The hypo-oestrogenic state of the postpartum period leads to bothersome genitourinary symptoms in some lactating women. These symptoms have been named 'Genitourinary Syndrome of Lactation' (GSL), and include vaginal dryness, atrophy, urinary incontinence (UI), urinary tract infection (UTI), delayed wound healing and dyspareunia. Despite its prevalence, the experiences, awareness, quality of life, treatments offered and health-seeking behaviours of mothers with GSL in Australia are unknown.

A national cross-sectional survey was conducted in Australia, assessing health-seeking behaviours, healthcare provider discussion (provider or patient-initiated), type of healthcare provider, and treatments offered. Quality of life (QoL) was assessed using sliding scales (0-100) to determine the significance of impact across domains.

One hundred and thirteen Australian women, aged 22-48 years responded (mean 33.9). Findings indicated 37% of women were aware of GSL, leaving almost two-thirds unaware. Sixty three percent (n = 65) of women reported at least one genitourinary symptom, with vaginal dryness (57%), urinary incontinence (UI) (27%) and dyspareunia (36%) the most prevalent. Furthermore, one in five respondents reported a healthcare provider-initiated discussion; in contrast, one-third (33%) of respondents reported initiating the discussion. Of respondents, twenty-eight per cent (n = 29) reported being offered treatment, with the primary barrier to treatment (32%) lack of treatment awareness. GSL had a moderate to severe impact on quality of life across the following domains: sexual activity (43%), daily activity (25%), mental health (anxiety, stress, and frustration) (25%) and caring for baby (7%).

A significant proportion of breastfeeding women had GSL symptoms, but many were unaware of the condition. Screening, awareness, and referrals must be enhanced in primary care settings to improve diagnosis, management and minimise barriers to treatment.

Posttraumatic stress disorder (PTSD) affects up to 25% of trauma-exposed adolescents; yet, access to evidence-based treatment remains limited in rural regions. Trauma-focused cognitive behavioral therapy (TF-CBT) is the first-line intervention, but structural barriers such as long travel distances and therapist shortages hinder implementation. Digital and blended formats may improve accessibility, but evidence for adolescents with PTSD is limited. Shame and self-criticism are common following interpersonal trauma and can reduce engagement; compassion-focused strategies target these mechanisms and aim to enhance emotional safety.

This protocol outlines a pilot randomized controlled trial (RCT) evaluating the feasibility of delivering blended trauma-focused cognitive behavioral therapy with compassion (bTF-CBT-C) for adolescents with PTSD in routine clinical care. A secondary aim is to assess the acceptability of the intervention among adolescents and caregivers. In addition, the study explores patterns and variability in clinical outcomes to inform the design of a future noninferiority trial.

A 2-arm parallel-group pilot RCT will randomize 40 adolescents (12-17 years) with DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) PTSD to bTF-CBT-C or standard TF-CBT in routine child and adolescent psychiatric services. The intervention includes an approximately 5-week web-based stabilization phase, followed by 7-14 therapist-led sessions delivered primarily via videoconference, with some in-person sessions. Primary outcomes will assess feasibility (recruitment, retention, adherence, data completeness, and adverse events) and acceptability (satisfaction, alliance, and qualitative interviews). Exploratory outcomes include PTSD symptoms, self-compassion, emotion regulation, depression, anxiety, suicidality, and dissociation. Assessments will be conducted at baseline, poststabilization, posttreatment, and 6-month follow-up. Feasibility and acceptability will be summarized descriptively. Exploratory analyses using analysis of covariance and mixed effects models will estimate variance parameters, confidence intervals, and descriptive change trajectories without hypothesis testing. Qualitative data will be analyzed using reflexive thematic analysis.

Recruitment started in February 2026, and data collection is projected to be completed by December 2028. Feasibility and acceptability outcomes, along with exploratory clinical patterns, will be reported in accordance with the CONSORT (Consolidated Standards of Reporting Trials) extension for pilot and feasibility trials.

Findings will inform the refinement of the intervention, the assessment of trial feasibility, and the selection of outcomes for a fully powered noninferiority RCT. The study will also contribute to understanding how compassion-focused strategies may support emotional safety and engagement in trauma-focused treatment for adolescents.

The postpartum period represents a critical window for maternal health, yet many individuals lack sustained support and timely identification of physical and mental health risks. Digital health interventions offer a scalable approach to extend care beyond clinical settings. Yet, key elements, including real-world challenges, usability, and effectiveness of such platforms, are insufficiently characterized in this literature.

This study aimed to conduct a formative randomized evaluation to assess the feasibility, engagement, and preliminary signals of impact of the Joyuus platform and to examine the potential for early identification of postpartum health risks.

We conducted a 12-week randomized evaluation with postpartum participants recruited through community-based organizations. Participants were randomized to either the Joyuus intervention or standard postpartum care. Primary and secondary outcomes included the Barkin Index of Maternal Functioning, the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory, and the Connor-Davidson Resilience Scale. Analyses were conducted using an intention-to-treat approach with linear regression models adjusting for baseline values. Engagement metrics (ie, sessions, time on site, and feature use) were captured through in-app analytics. An exploratory predictive model was developed using baseline clinical, behavioral, and demographic variables to identify individuals at risk for postpartum depression.

Baseline characteristics were generally balanced across arms, and no statistically significant differences were observed in education, income, or marital status. No statistically significant differences were found between treatment and control groups in the 12-week changes for the primary or secondary outcomes. Mean EPDS scores were 9.7 in the intervention group and 9.3 in the control group. In the sample, 60 (45.5%) of the 132 participants met the criteria for elevated depression (EPDS score ≥11 or a positive response to question 10 on self-harm), indicating a high burden of symptoms within the study population. Engagement with the platform was highest during the first 4 weeks. Among intervention participants, 80% created an account. Participants reported high levels of perceived usefulness, ease of use, and relevance of content. Qualitative analysis of open-ended survey responses highlighted limited awareness of postpartum-specific resources and a preference for simple, accessible information. An exploratory predictive model demonstrated a recall of 0.89 and a precision of 0.73 in identifying individuals at risk for postpartum depression, suggesting the feasibility of early risk identification using integrated data inputs.

Joyuus demonstrated feasibility and acceptability but did not produce statistically significant improvements in maternal functioning or maternal health outcomes over 12 weeks. Joyuus identified high rates of depressive symptoms and early engagement patterns, which suggest an opportunity for earlier identification of risk and intervention during the postpartum period. Exploratory modeling results indicate the potential for data-driven approaches to support earlier detection. Future work includes optimizing engagement strategies and expanding validation of predictive detection to improve postpartum surveillance and outcomes.

Objectives. To describe cross-national variation in suicidal ideation in the past year across transgender women, transgender men, and nonbinary persons and trace the association between ideation and gender along the continuum of country-level public support for transgender rights. Methods. We applied ordered random-intercept logistic regression models to cross-sectional data from the 2023 European Union Fundamental Rights Agency LGBTIQ Survey III fielded in 27 EU member states. These individual-level data were combined with the 2023 "Special Eurobarometer 535" survey used to construct the 4-item country-level composite measure of public support for transgender rights. Results. Higher levels of public support for transgender rights were associated with lower levels of suicidality but unequally across groups. Transgender men were the most and transgender women the least responsive to changes in public opinion. Differences between groups converged at high levels of support. Conclusions. Mental health among transgender men may be especially sensitive to public opinion, suggesting a need for suicide prevention that addresses public opinion as a social determinant of health-and the need to do so in contexts antagonistic to gender minority populations. (Am J Public Health. 2026;116(8):1189-1197. https://doi.org/10.2105/AJPH.2026.308572).

Objectives. To examine associations of online space usage time and online harassment with suicidal ideation among US college students, focusing on gender disparities. Methods. We analyzed data from the 2023-2024 Healthy Minds Study (n = 104 729), a national survey of college student mental health. Analyses were restricted to students randomized to the digital behavior module (n = 46 914). Multivariable logistic regressions were conducted using complete-case data, with analytic samples varying by model. All models adjusted for depressive symptoms, sleep duration, and sociodemographic covariates. Results. Both higher time online and online harassment were independently associated with increased odds of suicidal ideation. Compared with those reporting less than 1 hour per day online, students reporting 1 to 3 hours (adjusted odds ratio [AOR] = 1.29) and more than 3 hours a day online (AOR = 1.45) had elevated risk. Online harassment nearly doubled the odds (AOR = 1.77). Among cisgender males, associations were stronger for time online (AOR = 1.76-1.97) and online harassment (AOR = 1.91). Conclusions. Digital exposure, particularly among cisgender males, may represent a modifiable risk factor for suicidal ideation, underscoring the need for gender-responsive suicide prevention efforts in digital spaces. (Am J Public Health. 2026;116(8):1104-1115. https://doi.org/10.2105/AJPH.2026.308576).

Objectives. To examine whether the Affordable Care Act's Medicaid expansion was associated with changes in firearm suicide among Black and White men, recognizing that masculine norms such as self-reliance and reluctance to seek mental health care may shape how policy interventions influence men's health. Methods. We conducted a retrospective state-level analysis of firearm suicide mortality from 2000 to 2023 among US men aged 18 to 64 years. Difference-in-differences (DID) and synthetic DID models estimated changes in firearm suicide rates before and after Medicaid expansion after adjustment for sociodemographic and policy covariates. Results. Medicaid expansion was associated with a reduction of approximately 1.4 deaths per 100 000 among White men aged 35 to 49 years (95% confidence interval = -2.45, -0.39), but no consistent effects were observed for other groups. Firearm suicide increased across all subgroups, with the sharpest rises among younger Black men in both expansion and nonexpansion states. Conclusions. Medicaid expansion alone was insufficient to offset the drivers of men's firearm suicide risk. Reducing firearm suicides requires strategies combining expanded health coverage and approaches that challenge harmful masculine norms, advance racial equity, and reduce access to lethal means. (Am J Public Health. 2026;116(8):1095-1103. https://doi.org/10.2105/AJPH.2026.308581).

This study explores the risk of delayed psychomotor development (PMD) in children treated for severe acute malnutrition (SAM) in the Democratic Republic of Congo. The present research is a sub-study of the EfRAMAS clinical trial conducted in health zones in the province of Kasaï Oriental. Children aged 6-59 months with SAM according to WHO criteria and no congenital malformations affecting child development were enrolled in the study. The risk of delayed psychomotor development was assessed among repeated cross-sectional samples of children at admission, discharge and 6 months after recovery, using the Ages and Stages Questionnaires (ASQ3). Mixed-effects linear regression with health center as random intercept was performed to identify potential predictors of the risk of psychomotor delay in children. A total of 413 children were included at admission, 143 at discharge and 581 at 6 months post-discharge. At admission, the risk of delayed psychomotor development was greatest in the domains of fine motor skills (21.3%), gross motor skills (23.7%) and problem solving (21.5%). At discharge, the risk of delay was considerably reduced, with 0% risk of delay in communication, while the three most affected domains hovered around 2%. At 6 months post-discharge, the risk of delay in gross motor skills and problem-solving was still present in over 10% of children. Age, sex, MUAC < 115 mm or WHZ < -3 as admission criteria, breastfeeding, episodes of illness during treatment, measles vaccination, mother's education level, and living in a female-headed household were predictors of the risk of psychomotor development delay. Globally, gross and fine motor skills and problem solving were the domains most affected for children with SAM. Regarding our findings, we recommend investing in the integration of children's psychosocial stimulation within the undernutrition management care pathway by trained health care workers, as well as in caregivers' parental skills. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Network (ISRCTN15258669). Registered 25/01/2022.

The Association of American Medical Colleges convened leaders from academic health systems, health policy, and integrated behavioral health on July 10, 2025, for a symposium entitled The Promise of Integrated Behavioral Health Care: Improving Health Outcomes. The recommendations and insights presented here reflect the shared conclusions that emerged from those presentations and discussions.

Rural communities face disproportionate burdens of chronic disease, mental illness, workforce shortages, and fragmented services despite historic national health spending. The Whole Health, Whole Communities: Dialogues to Reduce Rural Health Disparities symposium in Roanoke, Virginia, convened cross-sector leaders to identify reforms necessary to embed person-centered care into rural systems. Participants outlined staged reforms across governance, financing, workforce development, and data infrastructure. Priority actions include trauma-informed care expansion, payment redesign, sustainable community health worker funding, participatory research, and cross-sector coordination - advancing scalable, community-embedded Whole Health models to reduce rural disparities.

As forces prepare for large scale combat environments (LSCO), military medicine must adapt by building an in-theater system capable of providing prolonged casualty care under direct threat, moving away from reliance on access to specialty providers and rapid evacuation. This new approach needs to address mental health (MH) conditions by equipping front-line personnel with MH skills. This work aimed to evaluate the effectiveness of the BH GEAR training, which teaches MH prevention, identification and management skills to soldiers without prior MH training. Soldiers (n = 545) from seven U.S. Army units participated in the study from October 2022-April 2024, attended the training, and completed pre- and post-training surveys on the same day. The six-hour training provided instruction on conducting MH assessments, signs and symptoms of illnesses, interventions to prevent or manage concerns, and considerations for managing medical evacuations. Analyses examined satisfaction with the training, self-report of skills learned, and changes in scope of practice, knowledge and confidence utilizing the skills. Most participants (89%) rated the training as relevant and useful, and learned how to assess for (93%) and provide interventions for (91%) MH concerns. Post-training, participants experienced significant increases in MH-related scope of work, knowledge, and confidence. This work shows that completion of a one-day training is associated with increased MH skill knowledge and anticipated confidence using these skills with military service members. Integrating this training into military curriculums will increase the availability of support during current and future operations, ultimately sustaining readiness and lessening the impact of mental health challenges.