Child maltreatment has been associated with biological hallmarks of aging, including telomere shortening and epigenetic instability; however, its influence on physiological age and homeostatic dysregulation in early life remains unclear. The current study examined pediatric versions of physiological age and homeostatic dysregulation in children aged 8-13 with and without exposure to maltreatment. Maltreatment exposure was determined based on investigational records within 12 months prior to enrollment. Physiological measures were trained and validated utilizing external datasets - the National Health and Nutrition Examination Survey III and IV, respectively. Physiological age was computed using the Klemera-Doubal Method to indicate physiological developmental status. Homeostatic dysregulation level was computed as the Mahalanobis distance from an external reference group. 216 females and 245 males with a mean age of 11.4 years (SD 1.5) were included (76.6% White, 13.2% Black, and 13.0% Hispanic, 76.6% with maltreatment). Exposure to maltreatment was not associated with changes in physiological age but was associated with greater homeostatic dysregulation. Further analyses by maltreatment type and sex revealed that physical abuse was associated with greater homeostatic dysregulation, while sexual abuse was associated with delayed physiological development, specifically in males. Exposure to multiple types of maltreatment was associated with greater homeostatic dysregulation among males, but not among females. This study revealed that recent exposure to certain types of maltreatment may impair physiological development or regulation in children, with sex-specific patterns suggesting greater effects in males. Findings further indicate that physiological development composites in youth are sensitive to the impact of child maltreatment and can be incorporated in future work to evaluate the long-term sequelae of adverse exposures in pediatric populations. As the impact of maltreatment was only nominally significant after correction for multiple testing, validation work in other samples is needed.

Distress intolerance (DI), an individual's perceived inability to tolerate emotional discomfort, is a transdiagnostic factor implicated in many forms of psychopathology. Theory posits that DI impacts mental health in part through its associations with the emotion regulation (ER) process. Using data from a naturalistic study of emotions in daily life, we empirically tested whether trait DI was associated with important aspects of the ER process, specifically the perceived amount of effort individuals apply to the ER process, their perception of regulation difficulty, and their perceived success with ER. We also examined whether associations between DI and the ER process differed based on momentary negative affect (NA). Participants (N = 179; M_age = 35.2, SD_age = 11.9; 50% women) completed an experience sampling protocol during which they reported on their momentary NA and ER in response to emotional shifts five times daily for 14 days (mean number of surveys completed per participant = 48.5 [69.4%]). Participants also completed self-report measures of DI and depression. Multilevel models provided evidence that DI is associated with greater perceived effort and difficulty in ER, but not with perceived success in ER. Importantly, several of these associations remained significant after accounting for momentary NA and depression. Finally, the association between DI and ER effort was stronger during moments of elevated state NA. The findings indirectly suggest DI shapes how individuals appraise the ER process by amplifying the perceived burdensomeness of regulation (i.e., effort, difficulty) without impairing its perceived effectiveness in daily life.

Given clear connections between mental and physical health, the impact of dysfunctional brain-body communication on emotional behavior and psychopathology is garnering increased attention. Vagal circuits comprise a major neural substrate for communication between the brain and peripheral organs, and evidence suggests that these circuits are developmentally plastic and sensitive to stress and other environmental challenges. Here, we review historic and current literature regarding how early life experience shapes the development of vagal circuitry in rodents and in humans. We discuss the anatomical intricacies of the sensory and motor vagal systems in rodents and outline their pre- and postnatal windows of developmental plasticity. We then focus on how two core features of early life experience, i.e., nutrition and maternal care, alter vagal circuit development in rodents. We discuss human studies that use differing psychological frameworks for measuring, interpreting, and contextualizing vagal contributions to the development of emotional control and stress response systems. We focus on infant, child, and adolescent research that test relations between parental care and/or early life adversity and vagal function, and how these factors impact emotional regulation and development of psychopathology. By synthesizing literature across species, we draw attention to novel insights and testable hypotheses that can be explored using different model systems. We emphasize the importance of considering environmental context and developmental timing for study design and interpretation of results. We conclude that vagal circuitry is an environmentally sensitive system for encoding stressful experiences during early life in rodents and in humans, with lifespan health consequences.

We examined associations between prenatal tobacco exposure (controlling for other substance exposures) and autonomic functioning at early school-age via infancy autonomic regulation, harsh parenting, and cumulative postnatal adversities.

216 mothers (74% Black/African-American) and infants (51% girls) recruited at delivery were assessed repeatedly. Prenatal substance exposure was measured using multiple biomarkers and calendar-based interviews. Harsh parenting and early childhood adversity were assessed from birth to early school-age. Child ANS functioning was indexed via respiratory sinus arrhythmia (RSA) and skin conductance (SCL) at early school-age (both at rest and reactivity to frustration).

Prenatal tobacco and cannabis exposure accounted for unique variance in higher baseline SCL and RSA, respectively. Prenatal tobacco exposure was also indirectly associated with lower baseline SCL and blunted SCL reactivity via increased early childhood adversity. There was stability in baseline RSA from infancy to early school-age with prenatal cocaine exposure and prenatal cannabis exposure associated with lower baseline RSA in infancy. Prenatal cocaine exposure was also associated with higher baseline SCL and higher SCL reactivity via more harsh parenting.

Findings highlight unique direct and indirect effects of prenatal tobacco exposure on child ANS functioning at early school-age, controlling for exposure to other substances and co-occurring risks. Results underscore the importance of smoking cessation interventions in pregnancy that address prenatal polysubstance use.

The present study adds to the sparse literature on effects of prenatal tobacco exposure on autonomic nervous system functioning controlling for other substance exposure and co-occurring postnatal risks in a prospective design. Findings highlight the importance of smoking cessation treatments for pregnant individuals who use other substances in addition to tobacco. Furthermore, universal parenting interventions may promote positive outcomes even in the context of substance use. Efforts to address parents' mental health and provide parental support in the context of substance use may be of great benefit to families.

Humans show remarkable flexibility in adapting their behaviour to constantly changing environments. This flexibility relies on the ability to regulate motivation in response to changing motivational demands. Typically, the amount of effort required to achieve a certain goal is not precisely signalled by the environment but needs to be learnt from experience. By contrast, prior work examining motivated choices has usually directly instructed effort requirements. It therefore remains unclear how healthy individuals estimate and flexibly regulate effort and how they might achieve this in dynamically changing environments. In the current study, we examine how effort learning is shaped by different types of environmental uncertainty when motivational requirements are not explicitly instructed. Analogous to tasks in the reward learning domain, we designed a novel effort learning task that systematically manipulated two key sources of uncertainty: volatility and noise. Participants were asked to exert effort by squeezing hand-held dynamometers. We characterised effort learning across different stages of the effort production process (e.g., initiation of effort production, effort expectation, error-driven adjustment), which allowed us to capture the dynamics underlying effort estimation and regulation over time. Our findings reveal that humans are able to learn effort requirements by integrating both effort priors and sensorimotor feedback. We further show that effort learning is modulated by environmental statistics, with slower force initiation, weaker priors, slower learning, and faster within-trial force adjustments in high noise environments, but slower learning and slower within-trial force adjustments in high volatility environments. In summary, when effort information is not instructed, different sources of uncertainty about an action's required effort are integrated into participants' internal priors to flexibly guide effort exertion. Our work may provide a useful framework for understanding motivational disorders where abnormal effort learning and estimation may underlie the reduced willingness to exert effort for reward.

Body-focused repetitive behaviors (BFRBs), such as hair-pulling and skin-picking, have been described by physicians from Hippocrates onward. The descriptions have not been theory-neutral; clinicians and researchers have applied specific conceptual frameworks to understand such behaviors and to intervene accordingly. These include what might be termed "turns" to psychoanalysis, cognitive behaviorism, psychopharmacology, nosology, neuroscience, consumer advocacy, and global mental health. It is timely to consider lessons learned from this range of conceptual frameworks, each of which has both strengths and limitations. Rather than advocating for yet another paradigm shift to advance knowledge and treatment of BFRBs, we suggest that scientific pluralism is useful for clinicians and researchers and potentially allows iterative and integrative progress in this field.

Perinatal mental health is a critical public health concern. Women experiencing moderate to severe perinatal mental health conditions often require specialist support. Discharge from specialist services is a potentially challenging time; however, literature examining service discharge remains limited. Understanding multiple stakeholder perspectives of specialist perinatal mental health services is essential for informing evidence-based improvements.

To understand women's and multidisciplinary team members' experiences of care and discharge from an Irish specialist perinatal mental health service.

A multiperspectival interpretative phenomenological analysis study. Women (n = 6) who were discharged after receiving treatment from an Irish specialist perinatal mental health service and multidisciplinary team members (n = 6) working within this service participated in individual semi-structured interviews. Data were analysed using interpretative phenomenological analysis.

This paper presents a multiperspectival synthesis with four themes and subthemes: (1) In sanctuary, I return to myself, (2) Building strength through collaboration, (3) A tailored discharge, and (4) On the path forward. Women felt a sense of safety and connection during their care, marking a turning point from feelings of isolation and perceived judgement. Women advocated for person-centred, flexible discharge approaches. Post-discharge community support provided women with a sense of stability, continuity, and confidence.

The service provided a place of sanctuary where women received advocacy support until they regained self-agency. Individualised discharge care planning can enhance consistent communication and facilitate a supported, coordinated transition of care. Expanding community support, equitable care, and a national mother and baby unit are essential for the progress of Irish services.

Perceived neighborhood danger poses significant risks to mental health in later life, yet the underlying psychological mechanisms remain unclear. Given that environmental stressors can compromise sleep health, we conceptualize insomnia symptoms as a potential mediator in the association between perceived neighborhood danger and depressive symptoms. Data from 2,240 adults aged 65 or older from Wave 3 of the National Social Life, Health, and Aging Project (NSHAP) were analyzed. Multivariate analyses showed significant associations of both perceived neighborhood danger and insomnia symptoms with depressive symptoms after controlling for sociodemographic and health covariates. Bootstrap mediation analysis provided supportive evidence for the indirect effect of perceived neighborhood danger on depressive symptoms through insomnia symptoms (B = .04, SE = .01, bias-corrected 95% CI = [.02, .07]), accounting for 25.8% of the total effect. Insomnia symptoms were identified as an important pathway through which perceived neighborhood danger undermines mental health in older adults.

Congenital clubfoot is the most common musculoskeletal birth anomaly affecting infants. It may also have a profound impact on the psychological well-being of parents. The purpose of this study is to determine the prevalence of a positive screening for postpartum depression and/or anxiety symptoms for biological mothers whose infants were undergoing Ponseti casting for clubfoot.

The Edinburgh Postnatal Depression Scale (EPDS) screening tool was administered by convenience sampling to mothers of patients with clubfoot being seen at a single pediatric tertiary hospital between February 2023 and June 2025. The tool was provided at the initial visit to mothers whose infants were under 4 months old with no prior clubfoot treatment. Data were collected through standardized EPDS assessment and electronic medical records. Descriptive and nonparametric statistics were used for data analysis.

There were 56 biological mothers who completed the EPDS in clubfoot clinics. The median EPDS score was 3 out of 30 (IQR: 6.5). The prevalence of mothers who met the clinical cutoff for postpartum depression, defined as an overall score of ≥10, was 6/56 (10.7%). Mothers endorsed symptoms such as difficulty coping (50.0%) and feeling anxious (50.0%). For those who screened positive for postpartum depression, there was no association with age at initial visit ( P =0.640), race ( P =0.663), idiopathic or nonidiopathic clubfoot ( P =0.119), prenatal diagnosis ( P =0.168), prenatal consultation ( P =0.670), pregnancy complications ( P =0.186), and insurance type ( P =0.670). There was a significant association between a positive EPDS score and being seen by the clinical psychologist beyond the initial visit ( P =0.022). Mothers who screened positive were evaluated by the orthopaedic clinical psychologist.

The EPDS screening tool has a role in the clubfoot clinic. Most mothers endorsed postpartum anxiety and/or depressive symptoms, though they did not meet the cutoff for clinical postpartum depression. This prevalence is similar to the reported literature in the general population. This study highlights the importance of incorporating postpartum depression screening in clubfoot clinics to address the mental health needs of families undergoing Ponseti method clubfoot care.

Postpartum anxiety and depressive symptoms are endorsed in mothers of infants with a clubfoot diagnosis, and postpartum depression screening is important to address the needs of families undergoing clubfoot treatment.

The health of the population is shaped by political, social and environmental conditions - referred to as contextual factors in this paper - which influence the risk of type 2 diabetes and other non-communicable diseases (NCD). The article provides an overview of selected indicators for this topic.

The indicators were developed based on a literature review and a multi-stage selection process, considering their relevance for the prevention of diabetes and other NCD as well as the availability of data. Available nationwide data were used for operationalisation.

Six indicators were agreed upon: tobacco control, the consumer price index, food taxation and prevention expenditure in the area of health policy measures, the at-risk-of-poverty rate in the area of employment and social affairs, and use of means of transport in the area of built and physical environment. The time trends for these indicators are integrated into the NCD Surveillance of the Robert Koch Institute (RKI) and are presented on the web portal of the federal health reporting. The results for all indicators point to inadequate prevention measures.

Context indicators help to track changes over time in environmental determinants of health. As part of NCD Surveillance at the RKI, this topic will be continuously developed.