Depression in middle-aged and older adults often co-occurs with multiple physical health problems, yet its long-term co-evolution patterns remain unclear. Using data from 4 waves of the China Health and Retirement Longitudinal Study from 2011 to 2018, group-based multi-trajectory modeling was employed to identify covarying trajectories of depressive symptoms, number of chronic diseases, chronic pain, and functional disability. Multinomial logistic regression was used to analyze predictive factors. A total of 8961 participants aged 45 and above were included. Four distinct trajectories were identified: stable low-risk group (40.84%), low-risk improving group (11.24%), high-risk deteriorating group (23.96%), and high-risk fluctuating group (23.96%). Older age, female gender, and rural residence were risk factors for unfavorable trajectories, while higher education level, nonagricultural household registration, and social participation were protective factors. The long-term evolution of physical and mental health in middle-aged and older adults exhibits heterogeneous trajectories, with high-risk subgroups showing synchronous deterioration across multiple health dimensions. Identifying key predictive factors can inform stratified interventions and precision health management.

Smartphone addiction has become a widespread issue affecting the mental health of medical students. Shyness, a common personality trait, and self-acceptance have not been fully explored for their associative relationships with smartphone addiction among this population. This study aimed to explore the relationships among shyness, self-acceptance, and smartphone addiction, and to examine the mediating role of self-acceptance in these relationships. We adopted a cross-sectional survey, using the Smartphone Addiction Scale-Short Version, Shyness Scale, and Self-Acceptance Questionnaire, to conduct a questionnaire survey among 756 undergraduate students at a medical school in southwestern China. Results showed that shyness was significantly positively correlated with smartphone addiction (R = 0.312, P < .001) and significantly negatively correlated with self-acceptance (r = -0.621, P < .001). Self-acceptance was also significantly negatively correlated with smartphone addiction (r = -0.301, P < .001). Mediation analysis indicated that self-acceptance partially mediated the relationship between shyness and smartphone addiction, accounting for 34.1% of the total effect. Shyness was associated with lower self-acceptance, which in turn was associated with a higher level of smartphone addiction.

Evidence directly comparing the cognitive improvement effects of non-pharmacological therapies in patients with mild cognitive impairment or dementia is limited. Our objective was to evaluate the efficacy of various non-pharmacological therapies on cognitive function through a network meta-analysis.

PubMed, Embase, Cochrane Library, China Biology Medicine Database, China National Knowledge Infrastructure, Wanfang Database, and Web of Science were searched from database inception until October 2025. Two researchers independently screened studies, extracted data, and assessed bias risk.

Twenty-four randomized controlled trials (2082 patients) compared multidomain intervention (MI), music therapy (MT), cognitive rehabilitation (CR), physical exercise (PE), cognitive training (CT), and health education (HE). For Mini-Mental State Examination scores, CT (standardized mean difference [SMD] = 1.43, 95% confidence interval [CI] = 0.20-2.65) and HE (SMD = 2.02, 95% CI = 0.05-4.00) showed statistically significant improvements versus control (P < .05). Exploratory P-score ranking yielded values of 0.26 (MI), 0.39 (MT), 0.49 (CR), 0.59 (PE), 0.73 (CT), and 0.86 (HE), suggesting HE and CT may carry higher efficacy probability within this network. Regarding the Montreal Cognitive Assessment scores, PE (SMD = 2.26, 95% CI = 0.95-3.57), HE (SMD = 2.43, 95% CI = 0.43-4.43), and CT (SMD = 2.96, 95% CI = 1.57-4.35) showed statistically significant improvements compared to the control group (P < .05). Exploratory P-score ranking gave values of 0.07 (MI), 0.46 (MT), 0.69 (PE), 0.73 (HE), and 0.89 (CT), indicating CT had the highest preliminary ranking probability.

The results of this study indicate that PE, CT, and HE show good potential for improving cognitive function, but the screening results of different assessment tools show a certain degree of variability. MT, CR, and MI did not show significant efficacy. More randomized controlled trials may need to be included in the future.

This study aimed to examine mental health literacy, perception of health, and attitudes toward seeking professional psychological help among individuals from 4 ethnic groups (Assyrian, Turkish, Arabic, and Kurdish) living in the multicultural context of Mardin, Türkiye. This descriptive, cross-sectional, and correlational study included 398 participants recruited using convenience and snowball sampling. Data were collected using a demographic characteristics form, the Mental Health Literacy Scale, the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form, and the Perception of Health Scale. Data were analyzed using descriptive statistics, independent-samples t tests, one-way analysis of variance, Pearson correlation analysis, and multiple linear regression. Significant differences were observed among ethnic groups in mental health literacy, perception of health, and attitudes toward seeking professional psychological help (P < .05). Mental health literacy was weakly and positively correlated with help-seeking attitudes (r = 0.138, P = .006). Perception of health was positively correlated with both help-seeking attitudes (r = 0.640, P < .001) and mental health literacy (r = 0.328, P < .001). The multiple linear regression model explained 41.5% of the variance in help-seeking attitudes (R2 = .415). Perception of health showed a strong positive association with help-seeking attitudes (β = 0.666, P < .001), whereas mental health literacy showed a small negative coefficient after perception of health was included in the model (β = -0.080, P = .049). Mental health literacy, perception of health, and attitudes toward seeking professional psychological help differed among the ethnic groups examined. Perception of health showed the strongest association with help-seeking attitudes. Given the cross-sectional design and the absence of direct measures of cultural beliefs, stigma, religiosity, and related constructs, the observed ethnic-group differences should not be interpreted as evidence of cultural or causal effects. These findings may inform context-sensitive approaches to mental health promotion and professional help-seeking in multicultural populations.

Evidence linking plant-based diets with mental health is mixed. One reason may be that dietary labels do not always reflect habitual food intake and often coincide with other lifestyle characteristics.

We conducted a cross-sectional secondary analysis of 158 Polish adults: 105 omnivores and 53 participants who identified as following plant-based diets (34 vegetarians and 19 vegans). Habitual intake frequencies for 33 food groups and diet-quality indices were derived from KomPAN. Anxiety and depressive symptoms were assessed with HADS-M, empathy with the EQ-Short/SSIE, and physical activity with IPAQ. Self-identified dietary pattern was the primary exposure; meat/fish-abstention definitions were examined in sensitivity analyses.

Compared with omnivores, plant-based participants had lower BMI and nHDI scores, higher DQI values, and, among those with valid IPAQ data, higher physical activity. Nineteen of 33 food groups differed after false-discovery-rate correction. We found no statistically significant association between dietary identity and HADS-A or HADS-D in crude, minimally adjusted, or broader sensitivity models; the confidence intervals, however, were too wide to establish equivalence or rule out an association. Of the 53 self-identified plant-based participants, 36 (67.9%) met the meat/fish-abstention criterion and 17 (32.1%) did not. IPAQ analyses included 120 participants, and inverse-probability-weighted sensitivity analyses produced similar HADS estimates. No individual food-frequency variable was associated with HADS-A or HADS-D after multiplicity correction. In exploratory analyses, more frequent vegetable consumption was positively associated with empathy.

Dietary identity corresponded to clear differences in habitual food consumption, diet quality, and selected lifestyle characteristics, but we did not detect a statistically significant association with anxiety or depressive symptoms. The observed mismatch between dietary identity and reported behavior highlights the value of measuring both in studies of plant-based diets and psychological outcomes.

Background/Objectives: Teaching is a highly stressful occupation, yet the associations between occupational stress, nutritional health, and physical pain among schoolteachers remain understudied, particularly in non-Western contexts. This study examined whether high occupational stress is associated with reduced favorable dietary behaviors, as well as with the presence and prolonged duration of physical pain among Hong Kong schoolteachers. Methods: Cross-sectional data were analyzed from 267 secondary and special schoolteachers (65.5% female, mean age 41.5 years) who completed the Occupational Stress Indicator-2 (OSI-2), a dietary behavior questionnaire, and a region-specific pain assessment. One-way analysis of variance, independent t-tests, and linear regression (adjusting for age, gender, income, school type, depression, anxiety, stress, and sleep quality) were conducted. Results: In the adjusted linear regression, moderate red meat intake was associated with lower odds of high occupational stress. Shoulder, forearm/wrist, and hip pain were associated with high OSI-2 scores in univariable analyses. However, only pain duration of >30 days and depression remained significant in fully adjusted models. No other dietary variables or pain locations showed significant associations. Conclusions: Occupational stress among Hong Kong schoolteachers is independently associated with prolonged musculoskeletal pain, with depression strongly confounding the pain-stress relationship. An integrated approach is necessary to address the direct physical, nutritional, and mental health consequences of occupational stress.

Depression is a highly heterogeneous disorder involving diverse biological systems and pathogenic pathways. Clinical and prospective studies have revealed that a substantial proportion of patients present with elevated peripheral and central inflammatory cytokines, a phenotype strongly associated with poor response to standard antidepressants. The complement system has emerged as a pivotal upstream mediator that drives pathological neuroinflammation in depressive disorders. Overactivation of complement signaling drives glial activation, aberrant synaptic elimination, blood-brain barrier disruption, and neural circuit dysfunction. This process involves synergistic interactions between the C1q-C3-CR3 signaling axis and key regulatory proteins, including the high-mobility group box 1 protein, triggering receptor expressed on myeloid cells 2, Galectin-3, and neuronal pentraxin 2. Interventions targeting the complement system and its interacting proteins offer novel avenues for the treatment of inflammatory depression. The review systematically summarizes recent advances in the pathophysiological mechanisms of inflammatory depression and highlights the potential of complement-directed therapeutic strategies, aiming to provide actionable targets and fresh insights for drug development against this condition.

Chronic insomnia disorder (CID) is characterized by dysregulation of the insula, a key hub integrating emotional, cognitive, and autonomic processes. This study investigated insular subregional functional connectivity (FC) abnormalities in CID, longitudinal FC modulation following treatment with Suanzaoren Decoction (SZRD) or estazolam, and the associated molecular signatures. We recruited 82 patients with CID and 80 healthy controls. Patients underwent clinical assessments and resting-state functional magnetic resonance imaging at baseline and after six weeks of treatment. Twelve insular subregions were defined as seeds for whole-brain FC analyses. Longitudinal treatment effects were examined using mixed-effects models. Spatial correlations between FC alterations and gene expression maps from the Allen Human Brain Atlas were analyzed. At baseline, CID patients exhibited increased FC between the hypergranular insula and the opercular part of the left inferior frontal gyrus (IFG). Following treatment, both the SZRD and estazolam groups showed enhanced FC between the left hypergranular insula and the bilateral anterior cingulate cortex, and between the right dorsal agranular insula and the right mid/posterior cingulate cortex. Estazolam treatment was further associated with decreased FC between the left dorsal agranular insula and the left cerebellar lobule VI, and increased FC with the bilateral precuneus. Gene enrichment analysis indicated that the identified genes were significantly involved in fatty acid transport, neuronal ensheathment, and early endosome localization. CID is characterized by aberrant insular-IFG connectivity. Both SZRD and estazolam effectively modulate the insular subregional FC, and functional alterations are linked to specific transcriptomic profiles.

Atopic dermatitis (AD) is a chronic inflammatory skin disorder modulated by complex interactions between immune dysregulation and compromised skin-barrier integrity, in which the gut microbiome may play a role in the natural course of the disease. Therefore, by influencing the composition of the gut microbiome, one of the effective therapeutic options for AD treatment may include probiotics. To extend our knowledge of probiotics and how gut microbiome may affect disease evolution, this exploratory study assessed the systemic effects of a 90-day probiotic supplementation in AD patients, integrating clinical assessment, serum cytokine profile, and GC-MS-based metabolomics. Clinical improvement was observed following probiotic supplementation, with reductions in treated patients of the main clinical indices to assess the AD severity (i.e., SCORAD, EASI, and DLQI). These patients also showed reduced serum levels of pro-inflammatory cytokines (i.e., IL-1β, IL-6, and IL-8), indicating attenuation of systemic inflammation. Moreover, metabolomic analysis revealed a marked change between baseline (T0) and post-treatment (T1) serum profiles of AD patients, consistent with a reduction in inflammatory signalling and improved clinical status. These findings highlight meaningful metabolic remodelling associated with probiotic supplementation and support further investigation of probiotics as a potential adjunctive strategy in AD.

Mental disorders are a leading cause of work-related sick leave in Brazil, yet routinely collected surveillance data are seldom used to build prediction tools for occupational health services. We aimed to develop and internally validate machine learning models predicting work-related sick leave among individuals notified with work-related mental disorders.

We analyzed 21,601 notifications of work-related mental disorder (ICD-10 F99) from Brazil's national surveillance system (SINAN, 2006-2025). Elastic net, random forest, and XGBoost models were tuned by 5-fold cross-validation on a 75% training split and evaluated on a 25% test set. Discrimination, calibration, and clinical utility (decision curve analysis) were assessed; the model with the highest test-set area under the precision-recall curve (AUC-PR) was designated champion and examined for variable importance (SHAP) and fairness across sex, race/ethnicity, education, and region.

Workplace absence was granted in 13,896 (64.3%) notifications. Random forest was selected as champion (test AUC-ROC 0.697 [95% CI 0.682-0.710]; AUC-PR 0.802 [0.788-0.816]), similar to XGBoost (AUC-ROC 0.699) and better than elastic net (AUC-ROC 0.680). Decision curve analysis showed positive net benefit over default strategies for threshold probabilities of approximately 30-70%. Notification year, employment status, psychotropic medication use, region, and confirmed work-relatedness contributed most to predictions. Discrimination varied substantially across subgroups, with markedly lower AUC-ROC for Black individuals (0.620) and workers with secondary education (0.664) than overall (0.697).

Routinely collected surveillance data can support moderate-discrimination, potentially useful prediction of work-related sick leave in mental disorders, but subgroup disparities indicate that deployment as a decision-support tool would require targeted recalibration and fairness auditing, particularly for Black workers and those with secondary education. Internal validation alone is not sufficient to support deployment; external, prospective validation is required before any clinical or operational use, consistent with TRIPOD + AI guidance.