Chronic constipation and depression are highly prevalent worldwide. These two conditions frequently co-occur in clinical practice. Accumulating evidence indicates that gut microbiota dysbiosis mediates this comorbidity through the microbiota-gut-brain axis (MGBA).

This narrative review systematically summarizes current research on MGBA bidirectional communication mechanisms, gut microbiota alterations in comorbid patients, and microbiota-targeted intervention strategies.

The MGBA facilitates bidirectional communication through four major pathways: neural pathways via the vagus nerve, immune pathways via cytokines, endocrine pathways via the HPA axis, and metabolic pathways via short-chain fatty acids and neurotransmitter precursors. Gut dysbiosis is associated with comorbidity and may contribute to its pathogenesis through multiple mechanisms. First, neurotransmitter metabolism becomes dysregulated, particularly in the serotonin and GABA systems. Second, chronic low-grade inflammation develops with elevated pro-inflammatory cytokines. Third, intestinal barrier dysfunction occurs, leading to increased permeability and bacterial translocation. Fourth, HPA axis hyperactivity emerges. Fifth, production of microbial metabolites is altered, including short-chain fatty acids and tryptophan metabolites. Comorbid patients exhibit characteristic microbiota signatures. These include reduced abundance of butyrate-producing bacteria such as Faecalibacterium, Roseburia, and Coprococcus. Microbial diversity decreases significantly. Pro-inflammatory taxa become enriched. Several evidence-based interventions show promise. These include psychobiotics, fecal microbiota transplantation, and dietary modifications such as Mediterranean diet and high-fiber intake. Exercise and integrative approaches including traditional Chinese medicine also demonstrate beneficial effects.

The gut microbiota represents a critical hub connecting gastrointestinal and mental health. Microbiota-targeted therapies offer promising strategies for managing chronic constipation-depression comorbidity. Future research should establish causal relationships and develop reliable microbial biomarkers. Precision medicine approaches based on individual microbiome profiles are needed to optimize therapeutic outcomes.

Ethnic inequalities exist in the prevalence of mental disorders and their associated treatment outcomes. Cultural variation may influence psychological symptom expression; understanding this might inform care and ultimately reduce care disparities.

Data were analysed from 147,037 individuals referred to psychological treatment services in London, England. Moderated network analysis was used to examine the expression and co-occurrence of symptoms of depression, anxiety, and social functioning. Age and gender were included as covariates, and ethnicity (11 categories) was entered as the moderating variable. Symptom-level differences and differences in symptom-to-symptom relationships were estimated across all ethnic group comparisons.

There was substantial variation in symptom networks between ethnic groups. White British individuals showed the most differences compared to other ethnic groups, particularly with higher endorsement of anxiety-related symptoms (e.g. nervousness and excessive worry) and greater reported functional impairment in work and social domains. Differences in symptom co-occurrence (the relationships between symptoms) were less frequent than differences in individual symptom levels. Across groups, several symptoms showed consistent relationships, suggesting shared aspects of distress alongside culturally patterned variation in symptom expression.

The influence of ethnicity on both symptom levels and symptom co-occurrence underscores the importance of culturally informed assessment. These findings highlight the need for services to consider culturally relevant symptom presentations to promote more equitable and appropriate mental health care.

College students face significant mental health challenges during their academic journey, yet the heterogeneity in their psychological adaptation patterns remains poorly understood. Traditional variable-centered approaches fail to capture the diverse trajectories that students may follow. Recent studies indicate that 20-30% of Chinese college students experience clinically significant psychological distress, highlighting the need for person-centered analytical approaches.

This longitudinal study employed formal Latent Class Growth Modeling (LCGM) using the Expectation-Maximization algorithm implemented in Python to identify distinct mental health trajectories among 2,562 Chinese college students assessed at enrollment (T1), sophomore year (T2, 18 months), and junior year (T3, 30 months). The Symptom Checklist-90 (SCL-90) Global Severity Index served as the primary outcome. Model selection was based on a composite score integrating BIC, entropy, bootstrap stability, and clinical relevance.

A four-class solution demonstrated optimal fit (composite score = 0.768, entropy = 0.779, bootstrap stability = 0.933). Four trajectories emerged: Low-Optimal (13.2%; M_T1 = 1.04), Low-Stable (29.8%; M_T1 = 1.19), Moderate-Improving (32.9%; M_T1 = 1.47), and High-Risk-Improving (24.1%; M_T1 = 1.98). The four classes were primarily differentiated by baseline severity (η²baseline = 0.550), with more modest between-class differences in rate of change (η²change = 0.036). The high-risk class showed the steepest decline (slope = - 0.0100/month) but 31.8% remained above clinical threshold at T3. The high-risk class exhibited the largest observed within-class variability at enrollment (T1 SD = 0.562), indicating heterogeneous baseline symptom levels among students in this group.

Approximately one quarter of college students follow a high-risk mental health trajectory requiring targeted intervention. The formal LCGM approach with simultaneous parameter estimation provides robust classification with moderate classification quality (entropy = 0.779) and high bootstrap stability (0.933). These findings support implementing tiered early warning systems based on baseline screening.

Aortic dissection (AD) is a life-threatening cardiovascular emergency with declining postoperative quality of life (QoL). The teach-back method has shown effectiveness in chronic disease management, but its application in postoperative AD patients remains unexplored.

This quasi-experimental study with ward-level cluster allocation enrolled 210 AD patients (105 per group) at a tertiary hospital in Nanchang, China, from January 2023 to June 2024. The experimental group received teach-back method-based continuing nursing, while the control group received routine care. Primary outcomes included self-management behavior assessed by the Self-Management Assessment Scale (SMAS) and QoL measured by the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Short Form-36 Health Survey (SF-36) at baseline, discharge, 1-month, and 6-month follow-up. Secondary outcomes comprised health knowledge scores at baseline and 1-month post-discharge, and adverse clinical outcomes including 30-day unplanned readmission rates, 6-month AD recurrence rates, and total adverse events.

The experimental group demonstrated significantly higher SMAS across all dimensions with a significant time×group interaction (P < 0.001). Disease knowledge questionnaire score at 1-month was significantly higher in the experimental group (21.36 ± 2.89 vs. 15.82 ± 3.54, P < 0.001). Both PCS and MCS scores showed significant improvements over time (both P < 0.001), with the experimental group achieving higher scores than the control group at all follow-up time points (all P < 0.001). A significant time×group interaction effect was observed for MCS (P = 0.0052) but not for PCS (P = 0.599). The experimental group achieved significantly better blood pressure control at 6 months (SBP: 125.6 ± 10.8 vs. 133.4 ± 14.8 mmHg, P < 0.001). The experimental group had lower 30-day readmission rates (6.67% vs. 17.14%, P = 0.016), 6-month AD recurrence rates (4.76% vs. 14.29%, P = 0.014), and total adverse events (4.76% vs. 12.38%, P = 0.048). Follow-up completion rates exceeded 93% at all time points.

Teach-back method-based continuing nursing significantly improved self-management behaviors, QoL, and reduced adverse outcomes in postoperative AD patients, warranting integration into routine discharge protocols.

Elder abuse is a significant public health issue, particularly among those from ethnic minorities who often face unique cultural and social challenges that may exacerbate their vulnerability. However, research on elder abuse in this population remains limited. This study aimed to explore the prevalence of vulnerability to abuse among older ethnic minorities in China and to develop a risk assessment model to inform the development of prevention strategies in this population.

From February to September 2024, a cross-sectional study was employed to survey 314 older adults from ethnic minorities in Chenzhou, Yongzhou, and Jishou, in Hunan Province of China. The questionnaire included the Vulnerability to Abuse Screening Scale (VASS), the UCLA Loneliness Scale-8 (ULS-8), and the Patient Health Questionnaire-9 (PHQ-9). Statistical analyses were performed using the chi-square test and logistic regression.

The overall prevalence of self-reported elder abuse risk among older ethnic minorities in China was 58.92%, with the main types being psychological abuse (34.08%), physical abuse (29.94%), neglect (28.34%), and financial exploitation (13.06%). Loneliness and depressive symptoms were identified as risk factors for elder abuse vulnerability (odds ratio [OR] = 1.098 and 1.101, respectively), whereas living in rural areas and receiving community support were identified as protective factors (OR = 0.565 and 0.520, respectively). The risk assessment model was developed as follows: logit(p) = - 1.154 - 0.571×living in rural areas - 0.653× community support services + 0.094×loneliness + 0.096×depressive symptoms. The area under the receiver operating characteristic (ROC) curve of the model was 0.744, with a sensitivity of 0.568 and specificity of 0.860. The Hosmer-Lemeshow goodness-of-fit test showed a P value of 0.383.

The prevalence of self-reported elder abuse risk among older ethnic minorities in China is relatively high and is associated with living in rural areas, receiving community support services, loneliness, and depressive symptoms. The prediction model developed in this study has satisfactory discriminative efficacy and holds certain social application value. These findings inform policymakers and service providers to promote community support services, integrate mental health interventions, and improve older adults' rights protection networks in ethnic minorities to reduce the vulnerability to abuse.

Not applicable.

Psychiatric nurses in China face high psychological and occupational strain. Understanding the factors influencing their mental health is essential. This study aimed to determine the positive rate of psychological distress among Chinese psychiatric nurses and to examine the associations of psychological resilience and other psychosocial factors with psychological distress.

A cross-sectional study was conducted from October 2024 to January 2025. Using an online survey, 436 psychiatric nurses from six hospitals in Jiangsu Province, China, were recruited. Data were collected using a general information questionnaire, the 12-item General Health Questionnaire (GHQ-12), and the Connor-Davidson Resilience Scale (CD-RISC). Chi-square tests, Spearman correlation, and multivariate logistic regression were employed for analysis.

Of 436 nurses invited, 412 provided valid responses (response rate: 94.5%). The positive screening rate for psychological distress (GHQ-12 score ≥ 3) was 38.38%. Multivariate logistic regression analysis showed that among Chinese psychiatric nurses, higher psychological resilience (OR = 0.948, 95% CI: 0.931-0.965, p < 0.001) was associated with lower odds of psychological distress. In contrast, more frequent weekly night shifts (≥ 3 vs. ≤ 2; OR = 2.452, 95% CI: 1.212-4.959, p = 0.013) and poorer self-rated health status (per level increase; OR = 1.711, 95% CI: 1.274-2.299, p < 0.001) were associated with a greater odds of psychological distress.

Psychological resilience, night shift frequency, and self-rated health status are significantly associated with psychological distress among Chinese psychiatric nurses. Interventions aimed at building resilience, optimizing work schedules, and promoting health may help protect their mental well-being.

Not applicable.

Caregivers of individuals with substance use disorders (SUD) commonly experience affiliate stigma, low social support, and high burden. However, little is known regarding how these experiences differ across the sociodemographics and characteristics of Saudi caregivers.

A descriptive cross-sectional study was conducted with 209 caregivers recruited from the outpatient clinics of a governmental mental health hospital and from online caregiver support groups. Data were collected via the Affiliate Stigma Scale, the Multidimensional Scale of Perceived Social Support, and the Zarit Burden Interview-Abridged Version. The data were analysed via SPSS version 26.0 via descriptive statistics, independent-sample t tests, and one-way ANOVA with Tukey's post hoc comparisons, and the significance was set at p ≤ 0.05.

High affiliate stigma was reported by 58.4% of the caregivers and was higher among those who were older, female, had low income, were unemployed, and were a spouse or parent (p < 0.05). Perceived social support differed by sex and employment status, with males and employed caregivers reporting higher scores for family and significant-other subscales (p < 0.05). A high caregiver burden was observed in 51.2% of the participants, particularly among spouses and parents (p = 0.012).

Sociodemographic characteristics strongly influence levels of affiliate stigma, perceived social support, and the burden experienced by caregivers of people with SUD. These findings highlight the need for targeted, culturally specific interventions and sensitive support services addressing high-risk groups such as older female caregivers, those with lower incomes, and close family members.

Not applicable.

Fear of pregnancy can affect women's mental health, reproductive decisions, and quality of life, and may overlap with tokophobia. This study aims to assess its prevalence and determinants among women in Tabriz, Iran, and to develop evidence-based strategies to reduce it.

This sequential explanatory mixed-methods study consists of three phases. First, a cross-sectional survey will be conducted among 450 married women aged 15-49 years (nulliparous or with one previous pregnancy) using validated instruments, including the Fear of Pregnancy Scale (FOPS), Satisfaction with Life Scale (SWLS), Social Support Appraisals Scale (SSA), Health-Promoting Lifestyle Profile-2 (HPLP-2), and Depression, Anxiety, and Stress Scale (DASS-21). The psychometric properties of the FOPS will also be assessed. Quantitative data will be analyzed with descriptive statistics, correlations, and multivariable models in SPSS-26. In the qualitative phase, women with the highest and lowest FOPS scores will be purposively selected to ensure diversity, and semi-structured interviews will be analyzed through conventional content analysis. In the final phase, results from both stages, supported by a literature review, will be integrated and refined using the Delphi method to develop culturally appropriate strategies for reducing pregnancy-related fear.

This first mixed-methods study in Iran addresses a critical gap in understanding fear of pregnancy. Integrating quantitative and qualitative findings with expert input, it will inform evidence-based, culturally sensitive strategies and guide policies and clinical practice to support informed reproductive decisions.

Mental health disorders and substance use during pregnancy have been linked to adverse perinatal outcomes. Early identification may improve maternal and neonatal health. This study evaluated the impact of mental health disorder severity and alcohol consumption on perinatal outcomes.

A cohort of 2,014 pregnant women was screened with the AC-OK instrument for mental health and substance use problems between July 2016 and December 2019. Of these, 193 screened positive and underwent assessment for anxiety, depression, post-traumatic stress disorder (PTSD), and alcohol use. Moderate-to-severe symptoms were defined as PHQ-9 ≥ 15 for depression, GAD-7 ≥ 10 for anxiety, and PCL-5 ≥ 33 for PTSD. Perinatal outcomes -including gestational monitoring, pregnancy complications, delivery outcomes, neonatal parameters, and postpartum complications- were compared between women with and without moderate-to-severe mental health disorders, and between alcohol users and non-users. Group differences were assessed using Student's t-test or chi-square test. Associations between head circumference < 10th percentile and mental health problems or alcohol consumption were evaluated using logistic regression. A p-value ≤ 0.05 was considered significant.

Neonates of mothers with moderate-to-severe anxiety more often required resuscitation (25.7% vs. 11.4%; p = 0.05) and had lower head circumference percentiles (34.38 vs. 46.72; p = 0.016). Infants of mothers with PTSD also had reduced head circumference percentiles (34.30 vs. 46.39; p = 0.025). Maternal alcohol consumption was associated with lower neonatal head circumference percentiles (37.65 vs. 48.12; p = 0.014). Anxiety, depression, PTSD, and alcohol use were significantly associated with neonatal head circumference below the 10th percentile (p = 0.006; p = 0.002; p = 0.007; p = 0.026, respectively). No significant associations were observed for other maternal or neonatal outcomes.

Moderate-to-severe anxiety, depression, PTSD, and alcohol use during pregnancy were associated with reduced neonatal head circumference. These findings underscore the importance of early screening and intervention for maternal mental health and alcohol use. Further research is warranted to clarify long-term neurodevelopmental implications.

WOMAP (Woman Mental Health and Addictions on Pregnancy), registered at ClinicalTrials.gov (NCT06965270) on March 20, 2025; retrospectively registered.