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Suicide remains a critical global public health issue, accounting for nearly one million deaths annually and imposing profound societal and economic burdens. Despite its urgency, the lack of diagnostic and predictive biomarkers continues to hinder the development of effective prevention and treatment strategies. This study presents a comprehensive meta-analysis that integrates publicly available postmortem brain transcriptomic datasets and a domestic cohort, encompassing 16 cohorts. The transcriptomic data, sourced from the Gene Expression Omnibus repository, were generated using various techniques, including traditional RNA sequencing, microarray methods, and single-cell RNA sequencing. Differential expression analyses were performed across multiple brain regions, with meta-analyses stratified by cortical regions, the dorsolateral prefrontal cortex (DLPFC), and combined. We further analyzed whether covariates may affect the identified genes. Three meta-analytic approaches were employed, complemented by pathway and cell-set enrichment analyses. The unadjusted meta-analysis consistently identified several genes with altered expression, including upregulated P2RY12, CX3CR1, and GPR34, and downregulated SOX9 and PMP2, all at nominal significance. Additionally, multiple genes encoding long non-coding RNAs (lncRNAs) exhibited nominally altered expression in suicide, including RP5-837J1.4, AC159540.14, DNM1P47, AC004158.2, EEF1A1P30, and RP11-339B21.8. Several alternative strategies to run meta-analysis were performed and moderators were investigated. Cell-type-specific expression deconvolution and meta-analysis identified several genes overlapping with bulk expression meta-analysis, and genes were attributed to neuronal lineages. These findings highlight plausible molecular targets for future validation studies, suggesting the involvement of microglia (P2RY12 and CX3CR1), astrocytes (SOX9), immune responses (GPR34), myelin regulation (PMP2), and epigenetic modulation via lncRNAs. This research advances the understanding of the molecular architecture of suicide and provides a foundation for future studies focused on targeted prevention and therapeutic interventions.

Six-month follow-up results from a trial investigating the effects of Radically Open Dialectical Behavior Therapy (RO-DBT) in individuals with anorexia nervosa are presented. Participants (N = 23; median age 20 years; 96% female) completed a 32-week RO-DBT intervention. Repeated Measures ANOVAs were used to examine changes over time. The primary outcome was eating disorder psychopathology. Exploratory outcomes were BMI, obsessive-compulsive personality traits, emotion regulation, work function and treatment utilization. Statistically significant reductions in eating disorder psychopathology, albeit mean EDE-Q scores remained above the established clinical cutoff, and increases in BMI from pre-treatment to post-treatment were sustained at 6-month follow-up with significant effects of time. A statistically significant reduction in the doggedness scale in FFOCI-SF was observed between pre-treatment and the 6-month follow-up. Findings suggest that participation in RO-DBT is associated with sustained improvements in eating disorder symptoms and BMI for individuals with anorexia nervosa, suggesting that RO-DBT is a treatment alternative for anorexia nervosa that warrants further evaluation in controlled trials.

Background: Patients with emotionally unstable personality disorder (EUPD) report increased use and exposure to interpersonal violence and experience significant interpersonal difficulties. The relationship between the type of self-reported interpersonal problems and interpersonal violence among individuals with EUPD remains unclear. This study investigates the association between interpersonal problems and the cumulative lifetime violence burden among suicidal women with EUPD.

Methods: The study included 103 women diagnosed with EUPD who had attempted suicide at least twice. The inventory of Interpersonal problems (IIP) and the Karolinska Interpersonal Violence Scale (KIVS) were used to assess interpersonal problems and lifetime violence load. The eight IIP subscales were grouped into two factors: Factor 1 (Domineering; Vindictive; Cold; Social avoidant) and Factor 2 (Nonassertive; Exploitable; Overly nurturant, and Intrusive).

Results: The mean T-scores for IIP subscales ranged from 56 to 63, while the KIVS total score varied from 0 to 19, with a mean of 7.63. Cumulative lifetime violence burden was significantly associated with IIP Factor 1 (Spearman’s rho=0.26, p=0.0081), but not with IIP Factor 2 (r=0.014, p=0.89). Linear regression analysis revealed that Factor 1 (t=2.99, p=0.0039) and global assessment of functioning (GAF) (t=-2.26, p=0.027) significantly predicted accumulated lifetime interpersonal violence. Further post-hoc analysis showed that individuals with higher violence burdens exhibited significantly greater interpersonal problems in the three domains of Factor 1 - Domineering/Controlling, Vindictive/Self-centered, and Cold/Distant.

Conclusions: Specific Interpersonal problems and low functioning seem to be associated with cumulative lifetime violence burden among suicidal women with EUPD. These interpersonal traits may serve as key targets for treatment and prevention.

Introduction: The association between increasing diagnosis rates of autism-related disorders (ASD-R) in Swedish regions and diagnosis rates of major depressive disorders (MDD) in adolescents remains unexplored.

Methods: Following STROBE guidelines, this pre-registered (https://osf.io/duvq7) observational study, utilizing registry data from 2008 to 2022 across the 21 Swedish regions, employed a generalized linear mixed model (GLMM) to analyze the association between ASD-R (ICD-10: F84) and MDD diagnosis rates (ICD-10: F32) in 15–19 year olds, with registered primary diagnoses considered. The GLMM included psychiatric care affiliation rates (PCAR) as fixed effects and variations across years and regions as random intercepts. The model incorporated bipolar disorder (BD) rates and the male-to-female ratio of ASD-R diagnoses when justified. Separate models were created for combined sexes, males, and females.

Results: A significant inverse relationship was observed between ASD-R and MDD diagnosis rates across all sex groups. In the combined-sex model, the mean ratio was 0.40 (P = 0.003), while the sex-specific models showed ratios of 0.28 for males (P < 0.001) and 0.37 for females (P = 0.017). All ratios were significantly below 1, indicating a negative association between ASD-R and MDD diagnosis rates.

Conclusions: The study's observational nature limits causal inferences, but findings reveal that higher primary diagnosis rates of ASD-R correlate with lower primary diagnosis rates of MDD in adolescents of both sexes, although more pronounced in males. These results highlight the importance of further research on the relationship between ASD-R and MDD diagnosis rates, emphasizing the need for prospective, longitudinal, and individualized register data that include both primary and co-diagnoses.

Anorexia nervosa (AN) is a serious health condition with insufficient treatment options. Radically Open Dialectical Behavior Therapy (RO-DBT) offers a new treatment approach targeting maladaptive overcontrol, a proposed underlying mechanism in AN. This study evaluated the feasibility, acceptability, and the preliminary efficacy of a 32-week standard RO-DBT intervention for individuals with AN in an outpatient setting. Twenty-three participants with AN (median age 20 years; median illness duration 5 years; 95.7% female) were included. Feasibility was demonstrated by a high retention rate (83%) and satisfactory completion of outcome measures, while acceptability was demonstrated by high treatment satisfaction. Participation in RO-DBT was associated with significant reductions in eating disorder psychopathology (95% CI: 0.34–1.45, Cohen’s d = 0.90), significant increase in BMI (95% CI: 0.22–1.24, Cohen’s d = 0.74), and increased use of the emotion regulation strategy cognitive reappraisal (95% CI: 0.19–1.20, Cohen’s d = 0.70). These findings suggest that RO-DBT is a feasible, acceptable, and potentially effective treatment for AN.

Objective: To explore the impact on female partners of the discovery that their significant other is under investigation for Child Sexual Abuse Material (CSAM) offences, with a focus on the need for professional support.

Design: Semi-structured interviews were conducted and analyzed using reflexive thematic analysis.

Participants: Eight women partnered with men under investigation for CSAM offences.

Setting: ANOVA, a center for sexual medicine, andrology, and trans medicine at Karolinska University Hospital, Stockholm, Sweden.

Results: The findings show severe negative mental health impacts on partners following a disclosure that their significant other had committed CSAM offences. Identified healthcare needs include (1) crisis support in connection with police raid; (2) medical evaluation including suicide risk assessment and follow-up visits; and (3) counseling to manage shame, guilt, self-blame, and ambivalence regarding the future of the relationship. Significant barriers that hinder affected women from seeking and receiving support from friends and family as well as accessing healthcare services were also identified.

Conclusion: Female partners of CSAM offenders have healthcare needs that are currently inadequately met by the Swedish healthcare system. Healthcare professionals, both in primary care and sexual medicine clinics, may significantly contribute to improving treatment for this population. However, there is a need for improvement of healthcare practitioners’ knowledge of the experiences and needs of family members of sexual offenders.

Introduction: Compassion-focused therapy (CFT) has shown promising outcomes for young people, but research on CFT for this population remains limited. This study aims to evaluate the feasibility and acceptability of a seven-session, therapist-led, internet-based group CFT for young people, and to investigate its preliminary effects.

Methods: A two-arm pilot randomized controlled trial (RCT) was conducted. The study included 42 participants (aged 15–20), experiencing mild to moderate stress, anxiety, or depression, most of whom (90%) were female. In the intervention group, 22 participants were included in the intention-to-treat (ITT) analysis. The trial was registered at ClinicalTrials.gov (NCT05448014).

Results: The intervention group had low attrition and moderate attendance, with 77% completing four or more modules. No adverse events were reported, and participants generally expressed satisfaction with the intervention. Linear regression models showed preliminary between-group differences in two variables. Depressive symptoms increased post-intervention for individuals in the intervention group compared to the waitlist (WL) group (p = 0.002). Self-compassion improved in the intervention group (p = 0.023). These patterns were consistent among participants who completed more than two sessions. Within-group analyses indicated moderate, significant improvements in stress, self-compassion and compassion from others.

Discussion: These preliminary results suggest that CFT is feasible and acceptable and may offer benefits for young people, particularly by enhancing self-compassion and compassion for others. The observed increase in depressive symptoms in the intervention group, despite improvements in self-compassion, warrants further investigation. Larger studies are needed to confirm these preliminary results and to better understand the underlying mechanisms.

Introduction: Online group compassion-focused therapy (CFT) has not been thoroughly studied in young people, and the participants' perspectives on the treatment are highly relevant.

Methods: A seven-session internet-based group CFT program was evaluated for young people aged 15–20 (n = 42, females = 37). A self-report evaluation questionnaire, specifically designed for this study, was administered post-intervention. The current study investigated: (1) Potential factors influencing the treatment program goals (increase self-compassion, reduce self-criticism and increase affect-regulation abilities) and the participants' overall experience of the treatment; and (2) The effect each intervention exercise had on the program goals according to the participants' ratings.

Results: Participants generally reported high satisfaction and had a high attendance rate. Only 2.4% of the participants completed less than half of the sessions and 71% of the participants attended at least six of the seven sessions. Exercises that integrated traditional cognitive-behavioral therapy (CBT) and Compassion-Focused Therapy (CFT) principles received high ratings, whereas breathing and mindfulness exercises were rated lower in many cases. Several compassion exercises were also highly rated, such as the Threat-drive and security system, based on CFT affect-regulation theory. The majority did not find home assignments helpful.

Discussion: The findings suggest that internet-based group CFT could be an easily accessible and acceptable intervention for young people in primary care, though further research is warranted.

Background: Sexual Interest in Children (SIC) is a major risk factor for sexual offending, yet clinical trials are sparse. The present protocol outlines a randomized controlled trial (RCT) that aims to investigate the effectiveness of fluoxetine and Cognitive Behavioral Therapy (CBT) in help-seeking men with SIC.

Methods: Adult men contacting the Swedish telephone helpline PrevenTell are screened for inclusion and invited to further assessment on site. One hundred and eleven men with SIC (defined as DSM-5 pedophilic disorder or hebephilia) will be randomized (1:1:1 ratio) to receive one of three interventions for 14 weeks: (1) an internet-administered psychoeducational program (iPP), (2) iPP and the addition of fluoxetine 20-40 mg or (3) iPP and the addition of internet-administered CBT (iCBT). Exclusion criteria include severe psychiatric illness, contraindicating treatment and an elevated risk of committing hands-on sexual offences. Symptom intensity is assessed at baseline, pre-treatment, every other week for 12 weeks, and post treatment. The primary outcome measure is the Sexual Interest in Children: Current Assessment Scale (SIC: CAS) that quantifies sexual behaviors associated with SIC as well as perceived distress and impairment. Secondary outcomes include measures of dynamic risk-factors for committing sexual offences.

Results: The data collected during the initial 20 months of recruitment were analyzed to predict the required number of individuals to be screened and estimate the probable length of the data collection phase. As of March 2022 to November 2023, 146 men have called PrevenTell and disclosed a sexual interest in minors. Following pre-screening, 110 men were excluded from participation in the trial. Current SSRI therapy was the primary reason for exclusion (n = 24; 22%), followed by an elevated risk of committing hands-on sexual offences (n = 14; 13%). Among the 31 men who underwent the screening procedure on site, 26 were allocated to either iPP, iPP+fluoxetine, or iPP+iCBT. The recruitment rate indicates that the trial will be concluded within the pre-estimated timeframe.

Discussion: This is the first RCT of treatment with SSRI and iCBT in a population of help-seeking men with SIC. The significance of this trial and its methodological strengths and limitations are discussed.

Emotional unstable personality disorder (EUPD; previously borderline personality disorder, BPD) is associated with excess natural-cause mortality, comorbid medical conditions, poor health habits and stress related epigenomic alterations. Previous studies demonstrated that GrimAge – a state-of-the-art epigenetic age (EA) estimator – strongly predicts mortality risk and physiological dysregulation. Herein, we utilize the GrimAge algorithm to investigate whether women with EUPD and a history of recent suicide attempts exhibit EA acceleration (EAA) in comparison to healthy controls. Genome-wide methylation patterns were measured using the Illumina Infinum Methylation Epic BeadChip in whole blood from 97 EUPD patients and 32 healthy controls. The control group was significantly older (p < 0.0001) and reported lesser exposure to violent behavior in both youth and adulthood (p < 0.0001). Groups were otherwise comparable regarding gender, BMI, or tobacco usage (p > 0.05). EA estimator DNAmGrimAge exceeded chronological age by 8.8 and 2.3 years in the EUPD and control group, respectively. Similarly, EAA marker AgeAccelGrim was substantially higher in EUPD subjects when compared to controls, in both univariate and multivariate analyzes (p < 0.00001). Tobacco usage conferred substantial within-group effects on the EA-chronological age difference, i.e., 10.74 years (SD = 4.19) compared to 6.00 years (SD = 3.10) in the non-user EUPD group (p < 0.00001). Notably, past alcohol and substance abuse, use of psychotropic medications, global assessment of functioning, self-reported exposure to violent behavior in youth and adulthood, later completed suicide (N = 8) and age at first suicide attempt did not predict EAA in the EUPD group (p > 0.05). These results underscore the importance of addressing medical health conditions along with low-cost preventative interventions aimed at improving somatic health outcomes in EUPD, such as efforts to support cessation of tobacco use. The independency of GrimAge to other EA algorithms in this group of severely impaired EUPD patients, suggest it may have unique characteristics to evaluate risk of adverse health outcomes in context of psychiatric disorders.