Friday, March 7, 2025

Childhood Trauma, Early Puberty Associated With Internalizing Symptoms in Girls

Girls who experience childhood trauma are at a higher risk of developing internalizing symptoms like depression and anxiety by ages 12 to 14, an association that is partially explained by starting puberty ahead of their peers, according to a study issued this week in The Journal of Child Psychology and Psychiatry.

Niamh MacSweeney, Ph.D., of the University of Oslo, Norway, and colleagues used data from 4,225 girls enrolled in the Adolescent Brain Cognitive Development Study. Each participant, who enrolled at age nine or 10, was assessed annually over four years, with their parents reporting their exposure to trauma at baseline and their pubertal development at each assessment. When participants were between the ages of 12 and 14, they self-reported their internalizing symptoms.

Participants followed three distinct patterns of pubertal development:

  • Typical developers (76% of participants) were in the early stages of puberty when the study began and had the most rapid pace of development over time, such that they were in the later stages by ages 12 to 14.
  • Slow developers (15%) were just entering the early stages of puberty by ages 12 to 14.
  • Early starters (9%) were already midway through puberty by ages nine to 10 (these participants, however, showed a protracted pace of development and had about the same degree of pubertal maturation on average as typical developers by ages 12 to 14).

Early starters had significantly higher exposure to trauma at baseline compared with slow or typical developers, while slow developers had lower trauma exposure compared with typical developers. Slow developers also had significantly lower internalizing symptoms compared with early starters and typical developers. In examining the trajectories of the girls’ development, the researchers found that greater childhood trauma was linked with greater internalizing symptoms at ages 12 to 14, and this association was mediated by early puberty onset. Among early developers, having a slower pace of puberty development after age nine partially reduced this risk of internalizing symptoms.

“It has been proposed that the association between early pubertal timing and internalizing symptoms is underpinned by an asynchrony between a young person’s physical, cognitive and social development,” the authors wrote. “Additionally, the type of trauma experienced (e.g., threat vs. neglect) and the trajectory of internalizing difficulties across adolescence (e.g., limited to early adolescence, persistent across adolescence, or only emerging in later adolescence) will be crucial to consider in future longitudinal research to better characterize at-risk and resilient youth and inform prevention strategies.”

For related information, see the Psychiatric News article “Group School Intervention Helps Girls Cope With Internalized Trauma.”

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Thursday, March 6, 2025

Condensed, High Intensity TMS Found Effective in Patients With Treatment-Resistant Depression

Patients with treatment-resistant depression receiving three weeks of accelerated theta burst stimulation (aTBS)—a form of transcranial magnetic stimulation (TMS) using short, targeted bursts—experienced greater reduction in depression scores than did those who received a sham procedure, according to a report in JAMA Psychiatry.

“Our study introduced a pragmatic aTBS approach for clinical practice,” wrote Matheus Rossi F. Ramos, M.D., of the University of Sao Paulo Medical School, and colleagues. “The 78-minute daily treatment duration can likely fit into most outpatient participants’ routines, allowing them to maintain daily functionality.” Further, their protocol does not require neuroimaging equipment to identify where the TMS bursts should be directed.

From July 2022 to June 2024, 89 outpatients with treatment-resistant depression (average age of 41.7) were randomized to receive either 45 sessions of active aTBS over 15 weekdays or a sham procedure. All participants had scores of greater than 16 on the Hamilton Depression Rating Scale (HDRS), were considered at low risk of suicide, and had not responded to more than one antidepressant trial. The active aTBS involved three magnetic pulse sessions (each for six minutes and 18 seconds) interspersed with two 30-minute breaks. The magnetic pulses were directed to the brain's left dorsolateral prefrontal cortex.

Those patients receiving the active procedure experienced an average reduction in HDRS scores of 9.68 (a 55% decrease from baseline) compared with 5.57 in the sham group, indicating a medium-to-large effect size. A total of 17 patients (34%) in the active treatment arm experienced remission—defined as an HDRS score of eight or less—compared with eight participants (16%) receiving the sham procedure. The treatment was well tolerated, although those receiving active aTBS experienced scalp pain.

“Further research offers promising directions for future advancements in this field, including clinical trials comparing new aTBS protocols with standard ones and studies exploring the optimal parameters for these protocols,” the researchers concluded.

For related information, see the Psychiatric News article “FDA Clears Accelerated TMS Protocol for Depression.”

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Wednesday, March 5, 2025

Psychotherapy by Nonspecialists via Telehealth Can Be Effective for Perinatal Depression

A brief, manualized psychotherapy provided by trained and supervised nonspecialists was just as effective at helping perinatal women resolve their depression and anxiety as the same care delivered by mental health professionals in person, according to a study published in Nature Medicine.

“One in five women experience depression or anxiety during the perinatal period (pregnancy up to the year following childbirth). Treatment is essential, given the negative, long-term, and intergenerational impact on maternal and child developmental outcomes,” wrote Daisy R. Singla, Ph.D., of the University of Toronto, and colleagues. “However, access is limited, with barriers including cost, stigma, and the inequitable distribution of mental health professionals. As a result, only 10% of affected perinatal patients in high-income countries receive psychotherapy.”

Singla and colleagues recruited 1,230 racially diverse pregnant or postpartum women from five sites across North America from January 2020 to October 2023. All participants scored 10 or higher on the Edinburgh Postnatal Depression Scale (EPDS), indicating at least minor depression; the average score at baseline was 16, indicating moderate depression.

The participants each received six to eight weekly, manualized behavioral activation (BA) sessions; however, they were randomized to receive care either from trained, nonspecialist health care providers, such as nurses or midwives, via telehealth (472) or in person (145); or from mental health professionals via telehealth (469) or in person (144). Participants’ depressive and anxiety symptoms were assessed three months post-randomization with the EPDS and Generalized Anxiety Disorder-7 (GAD-7), respectively.

After three months, EPDS scores dropped by an average of seven points, regardless of type of provider or delivery. A change of four points on the EPDS is generally considered to represent a real and clinically meaningful difference in depression symptoms. Similarly, participants’ GAD-7 scores dropped by an average of six points (from a baseline average of 12), regardless of specialist type or delivery.

“The key to this success was the rigorous training and structured supervision throughout the study that was provided by experienced mental health professionals, who in this case had five years of experience, at minimum,” study co-author Samantha Meltzer-Brody, M.D., M.P.H., director of the University of North Carolina Center for Women’s Mood Disorders and executive dean at UNC School of Medicine, told Psychiatric News Alert. She added that one mental health professional can provide training and supervision to many nurses, doulas, and midwives. “This structure allows us to markedly expand the reach of perinatal mental health care in a powerful way.”

For related information, see the Psychiatric News article “Perinatal Treatment Requires Careful Risks, Benefit Consideration.”

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Tuesday, March 4, 2025

CBT Focused on Shifting Attention to External Cues Found Most Effective for Social Anxiety Disorder

Cognitive behavioral therapy (CBT) is the most efficacious psychotherapy for social anxiety disorder, according to a meta-analysis in the Journal of Affective Disorders.

Linghan Sun, of Southwest University in Chongqing, China, and colleagues analyzed data from 92 studies covering 90 randomized control trials and involving 6,971 participants. The selected studies examined multiple CBT protocols as well as cognitive restructuring, exposure therapy, psychodynamic therapy, interpersonal therapy, and/or mindfulness-based interventions to control conditions such as treatment as usual, placebo, and a waitlist. The researchers also explored the efficacy of different delivery formats (e.g., face-to-face versus online).

Overall, CBT modalities were the most efficacious, particularly the Clark and Wells protocols, which aim to help individuals with social anxiety disorder (SAD) shift their attention away from internal negative thoughts and toward external cues in social situations. The Hope, Heimberg, and Turk CBT protocols, which focus on verbal cognitive restructuring and exposure to feared situations, were also effective. Among the CBT models developed specifically for the online treatment of SAD, the Andersson and Carlbring protocols, which center on behavioral activation, had the highest efficacy. In terms of treatment delivery, clinician-guided, individual face-to-face CBT yielded the best efficacy, whereas self-help book–based CBT was the least effective. Psychodynamic therapy was the most effective non-CBT treatment.

“[B]y ranking treatments based on their relative effectiveness in reducing severity of SAD symptoms, clinicians could make more informed decisions about which psychotherapy might be most suitable for their patients,” the researchers wrote. “Furthermore, clinicians will be able to flexibly choose the suitable delivery formats of CBT based on the specific situation.”

For related information, see the Focus article “Cognitive-Behavioral Treatments for Anxiety and Stress-Related Disorders.”

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Monday, March 3, 2025

One in 10 Patients Starts Buprenorphine Treatment for OUD via Telehealth

One in 10 buprenorphine initiations is provided via telehealth, and about 20% of those involved no in-person visit within two years prior or 30 days after, according to a study in today’s JAMA Network Open.

“Our findings suggest that telehealth initiation of buprenorphine without a prior in-person visit is an important pathway for accessing this lifesaving treatment for adults with opioid use disorder,” lead investigator Beth McGinty, Ph.D., M.S., of Weill Cornell Medicine, told Psychiatric News. “The pending final rule on telehealth would support this access, and given that we know buprenorphine reduces risk of opioid overdose by 50%, it would save lives.”

The Drug Enforcement Administration issued a final rule in the waning days of the Biden administration that would allow a clinician to teleprescribe up to six months of buprenorphine without an in-person visit as long as the clinician reviewed the prescription drug monitoring program for the state where the patient resides. The rule had been scheduled to take effect in mid-February, but the Trump administration issued an executive order pausing all federal rules not yet in effect, pending further review.

McGinty and colleagues used IQVIA data to assess buprenorphine initiations from March 2020 through November 2022. The researchers included physicians who continuously practiced from 2018 to 2022 and who had treated at least one patient with opioid use disorder. They measured their proportion of telehealth initiations that had no in-person visit with the prescribing clinician within two years prior, and no in-person visit within two years prior or 30 days after.

During the study timeframe, about 10% of the 228,598 total buprenorphine initiations were via telehealth, involving 3,950 clinicians and 21,220 patients. Among these telehealth initiations, 28% had no in-person visit with the prescribing clinician in the prior two years, while 20% had no in-person visit with the prescriber two years prior or 30 days after. The proportion of telehealth initiations with no in-person visit before or after was higher among behavioral health physicians (27% of all telehealth initiations) than primary care physicians (15%) and nurse practitioners or physician assistants (22%).

“In-person visit requirements can impede access due to limited in-person provider appointment availability and other barriers, such as transportation,” McGinty said. “Additional research is needed to compare the effectiveness of telehealth buprenorphine initiations with and without in-person visits to determine if six months is the ‘right’ duration and to consider … whether fully remote telehealth models with no in-person visits are able to deliver comparably safe and effective care.”

For related information, see the Psychiatric News article “New Rules Allow Telehealth Prescribing, but ‘Special Registration’ Proposal May Create Barriers to Care.”

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