Substance-induced mental disorders (SIMD) are an under-recognized consequence of psychoactive substance use, despite major implications for treatment needs, health service demand and outcomes. In the context of British Columbia's (BC's) ongoing toxic drug emergency, we aimed to (1) estimate the incidence and prevalence of SIMD in the provincial population and (2) describe socio-demographic, geographic, clinical and substance-specific patterns over a two-year period. We conducted a retrospective, population-based study using linked administrative health data from Population Data BC for residents aged ≥12 years between 1 January 2022 and 31 December 2023. SIMD cases were identified using a novel algorithm combining diagnostic codes with temporal linkage between substance-related events (poisoning, withdrawal or substance use disorder) and subsequent psychiatric diagnoses. Incident cases had no record of the same mental disorder in the previous two years; prevalent cases met SIMD criteria at any point in the study period. We calculated monthly, annual and cumulative incidence and prevalence rates per 10,000 population, stratified by sex, age group, health authority, urban/rural residence, neighbourhood income, psychiatric diagnosis, substance class, concurrent substance use disorder, involuntary treatment and mortality. We identified 37,474 incident and 83,307 prevalent SIMD cases over two years, corresponding to a cumulative incidence of 77.5 and prevalence of 171.4 per 10,000 population. Monthly rates fluctuated in 2022, followed by a rise through 2023, with highest incidence (35.2 per 10,000) and prevalence (328.3 per 10,000) in May 2023. Males accounted for 62% of incident and 59% of prevalent cases; mean age was 43 years, with highest proportions in the 25-44 age range. Northern and Vancouver Island Health Authorities had the greatest burden. On average, individuals with SIMD had 3.2-3.6 healthcare visits per month. Cannabis- and hallucinogen-induced disorders were concentrated among younger people, while alcohol- and tobacco-related SIMD predominated in older adults; stimulant-related SIMD showed the highest hospitalization and involuntary treatment rates. Only about one-third of prevalent and fewer than one in five incident cases had a recorded concurrent substance use disorder. SIMDs are common, clinically complex and unevenly distributed across demographic and geographic groups in BC. The high rates, substantial service use and frequent occurrence outside documented substance use disorder diagnoses underscore the need for improved detection of SIMD, integration of psychiatric and addiction care and regionally tailored prevention and treatment strategies within the ongoing toxic drug emergency.
Burnout and compassion fatigue are crucial issues among the nursing workforce that are associated with compassion satisfaction and patient care behavior. Relatively little is known about burnout and compassion fatigue among psychiatric unit nurses (PNs) working in psychiatric units in developing countries, like Pakistan. This study examined and compared the prevalence of burnout, compassion fatigue, and compassion satisfaction among male PNs in public and nonpublic hospitals in Pakistan's capital territory. This study used a cross-sectional research design. This study recruited male PNs from psychiatry inpatient units in public and nonpublic hospitals through purposive sampling between June 2023 and December 2023. The Professional Quality of Life (ProQOL) scale was used to assess PNs' burnout, compassion fatigue, and compassion satisfaction levels. Among PNs, 59% had severe burnout, 88% had higher risk compassion fatigue, and 12% had high compassion satisfaction. Correlation analysis revealed a significant negative association between burnout and compassion satisfaction (r = -0.261, p < 0.01). Intergroup comparison revealed that PNs in nonpublic hospitals demonstrated higher burnout (M = 28.46 vs. 26.98, p < 0.05, Cohen's d = 0.330) and slightly higher compassion fatigue (M = 24.18 vs. 23.88, p > 0.05, Cohen's d = 0.048). In contrast, PNs working in a public hospital reported higher compassion satisfaction (M = 32.53 vs. 29.62, p < 0.05, Cohen's d = 0.442). The findings identify modest statistically significant cross-sector differences in occupational well-being indicators between PNs working in public and nonpublic hospitals, accompanied by small-to-moderate effect sizes. The tentative results highlight the necessity of targeted workplace interventions that may support the occupational well-being of PNs operating within resource-limited mental healthcare systems. This study underscores the necessity of targeted staff well-being interventions within psychiatric inpatient units. PNs in nonpublic hospitals exhibited elevated burnout and diminished compassion satisfaction relative to their public hospital counterparts, whereas compassion fatigue affected nurses across both hospital types equally. Nurse managers can prioritize these disparities by implementing well-being assessments, balanced workload distribution, and tailored psychological support programs. Boosting organizational support may mitigate burnout, enhance compassion satisfaction, improve staff retention, and promote high-quality psychiatric care.
Out-of-home care and parental death are both associated with psychiatric disorders. It remains unclear whether parental death moderates the association between out-of-home care and psychiatric disorders, particularly regarding timing and duration of out-of-home placement. This cohort study included 944,138 individuals (459,712 women and 484,426 men) born in Sweden (1972-1981). Of these, 23,106 individuals (2.5%) experienced out-of-home care between ages 0 and 19. Psychiatric disorders, identified from the National Patient Register, were examined as the outcome. Information on parental death between ages 0 and 19 years and familial covariates was obtained from linked national registers. Sex-stratified Cox proportional hazard models examined the associations between out-of-home care, parental death, and psychiatric disorders from ages 20 to 47 years. Individuals with experience of out-of-home care had increased psychiatric risk across adulthood, with the highest risks observed for teenage placements. Parental death was also associated with an increased psychiatric risk. Associations between parental death and psychiatric disorders were attenuated across the teenage, long-term, and early intermediate placement groups among women and across the early intermediate, teenage, and early short-term placement groups among men compared with non-placed counterparts. Findings suggest that parental death adds limited risk within a highly vulnerable and disadvantaged population, highlighting the importance of interventions addressing multiple risks across developmental periods.
A growing body of evidence identifies childhood trauma, encompassing both abuse and neglect, as a potent predictor of suicide attempts across the lifespan. Clear delineation of its mechanisms is essential for advancing trauma-informed psychiatric care. This study examined the role of childhood maltreatment in single and multiple suicide attempts among adult psychiatric inpatients. In this cross-sectional study, 300 adult psychiatric inpatients, with and without a history of suicide attempts, were assessed using the Childhood Trauma Questionnaire - Short Form (CTQ-SF), alongside the collection of sociodemographic and clinical data. Binary logistic regression was employed to evaluate the associations between childhood trauma, psychiatric diagnoses, and suicide attempt history, distinguishing between single and multiple attempts. All CTQ-SF domains were significantly intercorrelated (p < .01), with the strongest associations between emotional neglect and physical neglect (ρ = 0.708) and between emotional neglect and emotional abuse (ρ = 0.683). Emotional neglect was the most prevalent trauma type (93%), whereas sexual abuse was the least common (27%); 90% of participants reported two or more trauma types. Emotional abuse was associated with increased odds of any suicide attempt [odds ratio (OR) = 1.04], while physical neglect was associated with increased odds of multiple attempts (OR = 1.14). Our findings indicate that most forms of childhood trauma may contribute to repeated suicide attempts. Neglect exerts a heightened effect when co-occurring with other maltreatment types, suggesting a dose-response relationship. This synergistic impact underscores the need for comprehensive trauma assessments that capture both the severity and multiplicity of adverse experiences. Childhood neglect was highly prevalent among psychiatric inpatients and was strongly linked to repeated suicide attempts.People who experienced multiple forms of childhood maltreatment were more likely to report recurrent suicidal behaviour, highlighting the cumulative impact of early adversity.Physical neglect, major depressive disorder, bipolar disorder, and borderline personality disorder were key factors associated with repeated suicide attempts, underscoring the need for trauma-informed suicide prevention and early intervention. Antecedentes: Un creciente cuerpo de evidencia identifica el trauma infantil, que abarca tanto el abuso como la negligencia, como un potente predictor de los intentos de suicidio a lo largo de la vida. La delimitación clara de sus mecanismos resulta esencial para avanzar en una atención psiquiátrica informada en trauma. Objectivo: Este estudio examinó el papel del maltrato infantil en los intentos de suicidio únicos y múltiples en pacientes adultos hospitalizados en una unidad psiquiátrica. Método: En este estudio transversal, 300 pacientes adultos hospitalizados en una unidad psiquiátrica, con y sin antecedentes de intentos de suicidio, fueron evaluados mediante el Cuestionario de Trauma Infantil–Forma Abreviada (CTQ-SF), junto con la recolección de datos sociodemográficos y clínicos. Se empleó una regresión logística binaria para evaluar las asociaciones entre el trauma infantil, los diagnósticos psiquiátricos y los antecedentes de intentos de suicidio, distinguiendo entre intentos únicos y múltiples. Resultados: Todos los dominios del CTQ-SF mostraron intercorrelaciones significativas (p < 0,01), siendo las asociaciones más fuertes las observadas entre la negligencia emocional y la negligencia física (ρ = 0,708) y entre la negligencia emocional y el abuso emocional (ρ = 0,683). La negligencia emocional fue el tipo de trauma más prevalente (93%), mientras que el abuso sexual fue el menos frecuente (27%); el 90% de los participantes reportó dos o más tipos de trauma. El abuso emocional se asoció con un aumento de las probabilidades de presentar cualquier intento de suicidio (OR = 1,04), mientras que la negligencia física se asoció con un aumento de las probabilidades de intentos múltiples (OR = 1,14). Conclusión: Nuestros hallazgos indican que la mayoría de las formas de trauma infantil podrían contribuir a los intentos de suicidio recurrentes. Esto subraya la necesidad de evaluaciones integrales del trauma que capturen tanto la gravedad como la multiplicidad de las experiencias adversas.
Research on the link between threat-related and deprivation-related adverse childhood experiences (ACEs) and the risk of gastrointestinal (GI) and liver diseases in later life remains limited. This study aims to evaluate the independent associations of threat-related and deprivation-related ACEs with the development of GI and liver disorders in middle-aged and older Chinese adults. This prospective cohort study used data from the China Health and Retirement Longitudinal Study, which included participants aged 45 and older who had complete ACE data, two health assessments, and no pre-existing GI or liver conditions at baseline. Participants reported on five threat-related and deprivation-related ACEs before age 17. GI and liver diseases were classified based on self-reported physician diagnoses. The outcomes of GI and liver diseases are based on self-reported physician diagnosis and broad categories. Compared with no exposures, participants with two or more threat-related ACEs exhibited a higher risk of both chronic liver disease (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.04-1.52; P = 0.016) and GI disease (HR, 1.36; 95% CI, 1.20-1.55; P < 0.001); two or more deprivation-related ACEs showed stronger associations with GI disease (HR, 1.48; 95% CI, 1.28-1.70; P < 0.001); and no significant associations with liver disease risk across all exposure levels. Additionally, depressive symptoms accounted for 10.7% (P = 0.003) of the association between threat-related ACEs and liver disease risk and accounted for 12.7% (P < 0.001) of the association between threat-related ACEs and GI disease risk. Midlife loneliness accounted for 5.3% (P = 0.001) of the association between threat-related ACEs and incident GI diseases and for 3.7% (P = 0.004) of the association between deprivation-related ACEs and incident GI diseases. Threat-related ACEs are directly associated with an increased risk of liver and GI diseases. A modest proportion of this observed relationship is partially mediated through depressive symptoms and loneliness in middle age.
Suicidal ideation and behaviour (SIB) occur across various psychiatric disorders. Although certain disorders are associated with elevated rates of SIB, diagnostic labels alone provide limited information about suicide-related presentations. Psychological pain has been proposed as an important experiential process operating across diagnostic boundaries, but its relationship with psychiatric comorbidity remains poorly understood. This study examined associations between psychiatric diagnoses, the number of co-occurring diagnoses, and psychological pain across clinical groups differing in suicide-related presentations. N = 233 psychiatric inpatients were recruited (recent suicide attempters [SUAT], recent suicide ideators [SUID], clinical controls [CLIN]). Psychiatric diagnoses were assessed using the Mini-International Neuropsychiatric Interview; psychological pain was measured using the Mee-Bunney Psychological Pain Assessment Scale. Analyses evaluated group differences in the number of diagnoses and psychological pain, their association, and diagnostic patterns. SUAT and SUID had higher mean numbers of diagnoses than CLIN; these did not differ between SUAT and SUID. Psychological pain differed across all groups and was positively associated with the number of diagnoses across the sample and within each group. Affective-anxiety and alcohol-dysthymic profiles were associated with suicide-related status. The number of diagnoses did not reflect differences between suicide-related groups. Although suicidal groups displayed greater diagnostic complexity than non-suicidal controls, differences between ideation and attempt were not mirrored by the number of diagnoses. Psychological pain differentiated all groups and was associated with the number of diagnoses. These findings suggest that psychological pain captures aspects of suicide-related clinical states not fully represented by diagnostic descriptions alone.
Background: Adolescence is a developmentally sensitive period for trauma-related psychopathology, yet posttraumatic stress disorder (PTSD) is defined differently across diagnostic systems. The DSM-5 conceptualises PTSD broadly, whereas the ICD-11 distinguishes PTSD from complex PTSD (CPTSD), raising questions about diagnostic alignment and clinical meaning in youth.Objective: This study examined the diagnostic concordance between DSM-5 PTSD and ICD-11 PTSD and the differentiation between DSM-5 PTSD and ICD-11 CPTSD in adolescents, further evaluating whether adverse childhood experiences (ACEs) differentially predicted diagnoses.Method: Participants included 585 adolescents aged 13-20 years from psychiatric outpatient clinics and 2146 control adolescents from schools. DSM-5 PTSD was assessed using the PTSD Checklist for DSM-5, ICD-11 PTSD and CPTSD were assessed with the International Trauma Questionnaire (ITQ), and ACEs were measured using the ACE International Questionnaire (ACE-IQ). Least absolute shrinkage and selection operator (LASSO) logistic regression and receiver operating characteristic (ROC) analyses were used to identify stable adversity-based predictors and evaluate model discrimination.Results: DSM-5 PTSD prevalence was substantially higher than ICD-11 PTSD prevalence in both samples. ACEs showed minimal predictive value for ICD-11 PTSD but strong associations with DSM-5 PTSD and ICD-11 CPTSD, particularly cumulative adversity and community violence. DSM-5 PTSD aligned more closely with ICD-11 CPTSD than with ICD-11 PTSD in adolescents, and ACEs predicted diagnostic differentiation primarily in samples with lower trauma exposure.Conclusions: By directly mapping diagnostic overlap and adversity-based differentiation within adolescent cohorts, this study addresses a critical gap in the literature regarding the age-specific validity and clinical meaning of DSM-5 and ICD-11 trauma diagnoses. DSM-5 PTSD and ICD-11 PTSD showed limited cross-system equivalence in adoles-cents.ICD-11 CPTSD shows closer alignment with DSM-5 PTSD, supporting CPTSD as a distinct subgroup within the broader DSM-5 PTSD.The diagnostic utility of ACE showed limited discrimination in the high-trauma-burden clinical sample but clearer differentiation in the low-trauma-burden cohort. Antecedentes: La adolescencia es un período de desarrollo sensible para la psicopatología relacionada con el trauma, sin embargo, el trastorno de estrés postraumático (TEPT) se define de manera diferente en los distintos sistemas diagnósticos. El DSM-5 conceptualiza el TEPT de forma amplia, mientras que la CIE-11 distingue el TEPT del TEPT complejo (TEPTc), lo que plantea interrogantes acerca de la coherencia diagnóstica y su significado clínico en jóvenes. Objetivo: Este estudio examinó la concordancia diagnóstica entre el TEPT del DSM-5 y el TEPT de la CIE-11 y la diferenciación entre el TEPT del DSM-5 y el TEPTc de la CIE-11 en adolescentes, además de evaluar si las experiencias adversas en la infancia (ACEs por sus siglas en inglés) predecían de manera diferente los diagnósticos. Métodos: Los participantes incluyeron 585 adolescentes, edades 13 a 20 años de centros psiquiátricos ambulatorios y 2.146 adolescentes de control de escuelas. El TEPT del DSM-5 se evaluó utilizando la lista de chequeo de TEPT para el DSM-5, el TEPT y TEPTc de la CIE-11 se evaluaron con el Cuestionario Internacional de Trauma (ITQ), y las ACEs se midieron utilizando el Cuestionario Internacional de ACE (ACE-IQ). Se utilizaron análisis de regresión logística LASSO (least absolute shrinkage and selection operator) y análisis de curvas ROC (characteristic) para identificar predictores estables basados en la adversidad y evaluar la capacidad de discriminación del modelo. Resultados: La prevalencia de TEPT según el DSM-5 fue sustancialmente mayor que la prevalencia de TEPT según la CIE-11 en ambas muestras. Las ACEs demostraron un valor predictivo mínimo para el TEPT según la CIE-11, pero fuertes asociaciones con el TEPT según el DSM-5 y TEPTc según la CIE-11, particularmente la adversidad acumulativa y la violencia comunitaria. El TEPT según el DSM-5 se alineó más estrechamente con el TEPTc según la CIE-11 que con el TEPT según la CIE-11 y las ACEs predijeron la diferenciación diagnóstica principalmente en muestras con menor exposición al trauma. Conclusiones: Al mapear directamente la superposición diagnóstica y la diferenciación basada en la adversidad en las cohortes de adolescentes, este estudio aborda una brecha crítica en la literatura relacionada con la validez específica por edad y el significado clínico de los diagnósticos de trauma según el DSM-5 y CIE-11.
Childhood asthma and eczema are common chronic diseases that significantly affect the health of children and parents. These children experience physical and psychosocial problems, including behavioral and emotional disturbances. This study was conducted to identify the psychological issues such as children's attachment, maternal emotion regulation, and child-parent relationship in children with autoimmune disorders, especially asthma and eczema. This cross-sectional study included80 mother-child pairs (40 with asthma and 40 with eczema) recruited from Yazd autoimmune clinics between 2022 and 2023. Exclusion criteria included additional physical or psychiatric illnesses in parents and parental drug addiction. Participants completed a demographic questionnaire and three validated questionnaires: Children's Attachment Questionnaire, Gross Emotion Regulation Strategies Questionnaire, and Pianta Mother-Child Relationship Questionnaire. Results analysis and comparison showed that both the asthma and eczema groups have moderate levels of secure attachment with a 25% achieving favorable score. Emotion regulation showed very low desirability (up to 25% for its subscales). Geographical location had a slight but significant effect on attachment and emotion regulation. Scores of the Pianta mother-child relationship scale were generally positive. No significant effects were observed in relation to the child's gender, occupation, and educational status of the mothers. This study found moderate levels of children's secure attachment and maternal emotion regulation in both groups and favorable mother-child relationships in children aged 5 to 12 years with asthma and eczema. Only a small percentage of children demonstrated secure attachment, reflecting existing research linking childhood illness to parental distress and impaired child development.
Although numerous risk and protective factors have been identified as correlates of suicidal thoughts and behaviors (STBs), less is known about factors that differentiate increasing levels of suicide risk, from suicidal ideation (SI) to suicide planning (SP) to suicide attempts (SA). This study examined the prevalence and correlates of these STB stages in a nationally representative sample of U.S. veterans. Data were analyzed from the 2025-2026 National Health and Resilience in Veterans Study (NHRVS; N = 2636). Weighted estimates were used to determine the lifetime prevalence of SI, SP, and SA. Multivariable binary logistic regression analyses examined sociodemographic, military, psychiatric, and clinical characteristics associated with (1) SI vs. no lifetime history of STBs, (2) SP vs. SI, (3) SA vs. SI, and (4) SA vs. SP. The prevalences of SI, SP, and SA were 18.9%, 8.1%, and 5.0%, respectively. In multivariable analyses, SI (vs. no STB history) was associated with younger age, greater adverse childhood experiences (ACEs) and cumulative trauma burden, higher self-criticism, lower meaning in life, lifetime non-suicidal self-injury (NSSI), and major depressive disorder (MDD). Relative to SI, SP was associated with age, identifying as Non-Hispanic Black, being widowed, divorced, or separated, NSSI, and MDD, and posttraumatic stress disorder. Relative to SI, SA was associated with greater ACEs, NSSI, and anxiety disorder, while SA (vs. SP) was associated with greater ACEs, anxiety disorder, being unpartnered, and identifying as biracial/multiracial. Findings broadly support ideation-to-action theories and suggest suicidal thoughts and suicidal behavior in U.S. veterans may be influenced by overlapping but distinct processes. They also underscore the importance of addressing both distal vulnerability processes and proximal behavioral risk factors across stages of STBs to inform more precise and stage-specific suicide prevention strategies.
Mental health disorders such as depression, anxiety, and stress are prevalent in the general population, with various socio-demographic factors potentially influencing their prevalence. This study aimed to assess the prevalence of Depression, Anxiety, and Stress Scale - 21 Items and identify associated risk factors within the general population in Asir, Saudi Arabia. This cross-sectional study, conducted from April 27, 2025, to September 28, 2025, assessed depression, anxiety, and stress using the Depression, Anxiety, and Stress Scale - 21 Items and identified risk factors in the Asir region of Saudi Arabia. Data from 392 participants were collected through an anonymous online survey and analyzed using descriptive statistics and logistic regression. The study included 392 participants, with 55.1% females and 44.9% males. The largest age group was 18 to 30 years (27.3%). Most participants were nonsmokers (84.2%), 46.7% were employed, and 52% had graduate-level education. A majority were married (61.5%), and 32.9% earned <5000 Saudi Arabian Riyal per month. In terms of mental health, 36.5% were classified as normal for depression, 21.7% for anxiety, and 55.4% for stress. Depression was more common in single individuals (odds ratio [OR] = 4.999, P = .011) and those with 3 to 5 children (OR = 2.232, P = .060). Anxiety was higher in divorced/widowed individuals (OR = 3.828, P = .016) and the unemployed (OR = 2.033, P = .017). Stress was more prevalent in single (OR = 6.304, P = .007) and divorced/widowed individuals (OR = 2.994, P = .094), and those with 3 to 5 children (OR = 3.417, P = .030). Females had lower odds of anxiety (OR = 0.543, P = .021). Age, education, smoking, and income showed limited or nonsignificant associations with mental health outcomes. The study found high levels of depression, anxiety, and stress, with unemployment, being single or divorced, and having more children as significant risk factors. These findings highlight the need for targeted mental health interventions, accessible services, stigma reduction, and preventive strategies addressing social and economic influences on mental well-being.
Refugees bear the highest burden of mental health issues; however, they often underuse available mental health services. Interventions aimed at those with diagnosed conditions frequently do little to prevent the onset of disorders. Problem Management Plus for Immigrants (PMP-I) is a prevention intervention adapted from the World Health Organization's Problem Management Plus (PMP). PMP-I includes psychoeducation, problem-solving, behavioural activation, social support and networking, and mind-body exercises. This pilot randomized controlled trial (RCT) aimed to evaluate the impact of PMP-I on mental, social and emotional well-being outcomes among Bhutanese refugees resettled in Massachusetts. Bhutanese individuals aged 18 or older who had resettled in Massachusetts and scored ≤14 on the Patient Health Questionnaire-9 (PHQ-9) were randomly assigned to two groups: PMP-I (n = 58 families) and a talk programme with a community support services pamphlet (n = 58 families). Trained community interventionists delivered five sessions of PMP-I to intervention participants in their family settings. Primary outcomes included scores on measures of stress (Cohen Perceived Stress Scale-10), and anxiety and depression (Hopkins Symptoms Checklist-25), assessed at baseline, 6-week and 3-month post-intervention. Secondary outcomes included hair cortisol, coping, coping self-efficacy, social support, social network, family conflict resolution and family satisfaction. Linear mixed-effects models were used to analyse differences in changes in outcomes between the intervention and control groups, adjusting for baseline scores on the primary outcomes, as well as age, duration of residence, marital status and history of chronic diseases. All 232 participants recruited (116 families) were retained throughout the project. The intervention group evidenced a significantly greater decrease than the control group at both 6-week and 3-month post-intervention assessments on the primary outcomes of stress, anxiety, and depressive symptom scores. Similarly, the intervention group demonstrated significantly higher scores at both the 6-week and 3-month periods after the intervention compared to the control group on measures of coping, family conflict resolution, self-efficacy, family satisfaction and social networking with large effect sizes (Cohen's d > 0.8, p < .01). Hair cortisol concentrations did not differ significantly between the intervention and control groups at either baseline or 3-month post-intervention. The PMP-I improved the mental, social and emotional well-being of Bhutanese adults (PHQ-9 score ≤ 14) resettled in Massachusetts. Peer-delivered, family-centred PMP-I offers a significant public health benefit; however, a large-scale, RCT involving diverse refugee groups is necessary to replicate its success nationwide and beyond.
To estimate the minimal detectable change (MDC) for the Patient Health Questionnaire-9 (PHQ-9) and its eight item (PHQ-8) and two item (PHQ-2) versions including differences by participant and study characteristics. Individual participant data meta-analysis. Medline, Medline In-Process and other non-indexed citations, PsycInfo, and Web of Science, 1 January 2000 to 9 May 2018. Datasets from articles in any language if participants were aged ≥18 years, were recruited from any non-psychiatric setting, and were not recruited because they were seeking mental healthcare. Eligible datasets had a classification for major depressive disorder or major depressive episode based on a validated semi-structured or fully structured interview conducted within two weeks of administering the PHQ-9, PHQ-8, or PHQ-2. Pooled MDCs across studies were estimated for the PHQ-9, PHQ-8, and PHQ-2 with random effects meta-analysis for 95% (MDC95), 90% (MDC90), and 67% (MDC67) confidence that change beyond measurement error occurred. PHQ-9, PHQ-8, and PHQ-2 analyses included 42 548 participants (94 studies), 42 592 participants (94 studies), and 44 085 participants (98 studies), respectively. Mean participant age was 49 years (standard deviation 17), and 60% of participants were women. Overall, 10% of participants had major depression (range 1-57% across studies). MDC95 was 5.72 points (95% confidence interval (CI) 5.54 to 5.90, 95% prediction interval (PI) 4.00 to 7.44) for the PHQ-9, 5.51 points (95% CI 5.33 to 5.68, 95% PI 3.87 to 7.15) for the PHQ-8, and 2.26 points (95% CI 2.15 to 2.37, 95% PI 1.20 to 3.32) for the PHQ-2. For the PHQ-9, MDC95 was highest in inpatient healthcare settings at 6.48 (95% CI 6.05 to 6.92) points. MDC95 for the PHQ-9 increased by 0.40 (95% CI 0.25 to 0.55) points for each 10% increase in the proportion of participants with major depression. Sex and age had minimal or no association. Subgroup and meta-regression findings were similar for the PHQ-8 and PHQ-2. Based on the pooled estimate, a six point difference on the PHQ-9, the PHQ version most used in clinical practice, could be an appropriate MDC threshold in general practice. A higher threshold may be preferred in specialty mental healthcare. MDC67 or MDC90 thresholds would provide less certainty that change has occurred. Alternative strategies, such as using the upper end of a prediction interval, would provide more certainty but a greater likelihood of not recognising change. PROSPERO CRD42014010673.
Patients in forensic psychiatric care (FPC) are often treated with various psychotropic medications. However, evidence regarding their effectiveness in this setting is lacking. The study aimed to estimate how different psychotropic medications are associated with the use of coercive measures and recidivism during FPC. In this observational national register-based study, we included all patients newly registered as admitted to FPC in Sweden between January 2009 and August 2024. Exposures included major classes of psychotropic medication (typical antipsychotics, atypical antipsychotics, antidepressants, hypnotics and sedatives, antiepileptic medications, opioids, medications for addictive disorders and mood stabilisers), antipsychotic treatment strategies (no use, monotherapy, polypharmacy, long-acting injectables or clozapine) and specific antipsychotic agents. Outcomes were the use of coercive measures and recidivism into criminal behaviour. We performed a within-individual analysis using conditional generalised estimating equation models, where the risk of outcomes was compared between exposed and non-exposed time periods. In total, 2690 patients were included, of which 25.1% experienced at least one occasion of coercion and 27.1% at least one event of recidivism during FPC. Atypical antipsychotics were associated with a reduced risk of subsequent use of coercive measures (OR 0.70, 95% CI 0.55 to 0.89) and recidivism (OR 0.79, 95% CI 0.63 to 0.99). Medication for addictive disorders was associated with a reduced risk of coercive measures by 34% (OR 0.66, 95% CI 0.47 to 0.93). Among antipsychotic agents, clozapine was associated with the largest risk reduction in the use of coercive measures (OR 0.48, 95% CI 0.33 to 0.69) and recidivism (OR 0.49, 95% CI 0.33 to 0.74). There was no significant difference between long-acting injectable, oral monotherapy or polypharmacy. We observed that atypical antipsychotics, especially clozapine, were associated with a risk reduction for coercive measures and recidivism during FPC. Additionally, medications for addictive disorders were associated with a reduced risk of coercive measures. Our results can help inform decision-making processes in this clinical setting regarding pharmacotherapy but should be interpreted as one of many aspects influencing treatment success in FPC.
The importance of mental and physical health is crucial, as it not only affects the quality of individual life, but also influences their behavior and performance at work. The role of burnout and depression is of particular importance in research. Burnout is most often associated with helping occupations, such as healthcare. We used a questionnaire method. Burnout was measured using the BAT-C and BAT-S questionnaires, and depression was measured using the Beck Depression Scale and the Male Depression Risk Assessment Scale, so both types of depression could be examined. According to our N=254 sample, the reliability and validity indicators of the BAT questionnaire in a healthcare sample proved to be adequate. Burnout and depression are positively correlated with each other. Women are more likely to experience emotional suppression, exhaustion, and symptomatic appearance of burnout. Decreased emotions and psychological symptoms predict depression. Masculine depression is also characterized by somatic symptoms. Burnout is closely related to depressive symptoms and various dimensions of burnout. Burnout not only causes mental and physical exhaustion, loss of motivation and concentration difficulties, but can also be accompanied by sleep disorders, anxiety, somatic complaints (e.g. headache, stomach and muscle pain), and these are already a pre cursor to depression. Regular screening with burnout and depression questionnaires is important for prevention and intervention, especially in those who have problems expressing emotions, suppressing emotions, and increased psycho logical or somatic symptoms.
Financial strain is associated with suicide risk; however, no research has examined financial stressors in the year preceding suicide using national credit data. To assess financial stressors in the 12 months preceding suicide in a national sample of veterans by linking financial, mortality, and health care records. This case-control study of 5000 veterans who died by suicide (January 1, 2015 to December 31, 2017) used mortality data from the US Department of Veterans Affairs (VA) and the US Department of Defense. Cases were matched to 12 500 living controls on age, sex, VA health care use, and suicide index date. Analyses were conducted in December 2025. Financial stressors in the prior 12 months were identified in TransUnion credit records provided by FinThrive. The primary outcome was death by suicide. Differences between cases and controls were analyzed using multivariable conditional logistic regression, adjusting for demographics and, among VA users, marital status and diagnoses of depression, posttraumatic stress disorder, and substance use disorder. Among 17 439 veterans included in this study, the mean (SD) age was 52.9 (15.7) years, and 94.6% were male. Suicide was associated with having (vs not having) delinquent mortgage payments (odds ratio [OR], 1.4; 95% CI, 1.2-1.7), repossessions (OR, 1.9; 95% CI, 1.3-2.7), and credit card payments 30 or more days past due (OR, 1.7; 95% CI, 1.6-1.9). Lower credit score categories were associated with increasing odds of suicide. Veterans with 3 or more financial stressors had higher odds of suicide (OR, 2.4; 95% CI, 1.9-3.0) compared with those who had none. Among individuals with available data, credit score declines of 51 to 100 points (OR, 1.3; 95% CI, 1.1-1.5) and greater than 100 points (OR, 2.8; 95% CI, 2.3-3.5) over 1 year, relative to no change in score, were associated with increased odds of suicide. Cumulative financial stressors and declining credit scores had the highest ORs for suicide when adjusting for demographics and, among VA users, marital status and prior psychiatric diagnoses. ORs were lower among VA users than among non-VA users. In this case-control study, suicide was associated with financial stressors in the prior 12 months. Incorporating financial stressors into clinical evaluations and safety planning may aid in identifying patients at risk for suicide. Policymakers and researchers could consider strategies to detect and mitigate financial stressors as part of comprehensive suicide prevention efforts.
Diabetic foot complications, including ulcers, infections, and amputations, remain a major cause of morbidity among individuals with diabetes, primarily driven by neuropathy and peripheral vascular disease. Despite being largely preventable, their burden remains substantial, particularly in high-risk populations. To assess the burden and associated factors of diabetic foot complications among patients attending a tertiary diabetes centre in the Qassim region, Saudi Arabia, between 2021 and 2024. A retrospective cross-sectional study was conducted using medical record data from 4119 patients attending a tertiary referral diabetes and endocrinology centre. Standardised clinical and demographic data were extracted and analysed to estimate the burden of diabetic foot complications and examine associated factors. The mean age of the participants was 58.8 ± 10.8 years; 60.5% were male, and 97.8% had type II diabetes. The mean BMI was 28.2 ± 2.9 kg/m2, and the mean HbA1c level was 8.9% ± 2.1%. Hypertension was present in 78.9% of participants. Foot ulcers were identified in 65.4% of patients, and 41.2% had a history of lower-extremity amputation. Multivariable logistic regression analysis demonstrated that age, male sex, type II diabetes, smoking, hypertension, elevated BMI, higher HbA1c levels, and lack of participation in diabetes-related educational programs were independently associated with amputation. Male patients had higher adjusted odds of amputation than females (AOR = 1.48, 95% CI: 1.23-1.79), while type II diabetes was independently associated with higher odds of amputation (AOR = 1.41, 95% CI: 1.02-2.07). A high burden of diabetic foot complications was observed in this tertiary referral cohort, likely reflecting the concentration of advanced and complex cases. Older age, male sex, type II diabetes, smoking, hypertension, elevated BMI, higher HbA1c levels, and lack of participation in diabetes-related educational programs were independently associated with lower-extremity amputation. These findings highlight the importance of earlier referral of high-risk patients, strengthening diabetic foot screening within primary healthcare settings, and enhancing multidisciplinary foot care services to prevent progression to advanced disease and reduce avoidable amputations. However, given the retrospective cross-sectional design, the reported findings should be interpreted as associations rather than causal relationships.
Populations affected by humanitarian crises, including conflict, disasters and displacement, are frequently exposed to elevated psychological distress, while access to mental health services remains scarce. Problem Management Plus (PM+), a low-intensity psychological intervention developed by the World Health Organization, has shown clinical efficacy. However, evidence on its implementation in humanitarian contexts remains limited. This systematic review aimed to synthesize available evidence on the implementation outcomes of PM+ and its delivery formats (individual, group and digital) in such settings. The review included individual PM+, group PM+ and Step-by-Step. Following PRISMA 2020 guidelines, we systematically searched four databases (PubMed, Scopus, Web of Science and CENTRAL) for studies published up to June 2025. Eligible studies included populations in humanitarian settings receiving PM+ in any format and reported at least one implementation outcome based on Proctor's framework (acceptability, adoption, appropriateness, feasibility, fidelity, cost, penetration and sustainability). Data extraction and quality appraisal were conducted independently by two reviewers. The protocol for this systematic review was prospectively registered in PROSPERO (Registration No. CRD42024551943). Of 2093 records screened, 23 studies met inclusion criteria, representing 5377 participants across diverse humanitarian contexts. Feasibility (70% of studies) and acceptability (65%) were the most frequently assessed outcomes, with consistently positive findings, including adequate recruitment, retention and cultural adaptability of PM+. Evidence was strongest for participant and provider acceptability and feasibility of delivery, whereas system-level outcomes such as sustainability, adoption, penetration and cost were rarely reported. Delivery by trained non-specialist providers was common and supported by supervision structures. Fidelity assessments (43%) demonstrated high adherence to intervention manuals. In contrast, sustainability (9%) and cost evaluations (17%) were infrequently reported. Barriers to implementation included stigma, population mobility and resource constraints, while facilitators included contextual adaptation, community engagement and ongoing supervision. PM+ demonstrates strong feasibility and acceptability when delivered by trained non-specialist providers in humanitarian contexts. However, gaps remain in evidence on long-term sustainability, cost-effectiveness and policy integration. The limited availability of system-level implementation data constrains conclusions regarding large-scale integration of PM+ in humanitarian settings. Future research should employ standardized implementation science metrics and focus on strategies to enhance scalability and embed PM+ within existing health systems.
Health and social care professionals are at a higher risk of suicide. This study explores the mediating role of perceived private support (from family and friends), workplace support (from colleagues, supervisors and superiors), perceived availability of workplace resources and perceived job recognition in the relationship between burnout and suicidality among these professionals. A cross-sectional study was conducted using an online questionnaire distributed across 21 partner organizations, primarily in the mental health sector, spanning seven Swiss states in three linguistic regions (German, Franch, Italian). Data from 2,388 health and social care professionals (physicians, psychiatrists, psychologists, social workers and other health and social care personnels) were analyzed using double mediation structural equation modeling. Burnout was significantly associated with higher levels of suicidality. It was negatively associated with perceived workplace support and private support, both of which, in turn, predicted lower suicidality. Both forms of support independently attenuated the association between burnout and suicidality. Similarly, perceived job recognition and availability of workplace resources were associated with lower suicidality and independently mitigated the association between burnout and suicidality. 42% of respondents were classified as at risk of burnout. No gender differences were found. The findings suggest that, while suicidality is a complex issue with many contributing factors, increased organizational support could reinforce the protective role of certain work-related factors. Consistently providing adequate support and resources in the workplace, as well as enhancing job recognition, are likely to reduce burnout-associated suicidality. Organizational measures to address burnout are also warranted, since distressed professionals may compromise quality of care, patient safety and institutional functioning or even leave the profession. Therefore, beyond personal suffering, the distress of personnels should also be addressed as a public health issue, especially in times of personnel drop out and shortages.
ADHD is a neurodevelopmental disorder linked to impulsivity and self-regulation difficulties. While the association between ADHD and nicotine dependence is well-established, less is known about the association with smokeless tobacco use, such as snuff. Given the adverse health effects of nicotine during pregnancy, this study examines whether women diagnosed with ADHD are more likely to use snuff prior to and early in pregnancy, and whether they persist in use between these periods. This study also explores the associations between ADHD and snuff use in the presence of common psychiatric disorders: depression, anxiety and substance use disorders (SUDs). Using Swedish population-based registers, we identified women who gave birth between 2000 and 2020. ADHD was defined based on clinical diagnoses and/or ADHD medication prescriptions. Snuff use was self-reported during a prenatal care visit. Logistic regression models estimated odds ratios (ORs) with 95% confidence intervals (CIs) for snuff use prior to and early in pregnancy among women with ADHD, adjusting for sociodemographic factors. We also stratified the analyses by depression, anxiety, and/or SUDs to assess potential differences in associations. Women diagnosed with ADHD were more likely to use snuff prior to pregnancy (adjOR = 1.89, 95% CI: 1.83-1.95), early in pregnancy (adjOR = 2.43, 95% CI: 2.32-2.55), as well as be persistent snuff users (adjOR = 2.39, 95% CI: 2.27-2.52) compared to women without ADHD. Stratification by common psychiatric disorders revealed that the associations between ADHD and snuff use prior to and early in pregnancy were strongest among women diagnosed with ADHD without depression, anxiety, and/or SUDs. ADHD is an important risk factor for snuff use prior to and early in pregnancy, underscoring the need for targeted interventions to prevent nicotine use in young women with ADHD as part of integrated care. Retrospectively registered.
Background and Objectives: Recovering from COVID-19 does not always imply a full return to health and may lead to the development of post-COVID-19 syndrome. Post-COVID-19 manifestations include, among others, symptoms of depression and/or anxiety. The aim of the study was to assess the prevalence of anxiety and depressive disorders and to identify their exogenous and endogenous predictors in individuals with post-COVID-19 syndrome. Materials and Methods: The study included 200 participants (116 women and 84 men, aged 18-80) diagnosed with post-COVID-19 syndrome. Participants completed psychological assessments, including the Hospital Anxiety and Depression Scale (HADS), the Generalized Anxiety Disorder 7 (GAD-7), and the Beck Depression Inventory (BDI). Comorbidities were also evaluated. Results: Based on the HADS, anxiety was identified in 41.5% of respondents and depression in 39.5%. Generalized anxiety disorder was screened positive for 36.5% of respondents (GAD-7), while mild depression was observed in 37.0% (BDI). Among participants with post-COVID-19 syndrome and diabetes, the risk of developing depression was three times higher than in individuals without comorbidities. In smoking women with post-COVID-19 syndrome and diabetes, the risk of developing depressive disorders was estimated to exceed 90%. Conclusions: The risk of developing anxiety and depressive disorders in individuals with post-COVID-19 syndrome and multimorbidity is very high, highlighting the need for preventive psychological care, including targeted screening programs, for those at greatest risk.