Search Results (355)

Background: Gastrointestinal (GI) cancer patients face a four-fold higher suicide risk than the general US population. This study explores psychosocial aspects of GI cancer patient experiences, assessing suicidal ideation and behavior, mental distress during treatment phases, and psychosocial factors on mental health. Methods: A two-phase mixed-methods approach involved a web-based survey and follow-up interviews. Quantitative data analysis validated mental health and suicidal ideation constructs, and correlation analyses were performed. The patient journey was charted from diagnosis to treatment. Results: Two hundred and two individuals participated, with 76 from the rural Appalachian region and 78 undergoing treatments. Quantitative analysis showed a higher prevalence of passive suicidal ideation than active planning. The post-treatment recovery period was the most emotionally challenging. Qualitative data emphasized emotional support and vulnerability to isolation. Care quality concerns included individualized treatment plans and better communication. Patients also needed clear, comprehensive information about treatment and side effects. The in-depth interview with four GI cancer patients revealed a healthcare system prioritizing expedient treatment over comprehensive care, lacking formal psychological support. AI emerged as a promising avenue for enhancing patient understanding and treatment options. Conclusions: Our research advocates for a patient-centric model of care, enhanced by technology and empathetic communication. Full article

Maternal mental illness significantly impacts caregiving, influencing both mothers and their children. This narrative review examines the challenges faced by mothers with conditions such as depression, anxiety, bipolar disorder, and schizophrenia, which often disrupt caregiving routines, emotional stability, and social integration. These difficulties can hinder secure attachments and contribute to adverse developmental outcomes in children, including heightened risks of anxiety, depression, behavioral issues, and cognitive impairments. Children of mothers with mental illnesses are 1.8 times more likely to develop emotional or behavioral problems and face a 2.7 times higher risk of suicidal ideation during adolescence. Intergenerational transmission of mental illness is also prevalent, with affected children showing a 2.5 times greater likelihood of developing mental illnesses in adulthood. Effective interventions include cognitive behavioral therapy (CBT), family-based approaches, and community programs integrating parenting education and mental health resources. These strategies have demonstrated improvements in maternal well-being and child resilience. The review highlights the need for comprehensive policies addressing maternal mental health, early intervention for children, and culturally sensitive support systems to break cycles of intergenerational mental illness. Future research should prioritize evaluating long-term intervention effectiveness and exploring innovative tools like digital mental illnesses solutions to support affected families. Full article

Background: Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition marked by persistent airflow limitation and is currently the fourth leading cause of death worldwide, accounting for 3.5 million deaths in 2021. While its physical manifestations such as dyspnea, chronic cough, and sputum production are well known, its psychological impact, particularly the high prevalence of depression among patients, remains under-recognized. Objectives: This narrative review aims to summarize the existing data on the association between COPD and depression, analyze their pathophysiological connections, explore treatment possibilities, and highlight the interrelationships between these conditions. Methods: A non-systematic literature search was conducted using PubMed, Scopus, and Google Scholar. Studies, reviews, and key publications addressing the relationship between COPD and depression were selected based on clinical relevance. Findings were synthesized thematically to provide a comprehensive and critical overview. Results: Depression in patients with COPD is linked to worse quality of life, increased functional impairment, higher suicide risk, and poorer adherence to treatment. Contributing mechanisms include chronic systemic inflammation, hypoxemia, oxidative stress, and psychosocial risk factors such as low educational level, socioeconomic disadvantage, and comorbidities. Despite evidence of this strong association, treatment strategies remain limited and underutilized, and no unified approach has yet been established. Conclusions: Depression represents a major comorbidity in COPD that exacerbates both disease burden and patient suffering. Further research is essential to clarify the underlying mechanisms and to develop integrated therapeutic approaches. Enhancing our understanding and management of this comorbidity holds promise for significantly improving patient outcomes and overall quality of life. Full article

Background: High-voltage electrical injuries (HVEIs) represent a complex and life-threatening entity, frequently involving multi-organ damage. While traditionally linked to occupational hazards, train surfing—riding on moving trains—and train climbing—scaling stationary carriages—have emerged as increasingly common causes among adolescents. Popularized via social media, these behaviors expose individuals to the invisible danger of electric arcs from 15,000-volt railway lines, often resulting in extensive burns, cardiac complications, and severe trauma. This study presents a 30-year retrospective analysis comparing cardiac biomarkers and clinical outcomes in train-surfing injuries versus work-related HVEIs. Methods: All patients with confirmed high-voltage injury (≥1000 volts) admitted to a Level 1 burn center between 1994 and 2024 were retrospectively analyzed. Exclusion criteria comprised low-voltage trauma, suicide, incomplete records, and external treatment. Clinical and laboratory parameters—including total body surface area (TBSA), Abbreviated Burn Severity Index (ABSI), electrocardiogram (ECG) findings, intensive care unit (ICU) and hospital stay, mortality, and cardiac biomarkers (creatine kinase [CK], CK-MB, lactate dehydrogenase [LDH], aspartate transaminase [AST], troponin, and myoglobin)—were compared between the two cohorts. Results: Of 81 patients, 24 sustained train-surfing injuries and 57 were injured in occupational settings. Train surfers were significantly younger (mean 16.7 vs. 35.2 years, p = 0.008), presented with greater TBSA (49.9% vs. 17.9%, p = 0.008), higher ABSI scores (7.3 vs. 5.1, p = 0.008), longer ICU stays (53 vs. 17 days, p = 0.008), and higher mortality (20.8% vs. 3.5%). ECG abnormalities were observed in 51% of all cases, without significant group differences. However, all cardiac biomarkers were significantly elevated in train-surfing injuries at both 72 h and 10 days post-injury (p < 0.05), suggesting more pronounced cardiac and muscular damage. Conclusions: Train-surfing-related high-voltage injuries are associated with markedly more severe systemic and cardiac complications than occupational HVEIs. The significant biomarker elevation and critical care demands highlight the urgent need for targeted prevention, public awareness, and early cardiac monitoring in this high-risk adolescent population. Full article

Suicidality, encompassing suicidal ideation, attempts, and completed suicide, continues to be a significant public health concern globally. Traditional research has emphasized genetic, neurobiological, and psychosocial factors; however, recent findings suggest that gut microbiota may play a crucial role in influencing suicidal behavior. The gut microbiota impacts neuroinflammation, neurotransmitter metabolism, and the hypothalamic–pituitary–adrenal (HPA) axis, all of which are associated with psychiatric disorders linked to suicidality. This review gathers current evidence on the gut–brain axis, investigating the role of microbiota in suicidality through mechanisms such as immune system modulation, serotonin regulation, and the stress response. We also consider the potential of microbiota-targeted interventions, such as probiotics and dietary changes, as innovative therapeutic strategies. Despite the accumulating evidence, research in this field remains limited, emphasizing the urgent need for further investigation to clarify the causal relationship between gut microbiota and suicidality. Full article

Background: Self-harm in young people is influenced by multiple factors, with media playing a significant role. While research has examined its harmful and protective effects, little attention has been paid to how healthcare professionals interpret and respond to media’s role in shaping young people’s experiences of self-harm. To our knowledge, no research has examined adolescent mental health professionals’ perspectives and, crucially, how these are constructed and understood. The study aimed to examine the following: (1) how mental health practitioners construct and use discourses to interpret the role of media in young people’s self-harm; and (2) how these discourses shape clinical understanding and practice. Methods: This qualitative study employed semi-structured interviews with ten clinicians from child and adolescent mental health services across England working with young people who self-harm. Data were analysed using critical discourse analysis to uncover how broader societal and institutional narratives shape clinicians’ perspectives. Results: Two dominant discourses were identified: “Media as Disruptor” and “The Hidden World of Youth”. These discourses framed media as both a risk factor and a potential intervention tool, positioning media as a powerful yet morally ambiguous force in young people’s lives. Clinicians largely framed media’s influence as negative but acknowledged its capacity for education and intervention. Conclusions: This research offers new insights into how media-related self-harm risks and benefits are framed and managed in mental health care settings. The study underscores the need for systemic changes in clinical practice, enhanced training, updated guidelines and a shift towards broader sociocultural perspectives in understanding self-harm and suicidal behaviour. Full article

Suicide in children is a major global health crisis, with profound impacts on families, friends, and society. Understanding ways to ameliorate the rate of suicide attempt (SA) is critical given that it is a key factor in predicting future suicide risk. SA is the deliberate act of causing physical injury to oneself with the intent of death. The incidence of SA may be influenced by physical activity (PA). PA includes bodily movement via skeletal muscles that results in energy expenditure and physical fitness. While there is evidence to suggest that PA improves dysregulation of the parasympathetic nervous system which underpins the physiology of suicidal behaviour, evaluating the impact of PA on SA in children is required. Objectives: This systematic review aims to determine the relationship between PA and SA in children to inform alternative preventative and interventional strategies. Methods: This systematic review was registered with PROSPERO: CRD42023389415. Eight electronic databases were systematically searched. References were transferred to Covidence software for title and abstract screening and full text review were performed based on eligibility criteria: (1) children aged 6–18 years old; (2) participated in PA (individual, group exercise, or team sports); and (3) examined SA as a dependent variable. The JBI Checklist was used to measure the quality and level of bias of included studies. Results: Of the 2322 studies identified, 21 were included in the final analysis of the review. Twenty studies were cross-sectional in design, and one implemented a prospective study design. Thirteen studies (61.9%) yielded statistically significant results, indicating that increased PA, particularly team sport, may be associated with reduced odds of SA. There was some evidence to suggest that certain intensities and frequencies of PA may be beneficial to some and detrimental to other subgroups. Conclusions: The results suggest that PA may reduce the risk of suicide attempts. Although PA may be associated with reduced SA in children, future research is required, which (1) uses standardised outcome variables; (2) adopts longitudinal and experimental study designs; (3) explores qualitative research to determine distinctive factors that influence participation in PA not captured by quantitative research; and (4) examines different target populations such as children with a broad range of mental health issues. Full article

The aim of this work is to explore and understand the lived experience of nurses who chose to schedule visits with an Emotional Support Animal (ESA), i.e., a dog, during their working shift. Background/Objectives: Nursing practice is rigorous, weighted with intense responsibility that creates an environment conducive to stress and anxiety for the nurses, who have reported a higher level of work stress than other healthcare professionals. Knowing and addressing the factors impacting mental health/nurses’ well-being is crucial to providing care to patients. Stressful work environments result in burnout, compassion fatigue, depression, anxiety, suicide, and resignation. Understanding nurses’ perspectives on work related stress encourages hospitals to structure practices supporting nurses’ mental health and ability to provide quality care. Methods: A qualitative hermeneutic phenomenological approach was employed. Participants scheduled six weekly 10-min visits with Rex, a certified Service Dog for anxiety depression and PTSD, and registered ESA. A sample of 11 RNs participated in Rex visits at the workplace; field notes were taken during observations of visits. Semi-structured 30-min interviews conducted via Zoom, audio-recorded, and transcribed with NVivo were conducted. Results: Data were examined with Interpretative Phenomenological Analysis. Four main themes emerged: Preparing for the unknown, Doing the work, Refueling and resetting-Visits with Rex, What about nurses? Conclusions: This study highlights the need for nurses and hospital systems to incorporate self-care/self-reflection, including time/opportunities for nurses’ stress management during their practice. Knowledge of nurses receiving ESA interventions sheds light on how to protect/preserve the well-being of nurses practicing in this demanding profession. ESAs for nurses in the workplace offers an option to utilize dog therapy to re-energize and continue their shift renewed and refreshed. Full article

Background: Hypothermia, occurring when core temperature drops below 35 °C, can lead to death when the body’s heat loss exceeds its heat production. This study investigates two hypothermia-related deaths, exploring the utility of immunohistochemistry, specifically focusing on chromogranin A (CgA) as a potential diagnostic tool. The aim is to assess whether CgA expression in neuroendocrine tissues can be considered a reliable indicator of premortem stress response in fatal hypothermia cases. Case Presentation: In the first case, a 67-year-old man was found on a snowy road 24 h after his disappearance. The autopsy revealed cold-induced skin lesions, gastric hemorrhages, and cerebral and pulmonary edema. Positive CgA immunostaining was observed in the pancreatic islets and adrenal medulla. In the second case, a 49-year-old man was found dead in a wooded area with indications of suicide. Both cases were examined with attention to macroscopic findings and histological samples from major neuroendocrine organs. As in previous cases, CgA immunostaining was positive in the pancreatic islets and adrenal medulla. Staining intensity was moderate to strong, consistent with heightened neuroendocrine activity, supporting the hypothesis of systemic stress prior to death. Conclusions: Although CgA is a potentially valuable adjunct in hypothermia diagnosis, careful consideration of cadaveric preservation is emphasized, particularly when bodies are preserved before autopsy. Further studies with larger sample sizes are needed to confirm its diagnostic specificity and to distinguish true pathological patterns from postmortem artifacts. Full article

Anorexia Nervosa (AN) is a psychiatric illness with serious medical and physiological implications. Anorexia Nervosa is characterised by significant disruptions in weight, growth and physical health resulting from disordered behaviours such as food restriction, purging and inappropriate exercise. The illness is associated with substantial physical, psychological, social and economic burdens affecting all areas of functioning. Typically emerging in adolescence, AN can have a chronic course and high risk of mortality, with evidence suggesting that approximately 10% of individuals diagnosed with AN will die from medical complications or completed suicide. Whilst inpatient treatment reduces mortality risks through nutritional and weight restoration, outpatient treatment is the preferred level of intervention. In the case of adolescents, family-based treatment (FBT) is the recommended and most researched outpatient model for medically stable adolescents. However, access to FBT is limited, and there are several barriers that exist to receiving care from trained clinicians. This review provides a literature update on studies reporting the real-world access challenges for FBT, with particular attention paid to non-research settings. The review also highlights how digitally delivered treatment, specifically telehealth, has been used to increase access to FBT and examines the preliminary outcomes of telehealth-delivered FBT, which appear comparable to traditional in-person care. Despite these promising findings, provider, intervention and systemic factors have challenged the delivery of traditional in-person and telehealth FBT in real-world settings. Critical areas for future research include the need to understand the impact of potential confounders and what adaptions may be required to increase model feasibility in community settings, where access to specialist services is often limited and access challenges are most felt. Full article

Background: Finasteride, a 5α-reductase inhibitor, is used for androgenetic alopecia and benign prostatic hyperplasia. However, concerns have emerged about its psychiatric side effects, including suicidality. This study analyzed finasteride-related reports from the FDA Adverse Event Reporting System (FAERS) to identify potential safety signals. Methods: Adverse events reported from 2015 to 2024 were extracted using preferred terms, quantified using Bayesian analysis and disproportionality metrics, including empirical Bayesian geometric mean (EBGM), information component (IC), reporting odds ratio (ROR), and proportional reporting ratio (PRR). Results: Most were male (87%), with 43% aged 18–40 years, primarily using finasteride for hair loss. Disproportionality metrics for suicidality-related events fluctuated between 2019 and 2024. In 2019, the ROR was 27.51 (95% CI: 23.22–32.58), the PRR was 21.96 (95% CI: 18.54–26.01), the EBGM was 20.50, and the IC was 4.36. A slight decline was observed in 2020, a surge in 2021, and a peak in 2022 (ROR 34.64 (95% CI: 28.36–41.88), PRR 27.82 (95% CI: 22.30–34.61), EBGM 24.96, IC 4.64). Although a sharp rise in suicidality reports was noted in 2024, the rates of ROR and PRR dropped to 19.04 (95% CI: 17.02–21.30) and 16.53 (95% CI: 14.78–18.50), respectively. Serious outcomes such as disability (18.7%), life-threatening events (12.9%), and death (7.5%) were also noted. Conclusions: The upward trend in suicidality-related safety signals among young male users since 2019, which peaked in 2024, reflects emerging safety concerns among finasteride users, reinforcing the need for pharmacovigilance. Collaborative action among healthcare professionals, regulatory authorities, and pharmaceutical companies, along with clear warnings and mental health assessments before and throughout finasteride therapy, can mitigate potential psychiatric risks and enhance patient safety. Full article

Background: Mental health issues among youth are a growing public health concern. Schools play a vital role in the early detection and prevention of mental health issues, with principals being central to the implementation of mental health initiatives. This study assessed the attitudes, preparedness, and practices of school principals regarding mental health promotion and prevention among school-aged children. Methods: A cross-sectional survey using computer-assisted web interviewing (CAWI) was conducted between March and April 2025. A 19-item questionnaire was sent to all 1564 primary and secondary school principals in the Lodz region. Data from 605 respondents (response rate: 38.7%) were analyzed. Results: A total of 94.9% of the principals reported an increase in student mental health problems over the past five years. Over one-quarter of school principals (26.3%) declared a very good or rather good level of preparation for teachers to work with students diagnosed with a mental disorder. Moreover, 42.3% declared a very good or rather good level of preparation of teachers for conversations with parents about mental health problems observed in their children. Mental health education was conducted in 94.7% of schools, and teacher training in 73.2% of schools. Secondary schools more often offered such training (81.9% vs. 70.7%; p = 0.01) and reported stronger support from specialist teachers (79.7% vs. 67.7%; p = 0.01) than primary schools did. Rural schools rated teacher-parent communication more positively (47.0% vs. 37.7%; p = 0.02) despite fewer training initiatives (68.7% vs. 77.7%; p = 0.01). Suicide response procedures were implemented in 78.5% of schools. Conclusions: The findings confirm a marked rise in student mental health needs and reveal structural disparities in providing school-based support. Enhancing school leadership, expanding teacher training, and ensuring systemic support may facilitate mental health promotion interventions in schools. Full article

Ketamine and esketamine are two closely related compounds with fast-acting antidepressant properties that have reshaped the treatment landscape for individuals with treatment-resistant depression (TRD). Originally developed as anesthetic agents, both have since demonstrated rapid and robust antidepressant effects in patients who have not responded to conventional treatments such as selective serotonin reuptake inhibitors (SSRIs) or cognitive behavioral therapy. This narrative review synthesizes evidence on their pharmacology, mechanisms of action, clinical efficacy, safety profiles, and regulatory considerations, with a particular focus on their neuroplastic effects. While ketamine is a racemic mixture composed of equal parts R- and S-enantiomers, esketamine consists solely of the S-enantiomer and has been approved for intranasal use by the FDA and EMA for TRD. These agents have been shown to produce symptom relief within hours of administration—an unprecedented effect in psychiatric pharmacology. This rapid onset is particularly valuable in managing suicidal ideation, offering potential lifesaving benefits in acute settings. Furthermore, ketamine and esketamine’s influence on synaptic plasticity, brain-derived neurotrophic factor (BDNF), and glutamate transmission provides insights into novel therapeutic targets beyond monoaminergic systems. This review incorporates recent real-world findings and peer-reviewed literature to contextualize the clinical use of these agents in modern psychiatry, bridging experimental research with practical application. Full article

Travestis and transgender women in Brazil face a disproportionate burden of mental health conditions, exacerbated by structural discrimination, violence, and social exclusion. This narrative review synthesizes evidence on the prevalence of depression, anxiety, suicidality, and substance use among travestis and transgender women in Brazil, and examines intersecting social and health disparities. We searched PubMed, Embase, and PsycINFO in April 2025, identifying peer-reviewed studies in English or Portuguese reporting mental health outcomes or associated social determinants of health in this population. Thirty-one studies across twelve different cities (n = 7683) were included and grouped into two thematic domains. Reported prevalence ranged from 16–70.1% for depression, 24.8–26.5% for anxiety, and 25–47.3% for suicidality. Substance use was also highly prevalent, with studies reporting high rates of alcohol (21.5–72.7%), tobacco (56.6–61.6%), cannabis (19–68.9%), and cocaine/crack (6–59.8%) use. Discrimination, violence, economic hardship, and HIV were consistently associated with psychological distress and barriers to care. These findings underscore the urgent need to integrate mental health, gender-affirming care, and HIV services into Brazil’s Unified Health System (Sistema Único de Saúde–SUS), strengthen anti-discrimination and violence-prevention policies, and adopt inclusive public health strategies that prioritize the leadership and lived experiences of transgender, nonbinary, and gender diverse people, particularly amid rising political threats to gender-affirming care. Full article

Glial cells exhibit multifaceted functions and represent essential contributors to various physiological processes in the brain, rather than just being silent supportive cells to neurons. Different glial populations of the central nervous system within involved brain regions play various functions, express different proteins, and result in fluctuating effects when altered. Glial cell pathologies were detected in most mental disorders including suicidal behavior. Suicidal behavior represents a health problem of high importance worldwide, where protective measures are required to be taken at many levels. Studies on patients with mental disorders that represent risk factors for suicidal behavior revealed multiple changes in the glia at diverse levels, including variations regarding the expressed glial markers. This review summarizes the role of glia in some psychiatric disorders and highlights the crosslink between changes at the level of glial cells and development of suicidal behavior in patients with an underlying psychiatric condition; in addition, the interplay and interconnection between suicidal behavior and other mental diseases will shed light on the routes of personalized therapy involving the development of glia-related drugs. Full article