Rehospitalisation rates after long-term follow-up of patients with severe mental illness admitted for more than one year: a systematic review.

AIMS: This study aimed to conduct a systematic review of studies on the outcomes of long-term hospitalisation of individuals with severe mental illness, considering readmission rates as the primary outcome. METHODS: Studies considered were those in which participants were aged between 18 and 64 years with severe mental illness; exposure to psychiatric hospitals or wards was long-term (more than one year); primary outcomes were readmission rates; secondary outcomes were duration of readmission, employment, schooling, and social participation; and the study design was either observational or interventional with a randomised controlled trial (RCT) design. Relevant studies were searched using MEDLINE, PsycINFO, Web of Science, CINAHL, and the Japan Medical Abstract Society. The final search was conducted on 1 February 2022. The risk of bias in non-randomised studies of interventions was used to assess the methodological quality. A descriptive literature review is also conducted. RESULTS: Of the 11,999 studies initially searched, three cohort studies (2,293 participants) met the eligibility criteria. The risk of bias in these studies was rated as critical or serious. The 1-10 years readmission rate for patients with schizophrenia who had been hospitalised for more than one year ranged from 33 to 55%. The average of readmission durations described in the two studies was 70.5 ± 95.6 days per year (in the case of a 7.5-year follow-up) and 306 ± 399 days (in the case of a 3-8-year follow-up). None of the studies reported other outcomes defined in this study. CONCLUSIONS: The readmission rates in the included studies varied. Differences in the follow-up period or the intensity of community services may have contributed to this variability. In countries preparing to implement de-institutionalisation, highly individualised community support should be designed to avoid relocation to residential services under supervision. The length of stay for readmissions was shorter than that for index admissions. The results also imply that discharge to the community contributes to improved clinical outcomes such as improved social functioning. The validity of retaining patients admitted because of the risk of rehospitalisation was considered low. Future research directions have also been discussed.

What outcomes in community mental health research are important to caregivers of people with schizophrenia? An exploratory qualitative analysis of an online survey.

AIMS: This study investigated outcomes in community mental health research that were important to caregivers of people with schizophrenia. METHODS: Using an online survey conducted from August 1 to 31, 2020, data were collected from caregivers belonging to the LINE Schizophrenia Family Association. Caregivers identified outcomes important in community mental health research. Two researchers categorized caregivers' statements into research outcomes. RESULTS: A total of 132 caregivers completed the online selfreported questionnaire, and 296 caregiver statements were identified. Qualitative analysis identified 17 outcome categories. The caregivers tended to value having more free time, maintaining an appropriate relationship with people with schizophrenia, and being able to cope with their symptoms. CONCLUSIONS: This exploratory study newly demonstrates the outcomes that caregivers of people with schizophrenia consider important in community mental health research. The findings may be useful in selecting outcomes for future studies of caregivers.

Adolescent cannabis use and the later onset of bipolar disorder: protocol for a systematic review and meta-analysis of prospective cohort studies.

BACKGROUND: Cannabis is used by adolescents worldwide. Adolescents are more susceptible to the psychological effects of cannabis because their brains are still developing. Cannabis use in adolescents has been reportedly associated with later onset of bipolar disorder. AIMS: The purpose of this study is to systematically review and analyze longitudinal prospective cohort studies of cannabis use during adolescence and evaluate the risk of developing bipolar disorder. METHODS: We defined the participants, exposures, comparisons, and outcomes (PECO) as follows: (P) adolescents in the 10-19-year age group at the baseline survey; (E) cannabis use at least once during lifetime; (C) never-used cannabis over lifetime; and (O) the onset of bipolar disorder. A systematic search for published prospective cohort studies will be conducted by using the following electronic databases: PubMed, EMBASE, PsycINFO, and Japan Medical Abstracts Society. The quality assessment will be performed by using Risk Of Bias In Non-randomized Studies - of Interventions. Meta-analysis will be done if the included studies that exist are more than three. Heterogeneity will be assessed using Cochran's Q test and I2 . Funnel plots and Egger's test will be done to assess publication bias. DISCUSSION: This study will clarify the association between adolescent cannabis use and the subsequent development of bipolar disorder, which could be useful for future research directions and policy making.

The preventive effect of internet-based cognitive behavioral therapy for prevention of depression during pregnancy and in the postpartum period (iPDP): a large scale randomized controlled trial.

BACKGROUND: Prevention of perinatal depression beginning from the antenatal period is essential. Therefore, this study aimed to investigate the effectiveness of recently developed internet-delivered cognitive behavioral therapy (iCBT) for preventing the onset of a major depressive episode (MDE) in the third trimester and at 3 months postpartum. METHODS: This is a two-arm, parallel-group, general-information controlled, randomized controlled trial. Participants were 5017 pregnant women at 16-20 weeks' gestation without MDE at baseline. They were randomly assigned to an iCBT (intervention; n = 2509) or general-information (control; n = 2508) group, stratified by psychological distress at baseline. The primary outcomes were the numbers of new MDE onsets, measured using the World Health Organization Composite International Diagnostic Interview 3.0, at 32 weeks' gestation and at 3 months postpartum. RESULTS: New MDE onset was reported by 59 participants (2.35%) in the intervention group and 73 (2.91%) in the control group during follow-up. Compared with the control group, the hazard ratio (HR) of MDE in the intervention group was 0.85 (95% CI 0.61-1.20), which was not significantly different. Among participants who scored between 5 and 8 on K6 at baseline, 10 (1.37%) in the intervention group reported new onset of MDE, compared with 28 (3.81%) in the control group, and the HR of MDE was 0.38 (95%CI 0.19-0.79). CONCLUSIONS: No intervention effect was found for iCBT in preventing new onset of perinatal MDE. iCBT might prevent perinatal depression only among pregnant women with subthreshold depressive symptoms. TRIAL REGISTRATION: UMIN000038190.

Multiple stakeholders' perspectives on patient and public involvement in community mental health services research: A qualitative analysis.

BACKGROUND: Patient and public involvement (PPI) has become essential in health research. However, little is known about multiple stakeholders' perspectives on the implementation of PPI in community mental health research settings. The present study aimed to qualitatively analyse multiple stakeholders' views on PPI, including potential concerns, barriers and approaches. METHODS: This study involved conducting focus group interviews and collecting qualitative data from 37 participants in multiple stakeholder groups (patients = 6, caregivers = 5, service providers = 7, government staff = 5 and researchers = 14) in the community mental health field. The data were qualitatively analysed using a data-driven approach that derived domains, themes and subthemes related to perspectives on PPI and to specific challenges and approaches for implementing PPI. RESULTS: The qualitative analysis identified four domains. The 'Positive views and expectations regarding PPI' domain consisted of themes related to supportive views of PPI in a mental health service research setting and improvements in the quality of research and service. The 'General concerns about PPI' domain included themes concerning the need for non-PPI research and tokenism, excessive expectations concerning social changes and use of evidence from PPI research, and heavy burdens resulting from PPI. The 'Specific issues regarding the implementation of PPI' domain consisted of four themes, including academic systems, selection methods (e.g., representativeness and conflict of interest issues), relationship building, and ambiguous PPI criteria. In particular, all stakeholder groups expressed concerns about relational equality during PPI implementation in Japan. The 'Approaches to PPI implementation' domain included themes such as facilitating mutual understanding, creating a tolerant atmosphere, establishing PPI support systems (e.g., training, ethics and human resource matching) and empowering patient organizations. CONCLUSION: The study replicated most of the barriers and approaches to PPI reported by qualitative research in Western counties. However, utilization of evidence produced by PPI research and partnership in the PPI process may be particularly serious issues in Japan. Future PPI studies should carefully address solutions that fit each culture. PATIENT OR PUBLIC CONTRIBUTION: A patient-researcher was involved in all stages of this project, from development of the research topic and the protocol to manuscript preparation.

Consensus development of priority outcome domains for community mental health cares by multiple stakeholders: Protocol for an online Delphi study in Japan.

BACKGROUND: Treatment goals for mental illness have expanded from hospital discharge and improved functioning to employment, living alone, and personal realization. These changes in treatment goals have also influenced mental health research. Recent studies have addressed the development of core outcome sets focusing on clinical aspects of mental illness such as depression and anxiety. However, a well-developed framework of essential outcomes for people with mental illness (service users) who live in the community is lacking. In addition, recent worldwide trends suggest more patient and public involvement and the importance of considering multiple stakeholders' views in the area of mental health research. Purpose of this study is to explore consensus on high-priority outcome domains among multiple stakeholders in community mental healthcare fields in Japan. METHODS: A three-step approach to developing an outcome list will be used. First, we developed a long list of outcomes for community mental health through a literature review, focus group interviews with key stakeholders, and online questionnaire surveys of service users and caregivers. Second, the long list was checked and revised in a pilot study. Third, the long list will be shortened to the outcome list through the Delphi methodology with participation from multiple stakeholders. DISCUSSION: Identifying important common outcome domains through collaboration with multiple stakeholders appears to contribute to the development of evidence for community mental health research in Japan. In addition, the study process itself may help promote patient and public involvement in education, practice, and research in the field of community mental health.

Association between Urban Upbringing and Compulsive Internet Use in Japan: A Cross-Sectional, Multilevel Study with Retrospective Recall.

The purpose of this study was to show the association between urban upbringing and compulsive internet use (CIU). The interview data of the sample (N = 2431) was obtained from the World Mental Health Japan Second Survey and a multilevel model was used to investigate the association. Multiple imputation was also conducted in this study. Growing up in a large city was significantly associated with higher Compulsive Internet Use Scale (CIUS) scores (γ = 1.65, Standard Error (SE) = 0.45) and Mild CIU + Severe CIU (Exp(γ) = 1.44; 95% Confidence Interval (CI) (1.04-2.00)) compared to growing up in a small municipality after adjusting for both sociodemographic characteristics and psychopathology. This study showed a possible association between urban upbringing and CIU. Future studies with longitudinal design are needed to better understand this association.

Care difficulties and burden during COVID-19 pandemic lockdowns among caregivers of people with schizophrenia: A cross-sectional study.

AIMS: The purpose of this study was to retrospectively investigate care difficulties experienced by caregivers of people with schizophrenia during COVID-19 pandemic lockdowns in Japan (April 7-May 25, 2020) and examine associations between these care difficulties during lockdowns and daily caregiver burden. METHODS: Data were collected from 132 participants of the LINE Schizophrenia Family Association using an online survey. RESULTS: Caregivers were mostly concerned about who would care for people with schizophrenia if caregivers become infected with COVID-19. A significant association was found between higher daily caregiver burden and more difficult care experiences during COVID-19 pandemic lockdowns (B = 0.58, 95% confidence interval, 0.40-0.75, P < .01, adjusted R-squared = .34). CONCLUSIONS: Further studies and supports for caregivers of people with schizophrenia are needed.

Psycho-educational interventions focused on maternal or infant sleep for pregnant women to prevent the onset of antenatal and postnatal depression: A systematic review.

AIMS: This systematic review aimed to evaluate randomized controlled trials (RCTs) to examine the effect of maternal and infant sleep intervention during women's pregnancy for the purpose of preventing perinatal depression. METHOD: A systematic search (from inception to January 28, 2019) for RCTs using five electronic databases-the Cochrane Controlled Register of Trials (CENTRAL), Embase, PubMed, PsycINFO, and Ichushi Web (Japan Medical Abstracts Society)-was conducted. Twelve investigators independently conducted initial screenings based on title and abstract, and then, two researchers performed full-text reviews one by one. A meta-analysis would be conducted if at least three studies were found. However, only two articles that met inclusion criteria, and narrative data synthesis was conducted for these two articles. The study protocol has been registered at PROSPERO (CRD42019119999). RESULT: A total of 13 654 studies were initially searched. After removing duplicates, 10 547 studies were screened, and finally, two studies met the inclusion criteria. In both studies, the intervention was a one-time face-to-face session during pregnancy to deliver the behavioral knowledge and skills for optimizing sleep hygiene for both infant and mother. Effectiveness of the intervention in improving maternal mood was not significant in one study. In the other, there was a significant difference in maternal mood between the intervention and control group. No mood comparison was made between baseline and postintervention. CONCLUSION: This study found limited evidence to support the effectiveness of sleep intervention for all pregnant women, which means "universal intervention," to protect maternal mental health. Further well-designed RCTs are needed to confirm these findings.

Association between energy drink consumption and substance use in adolescence: A systematic review of prospective cohort studies.

BACKGROUND: It is unclear whether energy drink (ED) consumption is associated with substance use (SU) in adolescence. The purpose of this study is to clarify the association. METHODS: A systematic review was conducted using a wide range of electronic bibliographic databases to search for published prospective cohort studies on the topic from inception to 14th August 2019. The risk of bias was addressed by using the Risk Of Bias In Non-randomised Studies - of Interventions; ROBINS-I. Studies targeting adolescents were collected. Additionally, we collected studies that examined an association between the extent of energy drink consumption as exposure variables and any substance use as outcome variables. RESULTS: Five studies met the eligibility criteria. ED consumption was associated with adolescent use of alcohol, tobacco, cannabis, prescription stimulants, and analgesics. However, the overall risk of bias in the included studies was severe. CONCLUSION: ED consumption may be associated with SU in adolescence, particularly alcohol use. The results, however, were still inconclusive due to the relatively low methodological quality in the included studies. Evidence from more well-designed trials is needed in future research.

Effects of multisession transcranial direct current stimulation as an augmentation to cognitive tasks in patients with neurocognitive disorders in Japan: a study protocol for a randomised controlled trial.

INTRODUCTION: Transcranial direct current stimulation (tDCS) is a potentially novel strategy for cognitive enhancement in patients with disorders. We present a study protocol for a randomised controlled trial designed to evaluate the safety and efficacy of tDCS combined with cognitive tasks on cognition in such patients. METHOD AND ANALYSIS: This is a two-arm, parallel-design, randomised, sham-controlled trial, in which participants and raters will be blinded at a single centre. Stratified randomisation will be conducted, and a randomisation sequence will be generated through the Electronic Data Capture system. Patients who met the Diagnostic and Statistical Manual of Mental Disorders-5 criteria for neurocognitive disorders will be recruited and randomised to receive either active (2 mA for 20 min) or sham (stimulation ramped up and down for 1 min) stimulation in 10 sessions over five consecutive days. A direct current will be transferred by a 35 cm2 saline-soaked sponge electrode. An anode will be placed over the left dorsolateral prefrontal cortex, and a cathode will be placed over the right supraorbital cortex. Calculation tasks will be conducted in both arms as a cognitive task for 20 min during the stimulation. This task consists of basic arithmetic questions, such as single-digit addition, subtraction, multiplication and division. The primary outcome will be the mean change in the Alzheimer Disease Assessment Scale-cognition at Day 5 after baseline. Depressive symptoms, as measured by the geriatric depression scale, and quality of life, as measured by the Medical Outcomes Study 36-item Short-Form Health Survey, will also be assessed. Data will be collected at baseline, within 3 days following the final stimulation and 1 month thereafter. The estimated sample size is 46 per group based on the assumptions that an estimated mean difference is -1.61 and SD is 2.7. Mixed models for repeated measures will be used for the statistical analysis. ETHICS AND DISSEMINATION: The National Center of Neurology and the Psychiatry Clinical Research Review Board (CRB3180006) approved this study. The results of this study will be published in a scientific peer-reviewed journal. TRIAL REGISTRATION DETAILS: Japan Registry of Clinical Trials jRCTs032180016.

Development and implementation of guidelines for the management of depression: a systematic review.

OBJECTIVE: To evaluate the development and implementation of clinical practice guidelines for the management of depression globally. METHODS: We conducted a systematic review of existing guidelines for the management of depression in adults with major depressive or bipolar disorder. For each identified guideline, we assessed compliance with measures of guideline development quality (such as transparency in guideline development processes and funding, multidisciplinary author group composition, systematic review of comparative efficacy research) and implementation (such as quality indicators). We compared guidelines from low- and middle-income countries with those from high-income countries. FINDINGS: We identified 82 national and 13 international clinical practice guidelines from 83 countries in 27 languages. Guideline development processes and funding sources were explicitly specified in a smaller proportion of guidelines from low- and middle-income countries (8/29; 28%) relative to high-income countries (35/58; 60%). Fewer guidelines (2/29; 7%) from low- and middle-income countries, relative to high-income countries (22/58; 38%), were authored by a multidisciplinary development group. A systematic review of comparative effectiveness was conducted in 31% (9/29) of low- and middle-income country guidelines versus 71% (41/58) of high-income country guidelines. Only 10% (3/29) of low- and middle-income country and 19% (11/58) of high-income country guidelines described plans to assess quality indicators or recommendation adherence. CONCLUSION: Globally, guideline implementation is inadequately planned, reported and measured. Narrowing disparities in the development and implementation of guidelines in low- and middle-income countries is a priority. Future guidelines should present strategies to implement recommendations and measure feasibility, cost-effectiveness and impact on health outcomes.

Antenatal psychological intervention for universal prevention of antenatal and postnatal depression: A systematic review and meta-analysis.

BACKGROUND: The high prevalence and severe consequences of antenatal and postnatal depression makes their prevention critical. Previous systematic reviews and meta-analysis have shown the effects of psychological interventions on perinatal depression in individuals at risk. However, none have focused explicitly on universal prevention in the antenatal period. The purpose of this study is to conduct a systematic review and meta-analysis to clarify the effects of antenatal psychological interventions on perinatal depression, specifically focusing on universal prevention. METHODS: Four electronic databases, the Cochrane Controlled Register of Trials (CENTRAL), Embase, PubMed, and PsycINFO, were used to search for published randomized controlled trials from inception to January 28, 2019. Twelve investigators conducted the first screening from title and abstract, individually, and then NY and ZN performed full-text review one by one. For the meta-analysis, a random effect model was conducted by using Review Manager 5.3 for Windows. Subgroup analyses were also conducted for studies that employed a cognitive behavioral (CB) based approach. RESULTS: A total of 13,026 studies were initially searched. After removing duplicates, 9,919 studies were screened, and finally 18 studies met the inclusion criteria. The meta-analysis showed a significant effect of antenatal psychological intervention on both antenatal and postnatal depression (SMD = 0.28, 95% CI = 0.11 to 0.44, SMD = 0.37, 95% CI = 0.08 to 0.66) with moderate to high level of heterogeneity (I2 = 61%, p = 0.01; I2 = 84%, p < 0.001). For subgroup analysis, a significant effect of a CB based approach on antenatal depression was found in an antenatal period (SMD = 0.53, 95% CI = 0.13 to 0.94) with high heterogeneity (I2 = 85%, p = 0.001), while non-significant results were shown on postnatal depression (SMD = 0.45, 95% CI = -0.03 to 0.92). LIMITATIONS: Limitations include a language bias, as we included only studies published in English, and that the assessment of antenatal and postnatal depression using different methods caused high heterogeneity across studies. CONCLUSIONS: Psychological intervention in an antenatal period could be effective for universal prevention of both antenatal and postnatal depression. However, the results were still inconclusive due to relatively low methodological quality in the included studies. The evidence from more well-designed trials is needed in future studies.

Personal values in adolescence and sense of coherence in adulthood: A cross-sectional study based on a retrospective recall.

AIMS: The purpose of this study is to retrospectively examine the association between personal values in adolescence and sense of coherence (SOC) in adulthood. METHODS: J-SHINE data from wave 1 (2010) and wave 3 (2017) were used in this study. We retrospectively measured personal values at age 15 in 2017 in two ways: (a) value priorities developed from Schwartz's theory of basic values; and (b) the commitment to values measured by Personal Values Questionnaire II (PVQ-II). Multiple regression analysis was used to estimate the association. RESULTS: Having a value priority of belief, pursuing one's interest, enduring active challenges, cherishing family and friends, and having a commitment to values in adolescence were significantly and positively associated, while avoiding causing trouble was significantly and negatively associated with SOC in adulthood. CONCLUSIONS: Personal values in adolescence may be associated with SOC in adulthood. Research of personal values in adolescence could contribute to the understanding the development of SOC.

Internet-based cognitive-behavioural therapy for prevention of depression during pregnancy and in the post partum (iPDP): a protocol for a large-scale randomised controlled trial.

INTRODUCTION: The objective of this randomised controlled trial (RCT) is to examine the effects of smartphone-based cognitive-behavioural therapy (CBT) in preventing the onset of major depressive episodes (MDE) among pregnant women. METHODS AND ANALYSIS: The target study population will be pregnant women of 16-20 weeks gestation who are currently users of 'Luna Luna Baby', the most widely used app for pregnant women in Japan. Those who meet the eligibility criteria will be randomly allocated to the 6-module internet CBT programme that was newly developed for pregnant women (n=2500), or to a treatment-as-usual control group (n=2500). Participants in the intervention groups will be required to complete the programme by 32 weeks gestation. The primary outcomes are the number of new onsets of MDE, measured by using WHO Composite International Diagnostic Interview 3.0 at 32 weeks gestation and 3 months post partum. Survival analysis will be conducted to test for the effectiveness of the intervention on the time to the onset of MDE. ETHICS AND DISSEMINATION: The study plan has been approved by the Research Ethics Review Board of the Graduate School of Medicine/Faculty of Medicine, the University of Tokyo (2019150NI). If the intervention programmes are found to produce a significant positive effect in this RCT, these programmes can be made available for all users of the app in the future. TRIAL REGISTRATION NUMBER: UMIN000038190; Pre-results.

Effects of brief family psychoeducation for caregivers of people with schizophrenia in Japan provided by visiting nurses: protocol for a cluster randomised controlled trial.

INTRODUCTION: Development of a support system for families caring for people with schizophrenia in routine psychiatric care settings is an important issue worldwide. Regional mental health systems are inadequate for delivering effective services to such family members. Despite evidence that family psychoeducation (FPE) alleviates the burden of schizophrenia on families, its dissemination in routine clinical practice remains insufficient, suggesting the need for developing an effective and implementable intervention for family caregivers in the existing mental health system setting. In Japan, the visiting nurse service system would be a practical way of providing family services. Visiting nurses in local communities are involved in the everyday lives of people with schizophrenia and their families. Accordingly, visiting nurses understand their needs and are able to provide family support as a service covered by national health insurance. The purpose of this study is to discover whether a brief FPE programme provided by visiting nurses caring for people with schizophrenia will alleviate family burden through a cluster randomised controlled trial (cRCT). METHODS AND ANALYSIS: The study will be a two-arm, parallel-group (visiting nurse agency) cRCT. Forty-seven visiting nurse agencies will be randomly allocated to the brief FPE group (intervention group) or treatment as usual group (control group). Caregivers of people with schizophrenia will be recruited by visiting nurses using a randomly ordered list. The primary outcome will be caregiver burden, measured using the Japanese version of Zarit Burden Interview. Outcome assessments will be conducted at baseline, 1-month follow-up and 6-month follow-up. Multiple levels of three-way interactions in mixed models will be used to examine whether the brief FPE programme will alleviate the burden on caregivers relative to treatment as usual. ETHICS AND DISSEMINATION: The Research Ethics Committee of the Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Japan (No 2019065NI) approved this study. The results will be published in a scientific peer-reviewed journal. TRIAL REGISTRATION NUMBER: UMIN000038044.

Association of response rate and prevalence estimates of common mental disorders across 129 areas in a nationally representative survey of adults in Japan.

OBJECTIVE: To investigate the association of area response rate with prevalence estimates of mental disorders in the 2nd World Mental Health Survey (WMHJ2). METHODS: The sample of the WMHJ2 was selected from community residents in 129 areas from three regions of Japan. The surveys were conducted between 2013 and 2015, and 2450 (43.4%) responded. Mental disorders as well as three disorder classes (mood, anxiety, and substance use disorders) were identified using the WHO CIDI/DSM-IV. Response rates and 12-month and lifetime prevalences were calculated for each area. A generalized linear mixed model analysis was conducted to associate area response rate with the prevalence of mental disorders, controlling for sex, age, urbanity, and geographical region. RESULTS: Area response rates ranged from 0.05 to 0.80 across the 129 areas. Area response rate was not significantly associated with 12-month or lifetime prevalence of mental disorder. Lifetime prevalences of substance use disorder were significantly lower in a survey with a higher response rate than a survey of the same area with a lower response rate. CONCLUSION: Response rate may not strongly affect the prevalence estimates of mental disorders in a community-based survey of the prevalence of common mental disorders during a particular time frame. However, a lower response rate could be associated with overestimation of lifetime prevalence of substance use disorder. This needs further elucidation.

Psychotic Experiences and Hikikomori in a Nationally Representative Sample of Adult Community Residents in Japan: A Cross-Sectional Study.

Psychotic experiences (PEs) may be associated with hikikomori. In the present study, we analyzed interview data from a community-based representative sample (N = 1,616) in Japan to know the association of PEs over a life time, as well as the two components, hallucinatory experiences (HEs) and delusional experiences (DEs), with lifetime experience of hikikomori (severe social withdrawal). Logistic regression analysis was used to estimate the association between any PE, any HE, and any DE; and hikikomori, adjusting for socio-demographics and other psychopathologies (mental disorder in the past 12 months or having autistic spectrum disorder trait). Any PE was significantly associated with hikikomori [odds ratio (OR) =3.44, 95% CI = 1.14-10.33] after adjustment for sociodemographic factors, although the association attenuated after adjusting for other psychopathologies. Any DE remained significantly associated with hikikomori, even after adjustment for all the covariates (OR = 10.50, 95% CI = 1.57-70.29). Any HE was not significantly associated with hikikomori. DEs may be associated with hikikomori. However, because the study sample was small and the temporal association between DEs and hikikomori was unclear, a future study is needed to examine a causal relationship between DEs and hikikomori.

Psychological intervention for universal prevention of antenatal and postnatal depression among pregnant women: protocol for a systematic review and meta-analysis.

BACKGROUND: Prevention of antenatal and postnatal depression is crucial, given its high prevalence and severe consequences. Although several systematic reviews and meta-analyses have examined the effects of psychological interventions on the population at risk for perinatal depression, few studies have focused on universal prevention and none have focused specifically on universal prevention in pregnancy. The aim of this study is to examine the effects of psychological interventions with a universal prevention focus on perinatal depression during pregnancy by performing a systematic review and meta-analysis based on both the latest articles and a broader literature search. METHODS: The literature search will be conducted using the Cochrane Controlled Register of Trials (CENTRAL), Embase, PubMed and PsycINFO, from inception onwards. Randomized controlled trials that examined the association between psychological interventions and universal prevention of antenatal and postnatal depression among pregnant women will be included. Study selection, data collection, quality assessment, and statistical syntheses will be conducted following a priori defined methods in the protocol. DISCUSSION: The findings of this systematic review and meta-analysis will have both clinical and political importance in the context of perinatal mental health. In addition, this study will promote future studies and clarify the direction of research on universal prevention of perinatal depression. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019118041.