Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 5 appraisals
The Spanish journal of psychology
A Systematic Review of the Risk and Protective Factors for Suicide in Autism Spectrum Disorder
The shorter lifespan and increased prevalence of physical and psychiatric comorbidities in autistic people is a challenge for mental health. There is a high risk of suicide-related behaviors in autism, which are related to mental health issues, social isolation, and other factors. Here we aimed to systematically review the evidence on risk and protective factors of suicidal behaviors in autistic people. Electronic datasets (PubMed, Scopus, Web of Science, and PsycInfo) were searched for empirical articles on the risk and protective factors for suicide in autism. The PRISMA guidelines were followed, and a series of inclusion and exclusion criteria were applied to the retrieved data. This review included 19 studies reporting multiple risk factors associated with suicide-related behaviors. Noteworthy contributors among these factors include psychiatric comorbidities, bullying, cyberbullying, teacher harassment, and cognitive functions. The evidence for protective factors is limited; however, social relationships are highlighted. Identifying risk and protective factors is paramount for detecting early warning signs and enabling the prevention and intervention of suicidal behavior. Our review identified key sociodemographic, clinical, and cognitive risk factors to take into account as alarm-signs when identifying suicidal behaviors in autism.
31 July 2026
Read appraisal →Current psychiatry reports
Sleep Interventions and the Prevention of Pediatric Anxiety: A Systematic Review
PURPOSE OF REVIEW: Anxiety disorders are prevalent in children, adolescents, and young adults. As many youth either do not receive adequate intervention or do not achieve remission, prevention of anxiety disorders is a public health priority. Sleep problems are a modifiable risk factor that precedes anxiety. This systematic review includes recent pediatric sleep interventions and anxiety outcomes, and introduces anxiety sensitivity as an understudied mechanism. RECENT FINDINGS: In 21 intervention and experimental studies, sleep intervention reduced anxiety symptoms/disorders and the onset of anxiety disorders. Three additional recent studies examined anxiety sensitivity in the relationship between sleep problems and anxiety, supporting the inclusion of anxiety sensitivity in future research studies. Sleep health is a scalable, accessible target for reducing anxiety and is an important part of pediatric anxiety prevention. Sleep treatments can be brief and implemented in psychiatric practice. Future research studies should consider anxiety sensitivity as a potential mechanism.
14 July 2026
Read appraisal →Depression and anxiety
Tree Imagery in Drawing Tests for Screening Mental Disorders: A Systematic Review and Meta-Analysis
Although tree imagery in projective drawing tests is a promising nonverbal tool for screening mental disorders, its clinical utility remains constrained by inconsistent predictor selection. To address this gap, the present systematic review and meta-analysis synthesizes the characteristics of tree imagery linked to mental disorders and evaluates their predictive efficacy. Following the PRISMA guidelines, we analyzed 42 studies involving 8552 participants from English and Chinese databases published between 1948 and 2024. The results showed that 24 specific characteristics significantly predicted mental disorders (p < 0.05), which were classified into five distinct categories: blackened out (e.g., blackened tree, odds ratio [OR] = 2.01), scribbled lines (e.g., weak lines, OR = 2.82), oddly shaped (e.g., flattened crown, OR = 3.10), no vitality (e.g., very small tree, OR = 3.93), and overly simple (e.g., simplified drawing, OR = 7.07). Furthermore, subgroup analyses indicated that features such as "blackened tree" (OR = 1.71), "no motion" (OR = 3.34), and "excessive separation" (OR = 2.77) were significantly associated with affective disorders, whereas the presence of "roots" (OR = 4.89) was uniquely associated with the thought-disorder subgroup. Ultimately, tree imagery may offer a valuable nonverbal, adjunctive approach to screening for mental disorders, offering several statistically supported indicators that may effectively complement traditional assessment tools.
13 July 2026
Read appraisal →Journal of affective disorders
Prediction models for longitudinal trajectories of depression and anxiety: a systematic review
BACKGROUND: Prediction of atypical health trajectories may enable early intervention. We systematically reviewed the existing literature on models for predicting longitudinal depression and/or anxiety trajectories. METHODS: MEDLINE, Embase and APA PsycINFO were searched (from inception to 31-Jan-2025). We included population-based studies of children and adults (aged 3-65 years). Risk of bias was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST-AI) tool. RESULTS: Seven of the nine included studies were in adult populations with a diagnosis of depression or anxiety at baseline; two focused on child and adolescent populations. Only one study included anxiety trajectories. Identified trajectories typically comprised three to four groups including: chronic/persistent-high, stable-low, increasing/worsening, and improved/remitted groups. Various supervised predictive modelling methods were used. The number of final predictors included in models ranged from three to 152. Family and own/personal psychiatric history were the most common predictors but were not always important for model performance. Models including more predictors did not always perform better. Overall risk of bias was high in all studies. No studies were externally validated and no studies assessed the clinical utility of models. CONCLUSION: This review highlights a need for robust, validated models that can forecast future risk of persistent or worsening anxiety and depression, especially in young people where early intervention is possible.
16 May 2026
Read appraisal →Psychological medicine
Joint effects of childhood adversity and genetic risk for psychosis on psychopathology in the UK Biobank
BACKGROUND: The individual effects of genetic factors and adverse childhood experiences (ACEs) on risk of psychosis, including schizophrenia (SCZ) and bipolar disorder (BIP), have been widely acknowledged, but their interaction effects on individual psychopathological symptoms remain unclear. METHODS: Based on data from 163,704 individuals in the UK Biobank, we investigated the joint effects of polygenic risk scores (PRSs) of SCZ and BIP and ACEs on psychopathology. ACEs status and 55 psychopathological symptoms from seven domains were measured retrospectively using an online mental health questionnaire in 2016. Recent genome-wide association studies for SCZ and BIP were combined with genotype data to generate PRSs. Logistic regression analyses were then conducted to explore univariate and joint main effects of PRSs and ACEs on psychopathological symptoms, as well as their additive and multiplicative interaction effects. RESULTS: The interaction mechanisms for PRSs and ACEs varied across symptom domains: additive interactions were observed on the depression (RERIBIP-ACEs = 0.20-0.25), anxiety (RERISCZ-ACEs = 0.20; RERIBIP-ACEs = 0.22-0.26), help-seeking (RERISCZ-ACEs = 0.24; RERIBIP-ACEs = 0.23), and cognition domains (RERISCZ-ACEs = -0.23 to -0.17), whereas multiplicative interactions were only detected on the psychotic (betaSCZ-ACEs = -0.543; betaBIP-ACEs = -0.181), mania (betaBIP-ACEs = -0.195), self-harm or suicide (betaSCZ-ACEs = -0.118), and cognitive domains (betaSCZ-ACEs = -0.204 to -0.157). CONCLUSIONS: The interplay mechanisms for genetic liability to SCZ and BIP and ACEs vary across symptom domains. This study reveals heterogeneity in gene-ACEs interaction mechanisms underlying psychosis and may provide personalized guidance for psychological care after ACEs.
8 Apr 2026
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