Scientia Psychiatrica

Clinical Profiles of Depressive and Stress-Related Phenotypes in Balinese Adolescents: A Retrospective Pilot Audit in a Secondary Care Setting

Ni Wayan Ika Widyaningsih — 2025-12-31

Introduction: Adolescence represents a critical window of neurodevelopmental plasticity and psychosocial vulnerability. While tertiary centers in Indonesia frequently report high rates of psychosis, data regarding common mental disorders in rural secondary care settings remain scarce. This study aims to elucidate the clinical phenotypes and diagnostic divergence between early and late adolescence in a Balinese district hospital.

Methods: This was a retrospective, observational pilot audit utilizing a total sampling strategy of all adolescent patients (aged 10–19 years) presenting to the Psychiatric Outpatient Clinic of Bangli Regional General Hospital throughout 2024. A total of 23 patients were eligible. Data regarding demographics, ICD-10 diagnoses, clinical severity (CGI-S), and psychosocial stressors were analyzed.

Results: The clinical cohort (N=23) demonstrated a female predominance (n=14) and a skew toward late adolescence (n=17). A distinct diagnostic divergence was observed: Depressive episodes (F32) were the most frequent diagnosis (n=7), clustering predominantly in late adolescence (n=5), whereas adjustment disorders (F43.2) were exclusively identified in early adolescence (n=3). Anxiety disorders showed a notable male predominance (n=2 versus n=1 female). Clinical severity was higher in the late adolescent group, with a greater frequency of moderate-to-severe symptoms compared to the situational distress seen in younger teens.

Conclusion: This pilot audit identifies a window of vulnerability for endogenous depressive pathology emerging in late adolescence (17–19 years), likely driven by academic transition pressures. Conversely, early adolescence is characterized by situational adaptability issues. The low utilization rate suggests significant barriers to care. Age-stratified interventions and school-based screenings are urgently recommended.

Syndemic Burden in People Living with HIV: A Systematic Review and Meta-Analysis of Depression and Anxiety Across Diverse Populations

Rifki Sakinah Nompo — 2026-04-15

Introduction: People living with HIV (PLWH) experience elevated rates of depression (31%) and anxiety (28–97%), which are often embedded within broader syndemic contexts involving multiple co-occurring psychosocial stressors. However, comprehensive meta-analytic synthesis of syndemic burden across diverse populations remains limited. This review integrates evidence on the relationship between syndemic burden (cumulative psychosocial stressors) and depression/anxiety in PLWH.

Methods: Systematic literature search across Scopus, PubMed/MEDLINE, and Web of Science (2000–2025). Eligible studies reported quantitative associations between psychosocial stressors and depression or anxiety in PLWH. Data were extracted independently by two reviewers. Random-effects meta-analysis using Hedges g and odds ratios (95% confidence intervals) was conducted separately for depression and anxiety. Risk of bias was assessed using the Modified Newcastle–Ottawa Scale. GRADE methodology was applied for the certainty of evidence.

Results: Seven effect sizes from six studies (N≈16,598 PLWH) were included. Depression showed robust, consistent effects (k=5, SMD=0.754, 95% CI: 0.694–0.815, I²=0%, p<0.001; OR=4.12, 95% CI: 3.05–5.54), representing a moderate-to-large clinical difference (3.8–4.5 points on PHQ-9). Anxiety also demonstrated significant effects (k=2, SMD=0.671, 95% CI: 0.012–1.330, I²=82.4%, p=0.046; OR=3.88, 95% CI: 2.76–4.91), though with high heterogeneity. The pooled effect across both outcomes was SMD=0.721 (95% CI: 0.595–0.847, I²=45.3%). Effects were consistent across cross-sectional (SMD=0.730) and longitudinal (SMD=0.749) designs. All studies were rated 7–9 on the Modified NOS, indicating low risk of bias.

Conclusion: Syndemic burden is substantially associated with depression and anxiety in PLWH. Depression manifests as a consistent, primary psychiatric consequence across diverse contexts, whilst anxiety severity varies by cultural and geographical factors. Integrated screening combining PHQ-9, GAD-7, and structured psychosocial stressor assessment is warranted.

Psychological and Psychosocial Interventions for Preventing Perinatal Depression in Single Mothers: A Systematic Review and Meta-Analysis

Andrian Fajar Kusumadewi — 2026-04-20

Introduction: Perinatal depression affects approximately 26.3% of mothers globally. Single mothers face an elevated risk due to financial instability and limited support. While preventive psychological and psychosocial interventions are proven in general populations, their specific efficacy for single mothers remains unclear. This systematic review and meta-analysis evaluate these interventions' effectiveness in preventing perinatal depression in this vulnerable group.

Methods: Searching five major databases through September 2025, we identified randomized controlled trials evaluating psychological (cognitive-behavioral therapy) and psychosocial interventions for single mothers from pregnancy through one year postpartum. Nine studies (n=681) met the inclusion criteria, utilizing a 75% single-motherhood threshold. We analyzed depressive symptom severity (Standardized Mean Difference, SMD) and episode incidence (Relative Risk, RR) using a random-effects meta-analysis.

Results: The meta-analysis for depressive symptoms (k=5; n=418) demonstrated a significant protective effect (pooled SMD = -0.585; 95% CI: -0.883 to -0.287; p = 0.0001) with minimal heterogeneity. For depressive episodes (k=3; n=171), incidence was reduced by 64% (RR = 0.36; 95% CI: 0.18 to 0.71). Despite these positive outcomes, GRADE assessment yielded a low certainty of evidence due to imprecision and severe geographic bias, as eight of the nine studies were US-based.

Conclusion: Psychological and psychosocial interventions can reduce perinatal depressive symptoms and incidence among single mothers. However, given the small evidence base, temporal limitations, and geographic concentration, findings warrant cautious interpretation. Further large-scale, globally diverse trials are essential before widespread clinical implementation can be confidently recommended.

The Anxious Pregnancy Across Three Trimesters: A Primary-Care Case Series of Non-Pharmacological, CBT-Based Multidisciplinary Management of Antenatal Anxiety

I Putu Adigama — 2026-06-19

Introduction. Antenatal anxiety is among the most common yet most overlooked complications of pregnancy and, left unrecognized, is associated with preterm birth, low birth weight, impaired bonding, and adverse child neurodevelopment. Evidence for first-line, non-pharmacological management within primary care—where most women in low-resource settings receive care—remains sparse.

Case presentation. We describe three pregnant women managed at an Indonesian community health center (UPTD Puskesmas Susut I, Bali), spanning all three trimesters. Case 1 was a 20-year-old primigravida at 9 weeks with a generalized anxiety presentation driven by an absent seafaring husband and unfiltered online health information (Beck Anxiety Inventory [BAI] 28, Perinatal Anxiety Screening Scale [PASS] 25, Edinburgh Postnatal Depression Scale [EPDS] 14). Case 2 was a 29-year-old multigravida at 20 weeks with anxiety and mild anemia rooted in a previous traumatic low-birth-weight delivery and in-law pressure (BAI 24, PASS 22, EPDS 14). Case 3 was a 22-year-old primigravida at 35 weeks with panic-like symptoms and fear of childbirth (BAI 24, PASS 22, EPDS 14). All three were managed without psychotropic medication using CBT, family psychoeducation, and obstetric monitoring, with serial screening documenting improvement across every instrument within one to four weeks.

Conclusion. A spectrum of antenatal anxiety can be recognized at the primary-care level using serial validated screening; in these three women, CBT-based multidisciplinary care without psychotropic exposure was followed by rapid improvement. As an uncontrolled series these observations are hypothesis-generating, but they support integrating perinatal mental-health care into routine antenatal services.