Gender-based violence in high schools undermines adolescents' rights, well-being and opportunities at a critical moment in their psycho-social development. While violence prevalence has been partially assessed in Sub-Saharan Africa, there remain gaps in understanding how adolescents themselves define, interpret and navigate these situations. This phenomenological qualitative study conducted in four high schools in Kinshasa (DR Congo) centers adolescent voices to explore how they perceive, legitimize, and manage School-Based Gender-Based Violence. It aims to identify the individual beliefs and practices that can be used to interpret, accept or challenge violence, as well as the institutional structures that produce and legitimize these conditions. In December 2024, 90 adolescents aged 15-17 participated in focus group discussions and individual interviews. Data were thematically analyzed using NVivo and iterative validation. Violence was pervasive and multifaceted, encompassing physical abuse, humiliations, economic coercion, and sexual harassment. Some instances of violence were seen as legitimate based on institutional and gendered expectations, and victim blaming was frequent. Community judgement deeply framed students' narratives, leading to stronger condemnation of arbitrary acts, public humiliations, and economic sanctions. Correspondingly, fear of reputational harm discouraged reporting, and silence and conformity emerged as key coping strategies. Students' ability to respond effectively appeared entirely constrained by their pre-existing reputation in the community, which determined whether they were believed, supported, or blamed. Findings indicate that addressing GBV in Kinshasa high schools requires both community- and school-level interventions that confront the norms legitimizing violence and victim-blaming, policies that strengthen accountability mechanisms and protect students who report abuse, and further research on adolescent-led strategies to transform harmful institutional and social expectations. Supporting adolescents' voices in defining and resisting school-based GBV is critical to safeguarding their rights and fostering equitable education. This study looks at how adolescents in Kinshasa, DR Congo, perceive, understand and respond to violence in their schools. Gender-based violence includes physical, verbal, economic, and sexual abuse. It violates young people’s rights and decreases their chances to succeed in school and to lead healthy, successful lives. Yet little is known about how students themselves experience and cope with such violence on a daily basis. The goal of this study is to examine: 1) how adolescents make sense of violence in their daily lives. 2) How they decide whether to accept or challenge it., 3) How schools and other institutions help maintain these patterns of violence. We spoke with 90 high school students aged 15–17 through group discussions and interviews in December 2024. We asked students “what bothers them” at school, allowing them to describe their experiences in their own words. Students reported many forms of violence, from slaps and insults to teachers demanding sex in exchange for grades. Sometimes the students considered some types of violence acceptable. They thought their reputation in the community affected how other people reacted to their suffering. Victims seen as “respectable” were more likely to be believed and supported, while others were blamed. Many students preferred to stay silent rather than report abuse, for fear of being shamed or punished further. They also felt that school personnel protected each other rather than supporting victims. The results show that ending gender-based violence in Kinshasa needs schools and communities to work together to change unfair norms, make abusers face consequences, and help students speak up. Supporting adolescents who speak out and rejecting the idea that violence is normal is key to making schools safer and more just.
Radiographic technologies pose barriers to the care of patients with larger bodies both in medical imaging and radiotherapy. Whilst research exists on staff attitudes, there is a lack of understanding of patient experiences. Therefore, this study investigated the qualitative experiences of larger bodied adults who have attended radiographic services within the United Kingdom (UK). A cross-sectional survey was distributed via social media. The anonymous survey collected demographic data and invited participants to describe their most impactful experience within radiographic services. Thematic analysis was conducted with three researchers agreeing the final themes. Ninety-two participants completed the survey. Most respondents (98.9%) reported their experience with medical imaging, while 16.3% reported their radiotherapy experience. Responses were categorised into three time periods (pre-appointment, during and ongoing) as well as 'societal beliefs' and 'suggestions of improvements'. Example themes included 'sense of self', 'exacerbating factors' and 'emotional impacts'. The experiences of both taller and larger individuals highlighted recurrent issues in access and care received, as well as some examples of good practice. The outcomes of such experiences led to health care avoidance in some cases, with others either fearful or hopeful of their future health interactions depending on how they were treated. This study highlights clear shortcomings in the care for patients with larger and taller bodies in radiographic services. Issues ranged from stigmatised staff attitudes to unsuitable equipment, often leaving patients feeling excluded or blamed. Impacts of poor practice and healthcare avoidance are widespread, and therefore these issues need immediate attention.
A tension between free will and determinism shapes narratives of type 2 diabetes and obesity, contributing to stigma and defining how these conditions are culturally understood. This research involved an interdisciplinary analysis drawing on philosophy, narrative theory and illness narrative scholarship. It undertakes close readings of two remission memoirs-William Banting's Letter on Corpulence (1863) and Tom Watson's Downsizing (2020)-in dialogue with Augustine's redemptive and conversion narrative, Confessions. Discourses of metabolic illness oscillate between models of personal responsibility and biological determinism. Subjects are both blamed and rendered passive. In contrast, Banting's and Watson's remission memoirs mobilise a redemptive narrative form structured by deficiency, transformation and renewal. The two texts, written a century and a half apart, assert the authors' agency while positioning them as generative people who seek to transform others. They contest dominant biomedical and institutional narratives that marginalise patient voice and prioritise clinical authority. This article links two memoirs of metabolic illness to a tradition of redemptive story-telling, asking for a rethinking of agency, responsibility and transformation regarding type 2 diabetes. There are implications for both clinical practice and cultural understanding.
A wide range of licensed foods (LFs) and foods prepared by individuals (FPIs) in local stores and restaurants have been frequently blamed for food poisoning in many consumers. To the best of our knowledge, no data are available on the status of contamination in these foods. This study was conducted to estimate the contamination levels and detect some bacterial pathogens in different food sources prepared by individuals in local stores and restaurants in Al-Kut City, Iraq. Food samples were subjected to microscopic examination and counting. These samples were also examined for the presence of Salmonella spp. and Helicobacter pylori using Quantitative Reverse Transcription Polymerase Chain Reaction. The ureC gene of H. pylori was detected by quantitative reverse transcription polymerase chain reaction using published primers. Deoxyribonucleic Acid was extracted using a commercial kit and amplified using SYBR Green (a DNA-binding fluorescent dye) Green chemistry. The results revealed high bacterial and fungal contamination as discovered by the microscopic method. Furthermore, these samples showed a significant (p < 0.05) presence of Salmonella spp. in many food samples at different rates ranging from 76% to 80%, especially in FPIs. In addition, these samples showed a significant (p < 0.05) presence of H. pylori, as it ranged from 12% to 17% of the FPIs. The ureC gene of H. pylori was detected in 16% of the food samples by quantitative polymerase chain reaction. The highest positivity was recorded in cheese (22%) and cream cheese (18%), while lower rates were found in juices (10%) and yogurt (12%). The difference between cheese products and juices was statistically significant (p < 0.05). These findings confirm that unprocessed dairy products are more contaminated with H. pylori ureC than other foods. The results suggest that high levels of contamination in different food samples need control procedures for better protection against food-borne diseases.
The belief that the moon disturbs sleep is widespread, but the factors associated with it remain poorly understood. I therefore examined how frequently poor sleep is attributed to moon phases, whether this varied across the lunar cycle, and which personal and environmental factors were associated with "moon blaming". Data were derived from an ongoing online survey. At the time of analysis, 1815 participants had completed a 16-item questionnaire assessing sleep quality, sleep duration, sleep timing on workdays and free days, alarm clock use, environmental and personal sleep-disturbing factors, residential setting, age, gender, attention to lunar phases, and whether the moon was perceived as a cause of poor sleep. The primary outcome was endorsement of the moon as a sleep-disturbing factor. Logistic regression with stepwise Akaike information criterion selection was used to identify the strongest predictors of attributing the moon for poor sleep. Questionnaire timing was also examined across the lunar cycle. Among environmental factors, the moon was the most frequently endorsed cause of poor sleep (36%), followed by outdoor temperature (31%), indoor noise (26%), and bad weather (22%). Rumination was the most commonly reported personal factor (73%), but it did not predict moon attribution. Instead, the strongest correlates were weather-related sleep complaints, tracking lunar phases, age, and gender, with endorsement increasing with age and being more common among women. Moon-related complaints also peaked during the week after the full moon. These findings suggest that perceived lunar effects on sleep are shaped, at least in part, by attributional and expectation-related processes.
To determine the level of post-traumatic growth (PTG) and its association with coping strategies among individuals with major depressive disorder (MDD). Patients aged ≥18 years with a diagnosis of MDD who had received treatment for at least 1 year (to ensure adequate time for the development of PTG) and could understand Bahasa Malaysia were invited to participate. Lifetime exposure to potentially traumatic events was assessed using the Malay version of the Life Events Checklist for DSM-5. Coping strategies were assessed in three domains (problem-focused coping, emotion-focused coping, and avoidant coping) using the Malay version of the 28-item Brief Coping Orientation to Problems Experienced. PTG was assessed in five domains (new possibilities, relating to others, personal strength, spiritual change, and appreciation of life) using the Malay version of the 10-item Post-Traumatic Growth Inventory-Short Form (PTGI-SF). In total, 122 patients with MDD (mean age, 35.5 years) were included in the analysis. On average, participants reported lifetime exposure to 7.08 traumatic events. The mean PTGI-SF score was 32.65, indicating a moderate level of PTG. The PTGI-SF score was positively correlated with the problem-focused coping strategies of active coping, planning, and instrumental support, as well as the emotion-focused coping strategies of positive reframing, acceptance, religious coping, emotional support, and venting. In contrast, all avoidant coping strategies showed no significant correlations with the PTGI-SF score, except for behavioural disengagement and self-blame. In the final model of hierarchical multiple linear regression analysis, problem-focused coping (β = 0.341, p = 0.002), emotion-focused coping (β = 0.234, p = 0.037), and age (β = 0.218, p = 0.005) remained significantly associated with PTG, explaining 36.6% of the variance. Trauma exposure, psychotherapy, and avoidant coping were no longer associated with PTG after adjustment for covariates. Among patients with MDD, PTG reflects adaptive cognitive and emotional processing rather than the absence of symptoms. Problem-focused and emotion-focused coping strategies were associated with higher levels of PTG.
This paper conducts a multimodal critical discourse analysis of 92 accompanying images in 22 articles related to adolescent depression published on the WeChat official accounts of major Chinese state-aligned media outlets, including People's Daily, CCTV.com, China News Service, and Health News. We pay special attention to analyze the multimodal discursive strategies employed to represent the causes and solutions of adolescent depression, as well as the implicit health ideologies embedded within these representations. Findings indicate that different gazes and hands are discursively represented as causes and solutions for adolescent depression. Specifically, a blaming gaze and judgmental hands visually construct the perceived origins of depression, while a mothering gaze and caring hands are deployed to depict pathways to recovery. In particular, the state media predominantly attribute the causes of depression to familial and socio-cultural factors-such as academic pressure and "face" culture-through discursive strategies including cool color palettes, spatial marginalization of adolescents, and metaphorical constructs like dominant parental figures, surveilling eyes, and encircling social judgments. In contrast, solutions are frequently visualized through warm tones, intimate compositions, and metaphors such as "healing hugs from mothers," emphasizing familial emotional support while underrepresenting professional medical intervention. We argue that these discourses may reinforce familial-centric ideologies and conventional gender norms of mothers. Implications for more sensitive and constructive media discourses on adolescent depression in the Chinese context are discussed.
Many trauma survivors mentally create alternative scenarios to the factual past (i.e., "what could have happened"), referred to as counterfactual thoughts (CFT). However, to date, research on the phenomenology of post-trauma CFT is sparse. We aimed to systematically explore the characteristics and content of CFT reported by young survivors of a terrorist attack. Approximately 8.5 years after the terrorist attack on Utøya island in 2011, 220 survivors (52.3% females, M age = 27.5, SD = 3.65) described their most common CFT related to the attack. The characteristics (e.g., direction, structure, social focus, and timing) and content of the survivors' CFT were analyzed using thematic analysis. The participants provided rich and highly detailed descriptions of their CFT. Most antecedents ("if…") were additive (action), self-referent, related to events occurring during the attack (e.g., if they had helped others, been located differently, or tried to overpower the perpetrator). The majority of the consequents ("then…") were upward and other-referent, particularly related how someone who was killed could have survived. Of note, many described CFT involving self-blame. Findings may have implications for clinicians in terms of understanding and alleviating psychological distress among survivors' post-trauma. It is important that clinicians are aware of this phenomenon, so that they better can identify and help patients cope with their CFT.
To explore intensive care unit (ICU) healthcare professionals' perceptions and experiences of shared decision-making with conscious patients. A qualitative descriptive study using semistructured interviews. Three ICUs at a Joint Commission International-accredited hospital in Hangzhou, Zhejiang Province, China. 16 ICU healthcare professionals (9 females, 7 males; aged 23-45 years) were interviewed between September and November 2024. We identified 10 subthemes that were classified into three themes: (a) conscious but not ready: unstable decision-making ability, insufficient emotional readiness and limited cognitive evaluability; (b) the roles of doctors and nurses in shared decision-making (SDM): physicians as advisors, not decision-makers, nurses' limited role in SDM and fragmented team communication hinders information flow and (c) the double-edged sword of patient participation: protection or blame, collaboration or burden, hope or harm and being caught between values. ICU healthcare professionals acknowledge the value of involving conscious patients in SDM but also recognise its complexity. Challenges include assessing patients' fluctuating decision-making capacity, poor team communication and the potential for both benefit and harm. These findings highlight the need for clearer professional roles and more structured support.
Urinary tract infections (UTIs) are highly prevalent, affecting up to 50% of women during their lifetime. Among these, 20-30% develop recurrent UTIs (rUTIs), defined as ≥ 2 UTIs within 6 months or ≥ 3 UTIs within 12 months. In addition to physical symptoms, existing research describes how rUTIs affect women's quality of life, mental well-being, and intimate and social relationships. Few studies have investigated how women experience encounters with primary care and how rUTIs shape women's self-image and illness perceptions. The objective of this study was to explore how premenopausal women experience the impact of living with rUTIs, as well as how they experience the encounters with GPs in a Danish primary care setting. This qualitative study was based on semi-structured interviews with 12 premenopausal women. The data was analysed using thematic analysis. Three themes were identified: (1) clashes between practice routines and women's perceptions, highlighting how standardised diagnostic and treatment practices were experienced as lacking, and that women expressed a need for clearer management pathways and a more patient-centred approach, (2) lack of validation from the GP, reflecting how women felt dismissed and insufficiently acknowledged in clinical encounters; and (3) gendered illness perceptions, illustrating how these experiences shaped women's understandings of their condition, leading to self-blame, normalisation, or feelings of injustice. rUTIs are highly distressing for women and the encounter with primary care often results in frustrations and unmet needs. Perceiving primary care routines as unclear can leave women feeling dismissed, compromise the patient-doctor relationship and affect the women's self‑image and illness perceptions. Improving rUTI management in primary care requires greater attention to women's lived experiences. GPs should recognize the broader impact of recurrent symptoms and ensure clear clinical routines that accommodate the recurrent condition rather than relying on repeated tests and prescriptions. Strengthening shared decision-making and aligning care with women's needs and understandings of health are essential for better support.
Eating disorders (EDs) are severe mental illnesses with significant morbidity and mortality. Adverse childhood experiences (ACEs) are recognized risk factors, but their specific impact across ED subtypes and the mediating psychological mechanisms require further elucidation. In this cross-sectional study (2008-2015), 970 outpatients with eating disorders (919 female) were assessed for adverse childhood experiences and clinical behaviors with the Eating Disorder Questionnaire, and for psychological traits with the Eating Disorder Inventory-1. This study used factorial ANOVA, Lasso regression, and mediation analysis to clarify the effects of ACEs and diagnostic subtypes, identify specific influencing factors, and explore the mediating role of psychological traits. ACEs were nominally associated with most clinical behaviors except dieting; after correction, the most robust associations were observed for binge eating, laxative use, and several onset-age variables. Childhood emotional abuse most profoundly impacted psychological traits. The cumulative number of ACEs was associated with increased severity of psychological traits and a higher likelihood of clinical behaviors. Mediation analyses revealed that psychological traits significantly mediated the relationship between ACEs and clinical behaviors. For instance, ineffectiveness mediated the link from cumulative ACE count (mediation proportion = 0.481), "criticism and blame" (mediation proportion = 0.629), and "abandonment threats" (mediation proportion = 0.601) to binge eating. Childhood emotional abuse and cumulative ACEs significantly correlated with worsened psychological traits and clinical ED behaviors, with notable implications for binge-eating/purging symptoms. Several psychological traits showed substantial indirect associations between ACE exposure and clinical ED behaviors. These findings highlight the necessity of routine ACE assessment and trauma-informed interventions targeting these psychological vulnerabilities in ED treatment. Eating disorders are serious mental illnesses, and adverse childhood experiences may shape how these illnesses develop and appear in clinical care. This study examined 970 Chinese outpatients with eating disorders to understand how adverse childhood experiences, such as emotional abuse, physical abuse, and sexual abuse, were related to eating-disorder symptoms and psychological difficulties. Patients who reported adverse childhood experiences tended to show more severe psychological traits, including feelings of ineffectiveness, perfectionism, difficulties sensing internal body states, body dissatisfaction, and bulimia-related concerns. Emotional abuse, especially repeated criticism, blame, and threats of abandonment, showed particularly strong links with these psychological traits. Having more types of childhood adversity was also associated with a greater likelihood of behaviors such as binge eating, purging, laxative use, and diet pill use. The analyses suggested that psychological traits may help explain the statistical association between childhood adversity and later eating-disorder behaviors. These findings support routine assessment of childhood adversity in eating-disorder services and highlight the importance of trauma-informed treatment that addresses self-worth, emotion regulation, and body-related psychological difficulties.
Patients with colorectal cancer and an intestinal stoma often experience a complex psychological state where posttraumatic stress disorder (PTSD) coexists with posttraumatic growth (PTG). This study aimed to explore the interplay between PTSD and PTG symptoms in patients with an intestinal stoma to better understand their relationships. This cross-sectional study was conducted between January 2026 and March 2026, involving patients from three tertiary hospitals in Beijing, Liaoning, and Jilin provinces in China. Data were collected using a sociodemographic questionnaire, the PTG Inventory, and the PTSD Checklist for DSM-5. Network analysis was employed to identify central symptoms and potential bridge symptoms. Model stability and accuracy were assessed through bootstrap resampling. Data from 416 participants were analyzed. The PTSD-PTG network identified the Posttraumatic Stress Disorder Checklist (PCL)10 ("Blaming yourself or someone else for the stressful experience or what happened after it") and the Posttraumatic Growth Inventory (PTGI) 5 ("A better understanding of spiritual matters") as the most central symptoms. Potential bridge symptoms linking PTSD and PTG included PCL20 ("Trouble falling or staying asleep") and PTGI1 ("My priorities about what is important in life"). The network model demonstrated acceptable stability and accuracy, although bridge expected influence estimates should be interpreted cautiously. This study identified potentially important PTSD and PTG symptoms and their interactions in patients with an intestinal stoma. Central and bridge symptoms may provide preliminary targets for clinical screening and individualized interventions to support both trauma-related distress and psychological growth. Longitudinal studies are needed to confirm these findings.
C-sections (CS) can be lifesaving in certain medical situations, but their prevalence has surged beyond recommended levels globally, raising concerns about inappropriate medical interventions and healthcare delivery quality. The study explores whether medical conditions alone determine C-sections or if socio-economic and institutional factors (i.e., Private/Public) also play a significant role. Using WHO and World Bank data, the relationship between C-section rates and income was analysed at the global level. Furthermore, at the national and state levels in India, the same analysis was conducted using data from the Ministry of Statistics and Programme Implementation and NFHS-5. Additionally, utilising the Birth recode datasets of NFHS-4 and 5, multivariate logistic regression was performed with C-section as the outcome variable and socio-economic and institutional variables, such as place of residence, levels of education, wealth index, and place of delivery, as predictor variables. Throughout the analysis, we found the institutional setting as the most significant influencing factor of CS rates, at both the national (OR: 4.11, 95% CI 3.98-4.24; NFHS-5) and state level for Bihar (OR: 16.19, 95% CI 13.76-19.05; NFHS-5), Uttar Pradesh (OR: 8.62, 95% CI 7.84-9.47; NFHS-5), Tamil Nadu (OR: 3.08, 95% CI 2.70-3.52; NFHS-5) and Andhra Pradesh (OR: 4.16, 95% CI 3.40-5.09, NFHS-5). On the contrary, we found that socioeconomic factors influenced the likelihood of CS only in states where medical infrastructure was lacking, indicating that socioeconomic factors are not directly responsible for CS rates; they are complicit only in determining institutional access. Additionally, an inverted U-shaped relationship was found between national per capita income and CS rates, indicating global inequality in the quality of healthcare. Within India, this relationship increasingly mirrors the global trend, possibly due to disparities in healthcare access and quality. Our analysis confirms that the increase in CS rates is not solely caused by medical conditions, but is also significantly influenced by non-medical factors, particularly institutional factors. Economic incentives strongly drive private healthcare providers to prefer CS deliveries. The results suggest the need for targeted policy interventions to mitigate perverse incentives for private facilities and enhance public medical infrastructure, particularly in underserved regions.
Lung cancer stigma is widespread, with consequences for patients psychologically and clinically. It can also be a barrier to lung cancer screening (LCS), though current evidence is limited. With LCS programs in development globally, this qualitative study explored the views, expectations, and potential impacts of stigma with people eligible for LCS before commencement of the Australian National LCS Program. Participants met eligibility criteria for the Australian National LCS Program (asymptomatic of lung cancer; aged 50-70 years; currently smoking tobacco cigarettes or quit within 10 years; ≥30 pack-year smoking history). Abductive thematic analysis was used. Interview questions and theory-based codes were guided by the Health Stigma and Discrimination Framework. Twenty-four participants were interviewed; 50% (n = 12) were currently smoking and 25% (n = 6) were from culturally or linguistically diverse backgrounds. Most participants had high levels of education, high self-reported health literacy and lived in major cities. Four themes were identified: (1) Harmful narratives of personal responsibility and self-infliction; (2) Smoking stigma is a "necessary evil" and is inevitable in LCS; (3) Identity as part of the LCS cohort; (4) Previous perceptions of stigma in healthcare shape expectations for LCS. Stigma in LCS - to some degree - is unavoidable given smoking-based eligibility criteria but may be reduced through: (1) messaging that dismantles industry-driven narratives around responsibility, blame and choice in tobacco use (e.g., by referencing external determinants of smoking behavior); (2) privacy and confidentiality of LCS participation; (3) communication training for LCS staff. Further work in priority communities considering intersectional stigmas is needed.
Sibling sexual behaviour and abuse (SSB/A) is common and has adverse effects not only to the child who is harmed and the child responsible, but the whole family unit is deeply impacted. The study aimed to understand how SSB/A is experienced by parents and what impact SSB/A has on parents. A secondary qualitative design was used to examine 22 narrative stories written by parents (primarily mothers) about their experience of SSB/A that were submitted to #SiblingsToo, a Canadian organisation dedicated to raising awareness of SSB/A. Thematic analysis was used to analyse all narratives. SSB/A produces multifaceted disruption across the family system, with parents describing emotional, relational and practical consequences in the aftermath of disclosure or discovery. Parents framed SSB/A as an event that changed their understanding of their family, forcing them to renegotiate family roles, restructure daily routines and confront intense feelings of guilt, shame, fear and self-blame, exacerbated in some circumstances by gendered expectations. Parents also reported the burden of navigating divided loyalties, while trying to maintain safety, stability and emotional availability. The strain of these competing demands frequently intersected with challenges in accessing professional support, particularly where services were experienced as inadequate, retraumatising, or focused primarily on the harmed child. This study contributes important new insights into the experiences of parents whose families have been affected by SSB/A. Through a collection of written narratives, the findings demonstrate that SSB/A constitutes a family-level negative impact that reshapes parents' emotional landscapes, daily routines, relationships and caregiving roles.
Although acute health crises can disrupt routines and open a window for behaviour change, these teachable moments are rarely harnessed by intervention designs. The RETURN intervention (comprising a dental nurse-led conversation, short peer videos and booklets supporting knowledge, skills and action-planning) aimed to change planned dental visiting behaviour among adults previously reliant on urgent care. The RETURN trial recruited 1179 predominantly socio-economically disadvantaged urgent dental care users. This qualitative study explored how RETURN impacted meaning, motivations, and practices related to routine dental visiting. In-depth interviews were conducted with 55 participants (39 intervention) at 6, 12 and 18-months post-intervention and analysed using reflexive thematic analysis. Urgent dental problems provide a liminal (transitional) space where routines and dental visiting identities are destabilised. RETURN enabled a reflective pause where participants could distance themselves from previous patterns of behaviour, re-evaluate their oral health trajectory and priorities, reduce shame and self-blame, and rework aspects of their self-identity. Intervention components operated synergistically while enabling individually patterned engagement. Four themes generated were: 1. pausing and labelling the problem; 2. reducing ambivalence and energising motivation; 3. normalising struggle, cultivating hope and grit; 4. developing knowledge and skills to enact change. Booklets functioned as a material artefact extending engagement for over 12 months beyond the brief intervention delivery. For some, capabilities developed transferred to other domains of life. Findings position urgent care as an under-utilised site for identity work and sustained behaviour change, with the potential to support disadvantaged groups in service use, thus narrowing health inequalities. The RETURN trial was registered at isrctn.com (ISRCTN84666712).
Although all patient deaths affect clinicians, it remains unclear how the impact of suicides differs from other deaths. Is the trauma of losing a patient by suicide qualitatively distinct, or are the emotional, professional and organisational consequences of suicidal and non-suicidal deaths more similar than assumed? To investigate the impact of patient suicide compared with other patient deaths on clinicians' psychological well-being, clinical practice and career. To explore clinicians' perspectives on how current support systems do, or do not, meet their needs. A mixed-methods approach was used. An online survey with two subsets of questions (one for suicidal and one for non-suicidal patient deaths) was circulated to clinicians across South London and Maudsley NHS Foundation Trust. A total of 122 responses were collected: two-thirds of respondents had experienced a patient suicide, with 53% reporting moderate and 12% reporting severe impact versus 36.6% reporting moderate and 4.2% severe for non-suicidal deaths. Non-suicidal death was associated with significantly lower impact (odds ratio 0.14, 95% CI [0.05, 0.41], p < 0.001) and less disruption to clinical practice. Blame emerged as a key factor shaping clinicians' responses: 98% of respondents rated suicide as <60% predictable in secondary care, and 69% rated the 'zero-suicide' policy as unachievable. Patient suicide has a heavier impact on clinicians, qualitatively distinct from other patient deaths. Blame shapes defensive responses in suicides, and internal questioning in non-suicidal deaths. The low-risk paradox and perceived unachievability of zero-suicide policies call for re-evaluation. Acknowledging predictability limits and clinicians' support needs can help systems navigate the complex impact of patient suicides.
A substantial proportion of people who experience incidents that meet definitions of rape do not acknowledge their experiences as rape. Rape acknowledgement has been associated with mixed outcomes for survivors, including increased risk for negative post-assault appraisals and posttraumatic stress symptoms. No study to our knowledge has examined these outcomes simultaneously, and most research has been conducted in small, single-gender samples at single universities. The current study examined the prevalence of unacknowledged rape and its associations with demographic characteristics, self- and perpetrator-blame and posttraumatic stress (PTS) symptoms among 334 college students from two universities who self-reported experiencing a rape since age 14. Findings indicated that 59% of those who experienced rape did not acknowledge their experiences as rape. In multivariate models, sexual minority students and those who experienced vaginal penetration, force and had a male assailant were more likely to acknowledge their rapes. Rape acknowledgement was associated with greater self-blame, higher PTS symptoms and lower rapist blame compared to non-acknowledgement. Findings underscore a persistently high prevalence of unacknowledged rape and robust associations between rape acknowledgement and distorted blame attributions that may underlie and/or maintain PTS symptoms.
This study aimed to explore inadvertent stigmatizing attitudes of healthcare professionals (HCPs) toward people with diabetes (PWD) and to develop a questionnaire to assess such stigma. One hundred items that might reveal stigmatization of PWD were drafted in consultation with HCPs and previous reports and were responded to on a 7-point Likert scale. Responses to the 100 draft items from 191 of 250 participants (51 males and 140 females, aged 36.0 ± 10.4 years) were subjected to exploratory factor analysis. We then developed a novel scale, the Kanden-Institute Components of Stigma for HCPs 24 (KICS-HCP24), which comprises 5 components: "blame and prejudice," "social distancing," "embarrassing," "deviation from social norms," and "less advocative," with 4-5 items in each component. The KICS-HCP24 was then undertaken by 460 HCPs (363 replied, 82 males and 281 females, aged 35.0 ± 10.2 years). Confirmatory factor analysis demonstrated acceptable model fit (Comparative Fit Index = 0.932). Internal consistency was good (Cronbach's alpha = 0.851), and test-retest reliability was excellent (intraclass correlation coefficient = 0.868, P < 0.001). Stigmatizing attitudes among HCPs were found to comprise five domains. The KICS-HCP24 is a valid and reliable instrument for assessing these components and may help to identify the potential for stigma in healthcare settings.
Psychological aggression in dating violence (PADV) is a prevalent yet normalized form of interpersonal violence. Understanding how gender biases shape perceptions of PADV is essential for improving prevention and victim support. This study examined how the gender of perpetrators, victims, and observers influence responsibility attribution and perceived severity of PADV among young adults in Spain. A total of 432 participants (50% women, n = 216), aged 18 to 25 years, were randomly assigned to evaluate 1 of 12 vignettes varying by perpetrator and victim gender (male/female), type of psychological aggression (insults, control, and humiliation), and couple type (heterosexual/same sex). Male-perpetrated violence was rated as more severe and attributed more strongly to the aggressor, whereas female-perpetrated violence elicited greater victim blaming. Observer gender also affected evaluations, showing that women rated PADV as more severe than men, with the strongest effect observed in humiliation scenarios, where women also attributed greater responsibility to perpetrators and less to victims. No significant differences were found between heterosexual and same-sex couples. These findings suggest that gendered attributional patterns persist even among younger generations socialized under equality-oriented policy frameworks. Addressing gendered attributions through prevention and educational initiatives is therefore essential to reducing tolerance of psychological violence.