Journal of Psychosomatic Research

Background and hypothesis.The increased anxiety owing to the COVID-19 pandemic has been suggested to contribute to unhealthy lifestyles and depression in patients undergoing haemodialysis (HD). Therefore, this study aimed to evaluate the degree of fear of COVID-19 after vaccination dissemination and the independent impact of high-order health literacy (HL) on fear, which have not been adequately investigated. Methods.This multicentre cross-sectional study, conducted in 2022, after the widespread availability of the COVID-19 vaccination in Japan, included adults undergoing in-centre HD. Multidimensional HL was measured using the 14-item Functional, Communicative, and Critical Health Literacy Scale. Fear of COVID-19 was measured using the 7-item Japanese version of the Fear of COVID-19 Scale. COVID-19 fear scores in patients with HD were compared with scores of adults in April 2020 (the beginning of the pandemic) using an unpaired t-test. The association between multidimensional HL and COVID-19 fear scores was estimated using a multivariable-adjusted general linear model. Results.A total of 446 patients were analysed, of whom 431 (97%) and nine (2%) received three and two doses of vaccination, respectively. Their COVID-19 fear scores were significantly lower than those of the general population at the beginning of the pandemic (p < 0.001; mean difference -4.4 [95% confidence interval (CI): -5.1 - -3.7]; standardised effect size [ES] 0.77). Higher functional HL was associated with less fear (per 1-pt higher: -2.8 [95% CI: -1.7 - -0.3]; standardised ES -0.51), whereas higher critical HL was associated with greater fear (per 1-pt higher: 3.2 [95% CI: 0.7 - 3.0]; standardised ES 0.80). Communicative HL was not associated with fear. Conclusion.Patients fear of low-functional HL, despite widespread vaccination, can be reduced by providing health information in an easy-to-understand manner. Thus, the fear of sceptics owing to excessive critical HL and honest explanations by healthcare providers may be important. Key learning points What was knownHeightened anxiety stemming from the COVID-19 pandemic exacerbates unhealthy lifestyles and depression, particularly in patients undergoing haemodialysis. Health literacy plays a crucial role in individuals with kidney disease and may mitigate anxiety. Comprehensive data on whether multidimensional health literacy (functional, critical, and communicative) independently correlates with fear of COVID-19, particularly in the context of patients undergoing haemodialysis are lacking. This study addsCOVID-19 fear scores were notably lower in patients undergoing haemodialysis who received the COVID-19 vaccination than in the general population at the onset of the pandemic. Elevated functional health literacy correlated with reduced fear, whereas higher critical health literacy was linked to increased fear. Potential impactFear among individuals with low functional health literacy can be alleviated by delivering health information in a clear and accessible manner, whereas transparent and honest communication from healthcare providers is crucial for patients with heightened fear owing to critical health literacy, who may be sceptical of accurate information.

ABSTRACT Purpose: Survivors of severe COVID-19 commonly experience post-intensive care syndrome (PICS), which includes depression and fatigue. Fatigue is far more common and may inflate depression severity given overlapping symptoms. We sought to disentangle fatigue from depression in PICS. Methods: We conducted a cross-sectional analysis of the RAFT COVID study, a national multicenter longitudinal cohort of severe prolonged COVID-19 survivors. We included participants who completed validated surveys at 1-year from hospitalization for depression (PHQ-9) and fatigue (FACIT-Fatigue). We described correlation of FACIT-fatigue with the PHQ9, and separately with PHQ-2 and PHQ-7, which both omit the two items we hypothesized are influenced by fatigue: tiredness and sleeping. Using a MIMIC model, we performed differential item functioning to evaluate the impact of fatigue on depression directly through these two questions and indirectly with the latent depression construct. We then compared PHQ-7 to PHQ-9 scores by fatigue status. Results: Among 82 participants, 61.0% reported fatigue (reverse-scored FACIT-Fatigue[&ge;]9), and 15.9% moderately severe depression (PHQ-9[&ge;]10). FACIT-fatigue was strongly correlated with PHQ-9 (r=.87, p<.001), but less so for PHQ-2 (r=.76, p<.001) and PHQ-7 (r=.82, p<.001). The MIMIC model identified significant direct effects on tiredness ({lambda}=.89, p<.001) and sleep ({lambda}=.52, p<.001). Among fatigued participants, the rescaled PHQ-7 was lower than the PHQ-9 (median of 4.5, IQR 1.50-9.75, vs 7, IQR 4-9.75). Conclusions: Fatigue significantly inflated depression symptoms in severe COVID-19 survivors through tiredness and sleeping PHQ-9 items. PHQ-2 may better screen for true depressive symptoms in PICS, minimizing the risk of misdiagnosis and overtreatment.

Background and AimsAvoidance of symptom-related situations is common in chronic gastrointestinal (GI) conditions, contributing to greater symptom severity, psychological distress, and reduced quality of life. However, no validated measure exists to comprehensively assess GI-specific avoidance. We developed and validated the GI-specific Avoidance Scale (GIAS), a self-report instrument measuring behavioral and cognitive avoidance specific to GI symptoms. MethodsFollowing literature review and multidisciplinary input, an initial pool of 58 items was generated and refined through expert and patient ratings, yielding 37 items. A sample of 102 adults (mean age 40.8 years) with medically diagnosed GI conditions completed the GIAS and validated measures of avoidance, psychological flexibility, illness shame, GI symptoms, distress, and quality of life. Exploratory factor analysis was used to determine factor structure. Internal consistency, convergent validity, incremental validity, and mediation analyses were conducted. ResultsFactor analysis supported a 20-item, three-factor solution: General Avoidance, Food Avoidance, and Intimacy/Body Exposure Avoidance. Internal consistency was excellent for the total scale ( = .94) and good-to-excellent for subscales ( = .82-.94). GIAS scores correlated positively with illness shame, GI symptoms, and distress, and negatively with psychological flexibility, self-compassion, and quality of life. GIAS showed incremental validity over a general illness avoidance measure (IBAS) in predicting GI symptoms and anxiety. Moreover, mediation models suggested that GI-specific avoidance partially mediates bidirectional associations between GI symptoms and psychological distress. ConclusionsThe GIAS is a novel, psychometrically robust, and multidimensional self-report questionnaire of GI-specific avoidance. It holds potential for clinical assessment, treatment planning, and evaluation of intervention mechanisms in GI populations.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and Long COVID are persistent multi-system illnesses affecting many patients. With no known effective FDA-approved treatments for either condition, patient-reported outcomes of treatments are invaluable for guiding management strategies in patient care and generating new avenues for research. Here, we present the results of an ME/CFS and Long COVID treatment survey with responses from 3,925 patients. We assessed the experiences of these patients with more than 150 treatments, as well as their demographics, symptoms, and comorbidities. Patients with each condition who participated in the study shared similar symptom profiles, including all the core symptoms of ME/CFS, e.g., 89.7% of ME/CFS and 79.4% of Long COVID reported post-exertional malaise (PEM). Treatments with the greatest perceived benefits were identified, which had varied effects on different core symptoms. In addition, treatment responses were significantly correlated (R{superscript 2} = 0.68) between the two patient groups. Patient subgroups with distinct profiles of symptoms and comorbidities showed varied responses to treatments, e.g., a POTS-dominant cluster benefiting from autonomic modulators and a cognitive-dysfunction cluster from CNS stimulants. This study underscores the symptomatic and therapeutic similarities between ME/CFS and Long COVID and highlights the commonalities and nuanced complexities of infection-associated chronic diseases and related conditions. Insights from patient-reported experiences, in the absence of approved treatments, provide urgently needed real-world evidence for targeted therapies in patient care and for developing future clinical trials. (Disclaimer: The findings presented in this paper are based on patient-reported information and are intended for research purposes only. They should not be interpreted as medical advice. Patients are advised to consult their healthcare provider before initiating or altering any treatment.)

BackgroundFibromyalgia is characterised by chronic widespread pain. Quality of life is further reduced by autonomic and cognitive symptoms, including subjective brain-fog and dissociative experiences. Although an association with joint hypermobility suggests variant connective tissue is a factor in both fibromyalgia and dysautonomia, the mechanisms underlying the neuropsychiatric symptoms are poorly understood. Methods21 fibromyalgia patients and 21 healthy controls were assessed for joint hypermobility dissociative experiences, autonomic symptoms and interoceptive sensibility. Mediation analyses were conducted according to the method of Baron and Kenny. ResultsPatients with fibromyalgia reported greater dissociative experiences and autonomic symptoms. The relationship between fibromyalgia and dissociative experiences was fully mediated by symptoms of orthostatic intolerance. Fibromyalgia, dissociative experiences and orthostatic intolerance all were associated with joint hypermobility and interoceptive sensibility. ConclusionsThis exploratory investigation highlights the relationship between dissociative experiences in the context of fibromyalgia and subjective experience of aberrant physiological responses. These findings can enhance the recognition and management of neuropsychiatric symptoms in patients with fibromyalgia, wherein dissociative experiences reflect disturbance of self-representation that can arise through abnormalities in internal agency, autonomic (dys)control and interoceptive prediction errors.

ObjectivesDepressive disorders are common in the primary care setting. Primary care practitioners must deal with different disorders and keep up with evidence-based treatment. Clinical practice guidelines (CPG) offer accessible information about up-to-date care but are poorly implemented. Research on the implementation of CPGs has focused on the practitioners perspective but has neglected the patients perspective largely. This scoping review aimed to identify terms related to the concept of patients perspectives on depression treatment in primary care building a comprehensive framework and to identify researched barriers and facilitators to partaking in care. MethodsWe conducted a scoping review on Medline and Psycinfo. Eligible publications contained information from the patients point of view on depression treatment in primary care in OECD member states. We used the PCC-framework to obtain inclusion criteria. Publications until August 2nd 2023 were considered. ResultsWe included 232 publications. Current literature focuses on behavioral and easily collected measures like satisfaction and on patient-sided barriers and facilitators to adherence. Other treatment-related behaviors are less researched. Patients often report exclusively or mainly physical symptoms in their visits which can impede diagnosis. ConclusionThis review provides a comprehensive framework for the concept. Research on the patients perspective on depression treatment in primary care is still inconclusive. RegistrationThis review is registered via OSF (https://osf.io/p9rnc).

Background/purpose: Excess weight has been identified as a potential risk factor for the development of post-COVID-19 condition (PCC). This review investigates whether excess weight increases the risk of neurological and neuropsychiatric symptoms associated with PCC. Methods: Studies published up to July 2023 were searched independently across eight electronic databases to evaluate the risk of developing neurological and neuropsychiatric symptoms more than 12 weeks post-infection between exposure and controls groups (excess weight vs. normal weight; obesity vs. non-obesity). Meta-analyses were conducted under a random-effects model. Results: Of the 10,122 abstracts screened, 18 studies (n = 139,091 adults) met the inclusion criteria and reported PCC symptoms according to nutritional status. These studies included 79,050 individuals with excess weight vs 57,926 normal-weight individuals and 30,694 individuals with obesity vs 107,612 non-obese individuals. The presence of excess weight in PCC significantly increased the risk of depression (RR = 1.21; 95% CI: 1.03-1.42), headache (RR = 1.21; 95% CI: 1.09-1.35), memory issues (RR = 1.43; 95% CI: 1.24-1.65), sleep disturbance (RR = 1.31; 95% CI: 1.16-1.48), and vertigo (RR = 1.21; 95% CI: 1.04- 1.41). Obesity significantly increased the risk of headache (RR = 1.41; 95% CI: 1.34- 1.49), smell disorder (RR = 1.15; 95% CI: 1.09-1.21), taste disorder (RR = 1.21; 95% CI: 1.07-1.36), and vertigo (RR = 1.44; 95% CI: 1.35-1.53). Conclusions: Excess weight or obesity increases the risk of experiencing neuro-symptoms related to PCC. Individuals with these conditions urgently need enhanced personalized care management in current post-pandemic context.

Background & AimsClinical evidence suggests significant interindividual differences in stress reactivity (SR), but biological mechanisms and therapeutic implications of these differences are poorly understood. We aimed to identify the biological basis of increased SR by investigating associations between a psychometric-based phenotype with blood transcriptomics profiles of increased sympathetic nervous system (SNS) activation and brain imaging phenotypes in irritable bowel syndrome (IBS) participants and healthy controls (HCs). MethodsA cross-sectional observational study design, transcriptomics profiling, multimodal brain imaging, and psychosocial assessments were obtained in 291 female and male IBS participants and HCs. Prior to analyses, unsupervised clustering was applied to derive high and low SR subgroups across participants based on two measures of SR. General linear models tested for SR group differences in clinical and biological parameters. Exploratory analyses examined associations between SR group-specific brain alterations and gene expression. ResultsThe high, compared to low SR group showed greater cyclic AMP response element-binding protein (CREB) gene expression consistent with tonic SNS activity and proinflammatory changes in whole blood. Brain imaging showed neuroplastic changes in the high SR group consistent with an upregulation of ascending arousal systems and sensory processing and integration regions, and functional connectivity changes in the central autonomic network. SR moderated the sex difference in extraintestinal symptoms. ConclusionsThe findings support a model of tonically increased SNS activity as a plausible risk factor for increased autonomic reactivity to psychosocial stressors and low grade immune activation in both IBS and HCs, with a greater prevalence in IBS. These findings may have important implications for personalized treatment interventions in IBS.

BackgroundLongitudinal data on the course of somatic symptom disorder (SSD) in ulcerative colitis (UC) and irritable bowel syndrome (IBS) are lacking. Understanding SSD trajectories and predictors in IBS and UC may clarify clinical relevance and guide psychological treatment decisions. This study examined the 12-month course and biopsychosocial predictors of interview-based SSD in patients with UC or IBS. MethodsLongitudinal data from a randomised controlled trial were analysed. SSD was assessed using DSM-5-based structured interviews at baseline and 12 months. SSD Criteria A (Somatic symptom severity) and B (symptom-related distress) were measured with the Patient Health Questionnaire-15 (PHQ-15) and the Somatic Symptom Disorder - B Criteria Scale-12 (SSD-12), respectively. Further variables included gastrointestinal symptom severity, inflammatory markers, depression severity, illness perceptions, and neuroticism. Logistic and linear regression models identified baseline predictors of SSD diagnosis and Criteria A and B at 12 months. ResultsThe sample included 213 patients (73.7% female; Mage=40.5, SD=13.98) with UC (n=110) or IBS (n=103). SSD was present in 42.3% (95%CI: 35.2-49.3) at baseline and in 15.5% (95%CI: 11.3- 20.7) at follow-up. Baseline SSD and depression severity predicted follow-up SSD. Criterion A was predicted by somatic symptom severity, female gender, and neuroticism; the B criterion by symptom-related distress, somatic symptom severity, neuroticism, and negative illness perceptions. Inflammatory markers and gastrointestinal symptom severity showed no predictive value. ConclusionStructured interview-based SSD was frequent in patients with UC or IBS at baseline and declined over time. Psychosocial rather than disease-related variables predicted SSD, highlighting modifiable targets for early detection and tailored interventions. Results should be interpreted in light of the studys interventional context.

BackgroundFood-related gastrointestinal (GI) symptoms are highly prevalent in patients with IBS. Although dietary components may trigger symptoms through luminal mechanisms, cognitive expectations may also shape symptom perception within the gut-brain axis. No validated instrument currently exists to measure food-related symptom expectations. Hence, we developed and validated the Food Expectation Questionnaire (FEX-Q). MethodsThe FEX-Q was developed using a stepwise process including focus group interviews and face-to-face validation to ensure content validity. The finalized digital questionnaire presents 44 food images with six items rated on a visual analogue scale (VAS; 0-100), including the core item assessing food-related symptom expectation ("How severe GI symptoms do you expect after eating this food?"). Additional domains assess taste preference, willingness to eat, perceived healthiness, and perceived fat and carbohydrate content. The finalized FEX-Q was administered in a nationwide online validation survey of adults with IBS and non-IBS controls in Sweden. Participants also completed validated questionnaires including GI symptom severity (combined GSRS), psychological distress (HADS), food-related quality of life (FR-QOL), and a screening tool for food avoidance (NIAS). ResultsTwenty adults with IBS and non-IBS controls participated in the face-to-face validation, resulting in a final version of the FEX-Q comprising 44 food images, which were properly identified and provided a range of macronutrient distributions and trigger foods. In the nationwide online study including 134 patients with IBS and 126 non-IBS controls, the FEX-Q demonstrated strong known-groups validity (mean symptom expectation 18.4 in controls vs 50.1 in IBS), strong construct validity (perceived vs actual fat content r=0.78, p<0.001 and carbohydrate content r=0.59, p<0.001), significant convergent validity with GI symptom severity and food-related quality of life, and high internal consistency (split-half reliability Spearman-Brown corrected r=0.88). ConclusionThe FEX-Q can capture individual food-related symptom expectations to distinct food images. This reliable measurement can be useful to reveal the mechanism of food-related symptom expectations and provide clinically relevant insights for personalized dietary management

BackgroundIrritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by significant gut-brain interactions and various symptoms such as abdominal pain, bloating, and altered bowel habits. Cognitive deficits in IBS have been linked to attentional biases, particularly towards somatic and symptom-related cues. Despite increasing interest in understanding these cognitive processes, the specific patterns of attentional biases and their relationship with anxiety in IBS remain inadequately explored. MethodThis study employed a dot-probe task to compare attentional biases toward somatic (bloating, pain) and social threat cues (angry/disgusted faces) in 15 patients with IBS, 15 individuals with high anxiety (HA), and 15 healthy controls (HC). Participants completed two tasks (Body/Face) with 500 ms stimulus exposure. Attentional bias indices (RT incongruent - RT congruent) were analyzed using mixed-design ANOVAs, controlling for anxiety (STAI) and IBS symptom severity (IBS-SSS). ResultsPatients with IBS exhibited significant avoidance of bloating-related stimuli compared to HC (p =.013), but not pain-related cues. Anxiety modulated attentional processing in IBS (p =.015) and HC (p =.013). HA showed no significant biases. IBS patients demonstrated slower overall reaction times than HC (p=.024), suggesting cognitive load. A positive IBS severity-anxiety correlation was observed in IBS (r = 0.574, p =.020). ConclusionsThe findings demonstrate that IBS is associated with selective avoidance of bloating-related stimuli, driven by a maladaptive interplay between hyper-precise symptom expectations and interoceptive noise--a mechanism distinct from anxiety-related attentional patterns. While anxiety amplifies this avoidance, it does not independently account for the cognitive profile of IBS. These results underscore the gut-brain axis role in shaping cognitive-emotional processing.

BackgroundGeneral Practitioners (GPs) play a key role in referring adolescents with depression and/or anxiety to mental health specialists and services, but their capacity to do so may be compromised by service wait times. It is unclear how GPs manage the mental healthcare of adolescents when the choice of treatment is not available. This study aimed to explore GPs self-reported referral practices to mental health specialists and services for adolescent depression and/or anxiety, as well as their perceived knowledge, acceptability, and impacts of the wait times for these. MethodsA cross-sectional online survey of 192 GPs in Australia who self-identified as treating adolescents (12 to 17 years old) with depression and/or anxiety. ResultsGPs most frequently referred adolescents with depression and/or anxiety to psychologists. However, the mean estimated wait time for psychologists was 57.26 days (SD: 47.91, Mdn: 45.0, range: 5-365), which was four times the proposed acceptable wait time (M: 14.66 days, SD: 8.70). Nearly all GPs (81.8%) had increased their level of care for adolescents due to long waits but had limited training in and knowledge of strategies for effective self-management. ConclusionsGPs in Australia lack information on the wait times for adolescent mental health specialists and services, despite frequent referrals. Greater knowledge of wait times, training in wait time approaches, and self-directed digital interventions may help to enhance the quality of primary care provided to adolescents.

ObjectiveThis study aimed to evaluate whether a self-management program using the eHealth system could reduce symptom severity in patients with irritable bowel syndrome (IBS). Impact of the intervention on quality of life and gut microbiota were also examined. DesignThis study was designed as an open label, simple randomized controlled trial comparing an intervention group that attended an eHealth self-management program and a treatment as usual group. Participants were Japanese women between the ages of 18 and 36. Forty symptomatic IBS individuals who met the inclusion criteria were recruited and randomly assigned to the two groups. The eHealth group received 8 weeks of unlimited access to the self-management program containing a wide variety of e-learning content. Participants severity of IBS symptoms, the main outcome, was assessed using the irritable bowel syndrome-severity index (IBS-SI) at baseline and 8 weeks. The secondary outcomes of participants quality of life and gut bacteria were also assessed at baseline and week 8. ResultsThere was a significant difference in the net change in IBS severity index (IBS-SI) score between the eHealth and treatment as usual group (-50.1; 95% CI, -87.6 to -12.6; p = 0.010). The eHealth group had significantly lower IBS-SI scores following 8 weeks of intervention compared with the baseline scores (t = - 3.2, p < 0.01). The implementation of the eHealth program was accompanied by improvement of quality of life and decrease of phylum-level Cyanobacteria occupancy, respectively. ConclusionThe implementation of eHealth for IBS was shown to reduce IBS symptoms. Key MessagesO_LIWhat is already known on this topic - eHealth programs based on diet and probiotic use have shown good results in reducing IBS symptoms C_LIO_LIWhat this study adds - a self-management program with an e-learning component based on a successful self-help guidebook for IBS C_LIO_LIHow this study might affect research, practice or policy - The proposed eHealth model reduces symptoms and improves the quality of life of IBS patients, providing an efficient and cost-effective intervention option to be adopted in policy and practice, and creates scope for future research in food intake, exercise, and sleep management through eHealth for IBS. C_LI

AimsPeople with diabetes experience a significantly higher prevalence of mental health issues, particularly depression. This adversely affects their diabetes management and overall health. This scoping review aims to develop a conceptual framework for understanding the connection between depression and diabetes outcomes globally, specifically focusing on intermediary factors that may influence this relationship. MethodsPubMed, EMBASE, PsycINFO, and Global Index Medicus were searched using relevant keywords on 17th May 2024. The inclusion criteria encompassed peer-reviewed studies involving adults diagnosed with Type 2 diabetes that assessed depression and analysed its impact on diabetes outcomes through various pathways ResultsThe review identified 30 studies examining the association between depression and diabetes outcomes. Results indicate that while depression is linked to poorer diabetes outcomes, the mechanisms are complex and often mediated by factors such as self-efficacy, social support, and diabetes-related distress. Notably, self-efficacy emerged as a critical mediator in the relationship between depression and self-management behaviours. Furthermore, social support was identified as a protective factor that can reduce the adverse effects of depression on glycaemic control. ConclusionsAddressing mental health concerns in diabetes care is essential for improving patient outcomes. This review underscores the need for integrated interventions that consider psychosocial factors to enhance self-management and glycaemic control among individuals with Type 2 diabetes. Future research should focus on exploring these relationships in diverse populations to inform tailored strategies for effective diabetes management. {blacksquare}Individuals with diabetes experience higher rates of mental health issues, particularly depression, which negatively impacts diabetes management and health outcomes. {blacksquare}This scoping review identified 30 studies linking depression to poorer diabetes outcomes and developed a conceptual framework that highlights the complex mechanisms involved, including factors such as self-efficacy, self-management, illness perception and social support. {blacksquare}The findings emphasize the importance of addressing mental health in diabetes care

BackgroundComorbidity between different subtypes of functional gastrointestinal disorders(FGIDs) is of high prevalence in clinical practice. Heterogeneity of clinical appearances has led to difficulty in individualized diagnosis and comprehensive management of FGIDs. AimsTo discover the hidden clinical patterns of patients with comorbidity between functional dyspepsia(FD) and irritable bowel syndrome(IBS). MethodsIn a retrospective cross-section study, a self-report questionnaire that consist of items indicating 5 different assessing domains including gastrointestinal discomforts, systemic discomforts, psychological disorders, and environmental aggravated factors was used as basic instrument for clinical assessment. With item response theory, the theoretical framework of assessment was evaluated, and latent traits of patient were quantified in the simulated computerized adaptive testing. Latent class analysis was used for uncovering the hidden patterns over the heterogenous clinical appearances. And differences among the profiles were compared referring to the spectrum of clinical appearances and the clinical diagnosis. ResultsWith 996 patients enrolled in the study, the validity and reliability of the instrument were evaluated as adequate (Cronbachs alpha indices =0.72, Split-half reliability =0.84). The construct validity was also evaluated to be adequate with Chi-square/df=3.45, CFI=0.92, GFI=0.96, RMSEA=0.05, TLI=0.90, RMR=0.02. The 7-profile model was evaluated to be with better fitness with Entropy=0.98, Lo-Mendell-Rubin likelihood ratio test-p value<0.01, Bootstrap likelihood ratio test-p value<0.01. And the patterns detailed the heterogeneity of clinical appearance of FGIDs patients either in general condition or discomfort in specific dimension. ConclusionsWith application of multidimensional variable analysis, this article summarized the hidden patterns beneath the heterogenous clinical features. And quantitative approaches helped equip clinician with individualized and comprehensive tool in the management of complex diseases such as FGIDs.

BackgroundNumerous neuropsychiatric symptoms, including affective symptoms, chronic fatigue syndrome, and fibromyalgia symptoms, are present in patients with end-stage renal disease (ESRD). This study examines the relationship between neuropsychiatric symptoms and red blood cell (RBC) parameters, kidney function tests, zinc, C-reactive protein, and calcium levels in patients with ESRD. MethodsThe above biomarkers and the Beck-Depression Inventory, the Hamilton Anxiety Rating Scale, and the Fibro-Fatigue Rating Scale were measured in 70 patients with end-stage renal disease (ESRD) and 46 healthy controls. ResultsIncreased scores of depressive, anxious, cognitive, and physiosomatic symptoms (including chronic fatigue, fibromyalgia, and autonomous symptoms) characterise ESRD. One latent vector could be extracted from these diverse symptom domains, which are, therefore, manifestations of a common core referred to as the physio-affective phenome. The combined effects of aberrations in red blood cells (RBC) (number of RBC, hematocrit, and haemoglobin), kidney function tests (glomerular filtration rate, ureum, creatinine, albumin, and total serum protein), C-reactive protein, zinc, and copper explained 85.0% of the variance in the physio-affective phenome. In addition, the effects of kidney function decline on the phenome were partially mediated by RBC aberrations and elevated copper, whereas the effects of dialysis frequency were entirely mediated by decreased zinc and elevated CRP. ConclusionsAffective (depression and anxiety), cognitive, and physiosomatic symptoms due to ESRD are interrelated manifestations of the physio-affective phenome, which is driven by (in descending order of importance) kidney dysfunctions, erythron deficits, inflammation, elevated copper, and decreased zinc.

BackgroundInequalities in healthcare may be driving unplanned and potentially avoidable hospital admissions for people diagnosed with Inflammatory Bowel Disease (IBD). Interventions to reduce unplanned and potentially avoidable admissions need to be developed based on a clear conceptual framework. This scoping review aimed to synthesise the health system components for reducing unplanned IBD admissions to develop a conceptual framework to guide future interventions for reducing unplanned admissions. MethodsA scoping review was conducted to identify literature exploring factors associated with unplanned IBD admissions and interventions to reduce IBD admissions. Literature published between January 2000 and October 2024 was identified from four electronic databases (Medline, Embase, CINAHL and Pubmed). A narrative synthesis presented the findings, guided by Candidacy Framework, to understand issues in healthcare access. Results and conclusionsOf 1980 records identified, 17 were included. Avoidable IBD admissions result from inequity across the patient journey through healthcare specifically in access to: (1) earlier intervention during a flare, (2) specialist clinical advice about symptoms and psychosocial issues, (3) rapid access to outpatient care, (4) patient education, (5) systems that support self-management, (6) proactive care strategies, and (7) collaborative health professional working and referrals. Addressing service permeability (ease of using services) and local production of candidacy (patient-provider relationships and macro-structural conditions) are understood as most important for addressing avoidable unplanned IBD admissions. The Health System Inequity Framework is useful for understanding how services need to address patient care. Brief summarySome unplanned and potentially avoidable hospital admissions in inflammatory bowel disease (IBD) may be avoided through improved access, experience, and outcomes of healthcare. This scoping review developed a framework outlining how avoidable IBD admissions could be reduced by healthcare service interventions, informing healthcare providers and commissioners of potential interventions. Key messagesO_ST_ABSWhat is already known?C_ST_ABSSome unplanned hospital admissions for people with inflammatory bowel disease could be avoided through reducing the existing disparities in healthcare access, experience and outcomes. What is new here?This review is the first to synthesise the current evidence on avoidable IBD admissions, producing a health system inequity framework outlining possible healthcare interventions for reducing avoidable unplanned IBD admissions. How can this study help patient care?The new health system inequity framework can inform healthcare providers and commissioners of IBD services of the possible interventions for reducing avoidable IBD admissions, therefore improving patient care.

BackgroundThe management of the long-term sequelae of COVID-19 infection, known as post-COVID-19 syndrome (PCS), continues to challenge the medical community, largely due to a significant gap in the understanding of its aetiology, diagnosis and effective treatment. AimTo examine general practitioners (GPs) experiences of caring for patients with PCS and to identify unmet care needs and opportunities for improvement. Design and settingThis study follows a qualitative design, using in-depth semi-structured telephone interviews with GPs (N=31) from across Germany. MethodInterviews were audio-recorded, transcribed verbatim and analysed using qualitative content analysis. ResultsPatients with persistent symptoms after SARS-CoV-2 infection often consult their GPs as the first point of contact, with symptoms typically resolving within weeks. While ongoing symptomatic COVID-19 is perceived to be more common, the relevance of PCS to GP practices is considerable given its severe impact on patients functioning, social participation, and the substantial time required for patient care. GPs coordinate diagnosis and treatment, but face difficulties because of the unclear definition of PCS and difficulties in attributing symptoms, resulting in a cautious approach to ICD-10 coding. Interviewees highlight lengthy diagnostic pathways and barriers to accessing specialist care. ConclusionThe findings confirm the high functional limitations and psychosocial burden of PCS on patients and the central role of GPs in their care. The study suggests a need for further research and health policy measures to support GPs in navigating diagnostic uncertainty, interprofessional communication and the limited evidence on effective treatments. How this fits inPost-COVID-19 syndrome has garnered attention in research and healthcare, but limited evidence on its causes and effective treatment challenges clinicians. This study illustrates the symptom-driven approaches to diagnosis and treatment adopted by general practitioners and their concerns about referring patients to specialist clinics. Greater collaboration and communication across sectors and disciplines is needed to meet the identified need for interprofessional care. Research should also focus on developing comprehensive differential diagnostic protocols, and health policy should address barriers to accessing specific outpatient services.

Fibromyalgia is associated with altered brain function and emotion regulation difficulties. Alexithymia is common in fibromyalgia and may further affect emotion regulation in this population. This study examined the interplay of alexithymia and fibromyalgia on the brain function during suppression of negative emotions. Twenty-seven females with fibromyalgia and 30 controls performed an emotion regulation task while undergoing functional magnetic resonance imaging. Alexithymia was assessed using the Toronto Alexithymia Scale (TAS). A series of whole-brain multiple linear regressions was performed to estimate the effects of group, alexithymia and their interaction on activation and seed-based task-related functional connectivity. Reduced activation in the left middle frontal gyrus during negative emotion suppression, as well as reduced left amygdala-right temporo-parietal junction connectivity, increased left anterior insula-right posterior insula connectivity, and increased left anterior cingulate cortex-precuneus and inferior parietal lobule connectivity were evident in fibromyalgia. Increasing alexithymia was associated to stronger left anterior insula-inferior parietal lobule connectivity, across all groups. Following significant association between the group-by-TAS interaction and right amygdala-lingual gyri connectivity, moderation analysis indicated that increasing alexithymia was associated with reduced connectivity in healthy controls but not in fibromyalgia. This study highlights disrupted integration between emotional, interoceptive, and self-referential networks as a key feature of negative emotion suppression in fibromyalgia. Alexithymia moderates these disruptions by reducing emotional clarity and increasing internal focus. Interventions enhancing interoceptive awareness, fostering emotional understanding, and strengthening cognitive regulation may help normalise neural function and improve emotional functioning, especially in individuals with elevated alexithymia.

BackgroundType 2 diabetes (T2D) and chronic gastritis/duodenitis (CGD) are both associated with the onset of depression and mortality. However, the impact of T2D-CGD comorbidity on incident depression and mortality remains unclear. MethodThis retrospective cohort study utilized data from 387,149 participants in the UK Biobank to examine the relationship between T2D-CGD comorbidity, incident depression, and all-cause mortality. OutcomePatients with T2D are more likely to develop CGD compared to those without T2D (odds ratio = 2{middle dot}10, 95% CI = [1{middle dot}97, 2{middle dot}24]). T2D, CGD, and their comorbidity each independently increased risks of depression incidence and all-cause mortality, with T2D-CGD showing the strongest associations for both (depression incidence: adjusted hazard ratio [aHR] = 2{middle dot}29, 95% CI = [1{middle dot}84, 2{middle dot}85]; all-cause mortality: aHR = 2{middle dot}57, 95% CI = [2{middle dot}28, 2{middle dot}88]). The synergistic effect of T2D and CGD on all-cause mortality was 1{middle dot}92 times that of their individual effects combined (synergy index = 1{middle dot}92, 95% CI = [1{middle dot}56, 2{middle dot}31]). The comorbidity was associated with a higher risk of depression and all-cause mortality within 15 years of disease onset. White matter hyperintensity, particularly near the cerebral ventricles, partially mediated the relationship between T2D-CGD comorbidity and incident depression. InterpretationIntegrated screening and long-term monitoring strategies should be prioritized for population with the comorbidity of T2D and CGD, as it significantly elevates the risk of both incident depression and all-cause mortality.