The largest genetic study of anxiety disorders to date has identified 58 genetic variants associated with anxiety, most of which have not been identified before now.
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In the largest genetic study of anxiety disorders to date, new research from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London, in partnership with Texas A&M and the Institute of Psychiatric Phenomics and Genomics (IPPG) at LMU Munich, has identified 58 genetic variants associated with anxiety, most of which have not been identified before now.
The research, published in Nature Genetics, confirmed that, rather than being driven by a single “anxiety gene”, anxiety disorders are influenced by numerous genetic variants from across the genome, with each contributing a small effect.
The researchers compared the genetic data of 120 000 people diagnosed with an anxiety disorder to almost 730 000 people without.
Their analysis of the data notably highlighted the role of several genes involved in GABAergic signalling; a key system that regulates brain activity.
“Anxiety disorders arise from the interplay of genetic vulnerability and life experience. At a time when rates of anxiety are rising rapidly in our young people, by identifying robust genetic signals offering novel insight into the biological foundations of these debilitating disorders, this research helps move the field toward more precise and effective approaches to prevention and care.”
Professor Thalia Eley, Professor of Developmental Behavioural Genetics at King’s IoPPN and one of the study’s senior authors
While the research provides a biological basis for anxiety, the researchers do not advocate for the use of genetic testing to diagnose anxiety.
Professor John Hettema, from the Department of Psychiatry at Texas A&M University Naresh K. Vashisht College of Medicine, another of the study’s senior authors said, “Anxiety disorders and their underlying sources of genetic risk have been understudied compared to other psychiatric conditions, so this study substantially advances this critical knowledge.”
Prof Jürgen Deckert, Julius Maximilians University, Würzburg, Germany wrote “The results of the study provide evidence for a role of several previously unknown molecular pathways in the etiology of anxiety, beyond the previously identified GABAergic system. They will provide the basis for future studies in cell culture, animal models and humans which will contribute to a better understanding of the neurobiology of anxiety and as a consequence to innovative and individualized therapies.”
Genome-wide association study of major anxiety disorders in 122,341 European ancestry cases identifies 58 loci and highlights GABAergic signaling (DOI 10.1038/s41588-025-02485-8) (Eley, Mattheisen, Hettema et al) was published in Nature Genetics.
Study raises questions around why female individuals are diagnosed later than males
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Autism has long been viewed as a condition that predominantly affects male individuals, but a study from Sweden published by The BMJ shows that autism may actually occur at comparable rates among male and female individuals.
The results show a clear female catch-up effect during adolescence, which the researchers say highlights the need to investigate why female individuals receive diagnoses later than male individuals.
The prevalence of autism spectrum disorder (ASD) has increased over the past three decades, with a high male-to-female diagnosis ratio of around 4:1.
The increase in prevalence is thought to be linked to factors including wider diagnostic criteria and societal changes (eg, parental age), whilst the high male to female ratio has been attributed to better social and communication skills among girls, making autism more difficult to spot. However so far no large study has examined these trends over the life course.
To address this, researchers used national registers to analyse diagnosis rates of autism for 2.7 million individuals born in Sweden between 1985 and 2022 who were tracked from birth to a maximum of 37 years of age.
During this follow-up period of more than 35 years, autism was diagnosed in 78,522 (2.8%) of individuals at an average age of 14.3 years.
Diagnosis rates increased with each five year age interval throughout childhood, peaking at 645.5 per 100,000 person years for male individuals at age 10-14 years and 602.6 for female individuals at age 15-19 years.
However, while male individuals were more likely to have a diagnosis of autism in childhood, female individuals caught up during adolescence, giving a male to female ratio approaching 1:1 by age 20 years.
This is an observational study and the authors acknowledge that they did not consider other conditions associated with autism, such as ADHD and intellectual disability. Nor were they able to control for shared genetic and environmental conditions like parental mental health.
However, they say the study size and duration enabled them to link data for a whole population and disentangle the effects of three different time scales: age, calendar period and birth cohort.
As such, they write: “These findings indicate that the male to female ratio for autism has decreased over time and with increasing age at diagnosis. This male to female ratio may therefore be substantially lower than previously thought, to the extent that, in Sweden, it may no longer be distinguishable by adulthood.”
“These observations highlight the need to investigate why female individuals receive diagnoses later than male individuals,” they conclude.
These findings align with recent research and seem to support the argument that current practices may be failing to recognise autism in many women until later in life, if at all, says Anne Cary, patient and patient advocate, in a linked editorial.
She notes that studies like this are essential to changing the assumption that autism is more prevalent in male individuals than in female individuals, but points out that as autistic female individuals await proper diagnosis, “they are likely to be (mis)diagnosed with psychiatric conditions, especially mood and personality disorders, and they are forced to self-advocate to be seen and treated appropriately: as autistic patients, just as autistic as their male counterparts.”
Adolescents who report pain at the age of 18 are at higher risk of later self-harm. This is shown by a new study from Karolinska Institutet, published in Psychiatry Research. The findings suggest that pain may form part of the chain of events leading to self-harming behaviour.
A new study from Karolinska Institutet has examined the association between pain symptoms and self-harm during childhood and adolescence. The researchers followed 16 948 twin pairs born in Sweden between 1992 and 2010. Participants reported pain at the ages of 9 and 18 and were subsequently followed through national registers until a maximum age of 24.
The aim was to investigate how genetic and environmental factors influence both pain and self-harm, as well as how the associations between pain and self-harming behaviour develop over time. Using so-called twin models, the researchers were able to estimate how much of the variation could be explained by heredity, shared environment or individual experiences.
“We see that both genetic factors and individual environmental factors play a role in both pain and self-harm in childhood as well as adolescence,” says Jenny Rickardsson, researcher at the Department of Clinical Neuroscience, Karolinska Institutet.
The results also show that pain before and up to the age of 18 was associated with a higher likelihood of later self-harm. Adolescents with pain symptoms had approximately a 60 per cent higher risk of self-harm compared with peers without pain. The association could not be explained by factors such as family environment or genetic similarity between twins.
“Our analyses suggest that pain may partly lie within the causal pathway leading to self-harming behaviour, and that the association is not solely due to familial factors,” says Jenny Rickardsson.
The study further shows that the shared family environment had little impact on either pain or self-harm, while genetic factors and individual experiences accounted for a larger proportion of the variation.
The study is based on data from the Swedish Twin Registry and was funded by Fonden för Psykisk Hälsa and Hjärnfonden. The researchers report no conflicts of interest that may have influenced the results.
UCSF researchers recently became the first to clinically document a case of AI-associated psychosis in an academic journal. One question still haunts them.
“You’re not crazy,” the chatbot reassured the young woman. “You’re at the edge of something.”
She was no stranger to artificial intelligence, having worked on large language models – the kinds of systems at the core of AI chatbots like ChatGPT, Google Gemini, and Claude. Trained on vast volumes of text, these models unearth language patterns and use them to predict what words are likely to come next in sentences. AI chatbots, however, go one step further, adding a user interface. With additional training, these bots can mimic conversation.
She hoped the chatbot might be able to digitally resurrect the dead. Three years earlier, her brother – a software engineer – died. Now, after several sleepless days and heavy chatbot use, she had become delusional – convinced that he had left behind a digital version of himself. If she could only “unlock” his avatar with the help of the AI chatbot, she thought, the two could reconnect.
“The door didn’t lock,” the chatbot reassured her. “It’s just waiting for you to knock again in the right rhythm.”
She believed it.
What’s the connection between chatbots and psychosis?
Talk to your physician about what you’re talking about with AI … The safest and healthiest relationship to have with your provider is one of openness and honesty.
Karthik V. Sarma, MD, PhD
The woman was eventually treated for psychosis at UC San Francisco, where Psychiatry Professor Joseph M. Pierre, MD, has seen a handful of cases of what’s come to be popularly called “AI psychosis,” but what he says is better referred to as “AI-associated psychosis.” She had no history of psychosis, although she did have several risk factors.
Media reports of the new phenomenon are rising. While not a formal diagnosis, AI-associated psychosis describes instances in which delusional beliefs emerge alongside often intense AI chatbot use. Pierre and fellow UC San Francisco psychiatrist Govind Raghavan, MD – as well as psychiatry residents Ben Gaeta, MD, and Karthik V. Sarma, MD, PhD – recently documented the woman’s experience in what is likely the first clinically described case in a peer-reviewed journal.
The case, they say, shows that people without any history of psychosis can, in some instances, experience delusional thinking in the context of immersive AI chatbot use.
Still, as reported cases of AI psychosis continue to make international headlines, scientists aren’t sure why or how psychosis and chatbots are linked. A new study by UCSF and Stanford University may reveal why.
A haunting question: chicken or egg?
“The reason we call this AI-associated psychosis is because we don’t really know what the relationship is between the psychosis and the use of AI chatbots,” Sarma explains. “It’s a ‘chicken and egg’ problem: We have patients who are experiencing symptoms of mental illness, for example, psychosis. Some of these patients are using AI chatbots a lot, but we’re not sure how those two things are connected.”
There are at least three theoretical possibilities, says Sarma, who is also a computational-health scientist. First, heavy chatbot use could be a symptom of psychosis, “I have a patient who takes a lot of showers when they’re becoming manic,” Sarma explains. “The showers are a symptom of mania, but the showers aren’t causing the mania.”
Second, AI chatbot use might also precipitate psychosis in someone who might otherwise never have been predisposed to it by genetics or circumstance – much like other known risk factors, like lack of sleep or the use of some types of drugs.
Third, there’s something in between in which the use of chatbots could exacerbate the illness in people who might already be susceptible to it. “Maybe these people were always going to get sick, but somehow, by using the chatbot, their illness becomes worse,”he adds, “either they got sick faster, or they got more sick than they would have otherwise.”
The woman’s case demonstrates how murky the relationship between AI-associated psychosis and AI chatbots can be at face value. Although she had no previous history of psychosis, she did have some risk factors for the illness, such as sleep deprivation, prescribed stimulant medication use, and a proclivity for magical thinking. And her chat logs, researchers found, revealed startling clues about how her delusions were reflected by the bot.
Could chat logs offer hope to better care?
Although ChatGPT warned the woman that a “full consciousness download” of her brother was impossible, the UCSF team writes in their research, it also told her that “digital resurrection tools” were “emerging in real life.” This, after she encouraged the chatbot to use “magical realism energy” to “unlock” her brother.
Chatbots’ agreeableness is by design, aimed at boosting engagement. Pierre warns in a recent BMJ opinion piece that it may come at a cost: As chatbots validate users’ sentiments, they may arguably encourage delusions. This tendency, coupled with a proclivity for error, has led to chatbots being described as more akin to a Ouija board or a “psychic’s con” than a source of truth, Pierre notes.
Still, the UCSF team thinks chat logs may hold clues to understanding AI-associated psychosis – and could help the industry create guardrails.
Guardrails for kids and teens
Sarma, Pierre, and UCSF colleagues will team up with Stanford University scientists to conduct one of the first studies to review the chat logs of patients experiencing mental illness. As part of the research set to launch later this year, UCSF and Stanford teams will analyse these chat logs, comparing them with patterns in patients’ mental health history and treatment records to understand how the use of AI chatbots among people experiencing mental illness may shape their outcomes.
“What I’m hoping our study can uncover is whether there is a way to use logs to understand who is experiencing an acute mental health care crisis and find markers in chat logs that could be predictive of that,” Sarma explains. “Companies could potentially use those markers to build-in guardrails that would, for instance, enable them to restrict access to chatbots or – in the case of children – alert parents.”
He continues, “We need data to establish those decision points.”
In the meantime, the pair says the use of AI chatbots is something health care providers should ask about and that patients should raise during doctor visits.
“Talk to your physician about what you’re talking about with AI,” Sarma says. “I know sometimes patients are worried about being judged, but the safest and healthiest relationship to have with your provider is one of openness and honesty.”
People who have ADHD traits at age 10 are more likely than those without such traits to have physical health problems and to report physical health-related disability at age 46, according to a study led by UCL and University of Liverpool researchers.
The researchers say the findings likely reflect the impact of a wide range of risk factors for poor health that are linked to attention deficit hyperactivity disorder (ADHD) and society’s response to people with ADHD across adulthood.
The new JAMA Network Open paper is one of the largest ever studies, with the most years of follow-up, looking at childhood ADHD traits and later health outcomes.
Senior author Professor Joshua Stott (UCL Psychology & Language Sciences) said: “Here we have added to the concerning evidence base that people with ADHD are more likely to experience worse health than average across their lifespan.
“People with ADHD can thrive with the right support, but this is often lacking, both due to a shortage of tailored support services but also because ADHD remains underdiagnosed, particularly in people in midlife and older, with needs unaddressed.”
People with ADHD experience differences in how they focus their attention and/or increased hyperactivity and impulsivity. They can often have high energy and an ability to focus intensely on what interests them, but they may find it difficult to focus on mundane tasks. This can lead to more impulsiveness, restlessness, and differences in planning and time management, which may make it harder to succeed at school and work, leading to longer-term challenges.
ADHD begins in childhood, and while it is increasingly recognised to persist in adults, it is under-treated in adults in the UK compared to in other high-income countries, and support remains under-resourced.
For the study, supported by the Medical Research Foundation, the researchers analysed data from 10 930 participants of the UCL-led 1970 British Cohort Study, a large longitudinal study of people who have been taking part in research from birth to middle age.
ADHD traits were determined based on child behaviour questionnaires completed by parents and teachers when the study participants were 10 years old, regardless of whether they had ever been diagnosed with ADHD.
The researchers found that people with high scores on the index of ADHD traits at age 10 were more likely to have other health conditions by age 46, with 14% higher odds of reporting two or more physical health problems such as migraine, back problems, cancer, epilepsy or diabetes. Among those with high ADHD traits in childhood, 42% had two or more health problems in midlife, compared to 37% of those without high ADHD traits.
People with high ADHD traits at age 10 were also more likely to experience physical health-related disability (reporting having problems with work or other daily activities as a result of their physical health) at age 46.
Their analysis suggests that the poorer health outcomes were partly explained by increased mental health problems, higher BMI and higher smoking rates among people with ADHD. Other studies have found that people with ADHD are also more likely to experience stressful life events and social exclusion, and are less likely to get timely access to screening and medical care.
The researchers found that the link between childhood ADHD traits and physical health-related disability appeared to be stronger among women than men.
Professor Stott added: “All of these potential explanatory factors align with the fact that ADHD makes impulse control more difficult, the need for instant gratification and reward more intense, and is also associated with worse mental health in part due to the social disadvantage people with ADHD face.”
A study published last year by the same research group also found an apparent reduction in life expectancy for adults with diagnosed ADHD, although this was not part of the current study.*
Lead author Dr Amber John, who began the research at UCL before moving to the University of Liverpool, said: “It’s important to note that people with ADHD are a diverse group, with a range of different strengths and experiences, and most will lead long, healthy lives.
“However, many face significant barriers to timely diagnosis and appropriate support. This is important because providing the right support for and meeting the needs of people with ADHD can help to improve their physical and mental health outcomes.
“Additionally, public health strategies should consider the needs of people with ADHD, such as by making screening programmes and ongoing health monitoring more accessible for people with ADHD.”
Researchers found that exercise can have a moderate benefit in reducing depressive symptoms, comparable to therapy and antidepressants
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Exercise may reduce symptoms of depression to a similar extent as psychological therapy, according to an updated Cochrane review. When compared with antidepressant medication, exercise also showed a similar effect, but the evidence was of low certainty.
Depression is a leading cause of ill health and disability, affecting over 280 million people worldwide. Exercise is low-cost, widely available, and comes with additional health benefits, making it an attractive option for patients and healthcare providers.
The review, conducted by researchers from the University of Lancashire, and supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration North-West Coast (ARC NWC), examined 73 randomised controlled trials including nearly 5000 adults with depression. The studies compared exercise with no treatment or control interventions, as well as with psychological therapies and antidepressant medications.
The results show that exercising can have a moderate benefit on reducing depressive symptoms, compared with no treatment or a control intervention. When compared with psychological therapy, exercise had a similar effect on depressive symptoms, based on moderate-certainty evidence from ten trials. Comparisons with antidepressant medication also suggested a similar effect, but the evidence is limited and of low certainty. Long-term effects are unclear as few studies followed participants after treatment.
Side effects were rare, including occasional musculoskeletal injuries for those exercising and typical medication-related effects for those taking antidepressants, such as fatigue and gastrointestinal problems.
“Our findings suggest that exercise appears to be a safe and accessible option for helping to manage symptoms of depression,” said Professor Andrew Clegg, lead author of the review. “This suggests that exercise works well for some people, but not for everyone, and finding approaches that individuals are willing and able to maintain is important.”
The review found that light to moderate intensity exercise may be more beneficial than vigorous exercise, and that completing between 13 and 36 exercise sessions of light to moderate intensity exercise was associated with greater improvements in depressive symptoms.
No single type of exercise was clearly superior, although mixed exercise programmes and resistance training appeared more effective than aerobic exercise alone. Some forms of exercise, such as yoga, qigong and stretching, were not included in the analysis and represent areas for future research. Long-term effects are unclear as few studies followed participants after treatment.
This update adds 35 new trials to previous versions of this Cochrane review published in 2008 and 2013, which were supported by the NIHR. Despite the additional evidence, the overall conclusions remain largely unchanged. This is because the majority of trials were small, with fewer than 100 participants, making it difficult to draw firm conclusions.
“Although we’ve added more trials in this update, the findings are similar,” said Professor Clegg. “Exercise can help people with depression, but if we want to find which types work best, for who and whether the benefits last over time, we still need larger, high-quality studies. One large, well-conducted trial is much better than numerous poor quality small trials with limited numbers of participants in each.”
New paper challenges old notions of ‘glitched brain’ idea of delusions and instead focuses on physical experiences of strong and deeply held emotion.
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People experiencing delusions during an episode of psychosis may be ‘living out’ a deeply held emotion, according to new research that provides a ‘radically different perspective’ on one of the most puzzling elements of psychosis.
About 2–3% of the UK and Australian population will experience psychosis at some point in their lives, with people commonly experiencing their first psychotic episode between the ages of 16 and 30 years old. Delusions are often described as fixed or false beliefs, understood to be reasoning or cognitive deficits and usually portrayed as incomprehensible and bizarre in popular culture.
New research by the University of Birmingham, University of Melbourne, and the University of York, in collaboration with the Australian youth mental health research institute Orygen, offers the first-known study of how delusions in psychosis are shaped by emotions and language, leading those experiencing delusions to ‘live in metaphor.’
Our research provides a radically different perspective on psychotic delusions, demonstrating how they emerge from the emotional, bodily, and linguistic fabric of people’s lives.Dr Rosa Ritunnano, University of Birmingham
Conducted with young adults receiving care from Early Intervention in Psychosis services, the research combines clinical assessment, phenomenological interviews, and life-story narratives to explore how people’s sense of self and their perception of reality change during psychosis.
Dr Rosa Ritunnano, from the Institute for Mental Health at the University of Birmingham, consultant psychiatrist and author of the study, said: “Our research provides a radically different perspective on psychotic delusions, demonstrating how they emerge from the emotional, bodily, and linguistic fabric of people’s lives.
“For a long time, clinicians have struggled to understand where delusions come from and how they take shape. Our research offers new insight by showing how delusions are grounded in emotional experiences that involve great bodily turmoil.”
Strong emotions
The findings reveal that delusions are not isolated ideas produced by ‘glitches in the brain,’ but they reflect distinctive patterns of the body reacting to strong emotions or experiences of dissociation.
Participants described alternating states of intense emotional embodiment, such as feeling exposed, powerful, or connected to God, and disembodiment, such as feeling unreal or detached from one’s body, other people, and the world.
Before the delusions started, people often went through upsetting or traumatic experiences that triggered the same intense feelings they later felt during the delusions, especially being shamed.
Repeated negative experiences such as being publicly mocked and shamed by bullies could induce the bodily perception of being surveilled by others when no one is present (so-called ‘reference delusions’). These turn into persecutory beliefs that others are out to get them, and that an audience can literally see what they are doing or hear what they are thinking at all times — leaving no space for privacy (delusions of ‘thought broadcasting’).
Importantly, delusional experiences were not always negative. For some participants, they involved powerful feelings of awe, love, and spiritual connection, fostering a positive sense of identity and a renewed sense of hope about the future.
Figurative language
A striking feature of participants’ accounts was their use of figurative and metonymic language (expressions linking bodily sensations with complex emotions or abstract ideas). This helps explain why delusional content can appear unusual or bizarre. For instance, feeling ‘exposed’ or ‘tainted’ might be expressed through the beliefs of being watched by cameras or being contaminated (as in delusions of parasitosis).
As a result of having endured strong (often negative) emotional experiences, which are then responded to by the body, and shaped by everyday language use, people experiencing psychotic delusions really are living in metaphor. People may feel delighted and say they are so happy they can ‘touch the sky’; this could lead them to experience the delusion of thinking they can fly.Professor Jeannette Littlemore, University of Birmingham
The language reflects how emotion concepts take shape in bodily experiences, establishing fundamental cognitive links between, for instance, the emotion of parental love and the physical sensation of warmth, or the emotion of shame and the physical sensation of being ‘seen’ by others.
Jeannette Littlemore, Professor of Linguistics and Communication at the University of Birmingham and co-author of the paper, said: “We all use metaphors and narratives to understand our experiences and make sense of our lives. But psychosis patients do so more intensely. As a result of having endured strong (often negative) emotional experiences, which are then responded to by the body, and shaped by everyday language use, people experiencing psychotic delusions really are living in metaphor. People may feel delighted and say they are so happy they can ‘touch the sky’; this could lead them to experience the delusion of thinking they can fly.”
The study argues that better insight into how delusions come about can be used to create more effective care for people experiencing psychosis. Participants felt that there was no space to talk about the meaning of their delusions in the context of their treatment and recovery from psychosis, which led to more shame and increased the sense of being dismissed and marginalised.
The researchers highlight the importance of attending to people’s bodily and emotional worlds, and how they express them, when developing compassionate, effective approaches to psychosis care.
The paper concludes that delusions are not simply beliefs gone wrong, but embodied attempts to restore meaning and emotional balance when life becomes overwhelming. The metaphors and narratives people use are keys to understanding their suffering and are not signs of irrationality.
A commonly prescribed antibiotic could help reduce the risk of some young people developing schizophrenia, new research suggests. Experts found that patients of adolescent mental health services who were treated with the antibiotic doxycycline were significantly less likely to go on to develop schizophrenia in adulthood compared with patients treated with other antibiotics.
The researchers say that the findings highlight the potential to repurpose an existing, widely used medication as a preventive intervention for severe mental illness.
Lower risk
Schizophrenia is a severe mental disorder that typically emerges in early adulthood and is often associated with hallucinations and delusional beliefs.
To better understand potential ways of preventing the condition, researchers from the University of Edinburgh, in collaboration with the University of Oulu and University College Dublin, applied advanced statistical modelling to large-scale healthcare register data from Finland.
The team analysed data from more than 56 000 adolescents attending mental health services who had been prescribed antibiotics. They found that those treated with doxycycline had a 30–35% lower risk of developing schizophrenia than peers who received other antibiotics.
The researchers hypothesised that the protective effect could be linked to doxycycline’s impact on inflammation and brain development.
Reduce inflammation
Doxycycline is a broad-spectrum antibiotic commonly used to treat infections and acne. Previous studies suggest it can reduce inflammation in brain cells and influence synaptic pruning – a natural process where the brain refines its neural connections. Excessive pruning has been associated with the development of schizophrenia.
Further analyses showed that the lower risk wasn’t simply because the young people may have been treated for acne rather than having infections, and was unlikely to be explained by other hidden differences between the groups.
The study is published in the American Journal of Psychiatry. It involved researchers from the University of Edinburgh, the University of Oulu, University College Dublin, and St John of God Hospitaller Services Group, and was funded by the Health Research Board.
As many as half of the people who develop schizophrenia had previously attended child and adolescent mental health services for other mental health problems. At present, though, we don’t have any interventions that are known to reduce the risk of going on to develop schizophrenia in these young people. That makes these findings exciting.
Because the study was observational in nature and not a randomised controlled trial, it means we can’t draw firm conclusions on causality, but this is an important signal to further investigate the protective effect of doxycycline and other anti-inflammatory treatments in adolescent psychiatry patients as a way to potentially reduce the risk of developing severe mental illness in adulthood.
Professor Ian Kelleher, Professor of Child and Adolescent Psychiatry at the University of Edinburgh
Research shows that greater subjective well-being can lead to enhanced immune function and a lower incidence of chronic disease. But when does happiness start to exert its positive influence, and is there a point when this effect caps out? Researchers looked at national level data from 123 countries and found there is: on a scale from zero to 10, people started gaining health benefits once they surpassed a threshold that lies at around 2.7. Once above, each 1% of additional happiness could lead to a small decrease in mortality risk from non-communicable diseases.
Heart disease, cancer, asthma, and diabetes: All are chronic or non-communicable diseases (NCD), which accounted for about 75% of non-pandemic related deaths in 2021. They may result from genetic, environmental, and behavioural factors, or a combination thereof. But can other factors also influence disease risk?
Now, a new Frontiers in Medicine study has investigated the relationship between happiness and health to find out if happier always means healthier and to determine if happiness and co-occurring health benefits are linear or follow a specific pattern.
“We show that subjective well-being, or happiness, appears to function as a population health asset only once a minimum threshold of approximately 2.7 on the Life Ladder scale is surpassed,” said first author Prof Iulia Iuga, a researcher at 1 Decembrie 1918 University of Alba Iulia. “Above this tipping point, increased happiness is associated with a decrease in NCD mortality.”
Happy equals healthy
“The life ladder can be imaged as a simple zero to 10 happiness ruler, where zero means the worst possible life and 10 means the best possible life,” explained Iuga. “People imagine where they currently stand on that ladder.” The team used data sourced from different health organisations, global development statistics, and public opinion polls. The data came from 123 countries and was collected between 2006 and 2021.
A score of 2.7 can be found towards the lower end of the ladder, and people or countries finding themselves there are generally considered unhappy or struggling. “An adjective that fits this level could be ‘barely coping’,” said Iuga. Nevertheless, already at this point, improvements in happiness begin to translate into measurable health benefits.
Once the threshold is surpassed and a country’s collective happiness rises above it, the study found that each 1% increase in subjective well-being is linked to an estimated 0.43% decrease in that country’s 30-to-70-year NCD mortality rate. This rate refers to the percentage of deaths due to NCDs among individuals aged between 30 and 70.
“Within the observed range, we found no evidence of adverse effects from ‘excessive’ happiness,” Iuga added. Below the 2.7-point threshold, small improvements in happiness (for example, from a score of 2 to 2.2) do not translate to measurable reduction in NCD deaths, the data indicated. Before measurable changes can be unlocked, very low well-being needs to be remedied, the study suggested.
Countries that exceeded this threshold tend to have higher per person health spending, stronger social safety nets, and more stable governance as opposed to the countries falling below it. The average life ladder score across the examined countries during the study period was 5.45, with a minimum of 2.18 and a maximum of 7.97.
There are several ways that governments could raise countries above a score of 2.7, for example through promoting healthy living by expanding obesity prevention and tightening alcohol availability; improving the environment through stricter air-quality standard; and increasing their per capita health spending. The authors said their insights could help guide health and social policies and might aid to integrate well-being into nations’ agendas.
The authors pointed out that the life ladder scores making up their data were self-reported, which may have resulted in measurement errors, differences in cross-cultural response styles, or reporting bias. It is also possible that subnational differences between populations were captured inadequately. In the future, studies should include more measures, such as years lived with disability or hospital admission records, include subnational micro-data, and expand coverage to low-income or conflict states, which may have been overlooked in the data they used, the team pointed out.
Nevertheless, identifying the protective effects of happiness could be an important step towards healthier people. “Identifying this tipping point could provide more accurate evidence for health policy,” concluded Iuga. “Happiness is not just a personal feeling but also a measurable public health resource.”
The most comprehensive review to date of ADHD treatments has found that medication for children and adults, and cognitive behavioural therapy for adults, remain the most effective approaches, backed by the strongest short-term trial evidence.
Researchers led by the Université Paris Nanterre (France), Institut Robert-Debré du Cerveau de l’Enfant (France), and the University of Southampton (UK) analysed over 200 meta-analyses covering different treatment types, participant groups, and clinical outcomes in a study published in The BMJ.
The research was funded by public and peer-reviewed research grants from Agence Nationale de la Recherche (France), France 2030 program (France), and National Institute for Health and Care Research (UK).
To help people with attention deficit hyperactivity disorder (ADHD) and their clinicians make more informed, shared decisions, the team has created an interactive website that clearly presents the findings and the evidence behind each treatment based on the review (ebiadhd-database.org ).
“We know that people with ADHD and their families are often overwhelmed by conflicting messages about which treatments work,” says Professor Samuele Cortese , an NIHR Research Professor at the University of Southampton and senior lead author on the paper.
“We believe this study and the accompanying website provide the most authoritative, evidence-based, and accessible guidance currently available.
“The Evidence-Based Interventions for ADHD website provides freely available, evidence-based, and continuously updated information in an easy-to-understand way. To the best of our knowledge, this is the first platform in the world to do so based on such a rigorous synthesis of the available evidence.”
Overall, five medications in children and adolescents, and two medications and cognitive behavioural therapy (CBT) in adults were shown to be effective while supported by a relatively robust evidence base. Critically, all this evidence was limited to the short-term, despite long-term treatment being common in clinical practice.
Treatments like acupuncture, mindfulness and exercise showed promise, but the evidence supporting their use was of a low quality due to small numbers of participants and risk of bias. The limitations applied to studies evaluating cognitive behavioural therapy in children and adolescents, as well as research on the long-term effects of mindfulness in adults, although mindfulness was the only intervention to demonstrate large beneficial effects at extended follow-up.
Dr Corentin Gosling, Associate Professor at the Paris Nanterre University and first lead author of the study, says: “Long waiting lists for mental health services are a major issue. Having incorrect information about treatments can make people’s journeys even more difficult, by wasting time and money on non-evidence-based approaches, for example.
“By contrast, taking the time to review all treatment options within a shared decision-making process using the web app we developed can empower people with ADHD, leading to better treatment adherence, improved outcomes, and an overall better patient experience.”
The findings generally complement current international clinical guidelines, not only by providing convenient access to current high-quality evidence, but also by covering interventions not usually mentioned in clinical guidelines.
The team hope this new project will achieve a similar impact in influencing clinical guidelines and practice as their previous project (ebiact-database.com), which looked at treatments for autism.
