Search Results (559)

Suicide is the third-leading cause of death in the age group 15–29. In recent years, suicide completions as well as attempts have notably risen, with suicide being highlighted as a major mental health crisis. While risk factors associated with suicide are well-documented, our qualitative understanding of the deeper experiences of suicidality remains limited. One factor that has been found to relate to suicidality is family size, with research finding that having more older siblings is associated with higher suicide risk. To better understand the dynamics of suicidality in large families, eight participants from families of four or more children were interviewed, and interpretative phenomenological analysis was used. A variety of internal and environmental factors that contributed to suicidality in large families were found, including exposure to suicide, poverty, abuse, and a sense of worthlessness. The findings of this study support the need for additional research to validate the factors associated with an aversive environment and internal processes in suicidality. Although not all multi-sibling families experience suicidality, factors exist that can exacerbate risk among large families. Discussion regarding future implications is included. Full article

Background and Objectives: Very preterm infants are vulnerable to late-onset infection and prolonged NICU exposure, with potential downstream effects on caregiver health. We evaluated neonatal outcomes and caregiver psychosocial status across culture-confirmed infection phenotypes. Methods: We investigated a single-center prospective cohort (March 2023–December 2025) of 87 preterm infants assigned to one of three groups: no proven infection (n = 44), bacterial sepsis (n = 31), or candidemia (n = 12). Neonatal outcomes included a composite adverse endpoint (death or major morbidity) and resource utilization. Caregivers completed the SF-36, WHOQOL-BREF, HADS, PHQ-9, GAD-7, and Body Image Scale near discharge. Results: Candidemia occurred later than bacterial sepsis (day of life 17.8 ± 4.8 vs. 10.1 ± 3.9; p < 0.001) and had a longer time to effective therapy (23.3 ± 9.5 vs. 13.3 ± 5.3 h; p = 0.004). The composite adverse outcome was 27.3% in the no-infection group versus 54.8% in the bacterial group and 58.3% in the candidemia group (p = 0.025); ROP requiring treatment increased from 4.5% to 29.0% and 25.0% (p = 0.012). Length of stay rose from 39.7 ± 10.2 to 50.1 ± 11.9 and 60.9 ± 13.1 days (p < 0.001), and ventilation days from 15.7 ± 7.6 to 23.3 ± 7.5 and 34.2 ± 10.4 (p < 0.001). Caregiver SF-36 mental health (MCS) scores decreased from 44.7 ± 7.5 to 38.5 ± 6.0 and 36.7 ± 6.4 (p < 0.001), while PHQ-9 scores increased from 9.4 ± 3.9 to 11.6 ± 3.3 and 15.5 ± 4.6 (p < 0.001); NICU burden correlated with PHQ-9 scores (r = 0.52, p < 0.001). Conclusions: Culture-confirmed infection, particularly candidemia, was associated with higher neonatal morbidity, markedly greater resource use, and substantial caregiver distress at discharge. Full article

Background: Fermented dairy foods, such as yogurt and cheese, contain bioactive components that differ from those in non-dairy foods, but their associations with depression and dementia risk in later life remain unclear. Methods: We analyzed data from the Sydney Memory and Ageing Study, a community-dwelling cohort of adults aged 70–90 years, to examine associations between dairy intake and depressive symptoms (Geriatric Depression Scale-15), psychological distress (Kessler-10), and incident depression (physician diagnosis or antidepressant use) and dementia (DSM-IV criteria). Intake of yogurt, cheese, and non-fermented milk was assessed at baseline using a validated food-frequency questionnaire. Longitudinal associations were examined using Fine–Gray competing-risks models that accounted for death; cross-sectional associations were also assessed. Results: Among 966 participants (mean age: 78.3; 55.5% women), compared with no consumption, higher yogurt intake (one standard serving) was significantly associated with lower depressive symptom scores (adjusted β: −0.37 and −0.39 for quartiles 3–4 (mean: 88.5–164 g/day), and so was low-fat cheese intake (mean: 13.2 g/day) (adjusted β: −0.35). Over a mean follow-up of 3.3 years, 120 incident cases of depression and 68 deaths occurred: higher yogurt intake and low-fat cheese consumption (versus non-consumption) were associated with lower risk of depression (adjusted subdistribution hazard ratios 0.41 [95% CI 0.19–0.88] and 0.40 [0.21–0.78], respectively). No significant associations were observed for psychological distress, cognition, or incident dementia (a mean follow-up of 5.2 years, 100 incident cases, and 153 deaths); no associations were observed for regular cheese or milk intake. Conclusions: These findings suggest a potential role for fermented dairy foods, particularly yogurt and low-fat cheese intake, but not non-fermented milk, in mental well-being in later life. Full article

Background: Medical Assistance in Dying (MAiD) was first legalized in Canada in 2016, with legislation expanding from foreseeable to non-foreseeable natural deaths. A sole underlying medical condition of mental illness is expected to be added in 2027. Although legislation and reporting requirements are federally mandated, the implementation and delivery of MAiD are the responsibility of individual provinces and territories. Objectives: The aim of this study is to compare the organization, delivery, and oversight of MAiD programs across provinces and territories in consideration of access, equity, and safeguards. Methods: This study used a mixed methods approach to collect data. A comprehensive and systematic search for published peer reviewed literature on MAiD programs in Canada was conducted along with qualitative interviews with key informants using purposive and snowball sampling. A qualitative descriptive design was used for qualitative data, including content analysis. To facilitate a detailed comparative analysis of MAiD across jurisdictions, separate tables were created for each component or element, organizing the results of the literature review and qualitative analysis by jurisdiction. Patterns within these tables were identified through qualitative interpretation. The findings were then summarized in a narrative format. Results: A total of 113 interviews were conducted, representing all provinces and territories but Nunavut. Findings showed varied practices throughout the MAiD process between jurisdictions. Conclusions: The main findings of this study are that the organization of MAiD programs, oversight, reporting methods to Health Canada, intake, preliminary assessments, assessments, provision, and bereavement support vary. In addition, specific policies related to potentially vulnerable populations are lacking and jurisdictional practices also vary. Centralized, multidisciplinary MAiD programs with strong oversight mechanisms may strengthen issues related to access, equity, and safeguards. Full article

Introduction: Female sex workers (FSWs) face heightened health risks, particularly from HIV, which accounts for 8% of FSW deaths in low- and middle-income countries. Adherence to antiretroviral therapy (ART) remains suboptimal and few studies have explored drivers of ART non-adherence among FSWs who died from HIV in sub-Saharan Africa. Methods: Using a community knowledge approach methodology, data on HIV-related deaths among FSWs were collected from a convenience sample across Kenya, Nigeria, and the Democratic Republic of the Congo between 1 February 2022, and 28 February 2023. Participants were recruited through local sex worker organizations and non-governmental organizations. A structured questionnaire was used to collect demographic data, HIV treatment history, and reasons for ART non-adherence from participants about the deaths of FSWs they knew of personally. A qualitative descriptive analysis was used to code the interviews for reasons for ART non-adherence. Results: A total of 853 FSWs reported the deaths of 445 peers who had died from HIV/AIDS. The mean age at death was 27 years; 70.6% were mothers. Among the deceased, 95.1% were not taking antiretrovirals at the time of their death, and 90% had stopped using ART, rather than never initiating treatment. The most cited reasons for ART non-adherence were food insecurity (97; 22.9%), alcohol and drug use (44; 10.4%), depression (57; 13.5%), and stigma (24; 5.7%). Conclusion: HIV-related deaths among FSWs in these three sub-Saharan African countries are associated with food insecurity, mental health issues, substance use, and stigma. Improving access to ART alone is insufficient to reduce mortality. Full article

This study compared real-world overall survival and the risk of physical comorbidities and mental health conditions among patients aged <65 years with versus without inherited retinal diseases (IRDs) in the United States (US). Optum^® Electronic Health Record data (January 2014–January 2023) were evaluated for IRD (patients with ≥2 medical visits with an IRD diagnosis; index date: second such medical visit) and non-IRD (patients without an IRD diagnosis; index date: random medical visit) cohorts. Baseline demographics were balanced between cohorts using propensity score matching (2:1). Outcome measures were overall survival (date of death due to any cause) and presence of physical comorbidities and mental health conditions (medical visit with a corresponding diagnosis code). In total, 4594 patients with IRD were matched to 9188 patients without IRD (mean age: 38.7 vs. 38.2 years, 53.9% vs. 55.1% female, mean follow-up: 53.1 vs. 52.8 months). Over 84 months, patients with versus without IRD had a 24% higher risk of death (overall survival: 95.8% vs. 96.7%; hazard ratio: 1.24; 95% confidence interval: 1.00–1.53; p = 0.046) and were at significantly higher risk for each evaluated physical comorbidity and mental health condition (all p < 0.05). The development of novel therapies is thus needed to address the clinical burden of IRD. Full article

Background: Suicide remains a leading cause of death in the United States, with more than 49,000 fatalities in 2023. Rural counties consistently face higher suicide mortality rates than urban areas, reflecting deep-seated mental health inequities. Methods: This study analyzes 39 U.S. states with suicide mortality rates exceeding the national average, as defined by the Centers for Disease Control and Prevention (CDC) (>14.1 per 100,000), to examine rural–urban disparities and their intersectional demographic factors. Age-adjusted mortality data (2019–2023) from HDPulse were analyzed using IBM SPSS Statistics, version 31.0. Counties were classified by USDA Rural–Urban Continuum Codes and stratified by region, sex, age, and race. Subgroup differences were tested using a two-way ANOVA (p < 0.01). Results: Rural suicide rates were significantly higher than urban rates (28.69 vs. 20.20 per 100,000; p < 0.001). The West reported the highest mortality and widest rural–urban gap (38.23 vs. 24.83), while the Northeast had the lowest. Men had higher rates than women, particularly in rural settings (37.12 vs. 11.77). The largest rural–urban gap occurred among young adults (20–39 years). American Indian/Alaska Native populations experienced the highest rates (rural: 58.73; urban: 35.15). The literature review highlighted limited healthcare access, social stigma, substance use, and economic hardship as variables commonly associated with rural–urban differences in suicide mortality. Conclusions: Suicide mortality is markedly elevated in rural America across all subgroups, with the greatest risks among young adults, men, and American Indian/Alaska Native populations. Tailored prevention strategies and expanded mental health infrastructure are critical for high-burden states. Full article

To understand how student journalists handle news coverage surrounding suicide, this study took a case study approach and analyzed how two student newspaper staffs at U.S.-based universities reported on the topic throughout the 2022–2023 academic year, in which multiple student deaths by suicide occurred on each campus. Guided by the literature on trauma in journalism and the Communication Theory of Coping, and through interviews with reporters, editors, and the newspapers’ advisors and a thematic analysis of the newspapers’ coverage during that academic year, we were able to glean insight into how coverage decisions were made, how students navigated such a sensitive topic, and how they enacted care for each other during and after the coverage period. Our findings underscore the pivotal role of the newspaper advisor in helping students navigate such sensitive reporting. Full article

(1) Background: Induced After-Death Communication (IADC) therapy is a brief intervention facilitating grief resolution through a perceived experience of communication with the deceased. Despite growing evidence of its efficacy, little is known about which individual characteristics may influence treatment responsiveness. (2) Methods: This pre–post study investigated psychological predictors of IADC outcomes in 73 bereaved adults. Standardized measures assessed grief severity, alexithymia, dissociation, attachment dimensions, and Big Five personality traits. Changes in grief-related distress and continuing bonds were analyzed using paired-sample t-tests and hierarchical regressions. (3) Results: IADC therapy produced substantial reductions in grief-related distress and enhanced continuing bonds. Dissociation, demographic variables, and most personality traits were unrelated to outcomes. Neuroticism showed a marginally negative association, whereas Openness predicted greater improvement. Alexithymia negatively predicted clinical gains, suggesting that limited emotional awareness may interfere with the therapeutic phase of abreaction and, in turn, limit access to the receptive state. Among attachment dimensions, only Need for Approval significantly predicted poorer outcomes, consistent with performance anxiety and self-evaluative control interfering with spontaneous mental processes. (4) Conclusions: IADC therapy appears highly effective across diverse individual profiles. Screening for alexithymia and Need for Approval may help identify these potential sources of therapeutic failure and be followed by targeted strategies aimed at counteracting their impact and mitigating their effects. Full article

Background/Objectives: Insomnia is common among adolescents and is associated with emotional, behavioral, and academic difficulties. Although high rates have been reported globally, evidence in Latin America—particularly in Peru—remains limited and heterogeneous. Many previous studies relied on small samples, descriptive designs, omitted key psychosocial variables, or were conducted during early pandemic waves, despite the rise in sleep disturbances following COVID-19 restrictions. This study aimed to estimate the prevalence of insomnia and identify associated factors among adolescents in northern Peru. Methods: An analytical cross-sectional study was conducted using secondary data from students attending five schools in Lambayeque, Peru. Insomnia was assessed using the Insomnia Severity Index (ISI). Sociodemographic, psychosocial, behavioral, and health-related variables—including self-esteem, family dysfunction, eating disorders, acne severity, mental health help-seeking, and digital behavior—were evaluated. Generalized linear models estimated prevalence ratios (PRs) and 95% confidence intervals (CIs). Results: Among 1313 adolescents (54.3% male; mean age 14.6 years), the prevalence of insomnia was 38.9% (95% CI: 36.1–41.5). In adjusted analyses, insomnia was associated with urban residence, non-Catholic religion, seeking mental health support, high social media use, internet use of 6–10 h/day, low self-esteem, eating disorders, greater acne severity, and experiencing the death of a family member due to COVID-19. Conclusions: Nearly four in ten adolescents reported insomnia, influenced by sociodemographic, psychosocial, and lifestyle-related factors. These findings provide updated post-pandemic evidence for the Peruvian context and highlight the multifactorial nature of adolescent insomnia. Further research is needed to clarify causal pathways and understand the long-term mental health implications of large-scale stressors such as the COVID-19 pandemic. Full article

Perinatal mental health (PMH) conditions are the most common complications of pregnancy and the first postpartum year. Adverse childhood experiences (ACEs) are increasingly recognized as important contributors to PMH, particularly postpartum depression and anxiety (PPD/A). This study examines a broad range of ACEs—including parental mental illness and substance use, incarceration, death, divorce, discrimination, economic hardship, and forced migration—to assess their influence on PPD/A. Using a modified explanatory sequential mixed-methods design, phase I included an online survey of racially, ethnically, and socioeconomically diverse U.S. women (n = 306) who delivered a live infant in the past year. Hierarchical regression showed that while ACEs initially predicted PPD/A, this association was no longer significant when social support, material hardship, and discrimination were added to the model. These current life circumstances emerged as stronger direct predictors of PPD/A than ACEs. In phase II, purposive and stratified sampling identified participants with ACE scores ≥ 4 for interviews (n = 22). Qualitative findings identified social support, financial security, work flexibility and choice, and time for self-care as central protective factors in adjustment to motherhood when these resources aligned with mothers’ individual needs and values. Results can inform clinical counseling, ACEs screening, and policies to strengthen PMH support. Full article

Considering the high prevalence of adolescent depression and anxiety, the profound functional consequences of untreated early psychosis and suicide being the number one cause of death in Australia among 15–19-year-olds, ensuring that teachers are literate about these disorders should be a high priority. Teachers’ disorder-specific literacy is a pragmatic response to healthcare system constraints. This scoping review aimed to map the evidence of teacher mental health literacy training programs, specifically for depression, anxiety, early psychosis and suicide risk. PRISMA-ScR guidelines were followed. Included studies were published in English between 2000 and 2024, focused on teachers working with students in Year 7–12 and measured teachers’ knowledge of depression, anxiety, psychosis or suicide risk. Studies were appraised for quality. Eighteen studies met the inclusion criteria. Nine evaluated knowledge of student depression, five evaluated knowledge of anxiety and five evaluated knowledge of psychosis, while nine studies focused on suicide risk. Providing disorder-specific training and evaluation, rather than general mental health literacy training, is recommended for future research. When healthcare systems lack the capacity to provide care for ill adolescents, schools often function as frontline sites for recognition and triage. Disorder-specific literacy is recommended for teachers so they can manage their real-world, health-system compensation role. Full article

Suicide in children and young adults is a leading cause of premature mortality, and there is a need to develop a more profound understanding of the factors that contribute to these deaths. This study is part of the nationwide Retrospective Investigation of Health Care Utilization in Individuals who died by Suicide in Sweden 2015, conducted at Lund University, Sweden. The aim was to examine symptoms and diagnoses in children and young adults who died by suicide, as documented in their medical records at their last visits for primary care, somatic specialist care, or psychiatric care 24 months prior to suicide, and to apply contemporary psychological research in youth suicidality to the findings to formulate clinical implications. The proportions of symptoms and diagnoses in children (0–17 years), young adults (18–24 years), males, and females are described. The main symptoms noted in the cohort were depressive symptoms (28%), anxiety symptoms (26%), and pain (25%). The diagnoses predominately covered mental and behavioural disorders, and the most frequent of the mental and behavioural diagnoses were neurotic, stress-related, and somatoform disorders (32%) and mood (affective) disorders (29%). The diagnoses and symptoms were not sufficient to uncover suicidality in children and young adults. The clinical implications for alternative assessments and preventive interventions are discussed. Full article

Background/Objectives: Suicide is the second leading cause of death among adolescents and young adults. Those suffering from psychiatric illnesses are at particular risk. Our study, conducted at an outpatient mental health facility in Northern Italy, aimed at delineating demographic and psychopathological features of youths aged 16–29 who attempted suicide and were referred to our community-based outpatient service. Methods: We identified 63 subjects, most of whom suffered from personality disorders, mood disorders, and schizophrenia spectrum disorders. Analysis of variance and post hoc pairwise comparisons were performed. Results: Inferential analysis yielded significant results in terms of age at index suicide attempt across diagnostic groups. Patients with personality disorders attempted suicide at a younger age (M = 18.70) compared to those with schizophrenia spectrum disorders (M = 23.64; η² = 0.32). Conclusions: Our findings highlighted the period of transition from adolescence to adulthood as a stress on the need of preventive approaches towards suicidality in young people in both clinical and non-clinical settings. Moreover, the difference of age at index suicide attempt across different diagnostic groups stresses the need for tailored clinical interventions based on the specific psychopathological trajectories and natural histories of the diseases. Full article

While most prison healthcare litigation seeks individual relief, some cases lead to broader structural reform via consent decrees—court-approved “legally binding performance improvement plans” designed to improve conditions. This study systematically analyzes 121 such settlements from 1970 to 2022 to assess their policy goals and implementation strategies. We identify the substantive areas targeted—general medical care, mental health, dental services, and treatment for specialized conditions like HIV, Hepatitis C, and COVID-19—and trace trends across time and geography. These agreements span 39 states and the federal system, with most states subject to multiple cases. They frequently mandate changes to budgets, staffing, facility infrastructure, training, and patient rights, alongside monitoring for quality improvement. Our findings suggest that consent decrees function not only as judicial remedies but as tools of policy development and institutional reform, shedding light on the role of courts in shaping correctional healthcare delivery. These findings also show how institutional responses to healthcare failures in prisons shape the conditions under which serious harm—and in some cases, preventable death—occur behind bars. Full article