This article casts a critical eye over the development of American psychiatry from 1980 to the present. It notes the rapid decline of psychoanalysis that followed the publication of DSM III; the rising influence of genetics and neuroscience; the re-emphasis on the biology of mental illness; and the collapse of public psychiatry that accompanied deinstitutionalization. It argues that while genetics and neuroscience have made scientific progress, the clinical utility of their findings to date has been very limited. The fifth edition of the DSM was supposed to base itself on this new science but that proved impossible. Diagnosis remains purely phenomenological and controversial. One of the ironies of research on psychiatric genetics is that has failed to find either a Mendelian origin of schizophrenia and depression or to validate the importance of hypothesized candidate genes. Genome-wide association studies have instead uncovered risk factors for major mental illnesses, but these overlap considerably, and the genetic associations are not dispositive. Most of those who carry these genetic variants do not develop mental illness. The status of psychopharmacology since the mid-1950s is scrutinized, as is the influence of the pharmaceutical industry on contemporary psychiatry, and the implications of its recent decision to abandon work in this arena. The paper concludes with an assessment of the crisis that it contends confronts contemporary American psychiatry: its overemphasis on biology; the urgent questions that persist about diagnosis and therapeutics; concerns about the directions of future research; and its inability to reduce the excess mortality that plagues the mentally ill.

In December 2019, clinicians and academics from the disciplines of public health and psychiatry met in Dublin at the Royal College of Surgeons in Ireland (RCSI), to restate their shared commitment to population health. The purpose of this review is to bring our discussion to a wider audience. The meeting could not have been more timely. Six weeks later, the COVID-19 emergency emerged in China and within 12 months it had swept the world. This paper, the contents of which were presented at that meeting in December recommended that future healthcare would be guided more by public health perspectives and informed by an understanding of health economics, population health and the lessons learned by psychiatry in the 20th century. Ultimately two issues are at stake in 21st century healthcare: the sustainability of our healthcare systems and the maintenance of public support for population health. We must plan for the next generation of healthcare. We need to do this now since it is clear that COVID-19 marks the beginning of 21st century medicine.

Internalizing symptoms are the most prevalent mental health problem in adolescents, with sharp increases seen, particularly for girls, and evidence that young people today report more problems than previous generations. It is therefore critical to measure and monitor these states on a large scale and consider correlates. We used novel panel network methodology to explore relationships between internalizing symptoms, well-being, and inter/intrapersonal indicators. A multiverse design was used with 32 conditions to consider the stability of results across arbitrary researcher decisions in a large community sample over three years (N = 15,843, aged 11–12 at Time 1). Networks were consistently similar for girls and boys. Stable trait-like effects within anxiety, attentional, and social indicators were found. Within-person networks were densely connected and suggested mental health and inter/intrapersonal correlates related to one another in similar complex ways. The multiverse design suggested the particular operationalization of items can substantially influence conclusions. Nevertheless, indicators such as thinking clearly, unhappiness, dealing with stress, and worry showed more consistent centrality, suggesting these indicators may play particularly important roles in the development of mental health in adolescence.

We evaluated whether the association between deviant peer affiliation and onset of substance use is conditional upon sex and sympathetic nervous system (SNS) reactivity as measured by pre-ejection period (PEP). Community-sampled adolescents (N = 251; M = 15.78 years; 53% female; 66% White, 34% Black) participated in three waves. PEP reactivity was collected during a mirror star-tracer stress task. Alcohol, marijuana, tobacco, or any substance use, as well as binge drinking and sexual activity involving substance use were outcomes predicted by affiliation with deviant peers and two- and three-way interactions with sex and PEP reactivity. Probability of substance use increased over time, but this was amplified for adolescents with greater deviant peer affiliation in conjunction with blunted PEP reactivity. The same pattern of results was also found for prediction of binge drinking and sexual activity involving substance use. Findings are discussed in the context of biosocial models of adolescent substance use and health risk behaviors.

The COVID-19 pandemic is a unique period of stress, uncertainty, and adversity that will have significant implications for adolescent mental health. Nevertheless, stress and adversity related to COVID-19 may be more consequential for some adolescents’ mental health than for others. We examined whether heart rate variability (HRV) indicated differential susceptibility to mental health difficulties associated with COVID-19 stress and COVID-19 family adversity. Approximately 4 years prior to the pandemic, we assessed resting HRV and HRV reactivity to a well-validated stress paradigm in 87 adolescents. During the pandemic, these adolescents (ages 13–19) reported on their health-related stress and concerns about COVID-19, family adversity related to COVID-19, and their recent emotional problems. The association between COVID-19 stress and emotional problems was significantly stronger for adolescents who previously exhibited higher resting HRV or higher HRV reactivity. For adolescents who exhibited lower resting HRV or HRV augmentation, COVID-19 stress was not associated with emotional problems. Conversely, lower resting HRV indicated vulnerability to the effect of COVID-19 family adversity on emotional problems. Different patterns of parasympathetic functioning may reflect differential susceptibility to the effects of COVID-19 stress versus vulnerability to the effects of COVID-19 family adversity on mental health during the pandemic.

When people living in poverty are asked to describe their living conditions, mental health issues quickly come to mind (grief, sadness, anger, fear, bitterness, frustration, discontent, anxiety, and emotional damage consisting of low mood and depression, fatigue, hypersensitivity, sleep difficulties and physical pain). Although the association between poverty and mental health have been widely demonstrated in the literature, care must be taken to avoid the psychiatrization of poverty. However, how can healthcare be provided to people living in poverty when basic needs are not met? This article explores the global challenge of providing mental health services in impoverished populations, using the example of the poorest country in America: Haiti. It examines the availability of services offered through the Mental Health Centre at Morne Pelé, and the necessity for innovative and comprehensive approaches to provide culturally appropriate care that meets the real needs of populations. It highlights effective measures that policy makers should implement to develop an efficient mental healthcare system based on the lessons of the Mental Health Centre at Morne Pelé.

Positive health endpoints are not the opposite of negative endpoints. Previous studies examining posttraumatic stress disorders (PTSD) and posttraumatic growth (PTG) trajectories have overlooked the co-existence of PTSD and PTG, making it difficult to accurately distinguish individuals with various posttraumatic presentations, causing the effects of targeted interventions to be discounted. To fill this gap, the current study sought to examine joint PTSD and PTG trajectories in children and adolescents. Eight hundred and seventy-six Chinese children and adolescents were recruited to complete self-report questionnaires 6, 12, and 18 months after the Ya'an earthquake. Multiple-process growth mixture modeling analysis was used to test the study proposal. Five distinct joint PTSD and PTG trajectory types were found: recovery, growth, struggling, resistant, and delayed symptoms. Female students and students who felt trapped or fearful were more likely to be in the struggling group, and students who experienced injury to themselves or family members were more likely to belong to the delayed symptom group. These findings suggest that postdisaster psychological services should be provided to relieve delayed symptoms in individuals who experience injury to themselves or their family members, and individuals in the struggling group should be supported to achieve growth.

The functioning of the hypothalamic–pituitary–adrenal (HPA) axis is implicated in the etiology and maintenance of depressive and posttraumatic stress disorder (PTSD) symptoms. However, different maltreatment experiences as well as the increased sensitivity of the HPA axis during puberty may alter associations between the HPA axis and mental health. To address these gaps, the current study examined the potential bidirectional associations between cortisol reactivity to a stressor, PTSD symptoms, and depressive symptoms among early adolescents across two time points, 1 year apart (n = 454; Mage = 10.98 at Time 1 and Mage = 12.11 at Time 2). Multiple-group path models tested the pathways between cortiol reactivity and mental health prior to and during puberty, for different types of maltreatment . Overall, the results showed that associations between cortisol output and symptoms of PTSD and depression were driven by those in the midst of puberty. Specifically, higher cortisol output at Time 1 was linked with higher levels of subsequent PTSD and depressive symptoms for neglected youth who had reached puberty. However, depressive symptoms predicted subsequent lower cortisol output for the physical abuse and emotional abuse groups. These findings demonstrate longitudinal links between cortisol, depressive symptoms, and PTSD symptoms among youth with different types of maltreatment histories and highlight the need to consider the reorganization of the stress system during puberty in order to advance our understanding of the HPA axis and mental health.

Early in their book A story of us, the evolutionary psychologists Leslie Newson and Peter Richerson remark of very early hominins that “we can't know what it is like to experience life with a brain so very different from our own” (p. 34). These words neatly encapsulate an unfortunate reality that confronts anyone who tries to understand or reconstruct the evolution of human cognition: we humans are so completely imprisoned within our own cognitive style as to be incapable of fully imagining what was going on in the minds of extinct hominins who were behaviourally highly sophisticated, but who nonetheless did not think like us—which basically includes all of them. The reason for this difficulty is that we modern Homo sapiens are entirely unique in the living world in the way in which we manipulate information about our exterior and internal worlds. We do this symbolically, which is to say that we deconstruct those worlds into vocabularies of mental symbols that we can then combine and recombine in our minds, according to rules, to make statements not only about the world as it is, but as it might be. And evidence in the archaeological record for the routinely symbolic behaviours that are our best proxies for the apprehension of the world in this fashion is at best very sparse indeed prior—and even for some time subsequent—to the initial appearance of Homo sapiens.