Introduction: Post-COVID syndrome (PCS) can lead to severe restrictions in the ability to work and participate in society and can lead to the development of depressive symptoms. The aim of this study was to investigate how many PCS patients suffer from clinically relevant depressive symptoms and to what extent PCS rehabilitation can modulate psychological symptoms as well as limitations in functional health. Methods: Prospective multicenter cohort study PoCoRe (N = 1,028). Assessment of depressiveness (PHQ-9, PHQ-2), fatigue (FSMC) and functional health and disability (WHO-DAS2.0). Frequency analyses, mean comparisons. Results: At the start of rehabilitation, 71.4% (n = 734) fulfilled the core symptoms of depressive disorders in general in the PHQ-2. In the screening-positive patients, the PHQ-9 total score was on average M = 23.74 (standard deviation = 4.43). As expected the depressive symptom burden was reduced more in depressed PCS patients (d = 0.50) than in nondepressed PCS patients (d = 0.32). Fatigue symptoms did not change. Functional health (WHO-DAS) improved above all in coping with everyday life (d = 0.71, or 1.04), and in the nondepressed patients also in mobility (d = 0.27). In the sociomedical assessment, 24.7% of the total samples were assessed as having an impaired capacity for the reference occupation and 19.5% as having an impaired capacity for the general labor market. Depressive patients had the worse sociomedical outcome. Conclusion: Depressiveness is common and can be well influenced by PCS rehabilitation. Fatigue is less easily influenced, which indicates that they are independent symptoms. Patients with persistent depression and fatigue have a poorer sociomedical prognosis.

Plain Language SummaryAgoraphobia is a condition where people feel strong fear or anxiety in everyday situations, such as taking public transport, waiting in a line, or going to crowded places. This fear often leads them to avoid these situations, which can seriously affect daily life. Many people experience these difficulties even if they do not have a formal mental health diagnosis, and they often do not seek professional help because of stigma. This study tested whether a virtual reality (VR) program called gameChange could help adults in Hong Kong who had agoraphobic symptoms but no psychiatric diagnosis. VR allows people to practise facing feared situations in a safe, computer-generated environment, guided by a virtual coach. The program was adapted to the local context, with settings such as buses, cafés, and clinics designed to reflect Hong Kong. A total of 272 adults took part. Half received three one-hour VR sessions over 3 weeks, while the other half were placed on a waitlist. Compared to those on the waitlist, people who used VR showed large improvements in avoiding feared situations, as well as reductions in social anxiety, general anxiety, depression, and difficulties in daily functioning. These benefits were still present 1 month after the program ended. Those with more severe symptoms at the start of the study gained the most from the VR training. The findings suggest that automated VR programs can be an effective and scalable way to help people manage agoraphobic symptoms, especially in communities where seeking help is difficult.

Plain Language SummaryExperiencing traumatic events can lead to the development of posttraumatic stress disorder (PTSD), a condition that is burdensome for patients and their loved ones. This study investigated the effects of a novel form of psychotherapy for PTSD called multi-modal motion-assisted memory desensitization and reconsolidation (3MDR). In this treatment, patients process traumatic events while walking on a treadmill in a virtual environment. The virtual environment is personalized by self-selected pictures and music that remind the person of the traumatic events. We investigated this treatment in 134 military veterans and first responders (such as police officers, firefighters and paramedics) in three treatment centers in the Netherlands. They had PTSD after work-related traumatic events such as losing a mate in a bombing, witnessing a suicide, unsuccessful resuscitation of a child, or severe violence by hooligans. They had not received trauma therapy before. Half of the participants received 3MDR and the other half received standard trauma therapy in a sitting position. Results showed that 3MDR measured up to standard trauma therapy, even though it was given in fewer treatment sessions. Effects on a range of questionnaires (measuring PTSD, depressive symptoms, avoidance, and daily functioning) were comparable. The fact that 3MDR could be given in a smaller number of sessions may be advantageous for patients and therapists. 3MDR may also efficiently address multiple traumatic memories. Moreover, walking in 3MDR can appeal to veterans and first responders who are often physically active in their work. The findings of the study support the application of 3MDR as a first treatment for work-related PTSD.

Plain Language SummaryAccess to effective treatment for post-traumatic stress disorder (PTSD) is limited in low mental health resource regions (LRRs), a challenge that is particularly pronounced in populous countries such as China. This study tested a new telehealth therapy called guided written exposure (GWE), designed to be more accessible for patients in China. GWE integrates the storytelling approach of Narrative Exposure Therapy with the writing format of Written Exposure Therapy, incorporates a comprehensive psychoeducation component, and is delivered through 5–8 modular video sessions over a 3-week period. We conducted a study with 95 adults in China who had PTSD (n = 81) or subclinical PTSD (n = 14). Participants were randomly assigned to either receive GWE (n = 65) or to a comparison group that received brief weekly check-ins (minimal contact control; MCC; n = 30). The GWE group showed a greater improvement in PTSD, depression, and insomnia symptoms compared to the MCC group at posttreatment and 1-month after the treatment ended. These positive effects were still present 6 months after treatment ended, and 88% of the participants completed the therapy. At the 6-month follow-up, 45 participants (69%) in the GWE group had achieved clinically significant improvement. These findings suggest that GWE may be an effective treatment for Chinese PTSD patients. Its LRR-friendly format has the potential to reach more people with PTSD.

Introduction: Understanding chronic stress as a potential risk factor for COVID-19 progression could inform public health measures and personalized preventive interventions. Therefore, we investigated the influence of chronic stress prior to SARS-CoV-2 infection on symptom persistence 1 month after COVID-19 onset. Methods: The participants of this prospective cohort study named “StressLoC” were adults with COVID-19 who had tested positive for SARS-CoV-2 infection within the last 7 days. Pre-existing perceived chronic stress assessed by the Perceived Stress Scale (PSS-10) was the primary predictor. The number of stressful life events and hair cortisol concentration served as additional measures of pre-existing chronic stress. The main outcome was examined using the Long COVID Symptom and Impact Tool. It was defined as the presence of any new and impactful COVID-19-related symptom at month 1 after inclusion. Accordingly, participants were assigned to either the ongoing symptomatic COVID-19 group (OSC-G) or control group. Results: The study cohort comprised 288 participants (73.3% female), with a median age of 46 years (IQR 35–56). A total of 210 participants (72.9%) were categorized as OSC-G. Multivariate logistic regression showed that allocation to OSC-G was predicted by perceived chronic stress in the month prior to COVID-19 (OR: 1.08, 95% CI: 1.03–1.14; p = 0.002) and the number of pre-existing symptoms (OR: 1.08, 95% CI: 1.03–1.13; p = 0.001). The number of stressful life events and hair cortisol concentration did not predict OSC-G allocation. Conclusions: Results suggest that higher levels of pre-existing perceived chronic stress increase the odds of developing ongoing symptomatic COVID-19.

Introduction: Most previous mortality research in eating disorders (EDs) involves individuals attending specialist treatment services. Data linkage across jurisdictional health databases at a population level improves the generalisability of findings. This study investigates mortality risk and causes of death for people with an ED across a large geographic region using administrative health datasets. Methods: Using linked hospital, mental health, and death records, a retrospective cohort study was conducted including individuals aged 10–59 years who received an ED diagnosis during hospital-based encounters in Australia, over a 10-year period between 2010 and 2019. A contemporary cohort of people accessing community care only was also evaluated. Mortality rates and standardised morality ratios (SMRs) compared to the general population were calculated for each state, and by sex and age groups. Cox regression models were used to assess the risk of socio-demographic characteristics on mortality. Results: Mortality in people hospitalised with an ED (N = 19,697) was more than four times higher than the general population (SMR: 4.54), and highest in people aged 30–39 years (SMR: 13.32). Men hospitalised for EDs had a higher risk of death. Mortality rates in anorexia nervosa were not higher than other ED diagnoses. Almost three-quarters of deaths were caused by suicide/self-harm or cardio/respiratory illness. Conclusion: People accessing hospital care with EDs in Australia have a higher risk of premature death regardless of age, sex, or ED diagnosis. Gender and age group disparities can inform policy and resource allocation and support the development of targeted interventions.

Introduction: Individuals with a personality disorder (PD) often report high exposure to adverse events. Given the strong link between negative life events and PD pathology, it is essential to evaluate trauma-focused treatments in this population. This study evaluated the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy versus waitlist in reducing post-traumatic stress disorder (PTSD) symptoms and diagnostic status, distinguishing between patients with and without PTSD. Second, it examined the impact of EMDR therapy on adverse event memories, both meeting and not meeting Criterion A for PTSD. Methods: Participants (n = 159) were randomly assigned to EMDR therapy or a waitlist. PDs were assessed using the Structured Clinical Interview for DSM-5. PTSD symptoms and diagnoses were evaluated using the Clinician-Administered PTSD Scale for DSM-5. Secondary analyses examined the effectiveness of EMDR on various types of memory. Results: Significant group-by-time interactions showed a greater reduction in PTSD symptoms in the EMDR therapy group, regardless of the baseline PTSD diagnosis. In patients with PTSD, large effects were found post-treatment (d = 1.26; control: d = 0.28) and at follow-up (d = 1.5; control: d = 0.69). In patients without PTSD, moderate to large effects emerged post-treatment (d = 0.77; control: d = 0.18) and at follow-up (d = 1.09; control: d = 0.46). EMDR therapy reduced symptoms associated with Criterion A trauma and other adverse events. Post-treatment, 65.5% of EMDR patients lost their PTSD diagnosis, increasing to 73.1% at the follow-up. Conclusion: EMDR effectively reduced PTSD symptoms in individuals with a PD, regardless of PTSD diagnosis, and proved effective for memories that did not meet Criterion A.

Introduction: Managing chronic pain is a significant healthcare challenge that requires a multimodal treatment approach. In particular, the frequent presence of comorbid insomnia symptoms and its complex bidirectional relationship with pain provides a challenge to adequate treatment. This study was set up to test whether the addition of digital cognitive behavioral therapy for insomnia (dCBT-I) to the regular treatment of chronic pain can improve symptoms in a population comorbid chronic pain and insomnia, when compared to a waitlist control (WLC) condition. Methods: Participants meeting criteria for chronic pain and insomnia were randomized (1:1) to either dCBT-I or WLC. Assessments took place at baseline, 8 and 24 weeks post-randomization. The primary outcome was insomnia severity (Insomnia Severity Index [ISI]). Secondary outcomes included sleep- and pain-related symptoms as well as measures of well-being and dreams. Linear mixed models were calculated to determine between-group differences. Results: A total of 207 participants (182 women, mean age = 51.96 ± 12.97 years) were randomized to dCBT-I (n = 103) or WLC (n = 104). The dCBT-I group showed large improvements in the severity of insomnia compared to the WLC both after 8 (−4.36, p < 0.001; d = −1.18) and 24 weeks (−4.88, p < 0.001; d = −1.32). Pain-related impairments and life control also improved, favoring dCBT-I (ds = 0.22–0.35). Moderate-to-large treatment effects were also observed for secondary outcomes, including daytime sleepiness, fatigue, and dysfunctional beliefs and attitudes about sleep (ds = 0.47–1.12). Conclusion: This study confirmed the effects of dCBT-I in reducing the severity of insomnia in individuals with chronic pain and insomnia. Improvements in symptoms of chronic pain further emphasize the potential of dCBT-I as a scalable, evidence-based intervention to address the complex challenges of dual pathology in clinical practice, and it presents a promising extension of multimodal pain management.