Irritable bowel syndrome (IBS) is a heterogenous disorder of gut-brain interaction, characterized by complex interaction between gastrointestinal symptoms, psychological distress and physical functioning. While physical activity is increasingly recommended as part of IBS management, the pathways through which physical and mental health relate to symptom severity remain incompletely understood. To explore the interrelationships between physical activity, physical health, mental health and IBS symptom severity using Structural Equation Modeling (SEM) within a biopsychosocial framework, in adults with IBS. In this cross-sectional exploratory study, 106 adults with a clinician-confirmed diagnosis of IBS (Rome IV criteria) completed validated questionnaires assessing IBS severity (IBS-SSS), physical activity (GPAQ), anxiety (GAD-7), depression (PHQ-8), and health-related quality of life (SF-36). Bivariate correlations were examined, followed by SEM to investigate relationships between latent constructs of physical health and mental health on IBS symptom severity. Participants (mean age: 45 ± 14 years; 82% female) reported high IBS symptom severity (333 ± 89) and wide-ranging physical activity levels (mean: 3382 ± 4482 MET-min/week). Bivariate analysis showed significant correlations between IBS symptom severity and anxiety (r = 0.235, p < 0.05), depression (r = 0.240, p < 0.05) and multiple physical health domains, including pain (r = 0.454, p < 0.001). In the SEM physical health demonstrated a large but non-significant association with IBS symptom severity (β = 0.68, p = 0.065), while mental health showed no statistically significant direct path (β = 0.19, p = 0.261). Physical activity was significantly associated with physical health (β = 0.22, p < 0.001) and physical and mental health latent constructs were strongly correlated (β = 0.72). In this exploratory SEM study physical and mental health were closely interrelated and associated with IBS symptom severity at the correlational level, although direct paths in the SEM did not reach conventional statistical significance. Physical activity was linked to physical health, suggesting a potential indirect pathway influence symptom severity. These findings support a biopsychosocial perspective and highlight the need for integrated, personalized IBS management approaches, while underscoring the important of larger, longitudinal studies to clarify causal pathways. This study explored how physical activity, physical health and mental health relate to symptom severity in adults with Irritable Bowel Syndrome (IBS). A total of 106 adults with clinically diagnosed IBS completed questionnaires measuring IBS symptoms, physical activity levels, anxiety, depression and quality of life. The results showed that more severe IBS symptoms were associated with higher anxiety and depression and poorer physical health. Physical activity was linked to better physical health, and physical and mental health were strongly related to each other. Overall, the findings support the idea that IBS symptoms are influenced by both physical and psychological factors, highlighting the importance of a biopsychosocial approach to IBS management.
BACKGROUND: The prevalence of psychosocial risk factors and disability are increasing in Nepal calling for biopsychosocial tools for evaluation of musculoskeletal pain and prediction of risk factors. Örebro Musculoskeletal Screening Questionnaire (OMSQ) is a 21-item tool that is used to identify patients at risk of developing disability from nonspecific musculoskeletal pain conditions. The purpose of this study was to translate OMSQ, validate and test the reliability of the Nepali version of the OMSQ in both the urban and rural population. METHODS: OMSQ was translated into Nepali according to Beaton and tested for validity and reliability in urban and rural clinics by adult persons with chronic non-specific musculoskeletal pain (n = 147). Internal consistency was calculated by Cronbach’s alpha and test–retest reliability was evaluated by intraclass correlation coefficient, ICC. Responsiveness using a ROC curve was used to estimate sensitivity and specificity to detect a change in OMSQ between the test and retest. Floor and ceiling effects of the OMSQ scores were analyzed. The experience with OMSQ was surveyed with closed- and open-ended questions. The narratives were assessed with categoric content analysis. RESULTS: Meaning and measurement properties of Nepali OMSQ were retained when translated into Nepali and found reliable (ICC > 0.75) and valid for use in both urban and rural settings in Nepal showing high internal consistency (Cronbach’s alpha urban pre-post; 0.790 and 0.768, rural pre-post; 0.827 and 0.783). ROC showed good responsiveness for urban and rural, area under curve (AUC) 0.751 and 0.760 respectively). Total scores were evenly distributed without floor or ceiling effects. In general, OMSQ was considered easy/moderate to understand/complete, though respondents in the rural sample needed more time to complete. Some of the participants had difficulties with long words and understanding of the Likert-scale. CONCLUSION: OMSQ was successfully translated to Nepali and found to be a reliable and valid instrument for assessing psychosocial parameters associated with nonspecific musculoskeletal pain across diverse settings in Nepal. TRIAL REGISTRATION: Not applicable.
Obesity is considered a risk factor for pain, and comorbid obesity and pain have a cumulatively worse impact on function and quality of life than either condition alone. The aim of this study was to estimate the prevalence of pain and describe the multidimensional biopsychosocial pain profiles of people with obesity (PwO). This pre-specified cross-sectional study reports the baseline data from a longitudinal cohort study. We recruited 519 PwO from three specialist obesity clinics in Ireland. Participants completed pain-, obesity- and health-related questionnaires to capture the multidimensional biopsychosocial characteristics of their pain experience. Data were analysed using descriptive and inferential statistics. Pain prevalence was 77% (95% CI: 73.1%-80.6%) (70.7% female; mean age 46.6 ± 12.7 years). Participants' pain characteristics reflected heterogeneity in the pain experiences of PwO, including (mean; SD): pain intensity (0-10 numerical rating scale) (3.97 ± 2.9), number of pain locations (0-35) (5.06 ± 5.3), levels of pain-related disability and self-efficacy. The prevalence of nociplastic pain was 54% (95% CI: 49.3%-58.6%) and neuropathic pain was 30% (95% CI: 25.6%-34.8%). Clinically significant levels of pain-related worrying and kinesiophobia were reported by 20.9% (95% CI: 17.3%-24.8%) and 49.9% (95% CI: 45%-54.7%) of participants. The majority (77%) of PwO attending specialist obesity treatment services report experiencing pain. The intensity, nature, and impact of their pain vary. Over half reported nociplastic pain, one-third neuropathic pain, one-fifth significant pain-related worrying, and half kinesiophobia. These findings have implications for pain management in PwO. This is the first multicentre prospective cohort study to investigate the multidimensional pain profiles of PwO. Pain prevalence was 77%. This is the first study to estimate (i) baseline prevalence of nociplastic-dominant pain in PwO (54%); (ii) baseline prevalence of neuropathic pain in PwO (30%); (iii) clinically significant levels of pain-related fear (20.9%); and (iv) clinically significant levels of kinesiophobia (49.9%), in PwO attending specialist obesity treatment services. These findings have clinical implications for the treatment of pain in PwO.
The study explored the profiles of childhood abuse and biopsychosocial outcomes in adulthood, as well as early predictive factors. Data were drawn from Wave I (ages 11-21 years) and IV (ages 24-33 years) of the National Longitudinal Study of Adolescent to Adult Health dataset (N = 5112). Latent profile analysis (LPA) was employed to identify distinct patterns of childhood abuse and biopsychosocial outcomes (cardiometabolic risk, depressive symptoms, and socioeconomic functioning) in adulthood. Multinomial logistic regression was subsequently utilised to examine the predictive roles of early demographic factors, lifestyle behaviours, and parent-child relationships in adolescence. LPA identified five distinct profiles: low risk-adaptive, low risk-psychosocial maladaptive, medium risk-biopsychosocial maladaptive, high risk-adaptive, and high risk-psychosocial maladaptive profiles. Compared with the high risk-adaptive profile, being female and having a lower family income predicted membership in the medium risk-biopsychosocial maladaptive and high risk-psychosocial maladaptive profiles. Reduced sedentary behaviour and higher maternal closeness and warmth emerged as significant protective factors for resilient development. These findings reveal the diverse biopsychosocial outcomes associated with childhood abuse of varying severities. We also emphasise the critical need for tailored interventions that reduce sedentary time and enhance parent-child emotional closeness across different social backgrounds to foster resilience in the face of childhood adversity.
Shift-and-persist (SP-the ability to adapt the self to stressors while preserving focus in the future) is associated with favorable cardiometabolic outcomes. SP may be relevant in Puerto Rico (PR), a population with a high burden of cardiometabolic diseases and stressors. We examined the association between SP and cardiometabolic markers among young adults in PR. Cross-sectional analysis of baseline PR-OUTLOOK data (September 2020 to March 2024). The analytic sample (n=2707) was aged 18 to 29 and 62% female. SP was measured with the Chen and Miller scale and categorized into tertiles (low, moderate, and high). Anthropometric measurements and fasting blood samples assessed cardiometabolic markers: BMI and waist circumference, blood pressure, blood glucose, HbA1c, and blood lipids (cholesterol, HDL, LDL, and triglycerides). Analyses included adjusted linear regression models. In adjusted models, persons with moderate and high SP had a BMI that was on average 0.96 (95% CI = -1.63,-0.29) and 0.83 (95% CI = -1.55,-0.12) units lower, respectively, than those with low SP. Similarly, those with moderate and high SP had a waist circumference that was 1.89 (95% CI = -3.45,-0.34) and 1.96 (95% CI = -3.62,-0.30) units lower, respectively, than those with low SP. In addition, persons with moderate and high SP had glucose readings that were 2.45 (95% CI = -4.31,-0.60) and 2.81 (95% CI = -5.79,-0.83) units lower, respectively, than those with low SP, whereas only those with high SP had a lower HbA1c (β=-0.10; 95% CI = -0.16,-0.04). Only those with moderate SP (vs. low) had significantly higher HDL (β=1.16; 95% CI = 0.16, 2.17). No significant associations were found for blood pressure and other blood lipids. Greater SP was associated with lower adiposity, lower concentration of markers of glucose metabolism, and, to some extent, with higher HDL. Longitudinal studies are needed to confirm study findings and understand how SP may promote biobehavioral mechanisms for cardiometabolic health.
This study aimed to explore the impact of coexisting Type D personality and depression on the incidence of major adverse cardiac events (MACEs) following percutaneous coronary intervention (PCI), and to examine the mediating role of heart rate variability (HRV). This prospective cohort study included 990 patients with coronary artery disease who underwent PCI between May 2022 and May 2023. Type D personality, depressive symptoms, and HRV were assessed at baseline. Patients were followed for 2 years to monitor the occurrence of MACE. During the follow-up period, 289 patients experienced MACE. HRV indices were lower in the comorbid group compared with the group without psychological conditions, particularly SDNN (82.50 vs. 94.33) and SDANN (71.32 vs. 80.95). In the "NA×Depression" interaction pathway, the indirect effects of SDNN and SDANN on MACE were statistically significant across low, moderate, and high depression levels, with the a × b effects being 0.676 and 0.688 at low depression, 0.604 and 0.618 at moderate depression, and 0.460 and 0.479 at high depression, respectively. Notably, the indirect effect estimates were slightly larger at low to moderate depression levels, and all values showed significant positive mediation effects. In the "SI×Depression" interaction pathway, the ab indirect effects of SDNN and SDANN were also statistically significant at low, moderate, and high depression levels, with the values being 0.377 and 0.411 at low depression, 0.309 and 0.342 at moderate depression, and 0.174 and 0.204 at high depression. Type D personality combined with depression elevates post-PCI MACE risk, with NA playing a core role. SDNN and SDANN (key HRV indices) mediate this association, supporting routine psychological and HRV screening plus targeted interventions to improve outcomes.
Chronic pain is a significant global public health problem affecting 1 in 4 adults and 1 in 5 young people. Despite the high prevalence of chronic pain, research into its prevention is scarce. In this review, we draw from current, interdisciplinary evidence to present a conceptual Situate - Experience - Learn - Feel (SELF) Framework that takes a developmental and biopsychosocial-societal approach to building children's resilience against future chronic pain. The SELF Framework considers the impact of one's Situation, including social and societal supports and structures, early life Experiences, Learning of skills and knowledge, and the ability to understand and differentiate Feelings, in establishing SELF-empowerment, SELF-enablement, and SELF-reliance for the management of future pain experiences. We argue that childhood (∼0-10 years) is a developmental period that provides a potentially critical and thus far untapped opportunity to build resilience to chronic pain in adolescence and beyond. Our framework has three pillars: (1) LEARN: 'Building Knowledge and Skills' - targets children's understanding of pain and healthcare and associated behaviours; (2) EXPERIENCE: 'Strengthening Social Support and Building Emotional Resilience' - targets the fostering of social supports, community, positive childhood experiences, and emotional wellbeing; and (3) FEEL: 'Building Brain-Body Integration' - targets the development and maintenance of movement, interoception, and body awareness. For each pillar, we present its definition and scope, an evidence-based rationale, and provide implementation strategies that could reduce the risk of chronic pain in the future. Importantly, the SELF Framework considers that disadvantageous aspects of a child's broader societal/structural and social SITUAT[ION] may demand additional supports to mitigate risk, and we present several avenues for future research on this.
BACKGROUND: Culture shapes care delivery, professional communication, and the development of trust between patients and providers. Culture encompasses identifiable elements, shared values and beliefs, and underlying assumptions that shape behaviour. The Emergency Department (ED) subculture arises from its complex, high-pressure focus on acute illness. ED professionals increasingly encounter older patients with frailty, whose complex but often non-urgent needs require more holistic, individualised care. However, the ED subculture may hinder the provision of appropriate geriatric emergency care. Despite its relevance, little is known of the influence of the ED subculture on the care for older patients. This study provides insight into the ED subculture in relation to the care of older patients with frailty by exploring its visible elements, shared values and beliefs, and underlying assumptions that shape behaviour. METHODS: A qualitative, micro-ethnographic study was performed. Data were collected through topic-guided observations of ED professionals over twelve days, followed by interviews. Ethnographic methods were used to analyse the data, with iterative cycles of collection and analysis. RESULTS: The themes ‘Equality and professional solidarity as drivers of care delivery’, and ‘Responsibility and compassion in navigating the misalignment between emergency care and the needs of older patients with frailty’ describe the ED subculture in relation to the care of older patients with frailty. The ED is highly structured, efficiency-driven, and professionals believe in equal care to all patients through responsibility and teamwork. Stabilising acute illness is prioritised during the initial assessment; other needs are considered once patients are stable or assertive. Professionals believe the ED is intended for acute problems; non-acute referrals of older patients are considered inappropriate. However, they value a strong moral responsibility, navigating between emergency care priorities and the needs of older adults with frailty. CONCLUSIONS: The ED subculture prioritises efficient, protocol-driven care and equal care for all patients, creating a challenge for delivering holistic, patient-centred care to older adults with frailty. Improving education and communication and integrating biopsychosocial principles into emergency care are essential. The ED subculture must be considered when developing and implementing future interventions to improve emergency care for older patients.
Identifying modifiable prognostic factors is essential for personalizing conservative interventions. Several psychological and systemic variables remain underexplored in the frozen shoulder (FS) population, particularly regarding their prognostic relevance for short-term changes in pain and disability. To estimate the prognostic value of psychological factors, central sensitization, and sleep disturbances in predicting clinical outcomes after 3 months of standardized conservative treatment. This multicenter, prospective cohort study was reported following the REMARK statement. Individuals were recruited between July and September 2025. Baseline demographic and clinical variables such as pain catastrophizing, state and trait anxiety, fear-avoidance beliefs (for Work and Physical Activity), central sensitization signs and symptoms, and insomnia were collected at baseline as potential prognostic factors. Shoulder pain and disability (measured with the SPADI subscores) served as outcome variables. Patients underwent a standardized multimodal conservative management for 3 months. Univariable and multivariable linear regression analyses were performed to examine associations between potential prognostic factors and SPADI pain and disability scores at 3-month follow-up. Eighty participants were included. Trait anxiety emerged as the sole significant prognostic factor for shoulder pain (exp (β) = 1.21, 95% CI 1.06-1.38), while state anxiety significantly predicted disability (exp (β) = 0.83, 95% CI 0.73-0.95). The removal of outliers during sensitivity analysis eliminated the statistical significance of all potential prognostic factors when SPADI pain was the outcome. Regarding disability, however, state anxiety remained a significant prognostic factor (exp(β) = 0.86; 95% CI: 0.74-0.99). Baseline trait and state anxiety showed prognostic relevance for short-term pain and disability outcomes in patients with FS receiving conservative care. Pain catastrophizing, fear-avoidance behavior, central sensitization, and insomnia did not show significant associations in this cohort. These findings underscore the importance of incorporating psychological profiling, particularly anxiety assessment, into the clinical evaluation and prognostic reasoning for patients with FS.
This review aimed to systematically synthesize qualitative evidence on the perceptions, experiences, and practices of athletes and stakeholders regarding sports injuries, with a primary focus on risk factors, consequences, injury reporting, rehabilitation, and prevention strategies. A systematic review of qualitative studies was conducted in accordance with PRISMA guidelines and prospectively registered in PROSPERO. Six databases were searched from 2000 to July 2025. Eligible studies explored the lived experiences of sports injuries in athletes and stakeholders. Data were extracted, appraised using the CASP checklist, and synthesized thematically. Thirty-five studies were included, spanning a range of sports and competitive levels. Five overarching themes were identified: (i) risk factors including excessive training loads, poor recovery, early specialization, and psychosocial stressors; (ii) consequences of injury such as disrupted performance, long-term disability, financial costs, and significant psychological distress; (iii) rehabilitation highlighting both the challenges of self-management and the importance of interdisciplinary support; (iv) injury reporting and monitoring where normalization of pain, fear of deselection, and cultural pressures inhibited disclosure; and (v) injury prevention and performance sustainability emphasizing load management, evidence-based practices, collaborative monitoring, and contextual barriers such as limited resources and fixture congestion. Athletes and stakeholders perceive sports injuries as complex biopsychosocial phenomena shaped by cultural norms, resource availability, and interpersonal dynamics. Sustainable prevention requires both individualized and systemic approaches, combining tailored training plans, athlete-centered care, and structured surveillance systems. Qualitative insights highlight the necessity of embedding prevention and rehabilitation strategies within the lived realities of athletes, thereby enhancing health protection and long-term performance sustainability. REVIEW REGISTRATION: This review was prospectively registered on the Open Science Framework in March 2025 (registration DOI: https://doi.org/10.17605/OSF.IO/V79D2).
The European Health Data Space (EHDS) regulation introduces a transformative framework for the exchange of health data among EU stakeholders. Among its interoperability measures is the inclusion of the International Classification of Functioning, Disability and Health (ICF) as a standard for documenting functioning in patient summaries and discharge reports. While ICF offers a biopsychosocial lens to complement disease-centric classifications, the availability of interoperable ICF data remains uneven. This structured narrative review examines the readiness of EU stakeholders to exchange and utilize ICF data within EHDS. It explores current practices from the data availability and technical infrastructure perspectives, discusses influencing factors such as legislative frameworks and socio-ethical conditions, identifies gaps, and proposes actionable recommendations for the future. Given the limited data available on this topic, a structured narrative review was performed, including a structured literature search from five databases. Additionally, targeted searches were performed in policy repositories and institutional sources. The search included documents written in English, Finnish, and Italian, and the study objective defined the scope for the literature search. Documents were analyzed to synthesize contextual information across stakeholders, identify gaps, and gain strategic insights. In total, 78 studies and gray literature references are discussed in the synthesis. The available evidence on ICF data infrastructures across EU stakeholders reveals significant disparities. Many countries lack standardized EHR support for structured ICF data storage. There is a need to include and map the ICF to international key terminologies and health informatics frameworks to ensure semantic interoperability. Low professional awareness further hinders data availability. Unequal digital literacy and limited citizen empowerment compromise efficient use of ICF. To address these gaps, a three-phase roadmap is proposed: (1) promoting ICF awareness and structured documentation, (2) advancing technical integration through FHIR and ontology development, and (3) aligning policy and governance to support scaling. Integrating the ICF into EHDS is not merely a technical task; it redefines how health is conceived and measured. By addressing readiness across data, technical, legal, and socio-ethical dimensions, the EU can unlock the full potential of functioning data to improve the well-being of its citizens.
The claudin-5 (CLDN5) gene is critical for blood brain barrier integrity and may link traumatic stress, accelerated aging, and neurological disease. Building on prior research showing associations between trauma exposure and PTSD with CLDN5 DNA methylation (DNAm), we tested if candidate CLDN5 DNAm loci were associated with advanced epigenetic aging in blood and brain tissue and with hippocampal volume. 1302 trauma-exposed individuals (Mage=44.23, SD=13.71; 76% male) underwent psychiatric diagnostic interviews and blood draws for obtaining epi/genetic information; 473 underwent magnetic resonance imaging of the brain. Data from 109 PTSD brain bank decedents with DNAm from ventromedial prefrontal cortex (vmPFC) were also examined (Mage-at-death=45.20, SD=14.21; 62% male). All candidate loci were associated with metrics of epigenetic age in blood (p-adj range: .0396 to 4.5e-05) and these associations largely extended to postmortem vmPFC. There was an indirect association between PTSD severity and CLDN5 DNAm in blood at cg21872764 via GrimAge residuals (indirect β=.033, P=.040) that was diminished when the direct PTSD association was modeled. The CLDN5 probe cg17411190 in blood was negatively related to left and right hippocampal volume (p-adj=.042) and with volume of multiple hippocampal substructures. The association between PTSD severity and hippocampal volume was indirect via blood DNAm at cg17411190 (indirect β=-.011, P=.045). PTSD severity-related accelerated aging may be associated with altered CLDN5 DNAm, which may signal neurodegeneration, such as reduced hippocampal volume. CLDN5 DNAm in blood may serve as a useful proxy for brain CLDN5 DNAm. Given that prior environmental enrichment and antidepressant studies show initial efficacy in altering CLDN5 expression, future studies could evaluate if PTSD treatment alters CLDN5 epigenetics and reduces risk for neurodegeneration.
Dietary habits adopted during young adulthood play a critical role in physical, emotional, and cognitive health. University students represent a particularly vulnerable group due to academic stress, lifestyle transitions, and increased autonomy, factors that may influence eating behaviors, body weight perception, and psychological well-being. This study aims to examine dietary habits among students and their associations with self-perceived body weight, lifestyle characteristics, and psychological factors within a biopsychosocial framework. A cross-sectional observational study was conducted using a structured, self-administered online questionnaire distributed to university students aged 18-30 years in Romania. The questionnaire assessed dietary habits, nutritional knowledge, lifestyle behaviors, and psychological variables, including perceived stress and body weight perception. Body mass index was calculated based on self-reported anthropometric data. The findings indicated substantial variability in dietary behaviors, with a high prevalence of irregular meal patterns, frequent snacking, and engagement in weight-control practices. Irregular meal patterns were reported by approximately 62% of participants, while 47% had engaged in at least one weight-loss diet. Discrepancies between self-reported BMI and perceived body weight were observed in roughly 38% of cases, and 83% of respondents reported at least one psychological symptom (stress, anxiety, or low mood) related to eating behaviors. A positive correlation was observed between sleep duration and perceived rest quality (r = 0.364, p < 0.001). High frequencies of caffeinated beverage consumption were also observed. Additionally, 204 participants reported no alcohol consumption, while the variety of alcoholic beverages consumed was strongly correlated with alcohol intake frequency (r = 0.734, p < 0.001). Dietary habits among university students are closely interconnected with body weight perception, lifestyle behaviors, and psychological well-being. These findings emphasize the need for integrative health promotion strategies that address nutrition, emotional regulation, and lifestyle balance to support mental and cognitive health during young adulthood.
Extensive research has established relationships between depression and inflammation, yet greater attention is needed to elucidate mechanisms through which these processes unfold across multiple levels of analysis and time scales. This cohort panel study evaluated the role of daily affect dynamics in bidirectional and longitudinal associations between depressive symptoms and inflammation. Using data from the second and third waves of the Midlife in the United States (MIDUS) study, the sample included 563 adults (M age =52.4; 57% female; 84% White). During the Biomarker Project, depressive symptoms were assessed at a single time point using the CESD-20, and the inflammatory markers were collected, including CRP and 4 cytokines (IL-6, IL-8, TNFα, IL-10). During the Daily Diary Project, daily affect and stress were measured over 8 consecutive days. Two affect dynamics indicators were specified: affective variability and reactivity to daily stressors. Multilevel structural equation models simultaneously tested autoregressive and cross-lagged associations between depressive symptoms and inflammation at the person-level, and day-level mediated paths involving daily affect dynamics. Results revealed that affective variability and reactivity mediated the autoregressive paths of depressive symptoms across 2 waves. Positive affective variability mediated the pathway from heightened baseline depressive symptoms to higher CRP levels at follow-up. Negative affective reactivity to daily stressors mediated the pathway from higher baseline CRP to subsequent depressive symptoms. Findings suggest daily affective processes as potential mechanisms linking depressive symptoms and inflammation, underscoring the significance of promoting affective stability and adaptive stress responses in everyday life.
To examine differences in social support, loneliness, and immune function by sexual orientation and to explore whether social support and loneliness mediate immune outcomes. Participants (394 heterosexual, 144 gay/lesbian, 144 plurisexual) completed the Perceived Social Support Questionnaire and the UCLA Loneliness short-form and provided dried blood spot samples to index i mmune markers [Epstein-Barr virus (EBV) titers, C-reactive protein (CRP), interleukin-6 (IL-6)] between September 2020 and November 2021. Plurisexual (Cohen's d =-0.80) and heterosexual ( d =-0.64) males had lower friend support than gay males ( p' s < .0015), plurisexual ( d =-0.42) and gay/lesbian ( d =-0.40) adults reported lower family support than their heterosexual peers ( p' s < .001), and plurisexual people had higher CRP levels compared with gay/lesbian ( d =0.37) and heterosexual people ( d =0.22) ( p 's < .039). Lower social support did not explain plurisexual adults' higher inflammation, but BMI partially explained plurisexual adults' higher IL-6 [indirect effect: 0.15 (0.04 to 0.26)] and CRP [indirect effect: 0.21 (0.04 to 0.38)], compared with heterosexual adults. Partnered plurisexual individuals face lower social support and greater inflammation-suggesting that partnered status alone does not ensure health equity. These findings underscore the need to better understand and address the unique social and biological vulnerabilities of plurisexual people. BMI may partially explain plurisexuals' higher inflammation, but further longitudinal research is warranted.
Adverse childhood experiences (ACEs) confer risk for depressive symptoms in adulthood, potentially through maladaptive cognitive-affective responses to stress. The neurovisceral integration model suggests that resting respiratory sinus arrhythmia (RSA), an index of parasympathetic regulation, shapes capacity to regulate cognitive-affective stress responses. The present study tested whether stress-related appraisals and perseverative thinking mediated the association between ACEs and depressive symptoms, whether RSA moderated these pathways, and whether effects varied under chronic caregiving stress. Participants were 222 middle-aged mothers (mean age=46.83, SD=6.03) experiencing higher (n=125) and lower (n=97) caregiving stress. ACEs and depressive symptoms were assessed with the Childhood Trauma Questionnaire and CES-D. Perceived threat, perceived control, and perseverative thinking were measured via daily diaries. Resting RSA, CES-D, and daily measures were collected at three timepoints across 30 months. Lower RSA strengthened the association between ACEs and depressive symptoms (b=0.269, SE=0.060, P<.001). Lower perceived control (b=0.022, 95% CI [0.001, 0.049]) and greater perseverative thinking (b=0.072, 95% CI [0.020, 0.128]) mediated the association between ACEs and depressive symptoms; lower RSA strengthened associations between ACEs and these mediators. Higher ACEs were associated with greater perceived threat among mothers with higher caregiving stress and lower RSA (b=0.014, SE=0.004, P<.001). Early adversity is associated with depressive symptoms through stress-related cognitive-affective pathways. Lower RSA may reflect diminished regulatory capacity that strengthens associations between ACEs and maladaptive cognitive-affective stress responses.
Placental corticotropin-releasing hormone (pCRH) is a peptide essential for fetal development and birth timing. Prenatal programming frameworks position maternal pCRH as a primary neuroendocrine mediator underlying the intergenerational transmission of stress, but empirical evidence is sparse. Using rigorous methodology, we conducted the first investigation of associations between pCRH and multi-informant indicators of offspring internalizing psychopathology during middle childhood. This study used the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) sample of socioeconomically diverse mother-child dyads ( n =838) followed prospectively from pregnancy. We estimated pCRH rate of rise and level at delivery using maternal second and third trimester blood plasma. We operationalized child internalizing psychopathology and related behavioral phenotypes at age 8 with maternal report of internalizing problems, child report of depression and anxiety, and task-based indicators of threat sensitivity. Covariate-adjusted regression models estimated associations between pCRH and offspring outcomes and whether fetal sex moderated associations. Neither rate of rise nor cumulative exposure was associated with any of the 6 multi-method, multi-informant child outcomes tested (eg, child-reported depression and anxiety symptoms, maternal-reported internalizing problems, task-based indicators of threat sensitivity) ( p s range from .16-.83). Fetal sex did not moderate associations. Contrasting theory and findings in smaller samples at younger ages, evidence from this study did not support pCRH as a plausible maternal neuroendocrine mediator for the intergenerational transmission of stress effects on offspring internalizing psychopathology during middle childhood. Future research exploring potential for waning associations across early childhood or other potential mechanisms is warranted.
To examine the sleep, psychological well-being, and political cognitive-emotional burden of the 2024 United States presidential election on first-time young adult voters. First-time young adult voters (N=186, mean age 20.57 y, SD=0.85) completed an 11-day daily diary and actigraphy protocol spanning the days before, of, and after the November 2024 U.S. presidential election. Daily measures included sleep efficiency (actigraphy), positive and negative affect, distress, rumination, and political concealment. The majority of participants voted for Harris (n=153); a smaller subset reported voting for other candidates. Across the full sample, sleep efficiency and positive affect declined and distress, negative affect, rumination, and political concealment increased in the days leading up to the election. Negative health effects intensified on the day after the election, with non-Harris voters reporting better health than Harris voters during this period. Most health indicators returned to pre-election levels by the end of the study; positive mood, however, remained lower and negative mood remained higher than pre-election baselines. The 2024 national election was associated with measurable, time-limited declines in sleep and mental health among first-time young adult voters, with election-day and post-election effects patterning by candidate preference. Most indicators recovered within days, but mood disturbances persisted beyond the study window, suggesting that elections function as acute political-cognitive stressors with lingering affective consequences for newly enfranchised young adults.
Pain is a prominent symptom in breast cancer survivors, but associated factors are still under investigation. Childhood adversity has been linked to pain in adulthood through emotional and biological pathways but has been relatively unexplored in the context of breast cancer. The current study examines the association between childhood adversity and pain in breast cancer survivors and meditation by ambivalence over emotional expression (hereinafter referred to as emotional ambivalence) and inflammation. We hypothesize a positive association between childhood adversity and pain, mediated by greater emotional ambivalence and higher levels of inflammation. Women diagnosed with stage 0 to IIIA breast cancer ( N =175) completed assessments 1 year after the completion of primary treatment, including questionnaires assessing childhood adversity (Risky Families), emotional ambivalence (ambivalence towards emotional expressivity), and pain (SF-36). Blood samples were collected to measure plasma markers of inflammation (IL-1ra, IL-6, CRP, and sTNFR-II). Childhood adversity was significantly associated with greater pain, B =0.36, p =.008, which was significantly mediated by emotional ambivalence, B =0.09, 95% CI [0.02, 0.18]. There were no significant indirect effects through any of the inflammatory markers. We also explored the associations between dimensions of childhood adversity and pain. Similar linear regression and mediation results were found for threat and neglect, whereas there were no significant findings in models examining household chaos. Findings highlight the relevance of childhood adversity as a contributor to persistent pain in breast cancer survivors and identify emotional ambivalence as a key pathway and potential target for intervention.
BACKGROUND: Competency-based medical education (CBME) emphasizes the acquisition of clearly defined, observable competencies aligned with clinical practice needs. Psychosomatic medicine service competency (PMSC) is increasingly recognized as essential for general practitioners (GPs) delivering holistic, biopsychosocial primary care. However, the extent to which PMSC is incorporated into China’s General Practice Standardized Residency Training Program (SRTP) from a CBME perspective remains unclear. METHODS: A national cross-sectional survey was conducted from May to August 2024. Training base representatives (e.g., program directors, teaching coordinators, and core faculty) from general practice residency training bases across mainland China were invited to complete an online questionnaire using convenience sampling. The survey explored training content, teaching strategies, evaluation methods, and institutional challenges among training practices for PMSC in SRTP. RESULTS: A total of 200 questionnaires were distributed, and 193 valid responses were received (response rate: 96.5%). While basic PMSC such as communication skills and empathy were reportedly covered in most programs, only a minority offered structured training in managing specific conditions. Less than 40% of programs employed interactive learning methods such as role-playing, multidisciplinary collaboration, or situational teaching. Major barriers identified included a lack of standardized curricula, insufficient qualified faculty, and limited institutional prioritization. Despite these gaps, 94.3% of respondents expressed strong support for enhancing PMSC for GPs in SRTP. CONCLUSION: PMSC training within China’s GP SRTP shows suboptimal alignment with CBME principles. Advancing psychosomatic education will likely require explicit competency definitions, structured workplace-based learning, and competency-oriented assessment. Given the convenience sampling design and reliance on institutional self-reporting by training base representatives, findings should be interpreted cautiously and may not directly reflect trainees’ experiences or actual competency attainment.