Nao Shiraishi

Background: Evidence regarding the validity of digital dietary recordings in the family-based nutritional management of anorexia nervosa (AN) remains limited. This study evaluated the validity of an AI-assisted dietary recording application (app) used by the parents of young patients with AN, with total energy intake as the primary outcome and major nutrient intake as the secondary outcome. Methods: During hospital leave prior to discharge, one day of dietary intake was recorded by parents using the app based on meal photographs. The energy and nutrient intakes estimated by the app were compared with a registered dietitian using visual estimation of the photographs. Differences were examined using the Wilcoxon signed-rank test, associations were assessed using Spearman’s correlation coefficients, and agreement was evaluated using Bland–Altman analysis. Sensitivity analyses excluding extreme outliers were performed. Results: Thirty female inpatients with AN (mean age: 14.8 ± 2.9 years) and their mothers participated. The median total energy intake did not differ significantly between the app and reference method (2462 vs. 2439 kcal/day). Moderate to high correlations were observed for total energy (ρ = 0.62) and major nutrient intakes. The app tended to overestimate these intakes; however, Bland–Altman analyses indicated no systematic bias. Exclusion of two outliers strengthened correlations for total energy intake (ρ = 0.74) and narrowed the limits of agreement. Conclusions: The app demonstrated an acceptable agreement for estimating energy and major nutrient intake in the therapeutic context of AN. Careful attention to dish type and portion size may further support its clinical use.

Aim: Spouses experience conflicting emotions when caring for partners with severe mental illnesses. They can have negative emotions while also regarding caregiving as positive and may develop a better marital relationship through the caregiving process. This study investigated factors affecting the negative and positive emotions of husbands and wives acting as caregivers of their spouses with severe mental illnesses.Methods: An online nationwide survey of 166 spouses caring for partners diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder was conducted. Caregivers' negative and positive emotions, personal and role strains in the care burden, sense of coherence, and patients' disabilities in family communication were assessed. We conducted a series of hierarchical multiple regression analyses to evaluate the effects of these factors on the emotions of husbands and wives separately.Results: Among the 166 spouses, 112 (67%) were husbands and 54 (33%) were wives. Husbands were caregivers to 1.4 times as many individuals diagnosed with psychotic disorder as were wives. The negative emotions of husbands were linked to personal strain, whereas those of wives were associated with patient disability in family communication. Sense of coherence was the only factor predicting positive emotions for both sexes.Conclusion: Support for spousal caregivers should be adjusted according to sex. A reduction in husbands' personal strain can alleviate their negative emotions, whereas wives' negative emotions can be relieved by improving communication within their families. Regardless of sex, a higher sense of coherence level has the potential to suppress negative emotions and enhance positive emotions.

Background: Internet-based cognitive behavioral therapy (iCBT) shows promise in the prevention of depression. However, the specific iCBT components that contribute to its effectiveness remain unclear. Objective: We aim to evaluate the effects of iCBT components in preventing depression among university students. Methods: Using a smartphone cognitive behavioral therapy (CBT) app, we randomly allocated university students to the presence or absence of 5 different iCBT components: self-monitoring, behavioral activation, cognitive restructuring, assertiveness training, and problem-solving. The active intervention lasted 8 weeks but the app remained accessible through the follow-up. The primary outcome was the onset of a major depressive episode (MDE) between baseline and the follow-up after 52 weeks, as assessed with the computerized World Health Organization Composite International Diagnostic Interview. Secondary outcomes included changes in the 9-item Patient Health Questionnaire, 7-item General Anxiety Disorder, and CBT Skills Scale. Results: During the 12-month follow-up, 133 of 1301 (10) participants reported the onset of an MDE. There were no significant differences in the incidence of MDEs between the groups with or without each component (hazard ratios ranged from 0.85, 95% CI 0.60‐1.20, for assertiveness training to 1.26, 95% CI 0.88‐1.79, for self-monitoring). Furthermore, there were no significant differences in the changes on the 9-item Patient Health Questionnaire, 7-item General Anxiety Disorder, or for CBT Skills Scale between component allocation groups. However, significant reductions in depression and anxiety symptoms were observed among all participants at the 52-week follow-up. Conclusions: In this study, we could not identify any specific iCBT components that were effective in preventing depression or the acquisition of CBT skills over the 12-month follow-up period, but all participants with and without intervention of each iCBT component demonstrated significant improvements in depressive and anxiety symptoms. Further research is needed to explore the potential impact of frequency of psychological assessments, nonspecific intervention effects, natural change in the mental state, and the baseline depression level.

BACKGROUND Internet-based cognitive-behavioral therapy (iCBT) shows promise in the prevention of depression. However, the specific iCBT components that contribute to its effectiveness remain unclear. OBJECTIVE To evaluate the effects of iCBT components in preventing depression among university students. METHODS Using a smartphone CBT app, we randomly allocated university students to the presence or absence of five different iCBT components: self-monitoring (SM), behavioral activation (BA), cognitive restructuring (CR), assertiveness training (AT), and problem-solving (PS). The active intervention lasted eight weeks but the app remained accessible through the follow-up. The primary outcome was the onset of a major depressive episode (MDE) between baseline and 52 weeks follow-up, as assessed with the computerized WHO Composite International Diagnostic Interview (CIDI). Secondary outcomes included changes in the Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), and CBT Skills Scale. RESULTS During the 12-month follow-up, 133 of 1301 participants (10.2%) reported onset of MDE. There were no significant differences in the incidence of MDE between the groups with or without each component (Hazard ratios ranged from 0.85 [95% confidence interval: 0.60-1.20] for AT to 1.26 [0.88-1.79] for SM). Furthermore, there were no significant differences in the changes on the PHQ-9, GAD-7 or for CBT Skills Scale between component allocation groups. However, significant reductions in depression and anxiety symptoms were observed among all participants at the 52-week follow-up. CONCLUSIONS In this study, all participants with and without intervention of iCBT components demonstrated significant improvements in depressive and anxiety symptoms and we could not identify any specific iCBT components that were effective in preventing depression or the acquisition of CBT skills over the 12-month follow-up period. Further research is needed to explore the potential impact of frequency of psychological assessments, non-specific intervention effects, natural change in the mental state, and the baseline depression level. CLINICALTRIAL UMINCTR-000031307 INTERNATIONAL REGISTERED REPORT RR2-10.1186/s13063-018-2719-z

Subthreshold depression impairs young people's quality of life and places them at greater risk of developing major depression. Cognitive behavioral therapy (CBT) is an evidence-based approach for addressing such depressive states. This study identified subtypes of university students with subthreshold depression and revealed discrete profiles of five CBT skills: self-monitoring, cognitive restructuring, behavioral activation, assertive communication, and problem solving. Using data from the Healthy Campus Trial (registration number: UMINCTR-000031307), a hierarchical clustering analysis categorized 1,080 students into three clusters: Reflective Low-skilled, Non-reflective High-skilled, and Non-reflective Low-skilled students. Non-reflective Low-skilled students were significantly more depressed than other students (p < .001). The severity of depression seemed to be related to the combination of self-monitoring skills and other CBT skills. Considering the high prevalence of poor self-monitoring skills in persons with autism, the most severe depression was observed in the significant association between Non-reflective Low-skilled students and autistic traits (p = .008). These findings suggest that subthreshold depression can be categorized into three subtypes based on CBT skill profiles. The assessment of autistic traits is also suggested when we provide CBT interventions for Non-reflective Low-skilled students.

Background: The coronavirus disease 2019 (COVID-19) pandemic was reported to have increased depression among university students which was associated with impairments in their campus lives. This study examined changes in depressive states among Japanese university students during the COVID-19 pandemic. Methods: A secondary data analysis from a factorial randomized controlled trial involving smartphone-based cognitive-behavioral therapy was performed. Six cohorts (N = 1626) underwent an 8-week intervention during the spring or autumn of 2019–2021, with a 9-month follow-up. We evaluated participants’ depressive states weekly using the Patient Health Questionnaire-9 (PHQ-9) during the intervention, with monthly evaluations thereafter. The follow-up periods included Japan’s four states of emergency (SOEs) to control COVID-19. Hypothesizing that SOEs caused a sudden worsening of depressive states, Study 1 compared the cohorts’ PHQ-9 scores, and Study 2 employed time series analysis with a mixed-effects model to estimate identified changes in PHQ-9 scores. Results: Although no changes in depressive states were observed in relation to the SOEs, Study 1 identified sudden increases in PHQ-9 scores at the 28-week evaluation point, which corresponded to the beginning of the new academic year for the three autumn cohorts. In contrast, the three spring cohorts did not exhibit similar changes. Study 2 showed that, for all three autumn cohorts (n = 522), the 0.60-point change was significant (95% CI 0.42–0.78; p < .001) at 28 weeks; that is, when their timeline was interrupted. Conclusions: While the results do not indicate any notable impact of the SOEs, they highlight the influence of the new academic year on university students’ mental health during COVID-19. Trial registration UMIN, CTR-000031307. Registered on February 14, 2018.

Aim: Care burden and sense of coherence (SOC) can facilitate an understanding of how family members interpret their caregiving experiences regarding a relative with psychosis. In informal caregiving, understanding siblings' experiences in this regard is necessary to mitigate negative emotions and strengthen positive ones. This study investigated whether care burden and SOC mediate the relationship between the disabilities of patients with psychosis and their siblings' emotions.Methods: A nationwide online survey was used to screen and recruit adult siblings of patients with psychotic disorders. The patients' disabilities in their work lives, socializing, and family communication, the siblings' care burden and SOC, and the siblings' positive and negative emotions were assessed. Structural equation modeling (SEM) was employed to test the path model that illustrated the mediating effects of care burden and SOC on patients' disabilities and siblings' emotions.Results: The sample included 237 siblings aged 42.3 years (mean) with a male‐to‐female ratio of 0.88 and 237 patients with schizophrenia (80.2%) or schizoaffective disorder (19.8%). In the SEM analyses, care burden connected each of the three disabilities with the two types of emotions through the pathways in which care burden positively predicted both negative and positive emotions. Additionally, SOC functioned as a mediator between disability in family communication and both types of emotions.Conclusion: Siblings' negative emotions should be alleviated through interventions aimed at suppressing the care burden and enhancing SOC to address disabilities in patients' socializing and family communication. Nevertheless, care burden might contribute to their positive emotions.

Aim: Parenting styles are determinants of psychosocial maladjustment in the subsequent generation. Modifiable factors that positively impact intergenerational transmission should be identified. Thus, this study investigated the mediating effects of adult attachment on the transmission of child‐rearing styles and the combined impact of fathers' and mothers' styles on their offspring's parenting.Methods: Overall, 396 fathers and 733 mothers participated. They were married or cohabiting when their children aged 0–10 years attended a pediatric office in Japan. The pediatricians distributed the self‐report questionnaires to examine perceived rearing (the Parental Bonding Instrument), adult attachment (the Relationship Questionnaire), and demographic characteristics. We then analyzed the data using structural equation modeling that illustrated intergenerational transmission of rearing styles between grandparents and parents.Results: Overall, 385 fathers (M_age = 35.5 years, SD = 6.0) and 699 mothers (M_age = 33.5 years, SD = 5.1) satisfied the eligibility criteria. The path models showed that adult attachment to partners mediated grandparental and parental care. However, no mediating effect was observed in other intergenerational patterns that transmitted overprotective rearing styles. Additionally, combined grandfather and grandmother care were positively associated with parental overprotection.Conclusion: This study suggested the potential of adult attachment in mediating loving, empathic, and warm rearing styles and the combined effects of both parents' styles on promoting the next‐generation parents' overprotective styles. Our findings clarify how to terminate the negative chain of the parent–child transmission.