The network organization of the human brain dynamically reconfigures in response to changing environmental demands, an adaptive process that may be disrupted in a symptom-relevant manner across psychiatric illnesses. Here, in a transdiagnostic sample of participants with (n = 134) and without (n = 85) psychiatric diagnoses, functional connectomes from intrinsic (resting-state) and task-evoked fMRI were decomposed to identify constraints on brain network dynamics across six cognitive states. Hierarchical clustering of 110 clinical, behavioral, and cognitive measures identified participant-specific symptom profiles, revealing four core dimensions of functioning: internalizing, externalizing, cognitive, and social/reward. Brain network dynamics were flattened across cognitive states in individuals with psychiatric illness and could be used to accurately separate dimensional symptom profiles more robustly than both case/control status and primary diagnostic grouping. A key role of inhibitory cognitive control and frontoparietal network interactions was uncovered through systematic model comparison. We provide evidence that brain network dynamics can accurately differentiate the extent that psychiatrically-relevant dimensions of functioning are exhibited across health and disease.

This study aimed to explore how young and middle-aged adults (aged 18-65 years) with multimorbidity and complex chronic conditions experience hospitalisation and the transition home.

In this qualitative study, semi-structured interviews were conducted. Data from the interviews were analysed using reflexive thematic analysis following Braun and Clarke (2022).

Two university hospitals in Switzerland (March to July 2024).

16 young and middle-aged adults with multimorbidity and complex chronic conditions from two university hospitals in Switzerland were selected as interview participants to gain an understanding of the experience of young and middle-aged adults with multimorbidity and complex chronic conditions within the hospital and on transition home.

Analysis of the interviews revealed four main themes that describe the experiences of younger and middle-aged adults with multimorbidity and complex chronic conditions during and after hospitalisation: experiences on a (1) physical, (2) emotional and psychological, as well as on a (3) social level and (4) the constant tension within the lived experience of illness; this constant tension in turn influenced the experiences of this patient group on a physical, emotional, psychological and social level. Conversely, these three levels influenced both the positive and negative experience of illness and the positive and negative anticipation surrounding it.

The study's findings confirm that this patient group requires integrated care, a care model that goes beyond the disease-centred comorbidity perspective of previous care models that supports coordinated proactive care by an interprofessional core team and a central coordinator and that operates within and between the different health sectors. Advanced practice nurses are particularly well-suited for a leading role within integrated care models due to their advanced nursing skills and knowledge. These results could serve as an important basis for this specific role design. The results of this study also confirm that this patient group requires a complex, holistic and person-centred approach to care to have the opportunity to return to a normal life despite massive limitations. Mental health plays a central role, as it is an important influencing factor that should be given special attention during treatment. It is essential for healthcare systems and medical professionals to understand the burden of diseases in the context of physical, financial, family and social circumstances. Further research into the experiences of young and middle-aged adults with multimorbidity and complex chronic conditions is recommended.

The focus of the present study is to highlight and understand the effect of hysterectomy on physical, psychological, social and marital status among women aged under 40 years of age, in the cultural context of Pakistan DESIGN: The study used a qualitative phenomenological approach to explore the lived experiences of the women.

The present study was conducted at Sheikh Zayed Hospital, a tertiary care public sector hospital located in Lahore, Pakistan.

The participants of the study were women under 40 years of age who have undergone hysterectomy in the last 2 years. The data of such women were recruited from the hospital and were selected using pre-defined inclusion and exclusion criteria through purposive sampling. In-depth interviews were conducted with seven women, and data were analysed thematically.

Four major themes and 12 sub-themes evolved during data analysis that included 1) physical and psychological effects (physical changes and recovery period, the tragedy of invisible loss of an organ and emotional distress and mood swings); 2) family and communal dynamics (reaction of in-laws, reaction of parents and siblings and reaction of friends and colleagues); 3) role fulfilment (wife and child bearer, sick role, professional role and domestic role) and 4) effects on marital life (relationship with husband and insecurity of the possibility of husband taking a second wife).

The present study found that women who have undergone hysterectomy before the age of 40 years have adverse physical, psychological, social and marital effects in their lives due to lack of societal support and acceptance related to the anatomical procedure. These findings highlight the profound influence of socio-cultural expectations and familial dynamics on women's post-hysterectomy experiences, underscoring the need for greater awareness and sensitivity toward their physical and psychosocial well-being.

Understanding how multiple long-term conditions (MLTCs) develop and cluster across the life-course remains a key public health priority. Evidence on how these patterns relate to patient-centred outcomes among patients with mental health disorders remains limited.

To evaluate patient-centred outcomes in patients with a history of depression and MLTC.

A retrospective matched cohort study design was implemented in the Clinical Practice Research Datalink, a UK primary care database. Patients aged ≥10 years with a first recorded diagnosis of depression between 1 January 2003 and 31 December 2023 were matched (1:1) to a comparator without a depression history on age, sex and practice. MLTC was defined using 256 long-term conditions. Clusters of MLTC were derived for each life decade via multiple correspondence analysis and k-means clustering. Patient-centred burden was assessed across eight patient-prioritised 'work themes': symptoms, emotions, investigation and monitoring, health service and administration, learning and adapting, medication, finance and accumulation and complexity. Poisson and logistic regression models assessed associations between decade-specific MLTC clusters and burden indicators.

Among 1 962 757 patients with incident depression, 1 563 065 (78%) presented with MLTC over a mean follow-up of 14 years (SD=6), compared with 987 138 (50%) of comparators (mean follow-up=10, SD=7). Patients with depression history had a higher median number of LTCs (5 (IQR 3-9) vs 4 (3-8)). Clusters of MLTCs varied by life decade: atopic triad and liver clusters predominated in early life, metabolic and cardiovascular (CVD) clusters in midlife and musculoskeletal (MSK) and respiratory in later life. The burden patterning varied between cases and their comparators, who showed lower overall burden and distinct early-life patterns. The strongest prognostic cluster for increased burden in patients with depression changed across life. In early life, the metabolic cluster had the highest risk (incidence rate ratio=1.02 (95% CI 1.01 to 1.03)), followed by respiratory and CVD during midlife and MSK/functional in later life.

MLTC in patients with depression is common, shows dynamic temporal patterning and leads to high patient-centred burden from adolescence onwards.

The study identified specific burdensome clusters of MLTC at each life decade which could inform MLTC prevention for patients with depression.

Sex differences in adolescent mental disorders are well documented, but less is known about how these differences evolve during the transition to adulthood, particularly during the shift from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS), a critical period marked by vulnerability to discontinuity of care.

To examine sex-specific differences in psychiatric symptom profiles and clinical trajectories during the CAMHS-AMHS transition using data from the European MILESTONE project, a 2-year longitudinal study.

A cohort of 1004 adolescents (aged 17-19) in CAMHS was assessed at baseline (T1), 9 months (T2), 15 months (T3) and 24 months (T4). Measures included the Child Behavior Checklist/Adult Behavior Checklist, Health of the Nation Outcome Scales for Children and Adolescents, and the Specific Level of Functioning Scale. Multilevel modelling included sex, diagnosis and time point as covariates, testing three-way interactions for differential trajectories.

Males showed higher symptom severity and impairment across measures, particularly in anxiety/somatic/trauma, eating disorder/obsessive-compulsive disorder (ED/OCD) and schizophrenia. Females exhibited better functioning. Significant sex differences emerged in internalising symptoms (eg, anxiety/somatic/trauma, autism spectrum disorder (ASD)), externalising symptoms (eg, attention deficit hyperactivity disorder (ADHD)), overall psychopathology (eg, ADHD, personality disorder/conduct disorder/substance use disorder) and functioning (eg, ED/OCD, schizophrenia spectrum disorder).

Sex-related differences in symptom severity, diagnosis and functioning persist across the CAMHS-AMHS transition, with males generally more impaired and females showing better adaptive outcomes.

Identifying sex-specific trajectories can enhance personalised transitional care, reduce misdiagnosis and guide targeted interventions-especially for under-recognised presentations such as ADHD/ASD in females and ED in males.

ISRCTN83240263.

Medical training is a high-stress period, and residents in surgical specialties face elevated risk for depression due to demanding schedules, intensity of training, persistent mistreatment, and long work hours. Obstetrics and gynecology (OBGYN) is the only surgical specialty predominantly composed of women, who face higher rates of depression than men and greater increases in depressive symptoms during internship. These challenges, compounded by work-family conflict and policy pressures, contribute to workforce strain in a specialty already facing a projected shortage. Understanding the mental health burden is critical to supporting both trainee well-being and long-term workforce sustainability, yet depressive symptoms, risk factors, and treatment-seeking have not been systematically studied in OBGYN trainees.

(s): To assess the prevalence of depressive symptoms and mental health treatment-seeking among OBGYN first-year residents and identify associated demographic, psychological, and workplace factors.

First-year OBGYN residents enrolled in the longitudinal Intern Health Study between 2009 and 2024 completed surveys at enrollment and quarterly throughout internship. Depressive symptoms were measured using the 9-item Patient Health Questionnaire (PHQ-9). Pearson correlations, χ² tests, stepwise linear regression, and generalized estimating equation (GEE) models were used to identify baseline and internship-related predictors of depressive symptoms. Sample weights were applied to address nonrepresentative sampling and attrition biases.

Of 1,603 enrolled OBGYN interns (86.5% women; median age 27 years), 1,271 (79.3%) completed at least one internship assessment and were included in the analysis. During internship, 35.6% screened positive for depression on the PHQ-9 at one or more assessments, yet fewer than one-third of those affected sought mental health treatment. Baseline predictors of increased depressive symptoms included history of depression, higher baseline depressive symptoms, neuroticism, a difficult early family environment, and not being in a committed relationship. Internship-related factors associated with worsening symptoms included fewer sleep hours, longer work hours, and reported medical errors.

(s): More than one-third of OBGYN residents screened positive for depression on the PHQ-9 during their first year, yet treatment-seeking remained critically low. Both pre-existing vulnerabilities and modifiable workplace stressors contributed to depressive symptoms. These findings are particularly notable given the female-predominant composition of the OBGYN field and the growing representation of women in surgical specialties. The low treatment-seeking rate highlights the urgent need for improved mental health access, including opt-out service models. Structural interventions targeting workload and sleep are essential to support trainee well-being and long-term workforce sustainability in OBGYN.

The perinatal period is a time of significant change for parents, characterized by higher risks of mental health issues that can have long-lasting consequences on family wellbeing. The Quebec government's perinatal action plan aims to increase parental awareness of resources to support their mental health. We therefore reviewed publicly available and accessible information on perinatal mental health services in Quebec, including where they are delivered, by whom, their target populations, and how they address perinatal parental mental health. This commentary summarizes our findings, while highlighting missed opportunities for access to care, lessons learned, and ways forward for perinatal mental health.

Caring for children with infantile neuroaxonal dystrophy (INAD), a rare and progressive degenerative disease, can compromise mental health and consequently affect the quality of care given; however, there are no studies addressing this issue.

To study mental health, focusing on anxiety, depression, hopelessness, quality of life, and sleep patterns among Brazilian caregivers of children with INAD, identifying associations among the variables.

We enrolled 20 caregivers of children with INAD in a cross-sectional study using the following self-report questionnaires: State-Trait Anxiety Inventory, Patient Health Questionnaire-9, Beck Hopelessness Inventory, World Health Organization Quality of Life, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale. We calculated the prevalence of psychological symptoms, and for the analyses of correlations among anxiety, depression, hopelessness, life quality, sleep quality, sociodemographic, and INAD symptoms, a Pearson's correlation test was applied.

Caregivers exhibited high levels of mental distress: 95% were depressed, 75% anxious, and all reported some degree of hopelessness. The quality-of-life scores were lowest in the psychological domain, and poor sleep quality was predominant. The correlation analysis uncovered that onset of physical decline in children appeared to be the most pervasive factor associated with mental suffering within our sample.

Providing care for children with INAD is associated with severe psychological challenges, particularly in the early stages of the disease. These findings highlight the importance of early psychological screening and structured psychosocial interventions to support caregiver's wellbeing and enhance caregiving capacity.

We describe the necessity and application of situation awareness (SA) in the context of neonatal resuscitation. Neonatal resuscitation is a time-constrained, high-pressure situation requiring efficient team decision making. In these moments, health care professionals benefit from team SA, coming together to synthesize real-time information through a shared mental model, predicting potential outcomes and adjusting clinical course for the best possible outcome.

Leveraging literature on situation awareness from human factors science as our foundational theory and comparing to clinical and operational observations of neonatal resuscitation, we evaluate barriers to SA in this context. We further examine previous studies on effective standards, simulation-based trainings, and debriefings in the context of neonatal resuscitation.

We identify significant challenges to effective team SA in the current healthcare system, from out-of-sync health information systems to shifting neonatal resuscitation team roles to complex patients requiring immediate intervention. Improving neonatal resuscitation requires rethinking hospital systems to support pathways to complete team situation awareness, including investments in real-time data on accessible in-delivery room monitors, predictive algorithms and decision support, simulation-based training with video debriefings, and standardized protocols.

Increasing supportive systems for situation awareness for neonatal resuscitation could improve safety and effectiveness in the delivery room.

The public health approach to suicide prevention recognises the importance of maintaining a whole-of-government policy focus. In many countries, this focus is achieved through the planning and implementation of a national suicide prevention strategy (NSPS). Evidence on the outcomes associated with NSPSs is, however, both scarce and inconsistent. In this Health Policy, we identify and review 26 studies that provide quantitative data on changes in the incidence of suicidal behaviour associated with the introduction of a NSPS. We found that reductions in suicide rates were observed in several countries, but there were also countries where there was no change or even an increase in the suicide rate. Moreover, multiple studies of the same NSPS and multiple iterations of a NSPS within the same country produced discrepant findings. Additionally, there are differences in research design and risk of bias between studies. We identified several methodological limitations (including threats to both internal and external validity) linked to the non-recognition of NSPS as a complex intervention. Finally, we propose a realist approach to evaluation as the keystone of a mixed-methods, multilevel research design for NSPS evaluation studies that does justice to the characteristics and complexity of the phenomenon under investigation.