and via sleep-related mediation, moderated by visit type and gender. Targeting social anxiety and sleep quality may optimise precision prevention/treatment for adolescent depression.
Analysis of Predictive Factors for Cognitive Function Improvement After tDCS Treatment in Patients With Post-stroke Cognitive Impairment
Objective: This study aims to identify predictive factors for significant cognitive improvement following transcranial direct current stimulation (tDCS) in patients with post-stroke cognitive impairment (PSCI), thereby providing evidence for individualized clinical intervention. Methods: A total of 123 patients with PSCI who received tDCS treatment were retrospectively enrolled. Based on changes in Mini-Mental State Examination (MMSE) scores, patients were classified into a cognitive improvement group (n = 61) and a non-improvement group (n = 62). Baseline clinical characteristics were collected, and activities of daily living were using the Modified Barthel Index (MBI). Univariate analyses were performed to compare differences between the two groups, and variables with statistical significance in univariate analysis were further entered into a multivariate logistic regression model to identify independent predictors of significant cognitive improvement following tDCS treatment. Results: The proportion of patients with a university education or above was significantly in the cognitive improvement group higher than in the non-improvement group (p < 0.001); whereas the proportion of patients with a history of stroke in the non-improvement group was significantly higher (p < 0.05). Patients in the cognitive improvement group had a significantly shorter disease duration compared to those in the non-improvement group (p < 0.05); meanwhile, a higher proportion of patients with Fazekas grade 0–1 was observed in the improvement group (p < 0.05). Results of the multivariate Logistic regression analysis indicated that educational level and disease duration were independent predictive factorsforsignificant cognitive improvement after tDCS treatment (p < 0.05). Conclusion: PSCI patients with higher educational level and shorter disease duration have a better cognitive improvement effect following tDCS treatment.
Severity of Cognitive Impairment and Its Correlation With Depressive Symptoms and Influencing Factors in Elderly Patients With Chronic Diseases
Background: Elderly individuals frequently suffer from chronic underlying disease like hypertension and diabetes. These illnesses not only impair physical health but also show a close link to elevated rates of cognitive impairment and depressive symptoms. The mutual influence between these two issues can further diminish the quality of life of elderly patients. Nevertheless, there remains a shortage of systematic investigations into the cognitiveemotional relationship within this specific population. Methods: A total of 206 elderly patients with chronic underlying disease were enrolled retrospectively. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Depressive symptoms were evaluated via the 15-item Geriatric Depression Scale (GDS-15). To analyse the correlation between cognitive impairment and depressive symptoms, the Spearman correlation analysis, univariate analysis, and multivariate Logistic regression were employed. Results: Among the 206 patients, the primary chronic underlying diseases were hypertension (64.56%), diabetes mellitus (39.32%), coronary heart disease (27.67%), and chronic obstructive pulmonary disease (21.84%). Additionally, 45.15% of the patients had two or more chronic diseases. The prevalence of cognitive impairment stood at 49.51% (102 cases), while the prevalence of depressive symptoms was 40.78% (84 cases). No significant differences were observed in the prevalence of cognitive impairment and depressive symptoms among patients with different types of chronic diseases (all p > 0.05). Spearman correlation analysis revealed a significant negative correlation between MoCA scores and GDS-15 scores (r = –0.552, p < 0.001). Binary Logistic regression analysis indicated that factors such as body mass index ≥21.42 kg/m2 , number of chronic diseases ≥2.5, GDS-15 score ≥4.5 points, and Multidimensional Scale of Perceived Social Support score ≥52.5 were independent risk factorsfor moderate-to-severe cognitive impairment (all p < 0.05). Conclusions: The severity of cognitive impairment in elderly patients with comorbid chronic underlying diseases increases with the exacerbation of depressive symptoms.
Influence of Preoperative Cognitive Function, Self-Efficacy, and Postoperative Psychological Counselling on Anxiety and Depression Levels in Patients Undergoing Botulinum Toxin Injections
Background: To investigate the prognostic influence of preoperative cognitive function, self-efficacy, and postoperative psychological counselling on treatment response following botulinum toxin injections in patients with anxiety and depressive disorders, and to identify key predictors of treatment response. Methods: A retrospective study was conducted on 176 patients who received botulinum toxin injections at Huzhou Maternity and Child Health Care Hospital between May and December 2025. Based on the treatment response of anxiety and depressive symptoms assessed eight weeks post-injection, participants were categorised into a responder group (n = 108) and a non-responder group (n = 68). Data collect included demographic characteristics, botulinum toxin injection details, psychological counselling records, pre-injection assessment of cognitive function and self-efficacy. Pearson correlation analysis was used to assess the relationship between preoperative cognitive levels and self-efficacy, and the effectiveness of postoperative psychological counselling on treatment outcomes of anxiety and depression. Multivariate logistic regression analysis was employed to identify factors influencing treatment response to anxiety and depression, and receiver operating characteristic (ROC) curves were used to evaluate the predictive performance of these factors. Results: Both study populations exhibited negative correlations between preoperative Pittsburgh Sleep Quality Index (PSQI) scores and Hamilton Anxiety Rating Scale (HAMA) reduction rates, as well as Hamilton Depression Rating Scale (HAMD) reduction rates. Conversely, preoperative Montreal Cognitive Assessment (MoCA) scores, preoperative self-efficacy, and duration per session showed positive correlations with HAMA reduction rates and HAMD reduction rates (all p < 0.05). Multivariate logistic regression analysis revealed that counselling frequency (OR = 3.808, β = 1.337), duration per session (OR = 1.092, β = 0.088), preoperative PSQI score (OR = 0.820, β = −0.198), MoCA (OR = 1.312, β = 0.272), and General SelfEfficacy Scale (GSES) score (OR = 1.175, β = 0.161) were identified as factors influencing treatment response of anxiety and depression following botulinum toxin injection (p < 0.05). ROC curve analysis indicated that the aforementioned variables possessed predictive value for treatment response. The combined predictive model yielded an area under the curve was 0.866 (95% confidence interval, ranging from 0.810 to 0.921). Conclusions: Preoperative cognitive function, selfefficacy and the duration per session were correlated with treatment response rates for anxiety and depression. Injection sites, counselling sessions, the duration per session, and preoperative PSQI, MoCA and GSES scores were identified as independent factors influencing treatment response following botulinum toxin injection.
Effectiveness of Mindfulness-Based Stress Reduction Therapy in Improving Quality of Life Among Anesthesiology Residents
Background: Anesthesiology residents face high levels of occupational stress that can negatively impact their well-being and quality of life. Mindfulness-Based Stress Reduction (MBSR) has emerged as a promising intervention to support mental health in healthcare professionals. To evaluate the effectiveness of a modified MBSR program on quality of life among anesthesiology residents. Material and Methods: This prospective, single-group pre-post intervention study included 27 third-year anesthesiology residents (mean age 28.8 ± 1.9 years; 59.3% female) from a tertiary care hospital. Participants completed a 6-week modified MBSR program consisting of three 15- minute sessions per week. Quality of life was assessed using the Short Form-36 (SF-36) Health Survey before and after the intervention. Pre-post comparisons were conducted using paired t-tests and Wilcoxon signed-rank tests as appropriate. Results: Significant improvements were observed in five of eight SF-36 domains: Physical Functioning (91.67 ± 11.43 vs. 97.96 ± 4.65, p = 0.001), Role-Physical (60.19 ± 33.44 vs. 81.48 ± 22.56, p = 0.006), Bodily Pain (74.81 ± 19.01 vs. 89.44 ± 15.60, p = 0.049), Vitality (48.33 ± 15.75 vs. 71.67 ± 17.26, p = 0.001), and Mental Health (59.89 ± 13.39 vs. 78.96 ± 14.73, p = 0.004). No significant sex-based differences in treatment response were observed. Conclusions: A brief, modified MBSR program significantly improved multiple dimensions of quality of life in anesthesiology residents. These findings support the integration of mindfulness-based interventions into residency training programs to enhance resident well-being.
Effects of Multi-Role Collaborative Palliative Care on Anxiety, Cancer-Related Fatigue, and Quality of Life in Patients With Advanced Lung Cancer
Background: This research aimed to examine the effects of multi-role collaborative palliative care on anxiety, cancer-related fatigue (CRF), psychological status, and quality of life in patients with advanced lung cancer, and to explore potential mechanisms using correlation analysis and structural equation modelling. Methods: We conducted a retrospective study of the medical records of 200 patients with advanced lung cancer. Based on the care they received, patients were divided into two groups: a control group (n = 100) that received standard nursing care, and a combined nursing group (n = 100) that received multi-role collaborative palliative care. Anxiety, CRF, psychological status, and overall quality of life were compared between the two groups based on the record documented before and after nursing care. Adverse events recorded during the nursing period were also reviewed and analysed. Path analysis of variables was conducted using the AMOS module of SPSS. Results: Following nursing care, the combined group showed significantly lower CRF and anxiety scores, and significantly higher psychological state and quality of life scores compared with both pre-nursing scores and the control group (all p < 0.05). There was no statistically significant difference in the rate of adverse event between the two groups (36.00% vs. 28.00%, p > 0.05). Path analysis indicates that multi-role collaborative palliative care is associated with lower levels of anxiety. This association has a direct relationship and indirect relationships through its connection with the reduction of CRF and the improvement of psychological condition. Path analysis shows that multirole collaborative palliative care not only directly alleviates patients’ inner anxiety, but also may indirectly reduce inner anxiety by lowering CRF and improving psychological conditions. Conclusions: Implementing multi-role collaborative palliative care for patients with advanced lung cancer can help alleviate CRF, relieve anxiety, improve psychological state and enhance quality of life. Exploratory path analysis suggests that this nursing model has a significant direct statistical association with lower anxiety. This association may also involve indirect interrelations with lower CRF and a better psychological state.
Effects of Hospice Care on Anxiety, Depression, and Pain in Patients With Terminal Colon Adenocarcinoma: A Retrospective Cohort Study
Background: Terminal colon adenocarcinoma is a debilitating condition often accompanied by severe pain and substantial anxiety and depression. Hospice care provides a dedicated framework to address this symptom complex, yet robust evidence for its real-world effectiveness within the Chinese healthcare context remains underdeveloped and insufficiently documented. This study aimed to evaluate the effects of hospice care on key clinical outcomes in terminal colon adenocarcinoma. Methods: This retrospective cohort analysis reviewed data from 92 patients with histologically confirmed terminal colon adenocarcinoma (≥stage Ⅲ) treated at The Affiliated Yangming Hospital of Ningbo University between January 2024 and June 2025. The cohort included 46 patients receiving integrated hospice care alongside standard oncology treatment and 46 matched controls receiving standard care only. Comparative analyses of depression (Hospital Anxiety and Depression Scale–Depression, HADSD), anxiety (HADS-A), pain (visual analogue scale, VAS), opioid usage, and healthcare utilisation were conducted at baseline, 1, 3, and 6 months. Results: Baseline characteristics were comparable between groups. HADS-D scores decreased more in the hospice care group (from 9.13 ± 3.39 to 5.91 ± 2.72) than in the standard group (from 9.35 ± 3.58 to 8.57 ± 3.04; p < 0.001). HADS-A scores showed a greater reduction in the hospice care group (from 8.63 ± 2.55 to 5.83 ± 2.57) than in the standard group (from 9.13 ± 3.17 to 8.48 ± 2.63; p< 0.001). The hospice care group demonstrated significantly greater reductions in VAS scores (from 6.83 ± 1.19 to 3.17 ± 1.01) compared with the standard group (from 6.74 ± 1.40 to 5.51 ± 1.63; p < 0.001) and a higher proportion achieved ≥30% pain reduction at 6 months(80.43% vs. 39.13%, p < 0.001). Additionally, hospice care was associated with lower opioid consumption, shorter hospital stays, fewer emergency visits, and reduced re-admissions (all p < 0.05), with no increase in adverse events. Conclusions: For patients with terminal colon adenocarcinoma, integrated hospice care was associated with significantly improved pain control and reduced anxiety and depressive symptoms. It was also associated with decreased healthcare utilisation with a favourable safety profile.
Prevalence and Associated Factors of Anxiety and Depression Among Primary Caregivers of Children With Haematological Malignancies: A Cross-sectional Study
Background: Primary caregivers of children with hematological malignancies endure immense physical and psychological stress, however their mental health status remains under-recognized in clinical settings. This study aimed to investigate the prevalence of anxiety and depression among these caregivers and to identify their independent associated factors, providing evidence for targeted nursing interventions. Methods: A cross-sectional survey was conducted involving 200 primary caregivers recruited from the Department of Haematology, Children’s Hospital of Soochow University. Demographic and clinical data were collected alongside psychological assessments using the Hospital Anxiety and Depression Scale (HADS), the Memorial Symptom Assessment Scale (MSAS), and the Multidimensional Scale of Perceived Social Support (MSPSS). Univariate analyses and multivariable logistic regression models were employed to determine the associations between potential predictors and psychological distress outcomes. Results: The study revealed a substantial burden of psychological morbidity. Specifically, 52.00% of caregivers exhibited anxiety and 42.50% showed symptoms of depression. Multivariable analysis further identified distinct risk profiles for each condition. Anxiety was independently associated with shorter time since diagnosis (odds ratio (OR) = 0.66, 95% confidence interval (CI): 0.47–0.92, per 6 months), greater child symptom burden (OR = 1.22, 95%: CI 1.03–1.46, per 10 points increase), and social support (OR = 0.48, 95% CI: 0.32–0.71, per 10 points). Conversely, depression was significantly associated with sociodemographic factors including educational level (OR = 0.34, 95% CI: 0.13–0.89, for college degree or above) and single marital status (OR = 3.97, 95% CI: 1.35–11.69), in addition to symptom burden (OR = 1.55, 95% CI: 1.25– 1.91, per 10 points) and social support (OR = 0.31, 95% CI: 0.19–0.50, per 10 points). Furthermore, sensitivity analyses highlighted that the frequency recent hospitalizations were consistently associated with higher levels of both anxiety and depression. Conclusions: Caregivers of children with haematological malignancies experience exhibits a high prevalence of anxiety and depression. Anxiety appears to be more closely related to acute clinical stressors and temporal factors, whereas depression is more closely related to persistent social and demographic disadvantages. Effective management of paediatric symptoms and the strengthening of multi-dimensional social support systems are essential. Future interventions should be tailored to the specific risk profiles of caregivers to improve their overall well-being.
Effects of Psychological Resilience and Social Support on Anxiety and Depression in Patients With Papillary Thyroid Carcinoma
Background: To investigate anxiety and depression in patients with papillary thyroid carcinoma (PTC) and analyse their associations with psychological resilience and social support. Methods: A total of 122 patients with PTC who received surgical treatment at our hospital between January 2022 and June 2023 were included. Clinical data of patients were collected. Psychological resilience, social support, and symptoms of anxiety and depression were evaluated using Connor–Davidson Resilience Scale (CD-RISC), Social Support Rating Scale (SSRS) and Hospital Anxiety and Depression Scale (HADS) at 1-month after surgery. Pearson correlation analysis was used to analyse the correlation among these indicators. And the influencing factors of postoperative anxiety and depression were analysed using multiple linear regression method. Results: All questionnaires were effectively collected. The total scores of CD-RISC, SSRS, and HADS were 80.00 ± 7.41, 53.17 ± 6.88, and 23.21 ± 5.22 points, respectively. Pearson correlation analysis showed that anxiety scores in the HADS were negatively correlated with CDRISC score and SSRS score, with coefficients of –0.496 and –0.584, respectively (p < 0.05). And depression scores in the HADS were also negatively correlated with CD-RISC score and SSRS score, with coefficients of –0.496 and – 0.482, respectively (p < 0.05). Multiple linear regression analysis showed that only CD-RISC and SSRS scores were independent predictors of postoperative anxiety and depression (p < 0.05). Conclusions: The levels of anxiety and depression were elevated in PTC patients after surgery. Both psychological resilience and social support were influencing factors for anxiety and depression in PTC patients.
Mental Health Screening in Prison: Psychometric Evaluation of the PHQ-9 and GAD-7 Among Incarcerated Men in Mexico
Background: Psychometric screening tools for persons in penitentiary centers (PPC) are key to assessing their mental health needs, given the shortage of both time and mental health personnel. Depression and anxiety are among the most prevalent mental health problems in PPC. Inadequate diagnosis can lead to increased symptom severity and even suicide. Therefore, validating instruments to assess depression and anxiety in PPC populations is essential to reduce the risk of misdiagnosis and its consequences. Methods: A cross-sectional study was conducted to evaluate the reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) in 272 men (>18 years old) deprived of liberty in a penitentiary center in Mexico. Both exploratory and confirmatory factor analyses were performed. Concurrent and discriminant validity were assessed using the depression and anxiety scales of the International Statistical Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11) Primary Health Care (PHC). Receiver Operating Characteristic curves were plotted to determine the best cut-off points in both instruments. Results: Both the PHQ-9 and GAD-7 showed items that were representative of their underlying constructs and supported the original one-factor structure, with satisfactory goodness-of-fit indices in both exploratory and confirmatory analyses. Both instruments exhibited good internal consistency in the sample of Mexican men incarcerated in penitentiary centers (α = 0.87 and α = 0.89, respectively). Furthermore, both scales showed strong correlations with the ICD-11 PHC depression and anxiety scales, along with adequate sensitivity, specificity, false positive, and false negative rates, resulting in a low misclassification rate. Conclusions: The PHQ-9 and GAD-7 can be used to briefly and reliably assess depression and anxiety among male PPC in Mexico City and in populations with similar institutional and sociodemographic conditions Given the specific characteristics of PPC populations across different countries, it remains necessary to continue testing these instruments in underrepresented populations to ensure the development of reliable and valid tools that help identify potentially confusing items and minimize diagnostic errors.
Association Between C-Reactive Protein–Triglyceride Glucose Index and Depressive Symptoms Among US Adults: A Nationally Representative Cross-Sectional Study From 2005 to 2023
Background/Objective: Depressive disorders represent a major global health challenge, with inflammation and insulin resistance identified as key pathophysiological factors. The C-reactive protein–triglyceride glucose index (CTI), a novel composite biomarker integrating the inflammatory and metabolic pathways, has demonstrated enhanced predictive value in cardiometabolic diseases. However, its relationship with depression remains unexplored. This study examined the association between CTI and depressive symptoms in a nationally representative U.S. adult population. Methods: We conducted a cross-sectional analysis using National Health and Nutrition Examination Survey data from 2005 to 2023. Depressive symptoms were assessed using the Patient Health Questionnaire-9, with scores ≥10 indicating clinically significant symptoms. CTI was calculated as 0.412 × Ln(CRP) + Ln[triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Multivariable logistic regression models were employed to evaluate CTI–depression associations, adjusting for sociodemographic factors, comorbidities and laboratory parameters. Restricted cubic spline analysis assessed dose–response relationships, and subgroup analyses examined consistency across demographic and clinical strata. Results: Among 15,318 participants (mean age 48.97 years; 49.78% female), 8.73% exhibited depressive symptoms. After comprehensive adjustment, each unit increase in CTI corresponded to a 23% increase in the risks of depression (odds ratio (OR) = 1.23, 95% confidence interval (CI): 1.11–1.36, p = 0.0001). Participants in the highest CTI tertile demonstrated 48% elevated odds compared with those in the lowest tertile (OR = 1.48, 95% CI: 1.17– 1.86, p = 0.0009), with a significant linear trend (p for trend = 0.0005). Restricted cubic spline analysis confirmed a linear dose–response relationship (p for nonlinearity = 0.1665). Associations remained consistent across age, sex, race/ethnicity and comorbidity subgroups (all p for interaction >0.05). Conclusion: Elevated CTI levels are independently associated with increased depression risk in U.S. adults, demonstrating a linear dose–response relationship. CTI may serve as a practical screening tool for identifying individuals at heightened depression risk, enabling integrated cardiometabolic–mental health interventions.
Antidepressant Use and Bone Health: Evidence From Mendelian Randomisation
Background: Antidepressant use has been associated with adverse skeletal outcomes in observational studies, but whether this association is causal remains unclear due to potential confounding factors. This study employed Mendelian randomisation (MR) to systematically evaluate the causal associations between genetically predicted antidepressant use and the risks of osteoporosis and fractures at multiple anatomical sites. Methods: Using publicly available genome-wide association studies (GWAS) datasets, we defined genetically predicted antidepressant use as the exposure and osteoporosis and fractures (spine, leg, and wrist) as outcomes. Genome-wide significant single nucleotide polymorphisms (SNPs) were selected as instrumental variables following dataset harmonisation. The inverse-variance weighted (IVW) method was used as the primary MR approach, supplemented by MR-Egger regression, weighted median, and weighted/simple mode methods. Heterogeneity tests, funnel plots, and leave-one-out sensitivity analyses were performed to assess the robustness and consistency of the results. Results: MR analysis demonstrated significant positive causal associations between antidepressant use and osteoporosis across two independent datasets (ukb-a-87 and ukb-b-12141), with IVW odds ratios of 1.0035 and 1.0016, respectively. Genetically proxied antidepressant use showed significant causal effects on fractures at all examined sites, with wrist fractures displaying the strongest association (IVW: odds ratio (OR) = 1.0027, p = 0.0041). Effect directions remained consistent across multiple MR methods, with no significant heterogeneity detected. Leave-one-out analyses confirmed no single SNP disproportionately influenced the results. Conclusion: This MR study provides evidence that antidepressant use may directly influence bone metabolism and increase fracture susceptibility, particularly at the wrist. These findings highlight the importance of bone health monitoring in patients receiving antidepressant therapy, especially those at elevated fracture risk. Further mechanistic studies and longitudinal validation are warranted.
Development and Validation of Machine Learning-Based Models for Predicting Postoperative Depression Risk in Patients With Ovarian Cancer
Objective: To develop machine learning-based prediction models for postoperative depression risk in patients with ovarian cancer and to evaluate their predictive performance and clinical application value. Objective: To develop machine learning-based prediction models for postoperative depression risk in patients with ovarian cancer and to evaluate their predictive performance and clinical application value. Results: Among 850 patients, 268 (31.5%) were positive for postoperative depression risk. Feature selection identified 13 predictive variables: age, operation time, length of hospital stay, pain score, white blood cell count, albumin, C-reactive protein, CA125, education level, history of depression/anxiety, postoperative insomnia, fatigue, and opioid analgesic use. Among the five models, random forest demonstrated superior performance with an AUC of 0.776 in the validation set, a Brier score of 0.182, sensitivity of 0.771, and an F1 score of 0.792, along with satisfactory calibration and clinical net benefit. SHAP analysis revealed that pain score, postoperative insomnia, albumin level, and opioid use contributed substantially to model predictions. A nomogram based on logistic regression model was constructed for intuitive individual risk assessment. Conclusion: The machine learning-based prediction models for postoperative depression risk in patients with ovarian cancer demonstrated satisfactory discriminative ability and clinical utility, with random forest model showing optimal performance. A clinical nomogram was additionally constructed to enable individualised and visual risk quantification suitable for bedside application. Together, these tools facilitate early identification of high-risk patients and provide evidence for clinical intervention.
Impact of the Interaction Between Screen Time and Activity Interests on Adolescent Depression Risk: Construction of a Predictive Model Based on Machine Learning
Background: Adolescent depression is an increasing public health concern, with excessive screen time elevating depression risk and activity interests providing protection. However, most studies examine these behaviors separately and rely on limited analytical methods. This study used machine learning (ML) to develop a predictive model and evaluate the combined influence of screen time and activity interests on adolescent mental health. Methods: A multi-center survey was conducted among adolescents aged 10–14 years in Chongchuan District, Nantong. Depression-related domains were assessed using the Child and Adolescent Mental Health Screening Questionnaire, integrating seven validated scales. A twostage feature-selection strategy identified 11 key predictors. Three ML models (logistic regression [LR], extreme gradient boosting [XGBoost], and categorical boosting [CatBoost]) were trained with an 80:20 stratified split. Class imbalance was addressed using synthetic minority oversampling technique and class-weighting. Model performance and interpretability were evaluated using receiver operating characteristic (ROC) and calibration curves, partial dependence plots, and shapley additive explanations (SHAP) analyses. Results: A total of 2202 valid questionnaires were analyzed. The distribution of depression severity was as follows: safe 59%, mild 17%, moderate 11%, and severe 13%. The integrated questionnaire demonstrated strong reliability (Cronbach’s α = 0.910) and good construct validity (Kaiser–Meyer–Olkin [KMO] = 0.91; root mean square error of approximation [RMSEA] = 0.049; and comparative fit index [CFI] = 0.859). ROC-Youden analysis confirmed expert-defined cutoffs (29, 32, and 35). Feature selection identified 11 key predictors, with activity interest and psychological functioning consistently ranking highest in importance. Across the three ML models, LR exhibited the best generalizability, XGBoost showed overfitting, and CatBoost achieved balanced performance. SHAP and partial dependence analyses revealed nonlinear screen-time effects and dose-dependent protective effects of activity interest, including the moderation of high screen exposure in severe-risk groups. Conclusions: This study suggests that ML models can be used to screen adolescents at risk of depression by capturing the combined influence of screen time and activity interests. The model is intended for screening rather than diagnosis and may support school-based early identification, and further validation in clinical contexts is needed.