Journal of Psychosomatic Research

ObjectiveTo develop and psychometrically evaluate an assessment of symptoms in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) MethodsAn initial symptom list was devised from the relevant literature with the patient and clinician advisory groups. An online survey with 85 symptom items in eight domains was completed by people with ME/CFS. Each item had two response structures (assessing symptom frequency and severity on five-point scales). Rasch analysis assessed each domain for unidimensionality, targeting, internal reliability, item fit and local dependency. ResultsSurvey data (n=721) indicated various item anomalies and inter-item dependencies, leading to item re-formatting or removal. The frequency and severity-based responses broadly replicated each other, and a four-point response format appeared more appropriate than a five-point response format. Following Rasch-based scale amendments, a revised version with a single four-point response format was re-administered to test the modifications. Validation data (n=354) showed the modified scale had an improved response structure and functionality across all domains, satisfying Rasch model assumptions. Additionally, domain-level super-items allowed for a summated total score along with sub-scales summarising neurological and autonomic symptoms, again satisfying Rasch model assumptions. ConclusionsThe Index of ME Symptoms (TIMES) and its associated sub-scales and domain scales are stable, valid assessments of symptoms in ME/CFS.

ObjectiveTo evaluate the criterion-related and discriminant validity, test-retest reliability and minimal detectable difference of The Index of ME Symptoms (TIMES) in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) MethodsPeople with ME/CFS in the UK completed the TIMES online (n=1055). Rasch-transformed interval data and parametric statistics were used: Pearson correlations (with the ME severity scale); analysis of variance; intra-class correlations (ICC) and standard error of measurement of ICC measured criterion-related and discriminant validity, test-retest reliability and minimal detectable difference respectively. ResultsHighly significant (P<0.001) moderate (r=0.400-0.528) correlations were seen between the TIMES scales and severity of ME/CFS except the gastro-intestinal and immune systems scales (r= 0.315 and 0.302 P<0.001 respectively). Discriminant validity was demonstrated with significant differences in TIMES scores between all five levels of ME severity, except between levels 4 and 5 in some cases, which were underpowered due to the small group numbers. Test-retest reliability was excellent (ICC>0.7, p<0.001) except the cranial nerves and immune system scales which were good (ICC = 0.681 and 0.669, p<0.001) and minimal detectable difference was excellent (3.95-17.45%). ConclusionsThe Index of ME Symptoms (TIMES) scales are valid, reliable, sensitive assessments of symptoms in ME/CFS. They are freely available for use.

ObjectiveAlthough trauma-focused psychotherapies are effective for posttraumatic stress disorder (PTSD), recovery under routine outpatient conditions remains variable. We examined whether participation in a structured Specialty Care (SC) model integrating clinician specialization, flexible treatment density, and coordinated navigation was associated with accelerated PTSD recovery compared with standard outpatient care. MethodsWe conducted a retrospective matched cohort study (2024-2025) of U.S. adults with active PTSD symptoms (PTSD Checklist for DSM-5 score [&ge;]31) receiving care through an employer-sponsored digital mental health platform. Access to SC was determined by employer benefit design. Propensity-score matching with weighting balanced cohorts on baseline severity and demographics. Primary outcomes included longitudinal PTSD symptom trajectories and time to recovery, remission, and reliable improvement. Secondary outcomes assessed depressive symptoms (PHQ-9). Linear mixed-effects and Cox proportional hazards models were applied. ResultsThe matched sample included 356 SC and 9,409 standard care participants. SC participants received higher treatment intensity, including greater session volume and faster early follow-up, and greater care navigation engagement. SC participation was associated with steeper PTSD symptom decline ({beta} = -1.3 per log-week, p < .001) and a higher likelihood of recovery (hazard ratio = 1.31; 95% CI, 1.10-1.57). At 12 weeks, predicted recovery was 29% in SC versus 23% in standard care. Depressive symptoms improved in both groups, without significant differences in time to categorical recovery. ConclusionsUnder routine outpatient conditions, a structured SC model was associated with accelerated PTSD recovery, suggesting that reorganization of outpatient delivery may improve real-world outcomes.

ObjectiveTo develop and conduct preliminary testing of the reliability and validity of the Healthcare Worker (HCW) Culture of Support Scale (COS), intended to assess health worker perceptions of institutional support resources and organizational culture related to their well-being. MethodsA cross-sectional survey was conducted with 533 HCWs from ambulatory clinic and rural hospital settings. The survey included validated measures and newly developed items. Exploratory and confirmatory factor analyses (EFA/CFA) were employed to determine the factor structure. Internal consistency and construct validity were assessed using Cronbachs and correlation with mental health outcomes. ResultsThe COS demonstrated a robust three-factor structure: 1) Organizational Support ( = 0.83), 2) Access to Peer Support ( = 0.92), and 3) Availability of Support ( = 0.97), accounting for 84.9% of variance. Cronbachs alpha for the overall scale was 0.94. CFA confirmed excellent model fit (RMSEA =.049, CFI =.992). Higher COS scores correlated with lower burnout (r = -.47, p <.001) and anxiety (r = -.35, p <.001), and greater resilience (r =.30, p <.001). ConclusionPreliminary evidence suggests that the COS is a reliable and valid measure of HCWs perceptions of organizational support for worker well-being. This scale and the three subscales can provide healthcare institutions with a way to evaluate organizational initiatives to enhance worker well-being and workforce resilience. Further testing is recommended in diverse settings.

Burnout, a state of chronic exhaustion often characterized by feelings of emotional exhaustion, cognitive and emotional dysregulation, and psychological distancing, is an increasingly recognized issue within most professions. This syndrome results in diminished job satisfaction, strained interpersonal relationships, and decreased well-being. Socio-demographic factors have been shown to play a role in burnout risk, while trait mindfulness has been identified as an effective method to mitigate it. This study aimed to identify the prevalence of burnout risk and its relationship with mindfulness and socio-demographics among medical researchers. An anonymous, online, cross-sectional survey was administered to corresponding authors published in MEDLINE. The survey consisted of screening and socio-demographic questions, as well as validated assessment tools (i.e., shortened work-related Burnout Assessment Tool [BAT-12] and shortened Freiburg Mindfulness Inventory [FMI-14]). Responses were analysed according to the BAT and FMI guidelines, alongside regression analyses. A total of 1,732 participants completed the survey, yielding a response rate of 1.88%. Overall, 38.8% of participants were at risk or at very high risk of burnout, and the mean mindfulness score was 37.51. Multiple linear regression analysis indicated that sex, age, and employment status were significant predictors of burnout risk, while age and region significantly predicted mindfulness. Hierarchical regression analysis showed that, after controlling for socio-demographic variables, mindfulness was a strong and independent negative predictor of burnout risk. These findings on burnout risk and the influence of mindfulness and socio-demographics could guide future research in developing tailored interventions and policies that improve the well-being of medical researchers.

ObjectivesFunctional neurological symptoms which do not meet clinical definitions of functional neurological disorder (FND) are common in clinical practice. Understanding the distinction between these benign functional symptoms and FND is crucial in defining FND as an entity for study, and as a clinical syndrome. We aimed to measure the frequency of functional symptoms in people who do not have FND. MethodsA survey was administered to 95 clinicians who attended an international conference on FND. Participants were asked to report the occurrence and characteristics of experiences with features of functional sensory or motor symptoms, or dissociation. ResultsOf the 95 people who responded to the survey, 57.4% reported having experienced any functional symptoms, and 47.9% reported having experienced functional motor or sensory symptoms. The symptoms reported were generally short-lived and caused only mild distress and disruption. Most respondents who reported having experienced a functional symptom reported having had multiple events through their lives. InterpretationThe results suggest that the lifetime occurrence of functional neurological symptoms is at least two orders of magnitude higher than the prevalence of FND. The high prevalence of functional symptoms in people who have never had FND challenges the common assumption that the occurrence of functional neurological symptoms is synonymous with FND. We propose that FND is better conceived of as a failure of the mechanisms by which functional neurological symptoms resolve, rather than the occurrence of functional symptoms per se. This reconceptualization implies new research directions for the underlying aetiology of FND.

Academic institutions privilege norms of continuous productivity and uninterrupted availability, creating conformity pressures that systematically disadvantage those who deviate from an implicit template of the ideal academic. This study explores how doctoral students and faculty in the health sciences perceive the reproduction of social homogeneity. Semi-structured interviews were conducted with nine participants at a German university hospital. Data were analysed using reflexive thematic analysis with extended idiographic engagement. Participants perceived homogeneity as reproduced through external exclusion, enacted by others through networks, normative expectations, or institutional arrangements, and self-exclusion, whereby individuals withdrew, reduced visibility, or reshaped identity in anticipation of exclusion ( anticipatory compliance). Across both processes, the tacit norm of the ideal academic organised access and belonging. Supportive supervision and visible role models were perceived as partial buffers but did not structurally alter underlying norms. Interpreted through the social identity threat framework, these findings are consistent with a self-reinforcing cycle: structural homogeneity may generate identity-threatening environments that activate concealment and withdrawal, concentrating homogeneity further. These findings suggest that achieving substantive inclusion requires challenging the structural conditions that naturalise presence, mobility, and availability as measures of academic success.

BackgroundThis study developed and validated a primary care assessment tool (SL-PCAT) for evaluating patients experiences in the Sri Lankan healthcare setting. MethodsThe study was conducted from April 2021 to August 2023 inside a medical faculty and selected communities in the Anuradhapura District. The tool was validated through item development, scale development, and scale evaluation processes. Items were selected through focused-group interviews, a literature review, and an expert review. Two language experts translated the tool into the Sinhala language. The scales construct was evaluated parallel to a cross-sectional household survey in 32 villages. First, 633 valid data were randomly split into two groups (Subsample-1 [n=320] and Subsample-2 [n=313]). Exploratory factor analysis was performed in Subsample-1 with principal component analysis (PCA), followed by reliability assessment with Cronbachs alpha. A confirmatory factor analysis (CFA) was performed on Subsample-2. Likert scale assumption testing and descriptive statistics were performed in the final factor structure. ResultsThe four factor solution from PCA explained 66.8% variance in data. Domains identified were contextual care at family and community with continuity, accessibility, patient-centred care, and comprehensive and coordinated care. The domains reported Cronbachs alpha values between 0.719 and 0.859. The goodness of fit index of the CFA improved after allowing a few modifications (X2=199, p<0.001, RMSEA= 0.079, GFI=0.916, SRMR=0.066, CFI=0.916). The corresponding convergent and discriminant validity of the Likert scale assumptions was optimum, with Item-scale correlations between 0.346 and 0.830 and scaling success rates over 70%. Three domains, except contextual care at family and community with continuity, reported positively skewed scores, indicating more positive responses. ConclusionsSL-PCAT is a feasible, valid, and reliable tool for assessing patients experiences of primary care in Sri Lanka.

IntroductionDepression is highly prevalent among young adults worldwide. While research links health behaviours, such as dietary intake, to depression, few studies have examined these associations among young adults in low- and middle-income countries, including South Africa. This study investigated whether dietary intake was associated with an increased risk of depression in a cohort of young South African adults, aged 20-30 years, as part of the Global burden of disease Lifestyle And mental Disorder (GLAD) project. MethodsThis five-year prospective cohort study was conducted in the North West Province of South Africa in accordance with the GLAD project protocol (DERR1-10.2196/65576). Dietary exposures were evaluated using three non-consecutive 24-hour dietary recalls, measuring daily intake of various food groups and nutrients as defined by the Global Burden of Disease study. Depression outcomes were assessed at baseline (N=1039) and follow-up (N=551) using the Patient Health Questionnaire (PHQ-9, cut-off [&ge;]10). Logistic and Poisson regression analyses were performed, with results presented as odds ratios (OR) and relative risk ratios (RR), respectively. Four models were run: unadjusted, sociodemographic-adjusted, total energy (TE) intake-adjusted and fully adjusted (including sociodemographic information and TE intake). For longitudinal analyses of incident depression, baseline depression cases were additionally excluded (n=403). ResultsParticipants (average age 24.55 years) had a balanced distribution of sex (51.4% female) and race (48.6% Black), and a 29.45% baseline prevalence of depression. Higher milk intake was associated with a lower risk of incident depression (RR=0.94, 95% CI 0.91-0.98) in the TE-adjusted longitudinal model. Cross-sectionally, higher sugar-sweetened beverage consumption associated with higher odds of depression, while higher calcium intake (OR=0.48, 95% CI 0.31; 0.76) and vegetable consumption (OR=0.74, 95% CI 0.61, 0.91) were associated with lower odds of depression after TE intake adjustment. Higher fibre intake was associated with lower odds of depression in the unadjusted model. ConclusionHigher daily milk intake was associated with a lower risk of depression, while higher calcium, vegetable, and fibre intake were associated with a lower prevalence of depression in young adults. These findings suggest that prevention strategies for common mental disorders could include dietary approaches within mental health care.

Smoking Cessation Efforts for Patients with Asthma and COPD IntroductionSmoking cessation can alter the natural history of both COPD and asthma by reducing the frequency and severity of exacerbations and slowing disease progression. Accordingly, the Global Initiative for Asthma and the Global Initiative for Chronic Obstructive Lung Disease recommend that clinicians address smoking cessation at every visit using counseling and pharmacotherapy. MethodsThe Mount Sinai Health System includes seven hospitals and more than 400 outpatient locations in the New York metropolitan area, all using a unified electronic medical record (Epic). De-identified data from calendar year 2024 were extracted for individuals identified as current smokers via the EMR smoking status tool. Patients with asthma and/or COPD were identified using ICD-10 codes. Tobacco treatment was defined as receipt of counseling or pharmacotherapy, including varenicline, bupropion, or nicotine replacement therapy. ResultsAmong 961,997 patients, 58,566 (6.1%) were identified as current cigarette smokers. Across all health system encounters, 32.6% of smokers with both asthma and COPD were given any treatment, followed by 26.7% of smokers with COPD, 13.0% of smokers with asthma, and 9.9% of cigarette smokers without these conditions. Smokers seen in pulmonary clinics were the most likely to be given treatment (17.4%), followed next by primary care (6.6%).The most commonly used treatment for all cohorts and all treatment settings was nicotine with the exception of the pulmonary clinic where varenicline predominated. DiscussionDespite higher treatment rates among smokers with asthma and COPD, only one-third of those with either condition received cessation treatment over a full year, underscoring the need for sustained system-wide quality improvement efforts.

BackgroundAlthough ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) are very similar regarding pathophysiology and clinical treatments, especially NSTEMI comprises a much more heterogenic group of patients and underlying diseases. We therefore aimed to assess the treatments and outcomes of both entities in a large contemporary cohort. MethodsPatients with STEMI and NSTEMI between 01/2010 to 12/2018 were identified from the largest German Health Insurance (AOK, {approx}26 million members). Patient demographics, their hospital course, adherence to guideline-directed drug therapy and overall survival were assessed. ResultsIn total 544,529 patients (mean age 74, IQR 62-82), one third of whom had a STEMI. Chronic kidney disease, peripheral arterial disease, and heart failure were more common in patients with NSTEMI. Patients with STEMI were more likely to get coronary angiograms and percutaneous coronary interventions. Although STEMI more frequently led to cardiogenic shock, the rate of serious cardiac events was lower. Mortality was higher for STEMI only within the first 30 days, whereas long-term survival rates were better. The combination of statins, angiotensin converting enzyme inhibitors /angiotensin receptor blockers, beta blockers, and oral anticoagulants or antiplatelet agents was associated with higher overall survival in patients with STEMI (hazard ratio [HR] 0.20; 95% confidence interval [95%CI] 0.18 - 0.24; p<0.001) or NSTEMI (HR 0.30; 95%CI 0.28 - 0.33; p<0.001). Nevertheless, the prescription rates decreased over time, particular in patients with NSTEMI. ConclusionClear differences between STEMI and NSTEMI were observed regarding short-and long-term survival. Guideline-recommended therapy improved long-term survival, but decreased during the follow-up period.

Depression is a common and clinically significant mental health condition among university students, particularly those experiencing academic failure and course repetition, and is associated with adverse effects on cognitive functioning, emotional regulation, and academic performance. This study evaluated the efficacy of an internet-based cognitive behavioural therapy (iCBT) intervention, MoodGYM, in reducing depressive symptoms among repeating undergraduate students at the University of Zambia Ridgeway Campus. A quasi-experimental quantitative study design was employed. Seventy-five repeating undergraduate students with depressive symptoms were enrolled, with 33 assigned to the MoodGYM intervention group and 42 to a control group. Depressive symptom severity was assessed using the Beck Depression Inventory (BDI) at baseline and after an eight-week intervention period. Statistical analyses included within-group and between-group comparisons, difference-in-differences estimation, and fixed-effects regression modelling. At baseline, participants exhibited predominantly moderate to severe depressive symptoms, with no statistically significant differences between the intervention and control groups. Following the eight-week intervention, the MoodGYM group demonstrated a statistically and clinically significant reduction in depressive symptoms, with median BDI scores decreasing from 22 to 16 (p < 0.001), representing a large effect size (Cohens d = 1.02). In contrast, the control group showed persistence or worsening of depressive symptoms over the same period. Difference-in-differences analysis confirmed a robust intervention effect, with an approximately 10-point greater reduction in depression scores among MoodGYM participants compared with controls (p < 0.001). These findings indicate that MoodGYM is an effective internet-based intervention for reducing depressive symptoms among repeating undergraduate students and offers a feasible and scalable approach to addressing student mental health needs in low-resource university settings.

BackgroundDementia affects over 57 million people worldwide. UK and international policy position personalised, conversation-based care planning as central to post-diagnostic support. However, delivery in primary care is inconsistent, and many practitioners lack dementia-specific communication training. Existing evidence focuses on single roles or settings, leaving a gap in understanding how communication operates across the primary care workforce. AimsTo identify what helps and hinders effective communication for integrated dementia care planning and determine the support and training needs of the wider primary care workforce. MethodsO_LISemi-structured interviews - 11 people with dementia, 13 family carers, and 19 primary care practitioners from diverse roles, exploring experiences of care planning conversations C_LIO_LIReflexive thematic analysis C_LI ResultsThree themes were developed, progressing from micro-level communication practices (Theme 1: Beyond the tick-box), through triadic dynamics (Theme 2: Balancing voices in the conversation), to organisational influences (Theme 3: From silos to meaningful shared care planning). Time and Conversation as intervention cut across all themes, shaping trust and disclosure. Participants reported reliance on tick box approaches, inconsistent preparation, and uncertainty about care plan purpose and ownership. Non-clinical roles were commonly viewed as well placed to support meaningful conversations, but were often described as constrained by unclear remit and weak integration. ConclusionsA persistent gap remains between policy ambitions and everyday practice. Time-pressured, checklist-driven encounters and fragmented systems undermine shared decision-making. The expanded primary care workforce offers untapped potential to address these gaps, but this requires clearer roles, formal integration, and targeted investment in communicative skills.

IntroductionNational trends in youth suicide risk may mask significant regional variations within a country. This article attempts to account for spatio-temporal trends through a comparative analysis across South America and Europe. This paper analyzes the spatiotemporal patterns in suicide mortality among young people (10-29 years) in Argentina, Chile, Spain, and Uruguay during the period 1997-2021. MethodsOfficial data from vital statistics and population censuses of the four countries were analyzed. Spatiotemporal clusters were detected using Poisson-based scan statistics. Sociodemographic characteristics of high-and low-mortality clusters were compared with the rest of each country using Kruskal-Wallis and Wilcoxon tests. ResultsWith the exception of Chile, each country showed the emergence of spatiotemporal suicide clusters extending through 2021. Indicators of social fragmentation and lower socioeconomic status were most consistently associated with the formation of high-risk youth suicide clusters. ConclusionRecent national increases in youth suicide rates appear to be concentrated in specific sub-national regions, underscoring the need to target resources toward improving living conditions and mental healthcare access for young people in these areas.

IntroductionSepsis is a life-threatening ailment caused by an exaggerated immune response to infection that poses a major health problem, with increasing prevalence, high costs, and poor outcomes. Improved outcomes are seen in patients when providers follow the Surviving Sepsis Campaign recommended clinical practice guidelines for identifying and treating sepsis using a 3-hour and 6-hour bundle after sepsis is suspected. Previous research has shown patients with mental health issues receive worse quality of diabetes and cardiac care and have poorer outcomes compared with those without mental health issues. Similarly, patients with mental health issues may receive worse sepsis care due to inability to explain symptoms, agitation, etc. This study explores sepsis quality of care among patients with vs. without an acute mental health crisis, and whether patients with certain mental health issues were more likely to receive sepsis bundle care than others. MethodsUsing data extracted from 2018-2019 at the Long Island Jewish Medical Center Emergency Department (ED), patients who met sepsis inclusion criteria were grouped into either having, or not having, a severe mental illness crisis on the basis of whether physical or chemical restraints were used in the ED. Patients with a history of a severe mental illness, but who were not in a severe mental health crisis, were grouped with the patients without mental health illness, as, in the absence of an acute psychiatric problem, their mental health issue unlikely affected sepsis care. We describe demographic characteristics of both groups and performed a univariate analysis using Students T-test to compare the percent of those with vs. without acute mental health crisis who received full 3- and 6-hour sepsis bundle care. Patients with an acute mental health crisis were grouped according to "cognitive" (eg, dementia) vs. "non-cognitive" (eg, schizophrenia) disorders. ResultsComparing those with vs. without acute mental health crisis, there was no difference in the percent of patients who received 3-hour sepsis bundle care (80.7% vs 74.9%, p = 0.1456). However, among patients who received the 3-hour bundle, a significantly-greater percent of those with an acute mental health crisis received the 6-hour sepsis bundle (51.0% vs. 30.7%, p <0.0001). There was no difference between different groups of patients with mental health issues (eg, "cognitive" vs. "non-cognitive") with respect to receiving 3- or 6-hour sepsis bundle care. DiscussionSurprisingly, although there was no significant difference in likelihood to receive a 3-hour sepsis bundle among patients with vs. without an acute mental health crisis, those with an acute mental health crisis were more-likely to receive 6-hour care. We suspect this difference might be due to increased attention paid to patients with an acute mental health crisis, including more-frequent room visits by hospital staff or more concerns among family members. No particular set of mental health conditions was associated with receiving or not receiving appropriate care. Future research could address possible confounding factors, go into more detail about the specific component of the sepsis protocol that patients failed to receive, and specify what aspects of a mental health crisis affected treatment plans. Future studies are needed to assess possible associations between severe mental illness crisis, bundle care, and mortality in relation to ED, Intensive Care Unit (ICU), or hospital length-of-stay (LOS).

Emergency nursing is essential to healthcare systems worldwide. Triage plays a pivotal role in emergency nursing, prioritizing patients based on the urgency of their medical condition and focusing on rapid assessment and prioritization of patient care according to their condition and its severity. In the emergency department, the triage nurse assesses vital signs and gathers information from the patient to determine the severity of their condition. This aims to provide appropriate medical intervention quickly for life-threatening cases and minimize waiting times for less critical cases, thus contributing to the efficient allocation of scarce resources. Our study aimed to evaluate the triage knowledge, skills, and practices of emergency nurses in Mafraq, Jordan. MethodsA cross-sectional study used a previously validated questionnaire. Fifty emergency nurses from two public and one private hospital in Mafraq participated. We collected data through an online survey then analyzed in SPSS. Results92% of nurses had sufficient triage knowledge ([&ge;]60%), while 14% exhibited deficient triage skills (<60%) and 86% had moderate skills (60-80%). Regarding practices, 32% rated as "poor" (<60%) and 68% as "adequate" (>60%). Length working in emergency, hospital type significantly related to nurses triage knowledge, skills, and practices. ConclusionThe study underscores continual trainings, simulation programs and mentorships importance for enhancing emergency nurses triage knowledge, skills, especially in rural settings. Implementing clear triage protocols, continuous support and integrating triage competencies into curricula are recommended to improve overall triage competency

Numerous studies have shown that adults with depression have distinct oculomotor alterations during saccade tasks, but whether similar alterations occur in adolescents is largely unknown. The purpose of this study was to test if eye-tracking during a structured saccade task could distinguish a group of adolescents with depression from healthy controls. We hypothesized that, due to overlapping circuitry between depression pathology and the oculomotor system, adolescents with depression would show alterations in fixation, saccade, and pupil behaviour. 51 adolescents with depression and 66 age-matched healthy controls completed the Interleaved Pro- and Anti-Saccade Task (IPAST) and several self-reported questionnaires for psychiatric symptoms. Oculomotor outcomes included fixation acquisition, fixation breaks, correct rate, saccadic reaction time, rate of correct express-latency pro-saccades, rate of express- and regular-latency anti-saccade errors, baseline pupil size, as well as pupil constriction and dilation sizes following task instruction. In comparison to healthy controls, adolescents with depression displayed impairments acquiring fixation (p<.001), made more fixation breaks in pro- (p=.023) and anti-saccade trials (p=.005), more anti-saccade errors (p=.013), more express-latency saccades overall (ps=.016), had a smaller pupil constriction in pro-saccade trials (p=.047) and had a smaller pupil dilation in pro- (p=.011) and anti-saccade trials (p=.041). No differences were found for saccadic reaction time, rate of correct pro-saccades, rate of regular-latency anti-saccade errors, pupil constriction size during anti-saccade trials, or baseline pupil size. Patients had psychiatric comorbidities and were using psychotropic medication. While this reflected clinical reality, these factors may have influenced oculomotor behaviour. Adolescents with depression had altered fixation, saccade, and pupil behaviour during IPAST. Given that many cases of adolescent depression remain undetected, accessible and objective screening approaches are highly needed. This oculomotor phenotype may be used in the development of such a screening tool to detect those at risk.

BackgroundMental well-being encompasses positive psychological functioning, life satisfaction, and engagement with daily activities. It is influenced by multiple interrelated factors, including symptoms of stress, anxiety, depression, and psychological inflexibility. Network analysis provides a data-driven framework for examining the complex interconnections between these components and for identifying elements that may play a central role in the mental well-being system. The present study aimed to identify key elements related to stress, anxiety, depression, and psychological inflexibility associated with mental well-being in individuals seeking online psychological support. MethodsThis cross-sectional study analyzed data drawn from the Online Well-being intervention. A total of 967 Mexican participants were included. A psychological network comprising seventy-four items was estimated, and centrality indices (strength, closeness, and betweenness) were computed to determine the relative importance of individual elements within the network. Network comparisons by gender were conducted to evaluate global and local differences. ResultsThe network revealed multiple inter-domain associations, particularly negative relationships between mental well-being and symptoms of depression, anxiety, negative stress, and psychological inflexibility. Items reflecting self-evaluation and emotional well-being consistently emerged as the most central elements in the network across centrality metrics. Gender-based comparisons indicated overall structural similarity between networks, although differences were observed in the strength of specific connections. ConclusionsNetwork analysis identified central elements linking mental well-being with psychological distress and inflexibility in a population seeking online psychological support. These findings contribute to a systems-level understanding of mental well-being and highlight potential targets for psychological interventions to enhance well-being and reduce distress.

BackgroundLiving with multiple long-term conditions (MLTC) is becoming increasingly common with far-reaching consequences for individuals and healthcare systems. People with MLTC often face complex care pathways through health systems - especially hospitals, which are largely configured for specialist treatment of single conditions - yet evidence on people with MLTCs lived experience in the hospital setting is limited. This study aimed to understand the hospital care experiences of people living with MLTC who had recently had an inpatient stay. MethodsPeople with MLTC who had experienced an inpatient stay in hospital within the previous six months were recruited via three hospitals in England and via patient networks. Semi-structured one-to-one interviews were conducted with each participant, focussing on their experiences of care from admission to discharge. An inductive thematic analysis was undertaken. ResultsA total of 44 people (mean age 68.4 years, 23 women) who reported living with between 2 and 11 long-term conditions, the majority of whom (96%) reported that their most recent hospital stay was unplanned, participated in the study. Three themes were constructed from the interview data, reflecting perceptions at individual, interpersonal and organisational levels. Participants experiences were shaped by internalised narratives of hospital care, where care was expected to be focussed primarily on single conditions within a resource-constrained environment. Relationally, the degree of alignment between clinician and patient knowledge on conditions was a key contributor to whether hospital care was experienced positively or negatively, and participants perceptions of organisational constraints to holistic care gave insights into their views on system-level barriers shaping the provision of care for MLTC in the hospital setting. ConclusionExperiences of inpatient hospital care for people with MLTC are complex, diverse and shaped by expectations of care in a specialist setting configured to provide care for single conditions. Healthcare professionals should incorporate patients experiential expertise into decision-making processes through consultation with people with lived experience of MLTC. Redesigning hospital services to provide holistic care will require flexibility to respond to the wide spectrum of MLTC experiences.

ObjectiveAlthough mental health and healthy lifestyle interventions are associated with functional outcomes in adolescence, the extent to which particular lifestyle factors explain relationships between mental health and outcome are unclear. Here we examined mediating effects of lifestyle factors on relationships between mental health and two functional outcomes measured 2-3 years later as well as the moderating effect of environmental risk factors on mediation strength in early adolescence. MethodsThis study analyzed data from 3 waves of the Adolescent Brain Cognitive Development Study (ages 10-11, 11-12, and 12-13). Mediating effects of sleep quality, screen time, physical activity and Mediterranean diet on the relationships between depression, anxiety, psychotic-like experience (PLE) distress, and total problems with two subsequent functional outcomes (academic functioning and social problems) were examined. Secondary analyses included environmental factors as moderators. ResultsSleep quality mediated 18.5%, 36.3%, 8.3%, and 3.4% of the relationships between depression, anxiety, PLE distress and total problems with academic functioning, respectively. Screen time was the second strongest mediating factor. For social problems, only sleep quality showed > 3% mediation (19.6% - 23.3%). Mediating effects of sleep and screen time on academic functioning decreased as financial adversity increased. Conversely, mediating effects of sleep quality on social problems increased with worsening family conflict, financial adversity, and school environment. ConclusionsThese results suggest that healthy lifestyle factors (in particular sleep quality) may partially explain the associations between mental health and functioning in adolescents and suggest that these effects are modulated by environmental factors. These results may have important implications for future intervention studies.