BACKGROUND Above-average exercise capacity and a high threshold for symptoms such as dyspnea or chest pain in athletes can create false reassurance regarding the absence of clinically significant coronary artery disease (CAD). The aim of this report is to present the diagnostic reasoning and therapeutic management of an amateur endurance athlete who developed exertional dyspnea during a marathon run. CASE REPORT A 50-year-old man who was an amateur long-distance runner with a history of hypertension, hyperlipidemia reported recurrent exertional dyspnea with the onset approximately at the 20th kilometer of a marathon run, forcing a short rest but not preventing completion. Cardiopulmonary exercise testing (CPET) showed normal exercise capacity (peak oxygen uptake of 34 ml/min/kg, 104% of the predicted value). No dyspnea or chest pain occurred during maximal exertion, although ECG showed 1- to 2-mm ST-segment depression and T-wave changes in leads II, III, aVF, V5, and V6. Coronary computed tomography angiography (CCTA) showed a circumferential non-calcified plaque in the left anterior descending (LAD) artery, suggesting spontaneous coronary artery dissection. Coronary angiography confirmed severe left anterior descending artery (LAD) disease with 80% stenosis in segment 6 and a critical lesion in segment 7. Two drug-eluting stents were implanted into the LAD during a single procedure. CONCLUSIONS Firstly, supranormal exercise capacity and mildness of symptoms in endurance athletes can mask advanced CAD. Secondly, electrically positive CPET findings (1-2 mm ST-segment depression) warrant further anatomical assessment even in patients with low risk factor-weighted clinical likelihood. Finally, CCTA should be considered early in athletes with new-onset exertional symptoms, as it can reveal significant stenosis.

Alongside the physical burden of cancer and its treatments, women with gynecologic cancer face substantial psychological and social challenges that strongly shape quality of life. Adaptive coping and timely psychosocial support may facilitate adjustment, adherence, and rehabilitation. To summarize coping strategies used by women with gynecologic cancer and their association with quality of life, and to describe the role of the multidisciplinary care team in delivering psychosocial support. We conducted a systematic search of PubMed, ScienceDirect, Google Scholar, BioMed Central, AKJournals, and ResearchGate for studies published between 2018 and 2025 without language restrictions. The search yielded 1419 records; after screening and full-text assessment, 36 studies were included. We extracted data on coping patterns, psychological outcomes, quality of life, and the contribution of psychosocial care and communication. Adaptive coping - particularly problem solving and seeking social support - was associated with better emotional well-being, lower distress, and higher quality of life. Avoidant coping was linked to higher anxiety, depressive symptoms, and poorer quality of life. Structured psychosocial interventions and consistent, empathic clinician-patient communication reduced tension, strengthened trust, and improved adherence. Integrating psychosocial support into oncologic care for women with genital tumors can enhance adaptive coping and improve quality of life. A patient-centered, interdisciplinary approach should include decision-making support, early assessment of coping and psychological burden, timely referral to appropriate professionals, and continuous development of communication and patient management competencies among providers. Orv Hetil. 2026; 167(18): 691-701.

OBJECTIVE: To examine sociodemographic, clinical, and healthcare-related factors associated with preoperative health-related quality of life (HRQoL) among patients undergoing surgery for degenerative lumbar spine conditions in a multi-ethnic Asian population. METHODS: This cross-sectional study used baseline data from the Spine PROM Surgery Registry, including 1194 patients scheduled for surgery within a Singapore healthcare cluster between 2017 and 2022. HRQoL was measured using the EQ-5D-3L, with utility scores crosswalked to the EQ-5D-5L index using the van Hout crosswalk. Hierarchical linear regression assessed factors associated with HRQoL across three blocks: sociodemographic, clinical, and healthcare/lifestyle. Multivariable logistic regression identified factors associated with reporting problems within each EQ-5D dimension. RESULTS: Mean age was 58.1 years (SD 16.1); 51.5% were female. Mean EQ-5D-5L index was 0.43 (SD 0.38). Pain/discomfort (93.6%) and usual activities problems (84.3%) were most commonly reported. Lower EQ-5D scores were independently associated with non-outpatient presentation (β = -0.37), non-Chinese ethnicity (e.g., Malay: β = -0.10), secondary education (β = -0.15), and accident/trauma history (β = -0.11). Dimension-level analyses showed secondary education was associated with higher odds of problems in mobility (OR = 2.72), self-care (OR = 1.87), usual activities (OR = 1.80), and anxiety/depression (OR = 1.97). Non-outpatient presentation was associated with markedly higher odds of self-care problems (OR = 2.98). CONCLUSIONS: Patients awaiting lumbar spine surgery appear to have impaired preoperative HRQoL. Although the modest explained variance limits robust risk prediction, preoperative profiles may still help inform clinical discussions and shared decision-making. Non-outpatient presentation may help identify patients who could benefit from enhanced preoperative support, although this requires prospective validation. Differences by ethnicity and education suggest opportunities for culturally tailored counselling. EQ-5D dimension profiles may indicate targets for prehabilitation and provide Singapore-based benchmark data for a lumbar spine surgery cohort for patient-centred care, service benchmarking, and health technology assessment.

OBJECTIVE: Pharmacotherapy guideline concordance for the treatment of major depressive disorder (MDD) is associated with improved symptom severity, but it is unclear whether such associations vary by patients' characteristics or their comorbidity burden. We sought to determine whether guideline concordance varied significantly by 1) sociodemographic characteristics or 2) comorbidity. METHODS: This study evaluated 1,403 U.S. adults (67% female, 85% non-Hispanic/Latino White, mean age of 43 years) with non-psychotic MDD and complete data ( = 1,241/1,403). We used a guideline concordance algorithm (GCA-8) to measure pharmacotherapeutic concordance with the Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines and multivariable general linear and proportional odds models to examine associations between this GCA-8 score and patients' characteristics. RESULTS: Being male was significantly associated with higher guideline concordance, but guideline concordance did not vary significantly by any other sociodemographic characteristics. Similarly, no comorbidities examined by this study presented substantial evidence of associations with guideline concordance. Within this sample, the GCA-8 algorithm consistently measured the degree of guideline concordance across different patient types. CONCLUSIONS: This study suggests that guideline concordance for MDD pharmacotherapy, as measured by the GCA-8, does not significantly vary by the comorbidities or sociodemographic characteristics analysed in this study, except for patient-reported gender.

PURPOSE: Breast cancer patients often experience significant psychological distress. This study examined distress trajectories from diagnosis to 6 months post-treatment and explored differences across demographic, medical, and psychosocial subgroups. METHODS: In this prospective cohort study, 528 patients with breast cancer were recruited between 1 December 2023 and 31 December 2024. Assessments were conducted at baseline (at diagnosis, T0), after the first treatment (T1), mid-treatment (T2), at treatment completion (T3), and at three (T4) and six months (T5) post-treatment. Growth mixture modeling (GMM) was used to identify distinct trajectories of psychological distress. Multinomial logistic regression analysis was performed to examine associations between patient-related factors and trajectory membership. RESULTS: Three psychological distress trajectories were identified: a high-distress remission group (17.05%), a moderate-stable distress group (11.93%), and a low-fluctuating distress group (71.02%). Multivariable analyses showed that higher educational attainment, breast-conserving surgery, early disease stage, partial self-management ability, and strong social support were associated with membership in the moderate-stable or low-fluctuating groups (p < 0.05). Employment, health insurance coverage, avoidant medical coping style, and higher baseline anxiety and depression scores were concurrently associated with membership in the high-distress remission group (p < 0.05). CONCLUSIONS: Although psychological distress generally decreased over time, 71.02% of patients followed a low-fluctuating trajectory, 11.93% maintained moderate distress with potential risk of persistence, and 17.05% showed high initial distress that remitted substantially within 6 months. Continuous monitoring and early psychosocial support are recommended, particularly for patients with moderate- or high-risk trajectories.

BACKGROUND: Periodontitis, a chronic inflammatory disease, is increasingly prevalent among young people and impairs their quality of life. Adverse childhood experiences (ACE), depressive symptoms, and suboptimal health status (SHS) are linked to health risks and chronic diseases, but their interrelationships with periodontitis in Chinese young adults remain unclear. This study aimed to explore associations among these factors. METHODS: From December 2024 to May 2025, 2,888 participants (aged 18-35) from Tongji Hospital completed surveys on demographics, ACE, depressive symptoms, and SHS. Periodontitis was diagnosed according to the 2018 criteria. Simple, parallel, and chain mediation models were used, controlling for age, sex, marital status, and smoking. RESULTS: Periodontitis prevalence was 25.00% and higher in married individuals (P < 0.001) and smokers (P = 0.004). ACE correlated positively with depressive symptoms (r = 0.28, P < 0.001), SHS (r = 0.19, P < 0.001), and periodontitis (r = 0.16, P < 0.001). Mediation analyses showed: Simple model: Depressive symptoms and SHS partially mediated the effect of ACE on periodontitis (indirect effect = 0.011 for both). Parallel model: Only SHS significantly mediated the effect (indirect effect = 0.011). Chain model: ACE was related to periodontitis via "depressive symptoms → SHS" (indirect effect = 0.010), with significant direct and indirect effects. CONCLUSIONS: ACE associated with higher periodontitis risk in young people. This association included both a direct link between ACE and periodontitis, and an indirect link through the chain pathway of "depressive symptoms → SHS"; among these pathways, SHS was a key mediator. CLINICAL TRIAL REGISTRY: The study was registered in the Chinese Clinical Trial Registry (ChiCTR) with the registration number ChiCTR2500103464.

BACKGROUND: Health-related quality of life (HRQoL) is a vital indicator of evaluating care outcomes and prognosis, yet little is understood about its developmental trajectories in older patients with chronic pain. This study aimed to identify latent HRQoL trajectories and their predictors, and to develop explainable machine learning models for predicting HRQoL deterioration. METHODS: This prospective cohort study assessed 608 older patients with chronic pain at admission and at 1, 3, and 6 months post-admission, collecting data on HRQoL, general characteristics, pain level, activities of daily living (ADL), depression, and perceived social support. Growth mixture modeling was applied to identify trajectories of physical and mental HRQoL. Predictors were selected using LASSO regression and SVM-RFE. Nine explainable machine learning models were developed for both components, and SHAP interpreted the outputs. An HRQoL decision-support dashboard was developed to facilitate potential clinical application. RESULTS: Three physical HRQoL trajectories were identified: Stable High, Decline and Low Stability, alongside two mental HRQoL trajectories: Improvement and Decline. Key predictors included education level, pain duration, pain level, ADL, depression, and perceived social support, with ADL and pain level being the most influential for physical and mental HRQoL, respectively. CONCLUSIONS: This dual-trajectory study identified five distinct HRQoL patterns in older patients with chronic pain, elucidating key predictors via explainable machine learning. The proposed HRQoL decision-support dashboard may provide an interpretable tool to support understanding of predictive relationships and assist healthcare professionals in HRQoL assessment. CLINICAL TRIAL NUMBER: Not applicable.

BACKGROUND: Depressive symptoms have been on the rise among young adults, with the transition to college, particularly the first year, being a critical period of vulnerability. Despite prior research on depression trajectories in college students, limited longitudinal studies have explored unique depressive symptom trajectory groups among first-year students and their associations with academic achievement (GPA), sleep patterns, and whether sociodemographic factors are associated with certain trajectories. METHODS: This study analyzed a pre-existing dataset that was collected over two waves from a private university (spring semester 2017 and 2018). The final pooled sample resulted in first-year undergraduate students (N = 271) who reported on their depressive symptoms (CES-D scale) at the start and end of the semester, signed a release record for their fall and spring term GPA, and provided continuous sleep data across the academic spring term with Fitbits. K-means + + clustering was conducted to form depressive symptom trajectory groups. ANOVAs, Watson-Williams, and Dunnett's post hoc comparison tests were employed to examine how the resulting trajectory groups were associated with GPA and sleep outcomes (bedtime, waketime, total sleep time, time in bed). Associations between sociodemographic variables and trajectory groups were investigated using chi-square tests. RESULTS: K-means + + clustering identified four trajectory groups: low-stable (n = 109), increasing (n = 72), decreasing (n = 51), and high-stable depressive symptoms (n = 39). The low-stable and decreasing group had a higher spring term GPA (M = 3.44 and M = 3.39, respectively) compared to the increasing and high-stable groups (M = 3.22 and M = 3.18, respectively). The low-stable group generally had an earlier wake time and bedtime, greater total sleep time and time in bed, relative to the decreasing and increasing trajectory groups. Gender, ethnicity, international student status, and first-generation student status were not associated with trajectory groups. CONCLUSIONS: Consistent with prior work, there are unique depression trajectory groups among first-year college students that represent stability and change of depressive symptoms over the course of a spring semester. Favorable trajectories (low-stable and decreasing symptoms) are associated with better academic performance and sleep habits.

INTRODUCTION: Hidradenitis suppurativa (HS), an inflammatory skin disorder characterized by painful nodules and abscesses, has varying prevalence among different races/ethnicities. This study explored the social drivers of health, burden, and impact of HS among different racial and ethnic groups. METHODS: An online, cross-sectional survey was conducted among adult patients with HS (September 2023-December 2023) in the USA. Patients were recruited through HS Connect (patient advocacy group) and AmeriSpeak (US national sample panel). Descriptive data were collected using patient-reported outcome measures and de novo questions about patients' disease knowledge and perception, healthcare access and utilization, impact on quality of life (QoL), and social impact. All analyses were descriptive and stratified by racial/ethnic groups. RESULTS: The study included 583 patients (mean age, 34.8 years; 95.5% female) representing a range of racial backgrounds: Black or African American (n = 273; 46.8%), white (n = 236; 40.5%), Two or More Races (n = 47; 8.1%), American Indian or Alaska Native (n = 18; 3.1%), Asian (n = 7; 1.2%), and Native Hawaiian and Other Pacific Islander (n = 2; 0.3%). Ethnic representation also varied (Hispanic/Latino = n = 76; 13.0%). Patients of all races and ethnicities reported considerable QoL impact (Dermatology Life Quality Index, EQ-5D-5L), with results for smaller subgroups (n < 10) included for descriptive completeness only and not intended for comparison with other groups. During flaring, most patients used over-the-counter products/medications (54.2%) or nonmedical intervention/home remedy (56.9%) Up to 36.5% of patients reported challenges in procuring food, utilities, medicine/healthcare, phone, clothing, or childcare when needed in the past year. Among those who paid out-of-pocket for their HS treatment, 55.6% reported that it stopped them from visiting a healthcare provider for treatment. CONCLUSION: The findings indicate a high burden and impact of HS across all races and ethnicities. Patients reported social drivers of health and challenges with healthcare utilization, indicating the need for integrating social workers and care management teams in dermatology practice, which could facilitate improved care of patients with HS.

BACKGROUND: Parents of undiagnosed children (POUC) experience significant psychosocial challenges, including anxiety, uncertainty, and isolation, that stem from parenting medically complex children while facing obstacles throughout the diagnostic journey. Despite these well-described challenges, a mental health intervention designed to meet the unique needs of POUC, which is necessary to promote the psychological and overall wellbeing of this population, does not exist. Acceptance and Commitment Therapy (ACT) has proven effective in a wide range of populations and shows promise for POUC. With the goal of designing and implementing an ACT-based intervention tailored to POUC, this pre-implementation study aimed to understand their psychosocial needs and prior mental health support experiences, explore their reactions towards ACT, and determine their anticipated barriers, facilitators, and preferences for participating in an ACT skills group, guided by the Consolidated Framework for Implementation Research (CFIR). METHODS: Semi-structured, individual interviews were conducted with 18 POUC, including an experiential portion that exposed participants to key ACT concepts and exercises. Inductive coding based on participant responses and deductive coding based on the CFIR were employed to code interview transcripts. Reflexive thematic analysis was performed to identify key findings. RESULTS: Isolation was a psychosocial challenge for which all participants desired support. Many participants reported inadequacies in their prior mental health support, primarily due to lack of understanding from therapy providers regarding their unique circumstances. Although most participants indicated that ACT could help them manage difficult thoughts and emotions and act in alignment with their values, they also described achievability, collaboration, and accountability as key elements that could support their uptake. The main barriers, facilitators, and preferences that participants highlighted were related to group design (accessibility, flexibility) as well as their own characteristics as recipients (capability, need, and motivation). CONCLUSIONS: This pre-implementation study affirmed the potential value of ACT for POUC and identified key opportunities for tailoring an ACT skills group to meet their needs. Future research, including pilot implementation studies, are needed to evaluate the effectiveness of a tailored ACT skills group and further refine both the intervention and its implementation strategy.

OBJECTIVE: To culturally adapt the Patient Health Questionnaire-9 (PHQ-9) for San Martín Quechua and to evaluate its structural validity, reliability, and measurement invariance in Peruvian adults. METHODS: A psychometric study was conducted on a non-probabilistic sample of 309 Quechua-speaking adults from the San Martín region of Peru, including both men and women aged 18 to 59 years. The study was carried out in two phases. The first phase involved the translation and cultural adaptation of the original English PHQ-9 into the Quechua variant spoken in San Martín. The second phase tested how well the adapted PHQ-9 worked by using different methods: confirmatory factor analysis (CFA) to examine its internal structure, multi-group CFA to assess measurement invariance across groups, the Average Variance Extracted (AVE) to evaluate construct representation, and reliability estimation. Convergent validity was also examined through correlations with related measures. RESULTS: A unidimensional model of the PHQ-9 Quechua San Martín showed adequate fit (CFI = 0.996, TLI = 0.994, SRMR = 0.048, RMSEA = 0.051) and high reliability (α = 0.86; Ω = 0.87). Measurement invariance was supported across sociodemographic groups (ΔCFI and/or ΔRMSEA < 0.01). Convergent validity was supported by an adequate AVE (0.53). Additionally, PHQ-9 scores correlated moderately with the Generalized Anxiety Disorder-7 and weakly and negatively with the Well-Being Index, supporting convergent validity based on relations with other variables. CONCLUSIONS: The San Martín Quechua PHQ-9 is a valid, reliable, and at least partially invariant single-factor instrument for assessing depressive symptoms in Quechua-speaking adults. It may be useful as a screening tool in similar populations.

BACKGROUND: Hashimoto's thyroiditis (HT) is the most common autoimmune cause of hypothyroidism, often accompanied by persistent non-specific symptoms despite normalized thyroid hormone levels. Lifestyle factors, including mood, sleep, diet, and exercise, are increasingly considered in the supportive management of HT, but comprehensive characterization of lifestyle patterns in HT patients remains limited. OBJECTIVE: To systematically assess the lifestyle patterns of HT patients, including psychological well-being, sleep quality, quality of life, dietary habits, and physical activity. METHODS: A single-center, cross-sectional study was conducted with 226 participants (105 HT patients and 121 healthy controls). Emotional status was assessed using the GAD-7 and PHQ-9; sleep quality with the Pittsburgh Sleep Quality Index (PSQI); and health-related quality of life with the SF-36. Dietary habits and physical activity were evaluated using validated questionnaires. Serum TPOAb and TgAb levels were measured, and correlations with exercise parameters were analyzed using Spearman correlation and multivariable linear regression. All HT participants were biochemically euthyroid at enrollment; prior clinical history of hypothyroidism and LT4 treatment were extracted from medical records. RESULTS: HT patients exhibited higher anxiety and depression scores, poorer sleep quality, and lower quality of life compared with controls. They also reported distinct dietary patterns, including higher daily intake of meat, dairy, vegetables, and fruits and less frequent use of iodized salt. In terms of physical activity, HT patients showed more conservative exercise patterns, with greater time spent in low-intensity activity and less in moderate-intensity activity. Among HT patients, high-intensity exercise time was inversely associated with TPOAb levels after multivariable adjustment. CONCLUSION: HT patients displayed poorer psychological status, impaired sleep, and reduced quality of life, together with distinct dietary adjustments and conservative exercise patterns. In this biochemically euthyroid HT cohort, high-intensity exercise time was inversely associated with TPOAb levels. TRIAL REGISTRATION: Not applicable.

BACKGROUND: Post-traumatic stress disorder (PTSD) is a common psychiatric condition, with a global prevalence of 3.9% and a lifetime prevalence of 7.4% in the Netherlands. Although numerous evidence-based treatments are available, their use varies considerably. Understanding patient perspectives and experiences in the decision-making process when choosing a specific treatment is crucial for improving the quality of care. OBJECTIVES: This study aimed to explore the decision-making process from the perspective of patients with PTSD, focusing on their considerations and experiences when choosing a specific psychotherapeutic treatment. METHODS: In this qualitative study, twelve semi-structured interviews were conducted with patients with PTSD (aged 21-55 years) receiving care at a mental health organisation in the east of the Netherlands. Data were analysed using reflexive thematic analysis, informed by grounded theory-inspired analytic techniques. Analysis was iterative and inductive, focusing on the identification and interpretation of patterns of meaning across patients' accounts. RESULTS: Five themes were identified, connected through an overarching interpretive concept of patient-attunement: (1) the role of treatment characteristics (2), the role of therapeutic factors (3), the role of treatment duration and intensity (4), the role of significant others, and (5) the role of information about trauma-focused treatment. Patients emphasised the importance of personalised information and support from clinicians and significant others. Ongoing responsiveness within the therapeutic relationship, including trust and collaboration, was central to experiencing the decision-making process as supportive and meaningful. CONCLUSIONS: For patients with post-traumatic stress disorder, multiple factors play a role in choosing a psychotherapeutic trauma-focused treatment. This study shows that continued attunement to patients' diverse needs is central to the decision-making process. Such attunement may take various forms, including attention to the therapeutic relationship, discussion of treatment characteristics and frequency, and responsiveness to patients' preferences regarding information provision. Involving patients' support systems may further support decision-making. Together, these findings suggest that clinicians should remain attentive to patients' needs at multiple points during the pre-treatment phase. Approaches such as shared decision-making may help facilitate this attunement. CLINICAL TRIAL NUMBER: Not applicable.

BACKGROUND: The evolving global disease landscape, in conjunction with the significant impact of an aging population, has led to mental‒physical multimorbidity, imposing unprecedented pressures on healthcare systems and economies. This study aimed to investigate the interrelationships among multimorbidity, depression, and catastrophic health expenditure (CHE) and to test whether the intensity of CHE mediates these links. METHODS: The analysis employed data from the China Health and Retirement Longitudinal Study (CHARLS), which conducted a longitudinal survey from 2011 to 2018, tracking 5,274 participants aged 45 years and older over a seven-year timeframe. Multimorbidity was ascertained through self-reported data from participants, whereas depression was evaluated via the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). The intensity of CHE was calculated as the ratio of out-of-pocket (OOP) payments to the capacity to pay (CTP), adjusted for a catastrophic threshold of 40%. The relationships among the three variables were analysed via an extension of the random intercept cross-lagged panel model (RI-CLPM), which includes covariates to predict the observed variables. Mediation via the intensity of CHE was tested using 5,000 bootstrap resamples. RESULTS: At the between-person level, multimorbidity and depression were positively correlated (Model 1 r = 0.349; Model 2 r = 0.246; both p < 0.001), whereas the intensity of CHE showed negligible between-person associations with either variable. At the within-person level, all variables showed significant autoregressive stability, with multimorbidity demonstrating the strongest persistence (β = 0.808 in Model 1 and 0.936 in Model 2). Cross-lagged associations were clearly asymmetric, with prior multimorbidity exerting the largest prospective effects on the intensity of CHE (β = 3.028) and subsequent depression (β = 0.646 in Model 1 and β = 0.789 in Model 2), whereas prior depression and prior intensity of CHE had much smaller effects on later multimorbidity. Mediation analyses indicated that the intensity of CHE (T) partially mediated the association from multimorbidity (T‑1) to depression (T + 1) (indirect effect = 0.063, 95% CI [0.042, 0.084]), but showed negligible mediation for the reverse pathway from depression (T‑1) to multimorbidity (T + 1) (indirect effect = 0.001, 95% CI [0.000, 0.001]). CONCLUSIONS: The study identified asymmetric bidirectional relationships among multimorbidity, depression, and the intensity of CHE in Chinese middle-aged and older adults, with effects predominantly running from multimorbidity to increased intensity of CHE and later depression; the intensity of CHE explained only a small portion of the multimorbidity→depression effect and virtually none of the depression→multimorbidity pathway. Policies that integrate multimorbidity management with routine depression screening could help reduce the combined physical, psychological, and financial burdens among middle-aged and older adults.

BACKGROUND: To investigate the current status and dyadic mechanism of maternal and spousal role adaptation for postpartum anxiety and depression. METHODS: Convenience sampling was employed to select 276 pairs of mothers and their spouses from October 2023 to October 2024 as study participants. Binary analyses were conducted using the actor-partner interdependence model (APIM) and the mediation model. RESULTS: The prevalence rates of anxiety and depression during the first postpartum year were 38.5% and 14.5% among mothers, and 36.9% and 12.9% among their spouses, respectively. The APIM revealed that maternal and spousal role adaptation significantly and negatively predicted their own postpartum anxiety (maternal actor effect: β = -0.120; spousal actor effect: β = -0.081) and depression (maternal actor effect: β = -0.165; spousal actor effect: β = -0.113), and that role adaptation similarly predicted each other's anxiety (maternal partner effect: β = -0.115; spousal partner effect: β = -0.059) and depression (maternal partner effect: β = -0.129, spousal partner effect: β = -0.064). Mediation analyses suggest that future time insight and parenting competence mediate this process. CONCLUSIONS: Postpartum anxiety and depression serve as a dyadic phenomenon, where maternal and spousal role adaptation significantly affects mental health outcomes. Future time insights and feelings of parenting competence serve as mediating variables in the relationship. CLINICAL TRIAL NUMBER: Not applicable.

BACKGROUND: Early adolescence is key for adopting healthier lifestyles, yet disadvantaged communities often lack resources to support these changes, perpetuating health inequities. Schools play a crucial role in promoting physical activity and healthy eating. eHealth solutions, like online platforms, offer scalable, cost-effective ways to deliver interventions. These platforms can also enhance adolescent engagement and help bridge health resource gaps. The ePro-Schools project aims to co-design and test an eHealth platform to promote healthy habits among adolescents in socially disadvantaged settings. METHODS: A randomized controlled trial (RCT) will be carried out with the participation of 6 secondary schools (three controls and three intervention), with a sample size estimated at 1000 students of Central Catalonia (Spain). In the intervention schools, focus groups sessions and meetings with stakeholders have been conducted to co-create the ePro-Schools eHealth platform. Students and school staff are pilot testing the platform to assess the platform's usability, functionality, and layout. Finally, the RCT will be conducted, in which the intervention group will have full access to the ePro-Schools platform (an interactive and informative platform), while the control group will only have access to the informative platform with health literacy content on physical activity, nutrition, and healthy habits. In both groups, adolescents will complete validated questionnaires at baseline, post-intervention, and at the six-month follow-up to assess their physical activity and eating habits, including depressive symptoms, quality of life, social isolation, and mental health. Sociodemographic characteristics will also be collected. Implementation, effectiveness, and cost-effectiveness analysis will be performed. DISCUSSION: The ePro-Schools project introduces a co-designed eHealth platform that integrates physical activity and healthy eating promotion within schools. The intervention aims to enhance adoption, relevance, and sustainability across diverse settings. ePro-Schools project could reduce health inequalities, improve adolescents' physical and mental well-being, and strengthen daily health habits. The model's scalability and embedded implementation planning may support long-term integration into school systems, informing future policies and contributing to educational engagement, reduced disease risk, and broader population health impact. TRIAL REGISTRATION: This trial is registered in ClinicalTrials.gov, with the registration number NCT06792461.

BACKGROUND: Adverse childhood experiences (ACEs) are strongly associated with poor physical and mental health across the life course. Maternal ACEs have been linked to prenatal stress, hypertensive disorders, gestational diabetes, shorter gestation, lower infant birth weight, and increased risk of prenatal and postpartum depression. Benevolent childhood experiences (BCEs) and social support may buffer these effects; however, ACE-informed perinatal care remains uncommon in low- and middle-income settings. This study aimed to estimate the prevalence of ACEs and BCEs among pregnant women in Mexico and to examine their associations with perceived stress and depressive symptoms during pregnancy. METHODS: We conducted a cross-sectional observational study at a large public maternity hospital (Hospital Materno Infantil y de Especialidades de Nuevo León) in Monterrey, Mexico, between September 2023 and March 2024. Pregnant women receiving prenatal care were invited to participate; of 400 eligible women, 368 consented, and 330 provided complete data for analysis. Participants completed the WHO Adverse Childhood Experiences International Questionnaire (ACE-IQ), the Benevolent Childhood Experiences (BCE) Scale, the Perceived Stress Scale (PSS-10), the Edinburgh Postnatal Depression Scale (EPDS), and the Social Support Questionnaire (SSQ-6). Sociodemographic and pregnancy-related variables were self-reported. Descriptive statistics summarized sample characteristics. Bivariate associations were assessed using chi-square tests and Spearman correlations. Structural equation modeling (SEM) was used to evaluate hypothesized pathways linking ACEs, BCEs, social support, perceived stress, and depressive symptoms. Model fit was evaluated using the comparative fit index (CFI), root mean square error of approximation (RMSEA), and χ²/df. RESULTS: Overall, 90% of participants reported at least one ACE, and 45.2% reported four or more ACEs. The most prevalent ACE domains were violence- and neglect-related adversities. Social support levels were moderate to high, and BCE scores were high (mean = 8.55). Perceived stress levels were moderate (mean = 17.87), and 13% of participants screened positive for depressive symptoms. SEM analyses indicated that higher ACE exposure was associated with lower benevolence and social support and with increased perceived stress. Both benevolence and social support were associated with lower stress and fewer depressive symptoms, with perceived stress acting as a central mediator. Overall model fit was acceptable (CFI = 0.93; RMSEA = 0.06). CONCLUSIONS: Pregnant women in this public maternity hospital sample experienced high levels of childhood adversity alongside substantial protective factors. ACE exposure was associated with increased perceived stress and depressive symptoms during pregnancy, while benevolent childhood experiences and social support appeared to mitigate these associations. These findings underscore the importance of integrating trauma- and resilience-informed approaches into prenatal care in low- and middle-income settings.

BACKGROUND: Geriatric syndromes (GSs) such as cognitive decline, malnutrition, and mobility impairment are common among older adults and associated with adverse health outcomes. Traditional paper-based assessments are often resource-intensive and difficult to implement in primary care. The World Health Organization's Integrated Care for Older People (ICOPE) framework emphasizes early detection, yet evidence on the implementation of self-administered online screening in Southeast Asia is limited. OBJECTIVE: This study aimed to (1) determine the prevalence of GSs in primary care, (2) identify associated factors, and (3) evaluate preliminary process indicators of an online self-administered geriatric screening tool based on the ICOPE framework and Thai national guidelines. METHODS: A cross-sectional study was conducted between April and December 2024 across seven primary care units in Bangkok, Thailand. Older adults aged ≥ 60 years were randomly selected from daily clinic lists. Participants completed an online questionnaire covering demographics, comorbidities, health behaviors, and 10 geriatric screening questions. Those screening positive underwent in-depth assessments by trained nurses using validated tools (e.g., Mini-Cog, Snellen chart, Timed Up and Go test). Associations between participant characteristics and GSs were examined using multivariable logistic regression. Preliminary process indicators were assessed through completion rates, need for caregiver assistance, acceptability, and completion time. RESULTS: A total of 374 participants (mean age 76.4 years, 63.6% female) were included. Multimorbidity was present in 76.7% and polypharmacy in 58.6%. The most prevalent GSs were limited mobility (49.7%), vision impairment (43.6%), and undernutrition (34.8%). Significant risk factors for GSs included older age for hearing loss (adjusted odds ratio [OR] 2.37, 95% CI 1.19-4.72), low education for limited mobility (aOR 8.14, 95% CI 2.25-29.52) and urinary incontinence (aOR 3.48, 95% CI 1.36-8.89), multimorbidity for urinary incontinence (aOR 3.12, 95% CI 1.34-7.29), and polypharmacy for cognitive decline (aOR 2.70, 95% CI 1.25-5.81) and depressive symptoms (aOR 3.40, 95% CI 1.31-8.84). Protective factors included regular physical exercise and normal body mass index against multiple GSs. Regarding preliminary process indicators, 81.5% completed the online screening independently, the average completion time was 12.8 min, and 88.9% reported the system was easy to use. CONCLUSIONS: A self-administered online geriatric screening tool adapted from the ICOPE framework is feasible, acceptable, and effective in detecting GSs in primary care. The high prevalence of GSs highlights the urgent need for scalable digital solutions. Integrating online screening into primary care workflows could facilitate early identification, optimize resource use, and promote healthy aging in resource-constrained settings.

Social defeat stress (SDS) is a rodent model used to assess the effect of chronic stress on depressive-like behavior and alcohol consumption. Our previous studies have indicated that the neurokinin-1 receptor (NK1R) mediates the behavioral responses to this stressor, especially through its actions in the nucleus accumbens (NAc). The NK1R is the high affinity, endogenous target of the neuropeptide substance P (SP). In the experiments presented here, we first infused a cre-dependent, retrogradely transported virus into the NAc of Tac1-cre mice (Tac1 is the gene for SP) to identify brain regions that send SP-expressing inputs to the NAc. We found that significant SP projections originated in the paraventricular nucleus of the thalamus (PVT). Next, we used this same tracing strategy, exposed mice to SDS or control conditions, and assessed Fos expression in the PVT. This experiment confirmed that SP projections from the PVT to the NAc are activated by SDS. To chemogenetically manipulate SP innervation of the NAc, we bilaterally infused a cre-dependent, retrogradely transported virus that expresses an inhibitory DREADD receptor into the NAc of Tac1-cre mice and delivered the DREADD actuator clozapine-n-oxide (CNO) prior to each defeat exposure. We found that this treatment had no effect on SDS-induced social avoidance, but did reduce alcohol consumption after stress. In a following experiment, CNO was administered just prior to behavioral testing, as opposed to during stress. In line with the previous experiment, chemogenetic inhibition affected post-stress drinking, but not social interaction. Conversely, chemogenetic activation of these inputs acutely increased alcohol consumption without affecting social behavior. Together, these results show that SP projections from the PVT to the NAc are activated by SDS exposure, and suggest that SP innervation of the NAc, possibly from the PVT, mediates post-stress alcohol consumption.

BACKGROUND: Cardiovascular diseases (CVD) are strongly associated with psychiatric disorders like depression and anxiety (D/A), which can exacerbate disease burden and worsen outcomes. However, mortality trends in patients with both conditions remain underexplored. This study examines mortality trends among U.S. adults in whom both depression/anxiety (D/A) and cardiovascular diseases (CVD) were documented on the death certificate from 1999 to 2023. METHOD: Data were extracted from the CDC WONDER Multiple Cause-of-Death database for adults aged ≥25 years to identify deaths in which both D/A and CVD were listed anywhere on the death certificate (underlying or contributing causes), and to calculate age-adjusted mortality rates (AAMRs) per 100,000 population. Joinpoint Regression v5.2.0 calculated annual percent changes (APCs) and average annual percent changes (AAPCs) with 95% CIs (p ≤ 0.05), stratified by year, sex, race, region, urbanization, and 10-year age groups. RESULTS: From 1999 to 2023, 299,201 deaths were attributed to coexisting D/A and CVD, with highest rates in older adults (AAMR: 22.26). After declining between 1999 and 2015, overall AAMR increased from 4.92 in 2015 to 7.14 in 2021 (APC: 7.51; 95% CI: 1.23-12.12). Females showed consistently higher mortality than males (5.62 vs 4.66), with female AAMR rising from 5.05 (1999) to 7.44 (2023) [AAPC: 1.61; 95% CI: 1.24-1.55]. Non-Hispanic Whites had the highest AAMR (5.90), followed by American Indians/Alaska Natives (4.62). Geographically, the Midwest (6.85) and West (5.08) had highest rates, while rural areas exceeded urban areas (6.78 vs 4.79). State-level variation ranged from North Dakota (11.33) to Nevada (1.85). CONCLUSION: Rising mortality involving co-listed D/A and CVD disproportionately affects females, Non-Hispanic Whites, Midwest residents, rural populations, and older adults. These findings highlight critical demographic and geographic disparities requiring targeted interventions and further investigation into underlying mechanisms.

This study examined the associations between maternal stress, postpartum depressive symptoms, breastfeeding success, parenting behavior, and maternal perceptions of the newborn in the early postpartum period. A descriptive, correlational design was conducted with 252 mothers recruited from a postpartum ward in Central Anatolia, Türkiye, between May 2024 and May 2025. Postpartum depression was identified in 11.5% (n = 29) of participants. At the nominal level, some variables appeared to be associated with study outcomes. However, after adjusting for multiple comparisons using the Benjamini-Hochberg false discovery rate (FDR) procedure, none of these associations remained statistically significant (all adjusted p > 0.05). Accordingly, no significant differences were observed between maternal characteristics and breastfeeding success, parenting behavior, or newborn perception after controlling for multiple testing. Regression analyses indicated that maternal stress and postpartum depression were not significant predictors of breastfeeding success or newborn perception. In contrast, parenting behavior was negatively associated with maternal stress. Further analysis showed that both maternal stress (B = -0.046, p < 0.001) and postpartum depression (B = -0.042, p = 0.011) were significant negative predictors of parenting behavior (F = 11.735, p < 0.001; R = 0.086). Moderation analysis further revealed that postpartum depression moderated the relationship between maternal stress and parenting behavior, with the negative impact of stress being stronger among mothers with higher depressive symptoms. These findings highlight the importance of maternal psychological well-being in shaping parenting behavior during the early postpartum period, underscoring the need for routine screening for stress and depression to support healthy parenting.

Anxiety disorders are the most common mental disorders in both young and old adults. However, most currently existing treatments, which are tailored for young patients, are not as effective in old patients. Therefore, investigating geriatric anxiety disorders would greatly benefit the mental wellbeing of the rapidly growing aged population. This study finds that innate anxiety-like behaviors elevate with aging in male mice. This study further identifies an aging-related increase in the excitatory synaptic transmission onto the glutamatergic neurons in the basolateral amygdala (BLA), which is mirrored by an increase in the expression of c-Fos, a marker of neuronal activity. Lastly, this study, by using chemogenetic intervention of BLA glutamatergic neurons, establishes a causal relationship between the aging-related increase in their neuronal activity and the aging-related elevation in innate anxiety-like behaviors in mice. Accordingly, we conclude that the aging-related microscopic physiological changes in BLA glutamatergic neurons might serve as a biological substrate underlying the aging-related elevation in innate anxiety-like behaviors. Thus, this study provides a potential intervention strategy for treating geriatric anxiety disorders, which is an urgent task given that the available treatments do not meet actual needs, while the affected population is rapidly growing.

Post-traumatic stress disorder (PTSD) frequently emerges following early-life trauma, yet the temporal dynamics of PTSD-like phenotypes and their pharmacological modulation during development remain poorly understood. In the present study, we investigated time-dependent behavioral and endocrine alterations in a peripubertal rat stress-restress model and assessed the effects of fluoxetine across early and delayed post-treatment stages. Male peripubertal rats were exposed to a combined stress-restress paradigm and treated with fluoxetine for 21 days. Anxiety-like behavior, social behavior, stress-coping behavior, and spontaneous locomotor activity were assessed immediately after treatment completion and again after a drug-free washout period, the duration of which (3-4 weeks) depended on the behavioral parameter evaluated. Serum corticosterone levels were measured as an index of hypothalamic-pituitary-adrenal axis activity. PTSD-like stress induced robust but domain-specific behavioral alterations that evolved over time. Anxiety-like behavior persisted across both observation phases but was expressed through different behavioral components at early versus delayed stages. Basal sociability was markedly reduced following stress exposure and was largely normalized by fluoxetine, whereas social novelty-related alterations were more selective and resistant to pharmacological modulation. Stress-exposed animals exhibited increased activity and reduced immobility in the forced swim test, reflecting altered stress-coping strategies rather than reduced depressive-like behavior. Consistently, spontaneous locomotor activity was elevated at early stages, indicating hyperarousal, which attenuated over time but was not robustly normalized by fluoxetine. Endocrine assessment revealed a biphasic corticosterone profile, with elevated levels in the early phase and reduced levels at the delayed stage; fluoxetine did not normalize corticosterone concentrations. These findings demonstrate that PTSD-like phenotypes induced during the peripubertal period are dynamic and strongly time-dependent, and that fluoxetine exerts selective, domain-specific effects rather than uniform normalization. The study highlights the importance of developmental stage and timing of assessment when evaluating behavioral outcomes and pharmacological efficacy in preclinical models of PTSD.