To compare biopsychosocial burden, depressive symptoms, and masticatory muscle pain sensitivity between patients with good and poor sleep quality in myogenous temporomandibular disorders (TMD). In this cross-sectional study, 95 adults with myogenous TMD according to the Diagnostic Criteria for TMD were classified into good or poor sleepers based on the Pittsburgh Sleep Quality Index. Pain intensity, biopsychosocial burden, insomnia severity, and pain catastrophizing were evaluated using validated instruments. Masticatory muscle pressure pain thresholds (PPT) assessed pain sensitivity. Poor sleepers reported higher pain intensity, depressive symptoms, anxiety, somatic burden, oral parafunctions, and insomnia severity. No significant differences emerged in pain catastrophizing, functional limitation, or PPT. Poor sleep quality remained associated with depressive symptoms but not pain intensity after adjusting for psychosocial domains. In this sample of myogenous TMD patients poor sleep quality appeared associated with greater psychological burden, particularly depressive symptoms, but not with reduced PPT.
Objectives: Temporomandibular disorder (TMD) is a multifactorial condition that significantly affects patients' quality of life. This study investigated the association between clinical, biopsychosocial, and genetic factors, including the MMP3 rs679620 polymorphism, and TMD in women from southern Brazil. Methods: A cross-sectional case-control study was conducted including 305 women, comprising 138 patients with TMD (disc displacement with or without reduction and arthralgia) and 167 controls without TMD symptoms. TMD was diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Clinical and biopsychosocial characteristics were evaluated, and the MMP3 rs679620 polymorphism was genotyped using real-time polymerase chain reaction (RT-PCR). Univariate and multivariate analyses were performed, with statistical significance established at p < 0.05. Results: Univariate analysis demonstrated significant associations between TMD and chronic pain (p = 0.002), somatic symptoms (p < 0.001), and depression (p = 0.007). Multivariate analysis identified pain preventing leisure activities, headache, ear ringing (tinnitus), and age as factors significantly associated with the presence of TMD. No significant association was observed between the MMP3 rs679620 polymorphism and TMD in the study population. Conclusions: Clinical and biopsychosocial factors were associated with the presence of TMD in this female population, whereas the MMP3 rs679620 polymorphism was not. These findings support the multifactorial nature of TMD and suggest that biopsychosocial factors may play a greater role than the genetic variant investigated in this population. Due to the cross-sectional case-control design, the observed associations should not be interpreted as evidence of causal relationships.
Primary headache is the most frequent neurological symptom in childhood and often coexists with psychosomatic risk factors. This study investigated functional (psychosomatic) features and anxiety in children and adolescents with primary headache, testing the hypothesis that a subgroup with high Children's Somatic Symptoms Inventory (CSSI-24) scores may present characteristics consistent with a functional disorder. In this prospective observational cohort study, 148 patients aged >6 years with primary headache, diagnosed according to ICHD-3 criteria by child neurologists at a tertiary hospital, were enrolled. Demographic and clinical data, psychosomatic risk factors, and anxiety were collected through interviews and validated questionnaires. Patients were stratified using the CSSI-24 into Group 1 (<19: low psychosomatic score) and Group 2 (≥19: high psychosomatic score). Associations between functional symptoms , anxiety, and headache characteristics were analysed. Overall, 42.6% of participants had CSSI-24 ≥ 19. Compared with Group 1, Group 2 included more females (p = 0.046), were older (p = 0.013), and reported greater pain intensity (p = 0.02), higher monthly headache frequency (p = 0.04), and more frequent chronic analgesic use (p = 0.012). They also showed multiple psychosomatic risk factors (p = 0.04), severe somatic symptoms across several systems (p < 0.001), and higher anxiety levels (p < 0.001). The identification of high CSSI-24 scores in a subgroup of children with primary headache could have implications for the conceptual model of pediatric headache and supports integrating neurodevelopmental and biopsychosocial perspectives. Early recognition of a "functional" phenotype may guide personalized, multidisciplinary interventions addressing stress, anxiety, and maladaptive behaviour.
This study applies Buysse's sleep health framework to examine sleep in children and adolescents with neurofibromatosis type 1 (NF1). By examining sleep timing, daytime sleepiness, sleep quality, sleep behavior, sleep duration, and sleep efficiency together, this framework captures the multidimensional nature of sleep and its relationship with biopsychosocial factors and health-related quality of life (HR-QoL) in NF1. This multi-site, prospective, cross-sectional study included 131 children and adolescents with NF1 and 71 typically developing (TD) controls aged 6 to 16 years. A sleep health composite was derived from carer rating scales and 7 days of actigraphy. A biopsychosocial framework was used to examine factors associated with sleep health in NF1, including sociodemographic, cognitive, psychopathology, and biological variables. Independent predictors of QoL were examined to assess the unique contributions of sleep quality, sleep duration, and previously established predictors of HR-QoL in NF1. Poorer sleep health was evident in children with NF1. Compared with TD controls, children with NF1 were five times as likely to have poor sleep quality, with almost 78% demonstrating impaired sleep efficiency and nearly half not obtaining sufficient sleep at night. The strongest risk factors were being male, elevated pain, and having greater levels of ADHD and autism spectrum disorder traits. Findings suggest sleep health in NF1 is interconnected with multiple biopsychosocial factors. A better understanding of these relationships will help identify early risk markers, improve prediction of clinical trajectories, and guide the development of targeted multimodal interventions for sleep disruption in NF1.
Introduction: Functional gastrointestinal disorders (FGIDs), conceptualized as disorders of gut-brain interaction, are among the most common chronic or recurrent conditions in childhood, affecting approximately 20-30% of children worldwide across community and clinical settings. FGIDs are associated with substantial impairments in quality of life, frequent school absences, and high levels of psychological comorbidity, contributing to a considerable burden for families and healthcare systems. Despite their high prevalence, the pathophysiology remains incompletely understood, with evidence pointing to a multifactorial interplay of biological, psychological, and environmental factors. Given their frequency across healthcare settings and their significant psychosocial and economic impact, a better characterization of FGIDs in real-world pediatric populations is needed. This retrospective chart review aimed to examine patterns of FGIDs and their associations with gender, temporal factors, geographic setting, and hospitalization burden in a Swiss pediatric cohort within a biopsychosocial framework. Methods: This retrospective chart review study included 1445 patients aged 0-18 years. Patients were selected based on having received an ICD-10 diagnosis attributed to FGID. The frequency and distribution of the aforementioned factors were determined, as well as their associations with each other. Results: A male predominance of FGIDs in newborns (p < 0.001), a female predominance in adolescents (p < 0.001), and sex-based differences in subtype distribution (p < 0.001) was found in this cohort of patients. A higher proportion of FGID cases were found among children in urban areas than in rural and suburban areas. Infants were hospitalized for significantly longer periods on average than older children and males were hospitalized for longer periods on average than females. Discussion and Conclusions: These findings highlight the importance of early, integrated, interdisciplinary care pathways. Given the growing mental health issues affecting adolescent girls and the well-documented bidirectional relationship between emotional stress and FGID symptoms, it is suggested that early psychological screening and family-based interventions could reduce the chronicity of symptoms, prevent unnecessary hospitalizations and improve long-term health outcomes.
Frailty is increasingly recognized in chronic diseases, including chronic respiratory diseases (CRD) which often represent progressive functional impairment. Frailty is multifactorial and may be a result of a complex interaction between biological, psychological, and social factors. Understanding the biopsychosocial interaction in the aetiology of frailty among CRD patients is necessary to optimize public health policies. To estimate prevalence of frailty in Chronic Respiratory Diseases (CRD) and to understand the mediating effect of biopsychosocial factors. ology: This cross-sectional study included 66434 community-dwelling adults (age ≥45 years, 52.9% females) with and without physician reported diagnosis of CRD from an ongoing population-based cohort. Frailty was assessed using Fried criteria. CRD showed a significantly higher frailty compared to controls [37.7% vs 25.7% (p<0.001)]. Frailty was significantly higher in CRD between 45-75 years (p<0.001) compared to controls, but no difference was noted after 75 years (p>0.05). Adjusted for covariates, CRD remained significantly associated with increased frailty [AOR: 1.49 (95% CI: 1.05, 2.12)]. Next to direct effect, structural equational modelling revealed an indirect association of age (estimate=0.159, p<0.001) comorbidities (estimate=0.031, p<0.001), cognition (estimate=0.006, p<0.001)), education (estimate=0.012, p<0.01) and economic status (estimate=-0.004, p<0.01) as frailty mediators. Frailty is abundantly present in CRD. Frailty in CRD appeared to be influenced by direct and indirect factors beyond chronological age. The results indicate an early and multifactorial trajectory of vulnerability to become frail in CRD individuals. Therefore, frailty screening is necessary in CRD from early onset to facilitate timely intervention.
Fatigue is a debilitating symptom in autoimmune liver disease, but prospective research on fatigue in Primary Sclerosing Cholangitis (PSC) remains limited. This study aimed to estimate fatigue frequency in patients with PSC and explore cross-sectional and prospective biopsychosocial associations with fatigue severity. This prospective study included 226 patients with PSC. Fatigue severity was assessed using the PBC-40 fatigue domain at baseline and six-month follow-up. Biomedical, psychological and social variables were assessed using clinical records, blood biomarkers and self-report measures. Descriptive statistics and multivariable linear regression models were used to examine cross-sectional and prospective associations with fatigue severity. At baseline, 19% of patients reported clinically significant fatigue. Patients with fatigue reported greater psychobehavioral burden and impairment across several domains. Cross-sectionally, greater fatigue severity was significantly associated with higher depressive symptom severity (p < 0.001) and greater fear-avoidance behavior (p < 0.001), whereas biomedical disease severity markers were not independently associated with fatigue severity. At six months, most patients without baseline fatigue remained below the clinical threshold (92%), while fatigue persisted in 79% of patients with baseline fatigue. Prospectively, greater fear-avoidance behavior (p < 0.001) and detectable IL-6 serum level (p = 0.02) were associated with greater fatigue persistence over time. Fatigue represents a clinically relevant and persistent symptom burden in PSC. Findings support a multidimensional biopsychosocial conceptualization of fatigue involving psychobehavioral and inflammatory processes and may provide useful directions for future mechanistic and interventional research.
School violence represents a major public health and educational concern with significant consequences for adolescents' psychological well-being, academic functioning, and social development. Increasing evidence indicates that violent behaviors in school environments arise from the complex interaction between individual vulnerabilities and broader social determinants. This scoping review aims to describe and discuss the available evidence on the risk factors, mental health outcomes, and prevention strategies associated with school violence. A comprehensive literature search was conducted across major databases, and studies were selected and charted according to predefined inclusion criteria. The evidence was analyzed following a developmental psychopathology framework. We identified and analyzed key individual risk factors, including emotional dysregulation, impulsivity, empathy deficits, trauma exposure, and psychiatric vulnerabilities such as attention-deficit/hyperactivity disorder, conduct disorder, and mood disorders. In addition, we mapped contextual determinants including family functioning, peer dynamics, school climate, and the growing role of digital environments, particularly cyberbullying. The review further categorized the psychological profiles of aggressors, victims, and bully-victims, highlighting the developmental fluidity of these roles. Attention was also given to biological and psychophysiological pathways linking school violence, trauma exposure, and adolescent mental health, including stress-system dysregulation, hypothalamic-pituitary-adrenal axis functioning, autonomic arousal, threat sensitivity, and neurodevelopmental vulnerability. Within a biopsychosocial framework, these mechanisms are discussed as potential mediators between adverse social experiences, emotional dysregulation, aggression, victimization, and subsequent internalizing or externalizing outcomes. We synthesized evidence on the mental health consequences associated with exposure to school violence, including depression, anxiety, post-traumatic stress symptoms, and suicidal ideation. Finally, evidence-based prevention and intervention strategies are discussed, emphasizing integrated approaches that combine school-based programs, family involvement, and collaboration with mental health services to support early identification and prevention. This review provides a biopsychosocial mapping of the current literature and highlights the need for future studies integrating psychosocial assessment with biological and psychophysiological measures of stress reactivity and neurodevelopmental vulnerability.
The objective of this study is to investigate functional, cognitive, physical and nutritional outcomes in adults with intellectual disabilities (IDs), comparing individuals with and without Down syndrome from São Paulo, Brazil, and to evaluate the associations of group, degree of disability, age and sex with these outcomes. Additionally, we hypothesized that individuals with Down syndrome would present greater vulnerability to cognitive and physical decline compared to those with ID of other aetiologies. This cross-sectional observational study included 52 adults with ID divided into two groups: (1) 24 participants with Down syndrome (ID-DS) and (2) 28 participants with non-DS aetiologies (ID-nonDS). Assessments included sociodemographic and clinical data; functional independence measure (FIM); physical performance (handgrip strength, 30-s sit-to-stand test, gait speed test and MiniBESTest); nutritional status (Mini Nutritional Assessment [MNA]); cognitive function (Cambridge Cognitive Examination for Mental Disorders of the Elderly-Down Syndrome [CAMCOG-DS]); cognitive decline (Informant Questionnaire on Cognitive Decline in the Elderly [IQCODE]); and functional activities (Pfeffer Questionnaire [QPAF]). Data were obtained through self-report whenever possible, and proxy report (caregivers) when necessary, based on participants' communication abilities. Compared with the ID-nonDS group, the ID-DS group demonstrated significantly poorer learning (β = -2.56; p = 0.049) and remote memory performance (β = -1.18; p = 0.011), a nonsignificant trend towards lower handgrip strength (β = -4.68; p = 0.051) and more falls (β = -0.39; p = 0.050). Sex and degree of disability were associated with several outcomes, whereas age showed no significant effect. Adults in the ID-DS group exhibited cognitive and physical profiles suggestive of increased vulnerability to age-related functional impairment compared with adults with other forms of ID. These findings should be interpreted cautiously due to the cross-sectional design and sample size limitations. Replication in larger samples will be necessary to confirm these observations.
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Given the high prevalence of mental health problems among university freshmen and the limited explanatory capacity of traditional unidimensional models, this study adopts a biopsychosocial (BPS) framework. Network analysis combined with simulation techniques based on the Node Identify via Recursive Graphs (NIRA) algorithm was applied to explore system-level interactions and potential targets within the network. A total of 3,116 first-year university students were recruited. The network comprised biological-related functional indicators (e.g., TCM constitution types such as Qi stagnation), psychological symptoms (depression, anxiety, suicide risk), psychological traits (resilience, emotion regulation, insight), and social factors (perceived stress, childhood trauma, and social support). An Ising network model was estimated, and centrality and bridge indices were calculated. Simulation analyses were conducted by manipulating node activation probabilities to examine potential changes in overall network activation. Psychological resilience emerged as the central hub node, while perceived stress acted as the strongest bridge node linking social and psychological domains. Simulation analyses suggested that reductions in stress-related nodes and improvements in Qi stagnation-related indicators were associated with decreases in overall psychological network activation. These findings support the utility of a network-based BPS framework for understanding freshmen's mental health. Psychological resilience and perceived stress may represent important components within the system. However, simulation findings should be interpreted cautiously, as they do not imply causal intervention effects.
Background: Telehealth acceptance for chronic low back pain (CLBP) remains unclear. It may depend on patients' knowledge, attitudes, barriers, and health factors. This study assessed telehealth physical therapy's acceptability for CLBP by examining willingness, knowledge, attitudes, and barriers, and comparing willingness among healthcare professionals. Methods: This study included 309 adults with CLBP. The Telemedicine Perception Questionnaire (TMPQ) assesses perceptions and barriers. Participants rated telehealth willingness and completed the PROMIS-29 for health factors. The descriptive statistics summarized the characteristics. The Friedman test was used to compare professional willingness, t-tests were used to examine sex differences, Pearson's correlation was used to assess PROMIS-29 and telehealth willingness, and multivariate regression was used to identify the related variables. Results: The participants had an average age of 26.06 years, and 90% were female. Willingness varied (p < 0.001), being highest among dietitians (3.86 ± 1.15), lowest in physical therapists (3.52 ± 1.13). Males reported more telehealth barriers (p = 0.043), and females had higher anxiety, depression, fatigue, and pain scores (p < 0.05). Willingness to use telehealth physical therapy correlated with physical function (r = 0.319). The knowledge score was most strongly correlated with physical function (r = 0.368). Regression analysis showed that knowledge (B = 0.057, p = 0.011) and attitude (B = 0.063, p < 0.001) predicted greater telehealth willingness, with the model explaining moderate proportion of the variance in willingness to use telehealth physical therapy (R2 = 0.381; adjusted R2 = 0.370). Conclusions: Telehealth physical therapy was moderately acceptable in adults with CLBP. Knowledge and acceptance increased the willingness to use telehealth services. Higher knowledge of telehealth and more positive attitudes were associated with a greater willingness to use telehealth physical therapy. These findings suggest that patient education and clear orientation to telehealth procedures may support readiness for telehealth-based physical therapy. However, the strong predominance of female participants (90%) and the self-selected online sample should be considered when interpreting the findings, as these factors may limit generalizability to the broader CLBP population.
Adolescent major depressive disorder (MDD) is clinically heterogeneous, with sleep disturbance often emerging as a prominent but variably expressed symptom dimension. This study aimed to identify latent symptom profiles in drug-naïve adolescents with MDD and examine their associations with recorded trauma/stressor exposure and neuroendocrine markers. This cross-sectional study included 711 drug-naïve adolescents with MDD. Latent profile analysis (LPA) was conducted using 16 symptom indicators derived from the Hamilton depression rating scale (HDRS), Hamilton anxiety rating scale (HAMA), and Pittsburgh sleep quality index (PSQI). Multinomial logistic regression examined associations of recorded trauma/stressor exposure and neuroendocrine markers with profile membership. A three-profile solution was retained: low overall symptoms (Profile 1; n = 200, 28.1%), PSQI-elevated subjective sleep disturbance (Profile 2; n = 215, 30.2%), and high overall symptoms (Profile 3; n = 296, 41.6%). Recorded family trauma/stressor exposure and violent incident exposure were associated with higher odds of Profile 3 membership relative to Profile 1, and these associations remained significant after neuroendocrine markers were added. Higher standardized testosterone (T) showed a modest association with Profile 3 membership, whereas FT3 showed only a marginal association. However, adding neuroendocrine markers did not significantly improve model fit beyond trauma-related variables. LPA identified three clinically interpretable symptom profiles in adolescent MDD, including a profile characterized primarily by elevated PSQI-assessed subjective sleep disturbance. Recorded trauma/stressor exposure was associated with the high overall symptom profile, whereas neuroendocrine markers showed limited incremental value. These findings highlight multidimensional symptom profiling and trauma assessment in adolescent depression, while suggesting that neuroendocrine findings should be considered exploratory.
Frequent psychiatric rehospitalizations, commonly referred to as revolving door (RD) pose major challenges to community mental healthcare system and may reflect patients' bio-psycho-social (BPS) complexity. The aim of the current study was to investigate the association between BPS complexity and RD in an acute psychiatric hospital ward, located in a Northern Italy province serving around 500,000 inhabitants. A retrospective cohort study design was implemented to review all adult admissions between December 2021 and March 2023. Sociodemographic, clinical, and service-related data were extracted from the electronic clinical records. BPS complexity was assessed using the INTERMED tool. RD was defined as ⩾3 hospitalizations within 12 months. Survival analyses estimated hazard ratios (HRs) with corresponding 95% confidence intervals (95% CIs) for time-to-RD, under the assumption of proportional hazards. A total of 322 patients were analyzed, and 31 (9.63%) met RD criteria. Compared to non-RD, RD patients displayed higher INTERMED scores, especially in psychological (HR: 1.28, 95% CI [1.06, 1.54]) and social (HR: 1.15 [1.05, 1.26]) domains. Living in a residential facility compared to a private house (HR: 7.14 [3.31, 15.38]), previous compulsory admissions (HR: 4.27 [1.73, 10.54]), long-acting injectable antipsychotic use at the first admission (HR: 3.46 [1.63, 7.35]), and receiving an individualized treatment plan at the community mental health center compared to not receiving it at the time of the first admission (HR: 5.30 [1.25, 22.42]) were all associated with an increased risk of RD during the follow-up. Higher complexity in psycho-social domains and history of coercive treatments increased the risk of RD. Addressing psychological distress, social disconnection, and agency in community care may support clinicians in recognizing and anticipating risk factors for RD.
Chronic pain (CP) affects an important proportion of the global population, imposing a significant socio-economic burden and serving as a leading cause of disability. While the biopsychosocial approach is the gold standard for treatment, many patients fail to receive adequate care due to healthcare resource constraints. Effective management requires a comprehensive assessment. However, traditional questionnaires often miss the subjective and multidimensional depth of the pain experience. Differently, written narratives (WNs) empower patients to describe their pain in their own words. Nevertheless, qualitative analysis, such as WN, is often time-consuming for clinicians.This paper explores how Large Language Models (LLMs) can facilitate clinicians in analyzing WNs. Evidence from the AINarratives project and other emerging studies indicates that LLMs can evaluate pain narratives with accuracy and utility comparable to human experts, identifying biopsychosocial themes that correlate with standardized clinical scores.We conclude that LLMs should serve as clinical companions rather than substitutes, streamlining qualitative data processing to enhance the clinician-patient interaction and facilitate personalized care. Chronic pain affects millions of individuals, leading to a diminished and challenging quality of life. To enhance patients’ well-being, healthcare professionals must understand how each person subjectively experiences pain. They typically rely on standardized measures; however, these tools often fail to capture the personal and multifaceted nature of living with pain.In recent years, an alternative that has been gaining ground is that of asking patients to write down their own stories about their pain. This lets people explain what truly matters to them using their own words. However, reading and analyzing these personal stories can be demanding and time-consuming for healthcare professionals.This article proposes a potential approach for using advanced Artificial Intelligence (AI) systems to assist healthcare professionals in analyzing patients’ personal stories. Research supports that AI can quickly read patients’ written stories and accurately pick out the most important details about how pain affects them from a biopsychosocial perspective. Most importantly, AI is meant to be a helpful tool, not a replacement for health care professionals. By quickly analyzing long texts, AI saves humans’ time. This gives healthcare professionals more time to focus on patients, leading to better and more personal care.
Birth weight and birth length are essential indicators of neonatal health and later development. However, evidence from Vietnam on the multidimensional determinants of these outcomes remains limited. Guided by the biopsychosocial model, this study examined factors associated with birth weight and birth length among term newborns. This retrospective cross-sectional study included 198 term singleton live births at Hai Phong Hospital of Obstetrics and Gynecology, Vietnam. Data were extracted from the medical records of newborns born at the hospital between December 2023 and May 2024. Because the variables did not meet parametric assumptions, the Mann-Whitney U test, Kruskal-Wallis H test, and Spearman correlation coefficient were used as nonparametric alternatives to the independent-samples t-test, analysis of variance, and Pearson correlation coefficient, respectively. Two multiple linear regression models were constructed to identify independent predictors of birth weight and birth length, with statistical significance set at p<.05. In the multivariable analysis, gestational age (β=.37, p<.001), maternal pre-pregnancy weight (β=.24, p<.001), protein supplementation (β=.13, p=.040), and infant sex (β=-.16, p=.008) were significant predictors of birth weight. Paternal height (β=.47, p<.001), gestational age (β=.23, p<.001), maternal height (β=.22, p<.001), and maternal pre-pregnancy weight (β=.16, p=.009) were significant predictors of birth length. Within the biopsychosocial framework, interrelated biological and behavioral factors were associated with birth weight and birth length among term newborns. Prenatal assessment of maternal and paternal characteristics may help inform strategies to support fetal growth, particularly in resource-limited settings.
Prenatal and early postnatal life is a period of rapid brain growth, making the developing brain particularly susceptible to external influences. Adapting the biopsychosocial model of mental health and illness, this review provides a systematic overview of how biological, psychological, and social exposures from conception to age three critically converge to shape brain development and neurodevelopmental outcomes. Following a pre-registered protocol and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, 55 studies were included, primarily published in the past 15 years. Earlier studies focused predominantly on biological exposures, while more recent work has increasingly examined psychological exposures and, more rarely, social exposures. While each exposure exhibited its own pattern of brain alterations and neurodevelopmental changes, an overarching pattern emerged across the different components of the biopsychosocial model. Adverse biological exposures were consistently associated with delayed brain maturation as reflected by brain imaging measures. Adverse psychosocial exposures showed a more complex pattern of associations with both delayed and accelerated brain maturation. Crucially, adverse exposures, whether associated with delayed or accelerated brain maturation, were consistently associated with poorer neurodevelopmental outcomes, underscoring the necessity of considering both brain and behavior when estimating the impact of early exposures. We conclude that research into early-life exposures on brain maturation and neurodevelopmental outcomes is on the rise, but there is a great need for further investigation, in particular of psychological and social exposures. The interactions between exposures, the brain, and outcomes are highly complex, requiring assessment of both brain development and behavior together, ideally in within-subject longitudinal designs in future studies.
Introduction: The Trauma Medical Home (TMH) randomized clinical trial tested the efficacy of a collaborative care intervention on the biopsychosocial recovery of older injured adults compared to usual care. Study enrollment occurred between 11 October 2017 and 13 October 2021 and study operations were impacted by the COVID-19 pandemic. It is important to measure the potential effects of COVID-19 on research study participants to ensure accurate reporting of results. The purpose of this secondary analysis was to compare depression and anxiety symptoms and health-related quality of life in older adults at TMH study enrollment pre-COVID-19 and during COVID-19. We hypothesized that those enrolled during COVID-19 would have worse symptoms and quality of life. Methods: This study was a secondary analysis of data from a multicenter randomized clinical trial (R01AG052493-01A1) TMH, that examined the ability of a collaborative care model to enhance the recovery of older injured adults compared to usual care. It was hypothesized that the TMH intervention would improve biopsychosocial recovery for injured older adults compared to usual care. The enrollment periods pre-COVID-19 and during COVID-19 were compared. Chi-square tests and Wilcoxon Rank Sum tests, then multivariable linear and logistic regressions were completed with SF-36 component scores and depression (PHQ-9) and anxiety (GAD-7) scores as the dependent variables, respectively. Results: A total of 429 participants were analyzed. There was no significant difference in anxiety and depression symptoms between the pre-COVID-19 and during-COVID-19 enrollment periods. Perceived limitations due to physical health problems were worse for those enrolled during COVID-19 (adjusted β = -9.8, 95% CI -18.3 to -1.4), but other health-related quality of life measures were similar between the two groups. Conclusions: These findings support the conclusion that the negative psychological impacts of the pandemic are likely due to individual factors other than age or COVID-19. These results suggest a high degree of psychological resiliency in older adults under stress. Future research should focus on the potential effects of socioeconomic status, demographic background, and level of physical functioning on psychological outcomes.
Chronic low back pain (CLBP) is the leading cause of disability in women over 50, compounded by menopause, caregiving demands, and reduced physical capacity. This article presents the Integrated Resilience Method, a six-pillar framework integrating evidence-based self-management strategies for postmenopausal women with CLBP. The framework is a conceptual model informed by clinical and lived experience with chronic low back pain and a broad, narrative review of the literature across pain science, rehabilitation, women's health, and lifestyle medicine. Its six interconnected pillars-Resilient Identity, Pain Signal Mastery, Nervous System Recalibration, Capacity Restoration, Anti-Inflammatory Foundation, and Sustainable Performance Habits-address the biopsychosocial factors that drive CLBP in postmenopausal women, including hormonal change, sarcopenia, sleep disruption, fear-avoidance, and caregiving stress. Within the framework, evidence hierarchy prioritizes exercise, pain education, and self-efficacy as the components with the strongest evidence, with nutrition and stress-resilience practices positioned as adjunct supports aligned with lifestyle-medicine priorities. The Integrated Resilience Method offers clinicians, nurses, physical therapists, and health coaches a practical, patient-centered model that translates current pain science into sustainable lifestyle interventions for midlife women. It is applicable in primary care, rehabilitation, and community-based settings, and is designed to complement-not replace-medical evaluation and treatment.