The H1N1 influenza, a highly contagious acute respiratory disease, causes a significant burden on public health, especially during the winter season when the number of cases surges. Emergency department nurses, who are on the frontline of patient care during this period, are exposed to high - stress situations, increasing their risk of developing post - traumatic stress disorder (PTSD). Understanding the status of PTSD among them and its influencing factors is crucial for safeguarding their mental health and ensuring quality healthcare. This study aims to investigate the status of post-traumatic stress disorder (PTSD) among emergency department nurses in multiple tertiary hospitals in Shanghai, China during the winter H1N1 influenza season and analyze its influencing factors.

A cross - sectional study design was adopted from October 2023 to December 2023. A total of 116 emergency department nurses from multiple tertiary hospitals in Shanghai were selected as research subjects using cluster sampling during the peak period of winter H1N1 influenza. The Impact of Event Scale-Revised (IES-R), Maslach Burnout Inventory (MBI), Simplified Coping Style Questionnaire (SCSQ), Connor-Davidson Resilience Scale (CD-RISC), and Social Support Rating Scale (SSRS) were used for data collection. PTSD was defined as IES-R score ≥ 35, and participants were grouped as PTSD positive or negative. The relationship between PTSD and occupational burnout, coping styles, psychological resilience, and social support was analyzed.

Among the 116 participants, the rate of PTSD positivity was 44.86% (48/107). The MBI scores in all dimensions were significantly higher in the PTSD positive group compared to the PTSD negative group. The positive coping scores in the SCSQ were lower in the positive group, while the negative coping scores were higher. The CD-RISC scores in all dimensions were significantly lower in the PTSD positive group, as were the SSRS scores in all dimensions. Higher emotional exhaustion was significantly associated with increased odds of PTSD (OR = 1.16), indicating that for each one-point increase in emotional exhaustion, the odds of PTSD increased by 16%. Greater reliance on negative coping strategies was also independently associated with PTSD (OR = 1.23). In contrast, higher levels of optimism (a resilience factor) and greater subjective social support were protective, significantly lowering the odds of PTSD (OR = 0.76 and OR = 0.70, respectively).

The occurrence of PTSD among emergency department nurses during the winter H1N1 influenza season is considerable and closely related to occupational burnout, psychological resilience, coping styles, and social support. These findings highlight the urgent need for attention to this issue. However, this study has several limitations. The sample was only from top - tier hospitals in Shanghai during the winter influenza season, which may limit the generalizability of the findings. Also, relying on self-reported questionnaires may be subject to recall bias and self - reporting subjectivity.

Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for chronic insomnia, yet a significant proportion of patients fail to achieve favorable outcomes. Baseline-only prognostic models show limited predictive performance, and the added value of early treatment variables remains unclear. This retrospective study aimed to investigate this issue.

We retrospectively included 1059 patients who completed face-to-face group CBT-I. Post-treatment outcomes were assessed using the Insomnia Severity Index (ISI), and 12-month follow-up outcomes were evaluated using the Pittsburgh Sleep Quality Index (PSQI). The dataset was randomly split into training (70%) and test (30%) sets. Candidate predictors were selected using Least Absolute Shrinkage and Selection Operator, Random Forest, and eXtreme Gradient Boosting. Variables consistently identified across all three algorithms were entered into multivariable logistic regression models. Predictive performance of baseline-only and combined models (baseline plus early treatment variables) was evaluated using the area under the receiver operating characteristic curve (AUC) and Brier Score, with bootstrap resampling used for model comparison.

Unfavorable outcomes were observed in 32.4% of patients at post-treatment (neither ISI < 8 nor a reduction > 7) and in 44.5% at the 12-month follow-up (PSQI > 5). The combined model significantly outperformed the baseline-only model in predicting post-treatment outcomes in the test set (AUC: 0.741 vs 0.630, p < 0.001), with week  2 ISI change identified as the strongest predictor. For the 12-month follow-up, the combined model demonstrated a non-significantly higher AUC compared with the baseline-only model (0.742 vs 0.735, p > 0.05), with age emerging as the strongest predictor.

Incorporating early treatment variables, particularly Week 2 ISI score reduction, may provide incremental value in predicting short-term CBT-I outcomes. However, the added value of early treatment variables for long-term outcomes appeared limited.

Menopause is a major global health issue affecting cisgender women, transgender people, and gender-diverse populations, yet it remains under-recognised in research and policy, particularly in low-income and middle-income countries. Rising life expectancy means that an increasing proportion of the world's population spends many years in peri-, menopausal or post-menopausal stages, often with significant physical and psychological symptoms. Despite this burden, evidence from diverse global settings is limited.

The MARIE WP2a project is a mixed-methods study that aimed to explore menopausal health across 13 countries. Study conducted from January 2024 to September 2025. Eligible participants (cis and transgender women) experiencing perimenopause, menopause, or post-menopause were recruited digitally from clinical and community settings from UK, Rwanda, Nigeria, Ghana, Tanzania, Sri Lanka, India, Pakistan, Nepal, Malaysia, Singapore, Oman and Brazil. Here, we report the quantitative component of the broader mixed-methods study within MARIE WP2a. The present analysis focuses exclusively on cross-sectional quantitative data to characterise symptom burden and associated health domains across participating countries. The primary aim of MARIE WP2a was to explore and document the physical and mental health impacts of perimenopause, menopause, and post-menopause among women. Secondary aims included exploratory assessment of symptom patterns in a subset of participants with repeated observations in the change in symptoms, lower-back pain, and quality of life. Symptom burden was assessed using validated scales covering psychological, somatic, pain, sleep, disability, and quality-of-life domains. Analyses included multivariable linear models; analyses involving repeated observations were conducted as sensitivity analyses only and, country-grouped heterogeneity models, and Gaussian Graphical Modelling to examine symptom interconnections.

A total of 5228 participants from 13 countries were included. The median age was 55 years (IQR 50-61). The distribution of menopausal stages was 18.6% (n = 972) perimenopause, 32.2% (n = 1684) menopause, and 49.2% (n = 2572) post-menopause. Symptom burden varied substantially across countries and menopausal stages. The UK and Rwanda exhibited the highest levels of anxiety, depression, somatic burden, vasomotor symptoms, and overall MRS scores, while Nepal, Sri Lanka, Malaysia, and Singapore consistently showed lower burden. Clinical complexity including endometriosis, disability, long-term conditions, premature ovarian insufficiency, and GnRH analogue use was strongly associated with worse outcomes. Burnout emerged as the most central symptom connecting psychological and somatic domains.

Menopause is a complex biopsychosocial transition shaped by geography, social determinants, and multimorbidity. Rather than testing causal hypotheses, this analysis is descriptive and hypothesis-generating, aiming to characterise patterns across diverse populations. Our findings highlight the need for holistic, multidisciplinary, equity-focused menopause care and policy approaches beyond narrowly symptom-based models. Future research should prioritise longitudinal designs and culturally grounded approaches to better understand trajectories and inform integrated models of care.

NIHR Research Capability Fund.

Programs to support mental health in workplaces, particularly those using digital methods, show promise for increasing appropriate use of services. However, it is unclear which factors influence the successful implementation of such programs.

Implementation outcomes from a cluster randomised trial (cRCT) of a digital single-session intervention (Helipad program) for improving mental health help seeking in employees were explored using both qualitative interviews (n = 16) and quantitative data collected at post-test during the cRCT (N = 344). Linear regression analyses tested predictors of participation (uptake) by workplace, and predictors of participant views about the acceptability, appropriateness, and feasibility of both the Helipad program and the control (static psychoeducation only). Qualitative data were thematically analysed to summarise feedback and recommendations around implementing the program, based on the Consolidated Framework for Implementation Research.

The Helipad program performed better than the control program for participant implementation outcomes, with significantly superior acceptability, appropriateness, and feasibility. More intensive methods to encourage participation such as additional emails, meetings, and delivery via a learning management system were associated with significantly greater uptake. There were few differences in acceptability ratings between workplace types indicating that the program may be useful and acceptable in a broad range of settings. Qualitative data indicated that the Helipad program was easy-to-use and contained a broad range of information on workplace mental health. A challenge identified by participants was how to best engage people with less interest or low perceived need for mental health support. Recommendations for implementation included ensuring workplace leader investment, allowing time during work to complete the program and modelling positive attitudes and behaviours towards mental health and help seeking.

Implementation of workplace mental health interventions can be enhanced by clear communication with workplace leaders about its benefits, and by facilitating engagement of employees with the program during work time. Partnerships with stakeholders such as insurance companies or industry bodies may improve reach.Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623000270617.

Alcohol dependence is associated with alterations in prefrontal cortical function; however, previous functional near-infrared spectroscopy studies using verbal fluency tasks have produced inconsistent findings. This study examined differences in task-related cortical activation between Chinese male patients with alcohol dependence and healthy controls.

Thirty-one right-handed male inpatients with alcohol dependence and 31 healthy male controls completed a Mandarin verbal fluency task. A 52-channel functional near-infrared spectroscopy system was used to measure task-related changes in oxygenated hemoglobin concentrations. Channel-wise Δβ values were compared between the groups using independentsamples t-tests with correction for multiple comparisons.

The groups did not differ significantly in age or years of education. Compared with healthy controls, patients with alcohol dependence exhibited greater oxygenated hemoglobin activation in channel 23, which primarily covered the right dorsolateral prefrontal cortex and partially overlapped with the right inferior frontal gyrus (t = 3.315, FDR-adjusted q = 0.104). No significant between-group differences were observed in the other channels.

Increased activation in the right dorsolateral prefrontal cortex and right inferior frontal gyrus may reflect compensatory recruitment of neural resources or increased engagement of cognitive-control and emotion-regulation systems. Functional near-infrared spectroscopy may be a useful tool for assessing cortical function in alcohol dependence, although larger, mixed-sex, and cross-linguistic studies are required to validate these findings.

Generalized anxiety disorder (GAD), characterized by persistent and excessive worry, exhibits high treatment resistance. While self-compassion training shows promise in alleviating anxiety, its acute effects on stress-related autonomic regulation in GAD remain unclear. This randomized controlled trial examined whether a single-session compassionate self-talk protocol improves emotional and autonomic stress responses in GAD, focusing on high-frequency heart rate variability (HF-HRV) as an index of parasympathetic engagement. Forty-six clinically diagnosed GAD participants were randomly assigned to either a compassionate self-talk group (n = 23) or a neutral self-talk control (n = 23). Participants completed a cognitive stress task (time-limited Raven's matrices with evaluative feedback) with continuous electrocardiogram (ECG) recording. State anxiety (STAI-S), perceived stress, state self-compassion (SSCS), and affect (PANAS) were assessed pre- and post-intervention. The self-compassion group showed greater reductions in perceived stress (t ₍₄₄₎  = -2.09, p = 0.043, d = 0.62) and increased positive affect (t ₍₄₄₎  = 2.29, p = 0.028, d = 0.67), though no significant group differences emerged for state anxiety or state self-compassion. During stress exposure, HF-HRV was significantly higher in the self-compassion group (t ₍₃₇₎  = 2.15, p _corrected  = 0.038) during a late post-feedback interval. Correlational analyses revealed that increased state self-compassion correlated with reduced stress (r = -0.54, p = 0.001) and anxiety (r = -0.45, p = 0.010). These findings suggest that brief compassionate self-talk may improve subjective stress coping in GAD and may be associated with altered event-related autonomic dynamics during cognitive stress. Given the modest sample and ultra-short HRV segments, physiological interpretations warrant a cautious approach. Future studies may test whether combining self-compassion training with HRV biofeedback optimizes intervention efficacy in clinical settings.

ChiCTR.org.cn, identifier ChiCTR2100053374.

Disorders of gut-brain interaction (DGBI) are common, disabling, and frequently accompanied by anxiety, depressive symptoms, sleep disturbance, symptom-related fear, and repeated health care use. In routine gastroenterology practice, these problems are often recognized late, after fragmented histories, multiple visits, and avoidable investigations. Recent work on generative artificial intelligence (GenAI) and conversational systems suggests a narrower and more practical clinical use case than autonomous diagnosis: supervised pre-consultation triage. We propose that DGBI is a suitable setting for this approach because triage depends on integrating symptom narratives, prior investigations, alarm features, and psychosocial context rather than on a single test result. A GenAI-enabled intake tool could summarize patient-entered histories, incorporate brief distress screening and symptom diaries, flag possible medical or psychiatric escalation, and help route patients toward standard gastroenterology review, integrated psychogastroenterology, dietetic input, or urgent assessment. Its value would lie in making the first consultation more efficient and more clinically informed, not in replacing specialist judgment. For such systems to be acceptable, five conditions are essential: a narrowly defined triage task, multidomain but proportionate data collection, explicit rules for medical and psychiatric escalation, clinician review before action, and prospective evaluation across workflow, safety, equity, and patient acceptability. DGBI offers a realistic opportunity to develop GenAI tools that are useful precisely because they are constrained, auditable, and embedded in multidisciplinary care.

Snakebite envenomation is a major public health issue in tropical regions like South India, yet its psychological consequences, particularly post-traumatic stress disorder (PTSD), remain underexplored.

To evaluate mental health outcomes and identify risk factors for PTSD among snakebite survivors.

This prospective observational study enrolled 98 adult snakebite patients at a tertiary care center, selected based on inclusion criteria and data completion. Sociodemographic, bite incident, and clinical data were collected via semi-structured interviews. PTSD severity was assessed longitudinally over 6 months using the short PTSD rating interview (SPRINT) scale. Chi-square tests and logistic regression analyzed associations between variables and PTSD.

Of the 98 participants, 38.78% developed PTSD (21.43% mild, 15.31% moderate, 2.04% severe). Significant associations with PTSD included rural residence (P = 0.012, OR = 1.98, 95% CI: 1.16-3.39), venomous snakebites (P < 0.001, OR = 2.45, 95% CI: 1.32-4.56), bite site (P = 0.003), loss of consciousness (P = 0.002, OR = 3.12, 95% CI: 1.67-5.83), and delayed hospital arrival (>4 hours, P = 0.004, OR = 2.89, 95% CI: 1.45-5.76).

PTSD is a significant concern among snakebite survivors, with identifiable risk factors. Integrated care combining medical and psychological interventions is essential for recovery. Future longitudinal studies and targeted interventions are needed.

Dual disorders, involving co-occurring mental health and substance use conditions, present diagnostic challenges due to overlapping symptoms.

To assess the diagnostic agreement of mental health professionals in evaluating dual diagnosis cases.

This Cross-sectional study surveyed 73 mental health professionals using two clinical vignettes that depicted common dual disorder scenarios: psychotic symptoms co-occurring with cannabis use and depressive symptoms co-occurring with alcohol use. Participants chose a diagnosis, rated confidence (1-10), and identified influencing factors, along with alternative differentials.

For the first case vignette, majority (60.2%) favored schizophrenia with cannabis use over cannabis-induced psychosis, while small number endorsed other psychotic disorders. In the second case vignette, most (89.0%) clinicians preferred major depressive disorder with harmful alcohol use, rather than alcohol-induced mood disorder. Overall confidence agreement was high (average measure ICC = 0.986) despite differences in diagnosis.

Although clinicians diagnostic reasoning varied but confidence ratings demonstrated excellent inter - rater agreement (Average ICC = 0.986).

Psychiatry remains underrepresented in undergraduate medical education in India. Despite curricular reforms increasing theoretical and clinical exposure, traditional lecture-based methods predominate, potentially limiting engagement, and skill acquisition.

To explore undergraduate medical students' perspectives on psychiatry teaching across South India.

Cross-sectional online survey was conducted among undergraduate students using a semi-structured questionnaire and the Medical Students' Perspectives of Effective Psychiatry Teaching Methods scale. Descriptive statistics and Chi-square tests were applied.

Sixty-three students (mean age 22.7 ± 1.16), predominantly from semesters 7 to 9 (batch 2020), participated. Faculty presentation skills, communication, and use of teaching aids were rated positively. However, innovative teaching methods were perceived as limited. Audio-visual aids, role plays, and small-group discussions were commonly suggested improvements. Significant associations were found with attendance, semester level, and year of joining.

While conventional teaching is effective, integrating innovative, learner-centered approaches and strengthening faculty development is essential to enhance psychiatric education.