Search Results (1,441)

Background: The introduction of targeted therapy in oncology has led to several challenges. These medicines are relatively new in clinical practice and are not well known to specialists with regard to adverse drug reactions (ADRs) and potential drug–drug interactions (pDDIs). In addition, cancer affects multiple body systems, including weight loss, anemia, liver and kidney function, depression, and pain. Patients frequently have comorbidities, leading to polypharmacy and the use of special foods, nutritional supplements, and herbal products for self-medication. Identification of pDDIs is essential, as concomitant use of multiple medicinal products increases the risk of ADRs and may compromise treatment. Objective: This study aims to retrospectively review and analyze data on ADRs and pDDIs in the treatment of non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) inhibitors and to evaluate the relationship between them. Method: EudraVigilance and UpToDate^® Lexidrug™ application were used to screen suspected ADRs and pDDIs, respectively. Descriptive statistical analysis was performed. Results: After reviewing Line Listing Reports (LLRs) from 2021 to 2023 in EudraVigilance, the number of suspected adverse drug reactions (ADRs) reported was higher when drug interactions classified as risk categories D and X were identified, compared with cases involving EGFR inhibitor monotherapy or other drug combinations. Of the 144 cases involving category D and/or X interactions, 63 demonstrated a possible association with the reported ADRs of EGFR inhibitors. The most common pDDIs detected were erlotinib–ranitidine (14 cases, category D) and osimertinib–amiodarone (13 cases, category D). Conclusions: Although EGFR inhibitors improve overall and progression-free survival in NSCLC, screening for pDDIs before treatment is essential to improve safety and quality of life. Full article

Background: This study examined age-related differences and interrelationships among psychological symptoms, personality traits, and emotional expression styles in a community sample of 151 participants aged 10–77 years, spanning four age groups: adolescents, young adults, middle-aged adults, and older adults. Methods: Psychological symptoms were assessed using the SCL-90, personality traits using the Big Five Inventory-2 (BFI-2), and emotional expression patterns were derived from facial expression recognition via a convolutional neural network (CNN) model. Kruskal–Wallis H tests were used to examine age-related differences. K-means cluster analysis was applied to identify emotional expression patterns, and logistic regression was used to construct a mental health risk screening model. Results: The young adult group (19–35 years) achieved the highest scores on the depression (M = 1.73) and anxiety (M = 1.61) dimensions, indicating a higher level of psychological distress during this life stage. Personality traits showed a significant developmental trajectory: neuroticism decreased with age (H(3) = 17.09, p < 0.001, η² = 0.11), declining from 2.69 in the young adult group to 2.17 in the older adult group; conscientiousness increased with age (H(3) = 37.39, p < 0.001, η² = 0.24), representing the most substantial age-related effect. K-means clustering identified three distinct emotional expression patterns: Cluster 1 was characterised by happiness, Cluster 2 by anger, disgust, and fear, and Cluster 3 by neutrality, sadness, and surprise. Cluster 2 exhibited the highest scores on neuroticism, anxiety, depression, and mood swings, and scored significantly higher than the other two clusters on interpersonal sensitivity, depression, anxiety, and hostility (p < 0.05). Mental health risk screening indicated that 26.5% of participants were classified as high-risk. Logistic regression analysis (AUC = 0.742) showed that neuroticism was the strongest predictor of elevated mental health risk (OR = 4.58), while extraversion (OR = 0.41) and conscientiousness (OR = 0.57) were significant protective factors. Conclusions: These findings provide exploratory evidence regarding age-related patterns of psychological symptoms and personality traits in a convenience sample and offer preliminary support for personality-based mental health risk screening. Notably, the SCL-90 was employed as a screening tool rather than for clinical diagnosis. Given the unequal age group sizes, particularly the small young adult subgroup, generalisability across the lifespan should not be assumed. Full article

Speech-based depression detection is promising for objective mental health assessment. However, conventional methods relying on short-frame acoustic features often fail to capture long-term temporal and behavioral characteristics of speech essential for modeling depression-specific speaking patterns. Herein, four novel acoustic feature sets extracted from long-term speech are proposed: utterance interval feature set (UIFS), pause interval feature set (PIFS), response interval feature set (RIFS), and speech density (SD). These features explicitly characterize temporal structures and session-level speech behaviors beyond short-frame analysis. These features are combined with conventional acoustic features, including standard features extracted using openSMILE and voice level features, and evaluated using support vector machines under subject-independent conditions for the binary classification of depressed and nondepressed speakers. Incorporating the proposed features improves classification performance compared with baseline features (accuracy: 0.54 for openSMILE and 0.52 for openSMILE + voice level features). The configuration integrating all four proposed feature sets achieves an accuracy of 0.58, a precision of 0.56, a recall of 0.58, and a specificity of 0.58, indicating consistent performance gains under subject-independent and strictly controlled evaluation conditions. Thus, depression-related speech patterns can be captured by explicitly modeling temporal and behavioral speech characteristics across entire dialog sessions. This study contributes to advancing acoustic feature design for speech-based depression detection and developing clinically supportive screening and monitoring technologies. Full article

Background: Refugees arriving from conflict zones often continue to experience trauma and are at increased risk of anxiety and depression. Those seeking asylum form a group at higher risk of suffering adverse mental health outcomes, with higher needs for psychosocial and therapeutic care. This study aimed to determine metabolic changes potentially associated with psychological distress in refugees from Syria, using a saliva-based metabolomics approach via proton nuclear magnetic resonance (1H NMR) spectroscopy. Methods: Participants were recruited from Lethbridge Family Services and categorized into high and low stress burden groups using questionnaires assessing depression (PHQ-9) and generalized anxiety (GAD-7). Salivary metabolomic profiles from 26 female and 32 male participants were analyzed using supervised and unsupervised multivariate statistical methods to identify metabolic differences linked to composite stress, depression, and anxiety. Results: Salivary metabolic profiles showed the most prominent differences associated with anxiety in female participants and depression in male participants. Multivariate statistical analyses identified 31 metabolites and 13 biological pathways that were significantly altered according to mental health status, with the greatest changes observed in glycolysis/gluconeogenesis, sphingolipid metabolism, and taurine/hypotaurine metabolism. Conclusions: These findings indicate that salivary 1H NMR metabolomic profiling can identify a quantifiable “metabolic fingerprint” related to impaired mental health and psychological distress in a cost-effective, objective, and non-invasive way. This analytical strategy shows potential as a screening tool to support effective decision-making, enabling early identification of individuals at highest risk who require timely emotional and medical support. Full article

Background: Emotion regulation and attachment styles are interrelated and are critical factors in psychopathology and treatment outcomes, particularly in youths with suicidal behavior receiving psychiatric inpatient care. This study examined the influence of emotion regulation and attachment style on psychiatric hospitalization duration among adolescents admitted due to suicidal ideation or behavior. Methods: Participants included 79 Israeli adolescents (mean age 15.35 years, 87.3% female) admitted to a tertiary psychiatric inpatient unit following a suicidal crisis. Data was collected using the Difficulties in Emotion Regulation Scale (DERS), the Experience in Close Relationships Scale (ECR), the Screen for Child Anxiety-Related Emotional Disorders (SCARED), the Patient Health Questionnaire (PHQ-9), and the Columbia-Suicide Severity Rating Scale (C-SSRS). Data were analyzed using correlation and multiple regression analyses. Results: Analysis revealed that greater emotion regulation difficulties predicted longer hospitalization duration (β = 0.41, p < 0.001), while avoidant attachment style was associated with shorter hospitalization duration (β = −0.35, p < 0.001). Notably, the level of suicidality as well as psychopathology symptoms (depression and anxiety) did not predict hospitalization duration. Conclusions: These findings underscore the important role of emotion regulation and attachment style in determining treatment duration in suicidal adolescents, beyond the severity of psychopathology and suicidality, suggesting their unique contribution to treatment planning. Clinical interventions targeting emotion regulation and attachment styles could enhance inpatient care effectiveness, offer a more personalized treatment approach and potentially reducing hospitalization duration. Full article

Therapeutic termination of pregnancy (TToP) represents an intervention that is performed for medical reasons, such as risks to maternal health or severe fetal anomalies. Advances in prenatal screening and diagnostic tools—including serum markers, ultrasound, cell-free fetal DNA, chorionic villus sampling and amniocentesis—have significantly improved early detection and clinical decision-making. This narrative review synthesizes current knowledge on the genetic, environmental and psychosocial determinants that influence the decision of the patients to pursue TToP. The literature search was performed primarily using PubMed database, while Scopus and Google Scholar were used to identify additional relevant studies. Some of the selected studies, as well as certain sections of this review, address both therapeutic and voluntary termination of pregnancy, whereas others focus exclusively on TToP. Moreover, this review describes the types of abortion (medical or surgical/aspiration) along with their management strategies to prevent or address potential complications. It is well known that demographic, cultural and socio-economic factors continue to influence the access to TToP, as well as the perceptions of it. Psychiatric comorbidities (such as anxiety, affective and psychotic disorders) are observed with a higher prevalence among women undergoing TToP and may influence both the decision and psychological outcomes post-procedure. While most women report emotional relief after TToP, some of them experience depression, post-traumatic stress disorder or substance misuse. Legal and ethical considerations further complicate access to safe abortion, leading to situations where patients may resort to unsafe procedures, which result in higher rates of morbidity and mortality. Data from the EUROCAT network show rising trends in congenital anomalies like trisomy 13, trisomy 18 and caudal regression syndrome (conditions commonly associated with TToP). Therefore, it is mandatory to form a multidisciplinary team in these cases, integrating medical, psychological and ethical dimensions. Ensuring safe, evidence-based and compassionate access to TToP remains a critical component of reproductive healthcare. Full article

Background: Mild traumatic brain injury (mTBI) is frequently associated with persistent cognitive and psychosocial symptoms, yet biological correlates of recovery remain poorly understood, particularly among Asian and Pacific Islander (API) populations. Pre-injury psychosocial adversity may further shape post-injury recovery trajectories. This pilot study examined associations between participation in a 2-week, home-based, dual-task cognitive–walking intervention (Daily Brain Exercise; DBE) and changes in cognitive, psychological, and salivary microRNA (miRNAs) measures among APIs with and without a self-reported history of mTBI. Methods: API participants completed remote cognitive testing (CNS Vital Signs), psychosocial assessments (Neuro-QoL), and saliva collection before and after DBE participation. Salivary RNA was purified, and miRNA expression was profiled using nCounter^® Human v3 miRNA Expression Panels (NanoString). Differential expression analyses were conducted using ROSALIND^® platform (OnRamp Bioinformatics, San Diego, CA, USA), a cloud-based bioinformatics analysis system, to calculate fold changes and p-values. Pre-injury psychosocial adversity was assessed via the Trauma History Screen and examined descriptively as a contextual modifier of functional outcomes. Results: Twenty-one APIs (mean age 22.9 years; 76.7% female) were enrolled, including 14 individuals with a self-reported history of mTBI (mean 4.64 years post-injury; 50% with multiple injuries). Following DBE participation, increases in cognitive flexibility and executive function scores were observed in both mTBI and control groups. Additional increases in psychomotor speed, processing speed, sleep disturbance, and depressive symptoms were observed descriptively within the mTBI group. Subgroup analyses suggested variability in pre–post patterns across combinations of mTBI history and pre-injury psychosocial adversity. Exploratory miRNA analyses identified seven miRNAs that were differentially expressed in the mTBI group following DBE (unadjusted p < 0.005), including hsa-miR-7-5p, previously reported in association with neurodevelopmental and neurological pathways. Conclusions: In this pilot, feasibility-focused study, participation in a brief, home-based, dual-task intervention was associated with descriptive changes in selected cognitive and psychosocial measures among APIs, particularly those with a history of mTBI and pre-injury adversity. The observed subgroup patterns warrant confirmation in adequately powered, controlled studies. Exploratory changes in salivary miRNAs co-occurred with functional improvements, thus generating a hypothesis for a future investigation. Full article

Reward motivation adaptation is defined as the extent to which the willingness to exert effort varies as a function of incentive salience, encompassing both motivational (‘wanting’) and hedonic (‘liking’) components. Although reduced reward motivation has been reported in subclinical depression and anhedonia, it remains unclear whether impaired adaptation is a general feature of subclinical depression or is more evident when depressive symptoms co-occur with anhedonia. We addressed this question in two behavioral studies using a task that systematically varied effort–reward ratios. Study 1 contrasted three screening-based groups: individuals with elevated social anhedonia, individuals with subclinical depression without high social anhedonia, and controls with low levels of both, and found no clear group differences in reward motivation adaptation across effort–reward conditions. Study 2 focused on female participants with subclinical depression who also showed higher levels of anhedonia, compared with non-depressed controls. In this sample, the subclinical depression group showed lower overall reward motivation and indications of reduced ‘liking’ adaptation. In conclusion, these findings suggest that deficits in reward motivation adaptation were not clearly observable when subclinical depression or social anhedonia were considered in isolation, but may emerge when depressive status and broader measures of anhedonia co-occur, though this pattern requires confirmation in larger and more diverse samples. Full article

Background: Depression in men often goes unrecognized, even though it leads to high rates of suicide. Men may show symptoms that are external, behavioral, or physical, which traditional assessment tools focused on internal symptoms do not adequately reflect. Methods: A narrative review was carried out to gather evidence on depression scales tailored for men. We searched PubMed up to November 2025 for studies discussing the development, validation, and clinical use of the Gotland Male Depression Scale (GMDS), the Male Depression Risk Scale (MDRS-22 and MDRS-7), and the Gender-Sensitive Depression Screening scale (GSDS-26). We organized the findings by instrument. Results: The studies indicate that male-sensitive scales capture symptom domains such as emotional suppression, anger, risk-taking behaviors, substance misuse, and somatic complaints. The GMDS has demonstrated applicability across psychiatric, somatic, and paternal perinatal populations. The MDRS-22 and MDRS-7 were particularly sensitive to externalizing symptom patterns associated with male presentations of depression and behavioral profiles linked to elevated suicide risk. The GSDS-26 integrates both prototypical and externalizing symptoms, enabling the identification of diverse depressive profiles. However, the current evidence base remains limited due to a reliance on non-clinical samples and the scarcity of long-term and cross-cultural validation studies. Conclusions: Male-sensitive depression scales may serve as useful complementary screening tools that improve recognition of male-typical depressive presentations and behavioral patterns associated with increased suicide risk. Further clinical and longitudinal research is needed to confirm their diagnostic accuracy and clinical utility. Full article

Background: Traumatic spinal injuries (TSI) are often associated with substantial physical burden and potential psychological consequences. Early detection of depressive symptoms may be important for improving quality of life during recovery. Despite the high prevalence of injury, unique sociocultural factors affecting mental health, and the need to optimize long-term rehabilitation outcomes, there is a lack of longitudinal assessments of depression in TSI patients in this region of the MENA (Middle East and North Africa). This study aimed to examine the occurrence of depressive symptoms following TSI over a 3-month period. Methods: A prospective cohort study was conducted to assess the occurrence of depression in TSI patients admitted between 2019 and 2022 at the Hamad Trauma Center. Conscious patients aged 18–65 years diagnosed with TSI were included. Perceived social support was assessed using the RAND Social Support Survey (Medical Outcomes Study Social Support Survey), a validated instrument measuring multiple dimensions of social support. Patient Health Questionnaire-9 (PHQ-9), a widely validated self-administered screening tool for depressive symptoms, was utilized twice: at 2 weeks and at 3 months post-trauma to evaluate early-onset depressive symptoms and their persistence or resolution over time. Results: A total of 189 TSI were included. The cohort was predominantly young individuals. The most common mechanisms of injury included falls (42.1%) and motor vehicle crashes (31.1%). The mean Injury Severity Score was 16.5 ± 8.2 and the spine Abbreviated Injury Scale score was 2.4 ± 0.7. Injuries involved cervical (32.8%), thoracic (38.1%), and lumbo-sacral (6.9%) regions. A total of 32.6% underwent spinal surgery, and 9.0% experienced neurological deficits. Most patients reported emotional and informational support (69%), and 62% reported caregiving support. At 2 weeks post-trauma, patients demonstrated mild depressive symptoms, with a mean PHQ-9 score of 4.6 ± 5.1, which decreased to 2.5 ± 4.2 at 3 months. The proportion of patients screening positive for depressive symptoms (PHQ-9 ≥ 5) decreased from 39.1% (52/133) at 2 weeks to 19.5% (26/133) at 3 months, corresponding to a 19.6% absolute reduction over the follow-up period. A subset of patients reported increased feelings of depression or hopelessness and sleep disturbances at three months compared with two weeks post-trauma. Conclusions: Patients with TSIs experience psychological distress in the early post-injury period, with a subset screening positive for depressive symptoms. Although depressive symptom scores declined over 3 months, continued psychological screening and follow-up care remain important components of comprehensive TSI management during recovery and rehabilitation. Our results should be considered cautiously because of gender-biased findings, single center data and potential attrition bias. Full article

Aging is associated with a high prevalence of insomnia, which is linked to somatic and neuropsychiatric diseases, as well as metabolic and immunological dysfunction. This study aims to identify alterations in the transcriptome profiles and functional metabolic pathways in older adults with different types of sleep disorders. This cross-sectional study included 1002 participants (60–90 years) who were screened for sleep disorders using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Two types of sleep disorders were identified in the study cohort, i.e., sleep onset insomnia and sleep maintenance insomnia. Both types of insomnia were further analyzed for associations with clinical characteristics, laboratory testing results, and socioeconomic backgrounds. The transcriptomic profiles of peripheral blood samples were examined in 236 individuals, supplemented with differential gene and dsRNA expression analyses (DESeq2). Both sleep onset insomnia and middle insomnia were associated with depression, chronic pain syndrome, and osteoarthritis, while only middle insomnia was associated with cardiometabolic diseases. No associations were observed between sleep onset insomnia or reduced sleep duration and transcriptomic profiles. In contrast, 244 genes were differentially expressed in patients with middle insomnia, indicating the activation of pathways related to viral infection response and inhibition of protein synthesis. Additionally, differential expression analysis of double-stranded RNA (dsRNA) identified 2139 significant changes. Middle insomnia in older adults is associated with transcriptomic changes indicative of an activated antiviral immune response, likely resulting from changes in dsRNA expression levels. The chronic inflammation arising from these transcriptomic alterations may underlie the observed association between middle insomnia and cardiometabolic conditions. Full article

Mental health disorders (MHDs) and acute coronary syndromes (ACSs) demonstrate reciprocal pathophysiological connections with substantial prognostic implications. Despite robust evidence linking MHDs to adverse cardiovascular outcomes, the bidirectional relationship remains inadequately characterized in clinical practice, with limited integration of mental health screening into routine cardiac care pathways. The present narrative review comprehensively presents contemporary data on epidemiology, shared biological mechanisms, clinical consequences, and integrated management strategies across the MHD–ACS continuum. A synthesis of peer-reviewed literature, meta-analyses, observational cohorts, randomized trials, and international guideline documents was performed, focusing on depression, anxiety, post-traumatic stress disorder, bipolar disorder, schizophrenia, and suicidality in relation to ACSs. MHDs are highly prevalent in ACS populations and independently predict increased mortality, major adverse cardiac events, and poorer functional recovery. Shared mechanisms include chronic low-grade inflammation, autonomic imbalance, hypothalamic–pituitary–adrenal axis hyperactivation, platelet hyperreactivity, and endothelial dysfunction. Selective serotonin reuptake inhibitors and cognitive behavioral therapy demonstrate the strongest evidence for treating depression in cardiac populations. Collaborative, stepped-care, and integrated cardiac rehabilitation models consistently improve psychological outcomes, with variable effects on cardiovascular endpoints. MHDs and ACSs form a self-reinforcing clinical continuum. Routine mental health screening and integrated cardio-psychiatric care represent essential components of secondary prevention and long-term outcome optimization. Full article

Background/Objectives: Postpartum depression affects 10–20% of women and may have long-term consequences for mental health. This study examines the association between postpartum depressive symptoms and women’s depression and anxiety symptoms 11 and 15 years after childbirth. Methods: Data were drawn from the Rhea Mother–Child Cohort in Crete, Greece. A total of 1079 women completed the Edinburgh Postnatal Depression Scale (EPDS) at approximately 8–10 weeks postpartum. Of these, 516 participated in follow-up assessments at 11 and 15 years, which included measures of anxiety (State-Trait Anxiety Inventory, Trait version [STAI-Trait]) and depressive symptoms (Beck Depression Inventory [BDI]). Multivariable linear mixed-effects models were used to assess the relationship between postpartum depressive symptoms (EPDS) and later anxiety (STAI-Trait) and depression (BDI) outcomes, adjusting for sociodemographic and family-related characteristics and psychosocial factors. Results: Higher postpartum EPDS scores were associated with greater anxiety (STAI-Trait) and depressive symptoms (BDI) across follow-up assessments. Associations remained significant after adjusting for maternal baseline characteristics and follow-up factors. An interaction with time suggested that the association between postpartum depressive symptoms and anxiety levels strengthened over time, with a stronger association at the 15-year follow-up, indicating a higher long-term mental health burden. Conclusions: Postpartum depressive symptoms are associated with higher levels of depressive and anxiety symptoms 11 and 15 years after childbirth. The association with depression appeared relatively consistent across follow-up assessments, while the relationship with anxiety was stronger at the 15-year follow-up. These findings suggest that postpartum depression is an early marker of long-term vulnerability to mood and anxiety disorders, highlighting the importance of early screening, intervention, and long-term mental health support for mothers to reduce the risk of enduring psychological difficulties. Full article

Psychological comorbidity is increasingly recognized as a critical factor influencing outcomes in chronic illness management, particularly in patients with end-stage renal disease (ESRD). The present study examines the psychological burden associated with long-term hemodialysis in patients with ESRD, focusing on emotional distress and maladaptive personality traits. Specifically, it explores group differences between hemodialysis patients and matched healthy controls in levels of stress, anxiety, depression, and psychopathological tendencies, including neuroticism, paranoia, and psychopathy-related traits, as well as exploratory associations with treatment duration. A purposive sample of 60 participants (30 patients undergoing chronic hemodialysis and 30 age- and sex-matched healthy controls) was assessed using validated psychometric instruments: The Hospital Anxiety and Depression Scale, the Pichot Neuroticism and Psychopathy Questionnaire, and a 23-item stress measurement questionnaire adapted to the dialysis context. Both descriptive and inferential statistical analyses were conducted, including independent-samples t-tests and effect size calculations (Cohen’s d). Compared to healthy controls, hemodialysis patients exhibited significantly higher levels of psychological distress across multiple domains. Large between-group effect sizes were observed for depression (Cohen’s d = 1.26) and perceived stress (d = 1.51), while moderate effects were identified for anxiety (d = 0.70), neuroticism (d = 0.58), and psychopathy-related traits (d = 0.82). Exploratory analyses indicated that patients with less than 10 years of dialysis experience reported significantly higher stress levels than those with longer treatment duration, whereas differences in anxiety, depression, and personality traits by dialysis duration were not statistically significant. These findings highlight the substantial emotional burden associated with long-term hemodialysis and underscore the importance of routine psychological screening and early psychosocial interventions to support adaptation, treatment adherence, and quality of life in nephrology care. Full article

Background and objectives: Sexual function commonly declines during late pregnancy and early postpartum, but recovery is heterogeneous and influenced by obstetric and psychosocial factors. We aimed to (i) describe longitudinal Female Sexual Function Index (FSFI) trajectories from the first trimester to 12 months postpartum and (ii) test whether sleep quality and relationship satisfaction are independently associated with sexual function at 6–12 months postpartum, beyond obstetric factors and depressive symptoms. Methods: In this single-center prospective cohort study, pregnant women (singleton pregnancy, ≥18 years, enrolled ≤20 gestational weeks) completed the FSFI at six timepoints: first trimester, second trimester, third trimester, 6–8 weeks postpartum, 3 months postpartum, and 6–12 months postpartum. At 6–12 months postpartum, participants also completed the Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms, the Pittsburgh Sleep Quality Index (PSQI) for sleep quality, WHOQOL-BREF for quality of life, a brief body-image disturbance scale, and a 1–5 relationship satisfaction rating. Delivery was categorized as vaginal low trauma, vaginal higher trauma, or cesarean. Multivariable linear and logistic regression modeled FSFI at 6–12 months postpartum and FSFI-defined dysfunction (FSFI < 26.55). Results: Among 112 women, FSFI-defined dysfunction at 6–12 months postpartum affected 58.0% (65/112). Mean FSFI declined from the first trimester (26.5 ± 4.1) to 6–8 weeks postpartum (18.8 ± 4.3) and recovered by 6–12 months postpartum (25.4 ± 5.0) (time effect p < 0.001). Dysfunction prevalence differed by delivery group (42.2% vaginal low trauma, 63.2% cesarean, 75.9% vaginal higher trauma; p = 0.012). In adjusted models, worse sleep quality and higher-trauma vaginal birth increased the odds of dysfunction, whereas higher relationship satisfaction was protective. Depressive symptoms and sleep quality were independently associated with lower FSFI in linear models. Conclusions: Late-postpartum sexual function follows a nadir-then-recovery trajectory shaped by additive psychosocial (sleep, mood, relationship) and obstetric trauma factors, supporting multi-domain postpartum screening and targeted referral pathways. Full article