Long COVID is a multisystem condition characterized by persistent or fluctuating symptoms following acute SARS-CoV-2 infection. Despite increasing scientific evidence, the alignment between patient needs and healthcare delivery remains limited. This study aimed to assess unmet clinical, psychological, and lifestyle needs among individuals previously evaluated at the Modena Long COVID Clinic and to inform a patient-centered redesign of Long COVID services.

This observational study included individuals assessed at least once at the Modena Long COVID Clinic (Italy) between August 2020 and July 2025. Participants with valid email and phone contacts were invited to complete an online questionnaire exploring unmet needs across clinical, mental health, welfare, and lifestyle domains. The questionnaire also assessed Long COVID symptom clusters and health-related quality of life (HR-QoL) using the EQ-5D-5 L and EQ-VAS. Data were compared between the first clinical visit (baseline) and the follow-up survey.

Of 707 individuals contacted, 162 (22.9%) completed the survey (median age 56 years; 54.9% male). At follow-up, 80.1% reported at least one Long COVID symptom cluster, with significant increases in musculoskeletal (30.1% vs. 60.8%), neurocognitive (23.5% vs. 52.4%), and psychological (25.3% vs. 51.2%) domains. EQ-5D-5 L scores remained stable (median 83.0 vs. 84.1; p = 0.927), while self-rated health improved (60 vs70; p < 0.001). Unmet needs were common: 22.2% reported insufficient access to specialist consultations, 15.4% lacked psychological support, and 15.5% reported unmet needs for pain management.

This study identifies substantial gaps between patient needs and existing care structures, emphasizing the need for a dynamic, cluster-based, and patient-centered approach. The results support the redesign of Long COVID services into five operational pillars: functional triage, empowerment and education, integrated cluster clinics, continuity of care through case management, and outcome-based evaluation. Such reorganization may enhance perceived health and well-being even when overall disability remains stable.

Clinical trial number not applicable.

The aim of this study was to assess the pattern of mutual relations within the Relationship Trust Scale (RTS) in a sample of individuals diagnosed with multiple sclerosis.

The participants comprised 189 individuals diagnosed with multiple sclerosis (M_age = 43.39 years; 123 females, 61 males, 5 missing). Analyses were conducted using RStudio and JASP.

The results indicated that, in terms of strength, the Cares node (Item: "My partner cares about my worries, feelings, joys, and troubles") had the highest strength in the network. Furthermore, regarding expected influence, the analysis revealed that the Cares node had the highest expected influence in the network, followed by the Availability node (Item: "Whenever I am upset my partner is always available, supportive, and I feel like he/she's there for me"), and Consideration in Decisions node (Item: "My partner takes me into account when making a decision."). Also, the Cares node had the strongest associations with Consideration in Decisions, Safety, and Respect nodes. Network stability analyses indicated that interpretations should be focused primarily on expected influence (CS-coefficient = 0.286), which exceeded the minimum recommended threshold (Epskamp et al., 2018), while other centrality indices showed lower stability. Betweenness and closeness centrality were not interpreted, as these measures may be conceptually unsuitable for psychological networks (Bringmann et al., 2019). All findings should be considered exploratory and preliminary.

These exploratory findings appear to highlight potentially relevant relationship processes among individuals diagnosed with multiple sclerosis that may be targeted to improve the overall quality of their relationships.

Over 70% of adults have lived through a traumatic event, which can have long-term physical and mental health repercussions. However, there is limited understanding of how to effectively communicate with patients about trauma or how trauma-related communication impacts patient outcomes.

Evaluate patient and clinician perspectives on communicating about traumatic experiences and the impact on health.

Semi-structured qualitative interviews completed from April 2023 to 2024 at two primary care safety-net clinics in Northern California.

Forty-eight participants (patients [n = 24] who had experienced trauma and their primary care clinicians [n = 24; 20 physicians, 4 nurse practitioners]).

Seven multidisciplinary researchers with clinical and qualitative expertise completed a two-phase (intra- and inter-) dyadic analysis using the framework method to analyze incongruencies and similarities within and between patient-clinician dyads. Patients and clinicians within dyads were interviewed separately, by the same interviewer. A hybrid of inductive and deductive reasoning was used to create and apply a codebook. All interviews were double-coded.

The analysis identified five themes related to (1) communication about trauma positively affecting treatments, health outcomes, and social needs; (2) the importance of patient-clinician relationships and continuity; (3) best practices for supportive trauma inquiry and response; (4) differences between patients and clinicians regarding the perceived risks of trauma-related communication; and (5) the need to address environmental and structural barriers to trauma recovery.

Supportive communication about trauma has the potential to be independently therapeutic on its own, underscoring its importance in clinical care and training. Participants reported that discussing trauma that occurred as an adult or as a child could have significant health benefits with minimal harm to patients. Results identify strategies to optimize communication that can inform clinician trainings on trauma-related communication, clinical policies regarding continuity of care and operationalizing trauma-care pathways, and allocation of resources to address external factors impeding trauma recovery.

Suicide prevention is a top clinical priority in the United States, and healthcare systems are increasingly addressing adverse life circumstances and social drivers that heighten suicide risk. Within the Veterans Health Administration (VHA), Suicide Prevention Coordinators (SPCs) play a central role in identifying and supporting Veterans at risk of suicide, including efforts to address adverse social determinants of health (SDH).

This study explores (1) barriers SPCs face when addressing Veterans' adverse SDH within the context of suicide prevention care and (2) strategies SPCs employ to address these barriers.

We analyzed transcripts from semi-structured telephone interviews conducted with SPCs between February and May 2022 using a rapid turn-around qualitative approach informed by the Consolidated Framework for Implementation Research (CFIR).

We recruited 15 SPCs using purposive sampling to ensure maximum variation by facility complexity, as defined by VHA.

The CFIR-informed interview guide elicited SPCs' perspectives across multiple topics, including how SPCs connect Veterans with services to address adverse SDH within and outside of VHA, perceived challenges to these processes, and strategies used to address identified barriers.

Barriers and strategies were identified across three CFIR domains. Outer setting barriers included eligibility policies and resource constraints; strategies focused on leveraging specialized VHA staff to connect Veterans with available services. Inner setting barriers included limited staff capacity and communication challenges between programs; SPCs responded by initiating improvements to referral tracking and follow-up. Barriers in the individuals (Veteran) domain included limited awareness of available services; strategies included engaging Veterans' families when feasible.

These findings inform ongoing suicide prevention efforts with VHA and other healthcare systems by highlighting the importance of leveraging community resources, expanding and supporting specialized roles, engaging Veterans' families and other supports, and formalizing collaboration and communication across programs.

In the Veterans Health Administration (VA), primary care teams include embedded specialists to facilitate timely access to effective mental health treatments, including same-day warm handoffs from primary care clinicians/staff to integrated mental health specialists.

Understand the impact of the post-COVID-19 shift to virtual care on depression assessment and treatment and explore clinician-identified ways to optimize hybrid (virtual/in-person) integrated care for primary care patients with depression.

Semi-structured interviews across three geographically diverse VA healthcare systems.

Forty-seven primary care clinicians/staff and integrated mental health specialists.

Interview questions were based on Fortney et al.'s Reconceptualized (Digital) Access Framework. Transcripts were coded using a qualitative descriptive approach with constant comparison.

Participants indicated that post-pandemic use of virtual care helped increase access to depression treatment. Particularly, they cited a model where integrated mental health clinicians/staff cover clinics across a healthcare system by offering telephone or video visits to patients at multiple sites. Primary care and mental health coordination appeared to work well; nevertheless, some primary care clinicians/staff preferred in-person warm handoffs. When asked about the optimal mix of in-person and virtual depression care, primary care clinicians/staff thought the initial assessment should be done in person, especially for patients presenting complicated cases. Ongoing care, namely cognitive behavioral therapy and medication management, was thought to be ideal for virtual delivery. Participants emphasized the need for offering Veteran-centric care, or care that "meets the Veterans where they are" and encourages them to continue engagement in mental healthcare.

Clinicians generally deferred to patients on their preferred care modality, but some indicated certain situations (e.g., initial assessment, complicated cases) may be better suited for in-person over virtual care. Further research should examine quality of virtual and in-person primary care-based mental healthcare, and patient satisfaction and experiences with these care modalities.

There is a high rate of worker turnover in public mental health settings, contributing to a critical provider shortage with serious implications for mental healthcare access, particularly for low-income and underserved populations. These challenges unfold within strained public mental health systems characterized by chronic underfunding, high caseloads, and administrative demands, all of which exacerbate workforce instability. The primary objective of this study was to qualitatively examine public mental health workers' perspectives on factors influencing turnover and experiences of ongoing workforce shortages. Semistructured interviews were conducted between September and October 2024 with mental health workers (N = 20) from 12 agencies within the public mental health system in Philadelphia. Thematic analysis identified four key themes: (1) identification of financial and occupational stressors that contribute to turnover, (2) profound dedication and commitment to serving acute community mental health populations, (3) reactions and implications of staffing shortages, and (4) factors important to staying at work in the public mental health system. A notable secondary finding highlighted disparities in access to care for Spanish-speaking clients with participants describing shortages of Spanish-speaking clinicians and interpreters across the public mental health system that may negatively impact therapeutic rapport and timely access to services. Findings highlight the value of frontline provider perspectives in informing policy and research efforts aimed at strengthening and sustaining the public mental health workforce while promoting equitable and linguistically responsive access to behavioral health services.

Most research on suicide focuses on the progression toward lethal action. Fewer studies have looked at individuals' past experiences with the desire to die and why they did not die by suicide. Moreover, the existing use of reasons to live in assessment and treatment is generally grounded in inventories of questions that, while groundbreaking and well validated, were developed decades ago and without a focus on individuals' lived experiences. In this study, an online user's query to formerly suicidal people on the popular Reddit platform afforded a novel opportunity to investigate reasons people lived in a large, naturally occurring sample of 16,648 self-reports about their experiences. Using a new method for computer-assisted qualitative content analysis, we identify categories, and themes organizing those categories, that affirm prior work and also provide new perspectives on that work, as well as suggesting connections between ideas in the literatures on reasons people die, reasons people live, and subjective and psychological well-being. The study highlights the value of computer-assisted methods as a way of achieving both scale and interpretable results, and it identifies a number of theoretical and clinical avenues for further investigation.

Voice plays a central role in trans women's experiences, influencing identity, mental health, and social participation. However, its role as a determinant of health remains insufficiently integrated into healthcare frameworks.

A scoping review was conducted following Joanna Briggs Institute guidance and PRISMA-ScR. Searches were performed in PubMed, Scopus, and PsycINFO, including qualitative, quantitative, and mixed-methods studies addressing vocal experience and well-being in adult trans women.

Ten studies (n = 214) were included. Voice is primarily conceptualized as a relational and perceptual phenomenon rather than a purely acoustic parameter. It is associated with anxiety, social avoidance, identity validation, and quality of life. Key barriers include binary gender norms and limited access to specialized services, while facilitators include affirmative care and supportive environments.

Voice should be understood as a complex determinant of health. Purely technical approaches are insufficient; instead, holistic models integrating psychosocial and contextual dimensions are needed to support autonomy and well-being.

People living with HIV (PLHIV) in situations of vulnerability in Catalonia, including those born outside Spain, at risk of social exclusion, or older adults, face greater barriers related to social determinants, mental health, stigma, and clinical complexity, which affect their adherence to ART and continuity of care. ActHIVa Cataluña was created with the objective of identifying strategic priorities, aligned with the Pla d'acció enfront del VIH i altres ITS 2021-2030, aimed at improving their comprehensive care and long-term quality of life.

A multidisciplinary group of 16 experts was convened to identify and prioritise lines of action through consensus, alongside conducting a Health Impact Assessment (HIA) to evaluate the potential impacts on health and equity of the proposed actions.

Twelve actions were agreed upon and grouped into four strategic objectives: early detection of risk determinants; assessment of quality of life and comprehensive care; strengthening of sociosanitary coordination; and involvement of PLHIV in decision-making. In a second phase, an HIA of the prioritized initiatives was carried out to estimate their potential effects on population health from an equity perspective.

The results highlight the potential of the proposed actions to strengthen comprehensive care and improve the quality of life of vulnerable PLHIV, enhancing their ART adherence and continuity of care, and supporting progress toward a more equitable, person-centred, and sustainable care model in Catalonia.

Many youth mental health reforms aim to shift care away from acute, hospital, or institutional settings and into community-based services, but few such initiatives have been subject to economic evaluations. We aimed to examine service utilisation and the corresponding return on investment for individuals receiving care via an enhanced primary-care youth mental health service.

We conducted a retrospective cohort study of an enhanced primary-care youth mental health service transformation in a major urban site of the pan-Canadian ACCESS Open Minds network, which provides assessment and interventions for all types and severities of mental health problems, with priorities co-designed by individuals with lived experience (young people, families, and carers). Administrative datasets were used to determine service utilisation and the associated costs, including programme implementation, for help-seeking youth aged 15-25 years with any mental health problem. A difference-in-differences approach compared outcomes pre-exposure with outcomes post-exposure to the ACCESS Open Minds service over 1 year, in relation to youth receiving a non-transformed service. Propensity score matching and sensitivity analyses ensured bias reduction and robustness of observations, respectively.

Between April 6, 2016, and Sept 30, 2019, 10 632 help-seeking youth (4821 [45·4%] males and 5801 [54·6%] females) were included. 1415 youths (mean age 20·1 years) received care from ACCESS Open Minds, and 9217 youths (19·3 years) received standard community mental health services. No ethnicity data were available in this administrative dataset. Compared with those receiving services in community mental health clinics, those receiving ACCESS Open Minds had more intensive service needs throughout the study period and had greater and statistically significant reductions in hospital admissions (CA$1961 savings); outpatient ($613 savings), specialist ($432 savings), and general practitioner visits ($47 savings); and public residential admissions ($1256 savings) per-person per-year. There were no significant differences in emergency department visits, the number of prescriptions dispensed, community mental health visits, or contracted residential admissions. Net cost reduction associated with ACCESS Open Minds was $4355 per-person per-year, with implementation costs of $448, representing a net benefit of $3907 (return on investment 9·7).

Consistent with principles of early intervention in mental health, ACCESS Open Minds implementation resulted in improved or equivalent outcomes but also shifted care towards community-based settings, with substantial net cost savings. These cost savings can be realised if novel services identify and treat not only new cases but also include those who were previously intensive users of standard services. The long-term return on investment of enhanced primary youth mental health models such as ACCESS Open Minds will likely rest on their commitment to including this population.

Canadian Institutes of Health Research and the Graham Boeckh Foundation.