To assess the risk of postpartum depression (PPD) in women with twin pregnancies using the Edinburgh Postnatal Depression Scale (EPDS), and to explore associations between maternal and neonatal complications and depressive symptoms during the postpartum period.

This prospective, mixed-methods study was conducted at the Multiple Pregnancy Outpatient Clinic. Fourteen women with twin pregnancies received psychodynamic psychological prenatal care throughout the pregnancy-puerperal cycle. Postpartum depressive symptoms were screened using the EPDS, with scores ≥13 indicating probable PPD. Associations between EPDS scores and obstetric or perinatal variables were analyzed using Pearson correlation and contingency tables.

A high prevalence of depressive symptoms was observed among participants, with 28.6% screening positive for probable PPD and an additional 21.4% at mild risk. Higher EPDS scores were associated with intrapartum hemorrhage, low APGAR scores (1st and 5th <7), cesarean delivery, and neonatal intensive care unit (NICU) admission. Breastfeeding was associated with lower depressive symptom scores. Despite the presence of depressive symptoms in part of the sample, improvements in emotional domains such as anxiety and sadness were noted, suggesting a potential benefit of continuous psychodynamic support.

Women with twin pregnancies are at increased risk of postpartum depression, particularly when compounded by obstetric and neonatal complications. Routine mental health screening and structured psychological support-such as psychodynamic prenatal care-should be considered integral components of care for women with multiple gestations. Further studies with larger samples and comparison groups are needed to refine preventive strategies.

Yoga has increasingly been recognized as a beneficial adjunctive therapy for mental health disorders in India. However, participation barriers persist. This study examines the factors influencing participation in yoga as an add-on treatment for Common Mental Disorders (CMDs) in India.

As the part of a larger open-label comparative study assessing in-person versus virtual yoga, 1147 patients with CMDs were screened at a tertiary care center in Southern India. Of these, 968 were eligible and 130 consented to participate (13.43%). Reasons for refusal were recorded and analyzed.

The overall refusal rate was 86.57%. The most common barriers were lack of time (30.78%), disinterest in yoga (21.12%), and distance to the yoga center (19.09%). Additional factors included ongoing psychotherapy (11.57%), preference for virtual sessions (10.26%), and unwillingness to randomization (7.04%). Participants who consented were significantly more educated and more females than males refused participation. The preference for virtual sessions reflected growing demand for accessible, technology-assisted interventions post-COVID-19.

Despite increased awareness of yoga, participation remains low because of logistical barriers. These findings underscore the need to develop and validate virtual yoga programs tailored to patient convenience and contemporary healthcare delivery models.

Musculoskeletal (MSK) disorders are a leading cause of disability and health care burden globally. While much research has focused on clinical outcomes, treatment efficacy, and system efficiency, less is known about how challenges in navigating the health care system affect patients' physical, psychological, and social well-being. Understanding these lived experiences is crucial to informing system-level care improvements.

To explore patients' experiences navigating the health care system and the associated impacts on their physical, psychological, and social well-being among individuals with musculoskeletal conditions in Alberta, Canada.

Qualitative study using the interpretive description approach.

Semi-structured interviews were conducted by telephone with a purposive sample of adult participants who received care for knee (soft tissue), low back (spine), and/or shoulder conditions. Data were analyzed using a framework analytic approach, with particular attention to themes derived from the data related to negative health impacts associated with system navigation.

Seventy-three participants completed an interview. The majority of participants described negative health impacts, which they attributed to challenges navigating the MSK health care system. Patient accounts reveal a spectrum of negative health impacts, including physical health deterioration over and above the MSK condition, a range of mental health challenges, and a decline in social well-being. Participants linked these experiences to specific system-level factors such as delays in receiving care, inconsistency in communications and treatment recommendations, care fragmentation, and affordability barriers.

These findings underscore the challenges of navigating the health system with an MSK condition, which can hinder recovery, exacerbate suffering, and add additional health burdens. Greater attention to the lived experience of system navigation is needed, alongside integrated, timely, person-centred and holistic approaches to MSK care.

Pregnant people in rural communities experience constrained social services and economic supports, increased social complexities, and limited access to maternal health care. Within this environment, crisis pregnancy centers (CPCs) have proliferated to serve rural perinatal populations in the United States. CPCs provide wraparound services to pregnant and postpartum people and their families, but little is known about the services provided for pregnant people with social complexities that increase maternal morbidity risk. We examine CPC leaders' perceived function in providing care to perinatal clients living in low-resource rural communities experiencing intimate partner violence (IPV), substance use, and mental health conditions.

We interviewed 17 leaders of CPCs serving communities with health professional shortage areas in a state with a large rural population. We ask about their perceived role, assessment, and care for clients who may be experiencing substance use, mental health concerns or conditions, or IPV.

We find that CPC leaders in this sample did not describe the capacity to appropriately address some of the primary drivers of maternal morbidity. CPC leaders' descriptions of delivery of medical, mental, and social care screenings, and that their policies and procedures are inconsistent with evidence-based medical care delivery, despite some CPC's use of medical technology. CPC leaders describe a lack of standardized, validated health and social risk screening, reliance on relationship-based risk identification, non-systematic referral processes, unclear anticipatory guidance for medical conditions, and sometimes employ stigmatizing language.

In this study, CPC efforts were found to be inconsistent and unsupported by current clinical care guidelines endorsed by medical professional societies.

Violence against women is a major human rights violation and public health concern with serious physical, mental, sexual, and reproductive consequences. Intrapartum obstetric violence can damage trust in healthcare providers and discourage women from using facility-based maternity services, sometimes more than geographic or financial barriers. However, evidence on intrapartum obstetric violence in Ethiopia remains limited.

This study aimed to assess the prevalence of Intrapartum Obstetric violence and its associated factors among women attending delivery care at public hospitals in Addis Ababa, Ethiopia.

An institution-based cross-sectional study was conducted among 316 postpartum women at six public hospitals in Gondar city from June 11 to July 31, 2023. Study participants were selected using systematic random sampling. Data were collected using an interviewer-administered, pretested questionnaire conducted in a face-to-face setting. Interviews were carried out at a consistent postpartum time point prior to discharge from the health facility. Collected data were checked for completeness, entered into EpiData version 3.1, and exported to SPSS version 25 for analysis. Descriptive statistics were presented using narration, tables, and figures. Bivariate and multivariate logistic regression analyses were performed to identify factors associated with intrapartum obstetric violence. Odds ratios with corresponding 95% confidence intervals were used to assess the strength of associations.

The magnitude of intrapartum obstetric violence was 27.3%. Age of mothers (AOR: 1.24, 95% CI (1.23, 13.95), educational level of mothers AOR: 24, 95% CI (0.02, 0.37), number of delivery (AOR: 1.35, 95% CI (1.20, 1.53), mode of delivery AOR: 0.27, 95% CI (0.18, 0.44) and occurrence of complication AOR; 0.16, 95% CI (0.03, 0.90) were factors that had association with the intrapartum obstetric violence.

More than one-fourth of participants experienced intrapartum obstetric violence. Maternal age, education, parity, mode of delivery, and complications were significantly associated. Hospitals should implement context-specific interventions targeting these risk factors to reduce obstetric violence.

Charles Bonnet syndrome (CBS) is a condition that can cause people with vision loss to see things that are not actually present, such as patterns, objects, animals, or people. Although these experiences are usually not a sign of mental illness, many individuals feel worried, confused, or reluctant to discuss their symptoms with healthcare professionals. A recent study in Therapeutic Advances in Ophthalmology showed that an educational podcast helped people with CBS better understand their condition and reduced some of the emotional distress associated with hallucinations. This finding highlights the value of simple, accessible educational tools in supporting patients. In our letter, we suggest that educational podcasts should be viewed as the first step in a broader support strategy. Education can help patients feel reassured, but it should be combined with routine screening, opportunities to discuss symptoms with healthcare providers, and clear pathways for referral when additional support is needed. We also emphasize the importance of making educational resources available in different languages and formats so they can reach people with varying levels of digital access and health literacy. By combining patient education with structured clinical support, healthcare systems may improve awareness of CBS, reduce stigma, encourage earlier disclosure of symptoms, and enhance quality of life for people living with this often-overlooked condition. Our goal is to promote practical, equitable, and patient-centred approaches that can be adopted in eye care services worldwide.

Starfruit (Averrhoa carambola) contains a potent neurotoxin, caramboxin, which can induce severe and often fatal encephalopathy in patients with impaired renal function. The diagnosis is frequently challenging due to nonspecific initial symptoms that can mimic other common complications in the end-stage renal disease (ESRD) population. A 63-year-old female patient with ESRD on maintenance hemodialysis presented with intractable hiccups, emesis, and chest pain. Her hospital course was immediately complicated by a hypertensive emergency and an elevated troponin level. Other labs were significant for hyperkalemia (potassium 5.7 mEq/L) and high-anion-gap metabolic acidosis. Following a hemodialysis session, she developed a severe, fluctuating encephalopathy. In view of a sudden decline in mental status, the patient underwent a CT head and an MRI head, which were negative for acute findings. The diagnostic workup was confounded by multiple concurrent issues, including lumbar puncture results suggesting meningitis, seizure-like activity requiring antiepileptic drugs, and an electroencephalogram (EEG) suggestive of toxic-metabolic encephalopathy. Furthermore, the patient developed new-onset atrial fibrillation. On the fifth day of admission, a detailed over-the-counter and dietary history obtained from the family revealed a significant starfruit ingestion two days prior to symptom onset. With the diagnosis of starfruit intoxication established, management was refocused on intensive hemodialysis. The patient's mental status gradually improved with increased frequency of renal replacement therapy as the toxin was cleared and confounding medications were withdrawn. This case illustrates how the classic presentation of starfruit neurotoxicity can be obscured by a complex clinical picture. It underscores that a high index of suspicion and a persistent, detailed dietary history are critical for a timely diagnosis and management of unexplained encephalopathy in all ESRD patients.

Adolescent non-suicidal self-injury (NSSI) is a growing public health concern. Adherence to 24-h movement guidelines yields notable health benefits, yet no studies have explored its association with adolescent NSSI. This study examined this association, alongside the moderating effect of sex and mediating role of psychological health (PH).

A total of 4,205 adolescents from five central Chinese cities were recruited. Self-reported questionnaires assessed sociodemographic characteristics, moderate-to-vigorous physical activity (MVPA), screen time, sleep duration, NSSI, and PH. Logistic regression analyzed associations between 24-h movement guideline adherence and NSSI; sex moderation was tested via interaction terms, and PH mediation via the PROCESS macro.

NSSI prevalence was 35.29%, while only 1.28% adhered to all three guidelines. Compared with adherence to none, meeting more guidelines was associated with progressively lower NSSI odds [1 vs 0: OR = 0.72, 95% CI (0.62, 0.83); 2 vs. 0: OR = 0.44, 95% CI (0.36, 0.54); 3 vs. 0: OR = 0.31, 95% CI (0.15, 0.65)]. However, adherence to three guidelines did not significantly further reduce risk vs. two [OR = 0.72, 95% CI (0.34, 1.49)]. Among equivalent adherence levels, combinations including the sleep guideline were associated with lower NSSI than those without (p < 0.05). Isolated MVPA guideline adherence showed no association with NSSI [OR = 1.15, 95% CI (0.74, 1.80)]. Sex significantly moderated the association for two guidelines and the "screen + sleep" combination (p < 0.05), with stronger negative associations in girls. PH significantly mediated the relationship.

Promoting adherence to 24-h movement guidelines, particularly the sleep guideline, may help manage adolescent NSSI risks, with emphasis on PH promotion and attention to sex differences.

The uptake of Family Interventions for psychosis (FIp) in routine settings has been limited across high-, middle-, and low-income countries due to geographic, systemic, and socioeconomic barriers. Psychosis REACH is a FIp that addresses these barriers by using a direct-to-family model co-facilitated by licensed mental health practitioners with expertise in Cognitive Behavioral Therapy for psychosis and family members with lived experience. While prior delivery relied on in-person training, this approach does not adequately address structural access challenges. The aim of this investigation was to evaluate caregiver outcomes of a hybrid asynchronous-synchronous version of Psychosis REACH consisting of (a) an online course, (b) a live virtual skills workshop, and (c) follow-along skills coaching from a trained family peer (Psychosis REACH Family Ambassador; pRFA).

Psychosis REACH was delivered via a hybrid digital format to 275 caregivers of individuals with psychosis, the majority of whom were parents (61.2%). We evaluated feasibility, acceptability, and participant characteristics, along with outcomes including depression, anxiety, caregiver burden, expressed emotion, attitudes toward psychosis, and self-perceived CBT skillfulness at post-training and 4-month follow-up.

Both asynchronous and synchronous components were rated as highly feasible and acceptable. Nearly all participants completed the online course; 85% went on to complete the virtual workshop, of which 66.7% endorsed intention to follow-up with a pRFA. Participants demonstrated significant improvements across multiple domains, including reduced psychiatric symptoms, caregiver burden, stigmatizing attitudes, and expressed emotion, along with increased confidence in CBT-informed skills.

Findings suggest that this hybrid digital training is both acceptable and feasible, offering a promising approach for disseminating evidence-based family support in psychosis. Clinical and educational outcomes were comparable to in-person delivery, underscoring its potential to reduce access barriers for some caregivers. Future research should prioritize randomized trials and active engagement of diverse and underserved families.

In recent years, there has been increased public concern surrounding the mental health of young people in Barbados. A significant challenge for young people experiencing mental health conditions is stigma, which is a key barrier to help-seeking. This study aimed to explore how young Barbadians with mental health conditions experience and respond to mental health stigma and help-seeking. Qualitative semi-structured interviews were conducted in 2022 with 28 Barbadians aged 18-24 years who reported being diagnosed with a mental health condition, or self-identifying as having experienced mental health challenges. The data were analysed through reflexive thematic analysis. The findings highlighted the importance of culture in how mental health is perceived, and the role of anticipated and experienced stigma deterring help-seeking. Social networks acted as both facilitators and barriers to stigma and help-seeking, and mixed experiences and opinions of formal services raised concerns regarding the quality of care and accessibility. These findings highlight the need for locally informed, culturally relevant strategies and interventions to address and reduce stigma, facilitate help-seeking and improve care outcomes within the community in Barbados.