BackgroundThe neuroimaging mechanism of major depressive episodes with mixed features (MMF) is not clear.AimsThis study aimed to investigate the functional connectivity of the default mode network (DMN) subsystems among patients with MMF and patients with major depressive disorder without mixed features (MDDnoMF).MethodsThis study recruited 47 patients with MDDnoMFand 27 patients with MMF from Beijing Anding Hospital, Capital Medical University, between April 2021 and June 2022. Forty-five healthy controls (HCs) were recruited. All subjects underwent resting-state functional magnetic resonance imaging scanning and clinical assessments. Intranetwork and internetwork functional connectivity were computed in the DMN core subsystem, dorsal medial prefrontal cortex (dMPFC) subsystem and medial temporal lobe (MTL) subsystem. Analysis of covariance method was performed to compare the intranetwork and internetwork functional connectivity in the DMN subsystems among the MDDnoMF, MMF and HC groups.ResultsThe functional connectivity within the DMN core (F=6.32, pFDR=0.008) and MTL subsystems (F=4.45, pFDR=0.021) showed significant differences among the MDDnoMF, MMF and HC groups. Compared with the HC group, the patients with MDDnoMFand MMF had increased functional connectivity within the DMN MTL subsystem, and the patients with MMF also showed increased functional connectivity within the DMN core subsystem. Meanwhile, compared with the MDDnoMF, the patients with MMF had increased functional connectivity within the DMN core subsystem (mean difference (MDDnoMF−MMF)=−0.08, SE=0.04, p=0.048). However, no significant differences were found within the DMN dMPFC subsystem and all the internetwork functional connectivity.ConclusionsOur results indicated abnormal functional connectivity patterns of DMN subsystems in patients with MMF, findings potentially beneficial to deepen our understanding of MMF’s neural basis.

Aims The pattern of suicidality in older patients with psychiatric disorders during the COVID-19 pandemic is not clear. This study examined the prevalence of suicidality and its association with quality of life (QOL) among older clinically stable patients with psychiatric disorders during the COVID-19 pandemic. Methods A multicenter, cross-sectional study was conducted from May 22 to July 15, 2020, among four major tertiary psychiatric hospitals in China. Suicidality was assessed by asking 3 standardized questions. Depressive symptoms, pain, and QOL were assessed with the 9-item Patient Health Questionnaire (PHQ-9), the numeric pain rating scale (NPRS), and the World Health Organization Quality of Life Questionnaire-brief version, respectively. Results A total of 1063 clinically stable patients participated and completed the assessment. The prevalence of suicidality was 11.8% (95% CI: 9.9%–13.7%) during the COVID-19 pandemic. Multiple logistic regression analysis revealed that poor treatment adherence (P = .009, OR = 1.86, 95% CI: 1.17–2.96) and perceived illness worsening during the COVID-19 outbreak (P = .02, OR = 2.07, 95% CI: 1.15–3.73), being diagnosed with major depressive disorder (P < .001, OR = 2.79, 95% CI: 1.68–4.64), PHQ-9 total score (P < .001, OR = 1.20, 95% CI: 1.15–1.24) and NPRS total score (P = .002, OR = 1.17, 95% CI: 1.06–1.29) were associated with higher risk of suicidality. After controlling for covariates, older psychiatric patients with suicidality had lower QOL compared to those without (F(1, 1063) =16.5, P<.001). Conclusions Suicidality was common in older patients with clinically stable psychiatric disorders during the COVID-19 pandemic. Considering its negative impact on QOL and personal suffering, routine screening and preventive suicide measures should be implemented for older psychiatric patients.