Posttraumatic stress disorder (PTSD) is a disruptive, multifaceted disorder with an estimated lifetime prevalence of 8.3% in the U.S. population. Yoga has been shown to reduce PTSD symptoms overall, though little is known about its efficacy relative to specific PTSD symptom clusters. In this systematic review and meta-analysis, we examined the associations between yoga and symptom change in each DSM-5 PTSD symptom cluster. We hypothesized that yoga participation would be associated with significant reductions in each cluster, particularly alterations in arousal and reactivity/hyperarousal (AAR/H), relative to controls. We searched PubMed, PsycInfo, CINAHL, and SPORTDiscus for eligible studies published through October 2025. Studies that were yoga intervention randomized controlled trials, enrolled trauma survivors, and reported PTSD subscale scores were included. We computed standardized mean difference scores and used an NIH tool to assess risk of bias. In direct models (k = 9 studies), yoga led to small-medium reductions in intrusions, d = -0.31, p =.027, and total PTSD symptoms, d = -0.29, p =.030. When including age as a moderator, yoga also improved avoidance, d = -2.28, p =.003, and AAR/H symptoms, d = -1.92, p =.007. There was a substantial risk of bias across studies. Yoga showed the most robust effects for reducing intrusions and total PTSD symptoms, with efficacy in reducing avoidance and AAR/H symptoms when age was added as a moderator. Yoga's emphasis on mindfulness in the present moment may allow for attentional awareness that is protective against intrusions.

Urinary tract infections (UTIs), mainly caused by Escherichia coli, are a major health concern, affecting over 150 million people globally each year, with a lifetime prevalence of 40-50% among females. This study, conducted from May 1, 2023, to February 29, 2024, in three hospitals in Kirkuk City, aimed to assess the frequency of multidrug-resistant (MDR) bacteria in UTI patients and examine the effect of seasonal variation. A total of 250 patients aged 17-78 were enrolled, with 110 confirmed UTI cases. Bacterial identification and antibiotic susceptibility testing were performed using the VITEK2 system and the disk diffusion method. Results showed a higher incidence of UTIs during the summer months, likely due to dehydration and increased bacterial growth. E. coli was the most common pathogen (39.1%), followed by Klebsiella spp. (22.7%) and Proteus mirabilis (14.5%), all exhibiting significant multidrug resistance. The findings highlight a seasonal pattern in UTIs, particularly among females, with higher prevalence in warmer months.

Women with endometriosis have a higher burden of anxiety and depression. Whether they are at increased risk of postpartum depression (PPD) remains unclear. We aimed to compare the risk of PPD between women with and without endometriosis and to explore mediation by previous history of major depression and infertility. In a population-based cohort study, we compared 1,159 singleton pregnancies to women with self-reported endometriosis and 74,590 pregnancies to women without endometriosis. We calculated a djusted risk ratios (aRR) with 95% confidence intervals (CI) using multivariable log-binomial regression, adjusting for age, body mass index, education and income. Mediation analyses assessed the indirect effect of any history of major depression or infertility. Women with endometriosis had a higher risk of PPD (aRR: 1.34, 95% CI: 1.15-1.55). Mediation analyses indicated that a large part of this association was explained by a higher lifetime prevalence of major depression among women with endometriosis (natural direct effect of endometriosis: aRR: 1.17, 95% CI: 1.00-1.36; natural indirect effect of any history of major depression: aRR: 1.14, 95% CI: 1.08-1.20), with 49.3% proportion mediated. Infertility demonstrated a negative natural indirect effect on the association between endometriosis and PPD (aRR: 0.87, 95% CI: 0.81-0.94). Women with endometriosis had an elevated risk of PPD which was largely explained by a higher lifetime prevalence of major depression. Our findings suggest that they constitute a high-risk group and could benefit from closer follow-up to facilitate early identification and intervention.

Background and PurposeAlthough trigeminal neuralgia (TN) imposes a substantial burden on quality of life and mental health, epidemiological estimates of its incidence and prevalence remain limited. Thus, we aimed to comprehensively assess the epidemiological and clinical features of TN from 1945 to 2024.MethodsA comprehensive literature search was performed using PubMed/MEDLINE, Embase, CINAHL, and Google Scholar databases up to January 22, 2025, with search terms related to “trigeminal neuralgia.” TN was defined according to the International Classification of Headache Disorders (ICHD)-1, Rushton and Olafson criteria, and International Classification of Diseases (ICD) codes prior to 2004, which primarily relied on clinical features for diagnosis, whereas the ICHD-2, ICHD-3, Read codes, and ICD codes after 2004 were grouped together, as these criteria incorporated imaging modalities into the diagnostic process. A random-effects model was applied to calculate pooled estimates with 95% confidence intervals (CIs) for the incidence, prevalence and lifetime prevalence of TN. In addition, meta-regression models were also fitted using inverse-variance weighting.ResultsA total of 17 eligible studies, comprising over 170 million participants and 109,070 patients with TN, were included in the analysis. Global pooled incidence of TN was estimated at 25.33 cases per 100,000 person-years (95% CI, 11.87–54.02), while the global pooled annual prevalence was 45.38 cases per 100,000 inhabitants (15.41–133.61), and the global pooled lifetime prevalence was 108.43 cases per 100,000 inhabitants (30.54–384.18). Incidence and prevalence estimates tended to be higher in females than in males, more often right-sided, and more frequent in the maxillary and mandibular divisions than in the ophthalmic division; however, the certainty of these subgroup differences was low. Lastly, the incorporation of imaging modalities into diagnostic criteria may have contributed to the increased prevalence of TN.ConclusionsThis study highlights substantial global variations in TN incidence and prevalence, with how the evolving diagnostic criteria affects the epidemiological features of TN.

Post-traumatic stress disorder is associated with increased rates of opioid prescriptions following primary total shoulder arthroplasty: a propensity-matched analysis.

Children with cerebral palsy (CP) functioning at Gross Motor Function Classification System (GMFCS) level III-V are at risk of reduced bone strength and low-trauma fractures. This systematic literature review aimed to identify fracture rates, locations, and risk factors in this population. Five databases (MEDLINE, Embase, CINAHL, Web of Science, and PsycINFO) were searched up until November 2024. Studies were included if they involved children younger than 18years with CP (GMFCS III-V). Included study designs were cross-sectional, cohort, case-control, or experimental, including both randomized control trials and quasi-experimental, which reported baseline data separately. The Newcastle Ottawa Scale was used to assess methodological quality. Study characteristics, population characteristics, fracture rate, location, and risk factors identified were extracted. Out of 2220 studies, 30 were included. The fracture rate ranged from 2.2 to 4.8 per 100 child-years, and lifetime prevalence estimates were between 9.4% and 15.5%. The most frequently reported fracture location was in the lower extremities, particularly the femur (54.1%). Risk factors for fracture supported by high-quality evidence were low bone mineral density, epilepsy, and weight imbalance; factors with mixed-quality evidence were anticonvulsant use, feeding difficulties, reduced weight bearing, history of fracture, and increasing age. Variability in methodological quality across studies and inconsistent reporting limited the generalizability of findings. Children with CP functioning at GMFCS III-V are prone to fragility fractures in the lower extremities with several modifiable risk factors identified, including poor nutrition, weight imbalance, uncontrolled seizures, and limited weight-bearing activity.

ABSTRACT Depression is a mental disorder with a high lifetime prevalence and one of the leading causes of disability worldwide. As many patients experience another depressive episode after being treated, predictive monitoring for the risk of relapse is essential for healthcare professionals to be able to follow up on patients and intervene early. However, automatically monitoring these large groups requires additional considerations going beyond predictive performance, such as data availability and interpretability. In the present paper, we study the suitability of using readily available administrative data for this prediction task. We contrast a logistic regression model containing only a small number of predictors on demographics, medication, and estimated depression severity with regularized regression and XGBoost models incorporating a large number of predictors describing individual treatment and social information. Our results demonstrate that the inclusion of more detailed input does not result in a significant improvement in performance when compared to simpler regression models. In similar data types, we therefore recommend to primarily focus on a small interpretable model.

Japan's addiction landscape appears paradoxical. The lifetime use of illicit drugs is among the lowest in Organisation for Economic Cooperation and Development countries, but harm from alcohol, tobacco, and gambling ranks among the world's highest. Historically, methamphetamine accounted for the majority of drug-related offenses, but the number of people who were apprehended for cannabis offenses in 2023 exceeded the number who were apprehended for stimulants for the first time since 1958. Nevertheless, the lifetime prevalence of illicit drug use among adults remains under ~3%. In contrast, heavy drinking among working-age men, decades of tobacco consumption, and rapid digitalization that has more recently led to a surge in online gambling and gaming disorder have imposed a substantial disease burden. The present review discusses Japan's epidemiology, social impact, policy changes, prevention, and treatment infrastructure of drug-related problems and the latest trends in addiction science and proposes ways to link policy and research. Japan's experience, balancing strict enforcement with health-centered care, may offer lessons for regions that have similar social contexts.

Background Haemorrhoidal disease (HD) is one of the most common anorectal disorders globally, significantly impacting individuals’ quality of life and productivity. Despite its importance, global prevalence remains unclear due to limited population-specific studies. This study aimed to systematically assess the global prevalence of HD through a systematic review and meta-analysis. Methods We conducted a systematic review and meta-analysis by searching PubMed, Scopus, Embase, Web of Science, and Google Scholar up to March 31, 2025, without language restrictions. Studies reporting prevalence of haemorrhoids in general, clinical, or high-risk populations were included. Exclusion criteria comprised studies lacking total sample size, focusing on other anorectal conditions, or using duplicate or insufficient data. Four independent reviewers extracted and appraised study quality using the Joanna Briggs Institute tool. The primary outcome was pooled point prevalence of HD, analyzed using a random-effects model with 95% confidence intervals (CIs). The study was registered in PROSPERO (CRD420251045600). Results From 6,312 records, 150 studies (210 datasets) comprising 8,960,338 individuals were included. The global pooled point prevalence was 25.92% (95% CI: 22.62–29.22). Lifetime prevalence was 27.19% (95% CI: 14.77–39.60), and one-year prevalence was 21.65% (95% CI: 14.33–28.97). Prevalence was higher in women (27.33%, 95% CI: 21.84–32.82) than in men, and highest in the African region 28.07% (95% CI: 15.34–40.79). Invasive diagnostic methods (28.05%, 95% CI: 23.86–32.26) yielded higher prevalence estimates than non-invasive methods. Also, factors showing associations with HD in unadjusted analyses include older age, obesity, pregnancy, diabetes, family history, constipation, and hypertension. Conclusion HD remains a prevalent condition globally, with minor variation across regions. The burden is consistent regardless of socioeconomic context. Diagnostic method and population characteristics influence prevalence estimates. These findings underscore the importance of targeted prevention and early intervention strategies, especially for at-risk groups.

Stimulants are the most commonly used illegal drugs in Germany, with a lifetime prevalence of 1.2-6.1%. In Germany, cocaine and amphetamines are the most commonly used illegal stimulants. Their use is on the rise and associated with significant morbidity, mortality, and crime. We present an overview of the management of stimulant-related disorders. This review is based on publications retrieved from a selective search in scientific databases and AI-supported platforms, with consideration of pertinent guidelines, reviews, meta-analyses, and original papers. Even in younger persons, stimulant use increases the risk of medical and neurological emergencies such as rhabdomyolysis (for amphetamines: 30.5%, 95% confidence interval [22.6; 38.5]) and stroke (for amphetamines: OR: 4.95 [3.24; 7.55]; for cocaine: OR: 2.33 [1.74; 3.11]). Stimulant intoxication manifests itself with agitation, aggression, or psychotic symptoms. There can also be long-term psychosis, depression, and cognitive impairment. Symptomatic acute treatment may be needed for dehydration, hyperthermia, and agitated states. Agitated patients need de-escalating communication and stimulus shielding and can be adequately treated with benzodiazepines or antipsychotic drugs in 70-90% of cases. The standard treatment for stimulant dependence is withdrawal treatment for several weeks, followed by rehabilitation therapy for several months. No type of pharmacotherapy has yet been approved for this. Cognitive behavioral therapy, contingency management, and exercise have been found to stabilize abstinence. Stimulant-related emergencies pose a therapeutic challenge because of their varied and unpredictable course and the limited available evidence on abstinence-maintaining treatment. Symptom-oriented treatment in acute situations, supplemented by a multimodal treatment strategy to promote abstinence, is recommended.

Prevalence of infertility among nationally representative women in Japan: A cross-sectional survey using a two-stage stratified systematic sampling design.

There is limited research on cyclists with a history of exercise associated muscle cramps (hEAMC) defined as muscle cramping (painful, spontaneous, sustained spasm of a muscle) during or after cycling. To determine the epidemiology, clinical characteristics, and risk factors associated with hEAMC in cyclists taking part in a mass participation cycling event. 21,460 race entrants from the 2016 Cape Town Cycle Tour completed an online questionnaire, which is based on the guidelines for recreational exercise participation from the European Association of Cardiovascular Prevention and Rehabilitation [EACPR]. The main outcome measures were: the lifetime prevalence hEAMC (%; 95% confidence intervals), independent risk factors (adjusted for age and sex) associated with hEAMC (history of chronic disease, history of allergies, history of chronic medication use, history of medication use before and during race, history of cycling injuries, and cycling training/racing variables). Poisson regression was used to calculate the prevalence (%) of the variables of interest, with 95% confidence intervals. The retrospective lifetime prevalence of hEAMC was 30.51%. EAMC in cyclists affects mainly the quadriceps muscles and occurs in the 4th quarter during a race. Novel independent risk factors associated with an increased risk of hEAMC in cyclists were: increased number of years participating as a recreational cyclist (PR=1.03 per 5 years increase; p<0.0001), a higher chronic disease composite score (PR=1.36 times increased risk for every 2 additional chronic diseases; p<0.0001), a history of any allergies (PR=1.18; p<0.0001), medication use before or during event (PR=1.41; p<0.0001) a history of an acute (PR=1.30; p<0.0001) and gradual onset injury (PR=1.29; p<0.0001). Our study identified novel independent risk factors associated with a hEAMC. These results, in combination with other known risk factors, could assist future targeted prevention programmes and the management of EAMC in recreational cyclists.

BackgroundChildhood adversity and trauma are prevalent risk factors for the development of mental health conditions. This two-part paper describes the conceptual basis and pilot implementation of a tiered model of pediatric population mental health, highlighting the local socioecological context in which it was developed and the trauma-informed approach used.MethodsUsing retrospective record review of three datasets from the primary and secondary care pediatric clinics of a large academic medical center, which were harmonized to cover the study period from July 1, 2023 to June 30, 2024, we conducted descriptive analyses of patients across three levels: pediatric primary care (n = 9535), an integrated primary care program, which embeds mental health clinicians in primary care (n = 267), and family-centered trauma-informed psychotherapies in secondary care (n = 63), designed to address emotion dysregulation in pre-adolescent children. Demographics and lifetime history of trauma and adversity (assessed with a comprehensive 19-item list coded based on standardized screeners) were assessed through electronic medical records.ResultsRelative to the pediatric primary care population, more patients in the integrated primary care program and trauma-informed psychotherapies identified as White. Using our 19-item assessment, the lifetime prevalence of adversity or trauma was nearly universal among patients in the integrated primary care (94.4%) and trauma-informed psychotherapy (98.4%) programs. However, the lifetime prevalence of childhood adversities differed significantly across the two programs (integrated primary care: 76.8%; trauma-informed psychotherapy: 98.4%) when we assessed prevalence based only on the 10-item Adverse Childhood Experiences Questionnaire (Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS, Am J Prev Med 14:245–58, 1998). There was a higher prevalence of family and parent-related adversities in the trauma-informed psychotherapy program.ConclusionsFindings support the need for trauma-informed, population mental health approaches in pediatric care. Developmentally tailored, family-centered, transdiagnostic screening and interventions are essential. Study findings, including gaps in programmatic fiscal sustainability, suggest avenues for policy reform to support and scale trauma-informed programs like ours. Programs seeking to implement trauma-informed approaches should leverage implementation and participatory research to ensure effectiveness and equitable accessibility for patients of diverse identities.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-025-13356-7.

Background/Objectives. Self-harm is a heterogeneous behaviour with a lifetime prevalence of around 20% in young people aged 16-25 years old. Recent neurocognitive evidence suggests that, for some individuals, self-harm is associated with motivational processes similar to addiction, including maladaptive mental imagery, reward anticipation, and goal pursuit. However, our knowledge of young people's subjective experiences of rewards and goals in relation to self-harm behaviour remains limited. Our study aimed to investigate how young people who self-harm experience enjoying and wanting rewards and pursuing goals in daily life and whether this experience changes during periods of self-harm. We also explored their use of mental imagery as a key cognitive process to support motivation. Methods. We conducted two parallel focus groups online (total of N = 12) with young people (mean age = 12.2, SD = 3; nine women, two men, and one non-binary) with a past-year history of self-harm behaviour. Qualitative data was analysed using inductive thematic analysis. Two young people with lived experience of self-harm informed the topic guide and data interpretation. Examples of questions were "Do you think your experiences of enjoying and/or looking forward to pleasant things are related in any way to self-harm, or not?" and "Do you visualise things you enjoy or may look forward to? If you do, how is that experience?". Results. There were six themes: rewards need deserving, high self-standards, keeping control, trapped into long-term goals, unhelpful mental imagery, and self-harm alters the experience and anticipation of rewards and goal attainment. Most young people reported enjoying conditional rewards and working towards long-term goals that tend to be unattainable and beyond their control. Imagining these goals was experienced as unhelpful by most. For all young people, periods of self-harm thwarted enjoyment and goal achievement, shifted the preference to short-term immediate gratification, including from self-harm behaviour, and devalued long-term goals. However, our data cannot determine if these experiences are specific to young people who self-harm. Conclusions. Our findings indicate that the reciprocal relationship between motivational processes and self-harm behaviour in young people warrants further investigation. Helping individuals develop more adaptive rewards and goals, including appreciation of short-term goals and use of motivational mental imagery, could represent valued support for young people with self-harm.

This review aimed to estimate the prevalence of non-medical anabolic-androgenic steroid (AAS) use among same-sex attracted men (SSM). We conducted a systematic review of peer-reviewed articles in English, focusing on AAS use among SSM. We excluded grey literature and studies that measure AAS use through some form of analysis (e.g., hair or urine). Ten databases were searched. Titles and abstracts for all articles were screened, followed by full-text assessment and data extraction by multiple authors. The pooled overall and subgroup (gym/community-recruited SSM) lifetime and past 12-month prevalence of AAS use among SSM was obtained using a generalised linear random effects model, which was reported when heterogeneity of estimates was not high. Risk of bias was assessed using the Joanna Briggs Institute Prevalence Critical Appraisal Tool. Nine studies met inclusion criteria. All studies were conducted in high-income countries. Overall, the pooled lifetime and past 12-month prevalences of AAS use were 13.9% (95% CI 9.2%-20.5%, 6 studies) and 8.1% (95% CI 3.9%-16.2%, 3 studies), respectively. Among the gym subgroup, the pooled lifetime and past 12-month prevalences were 15.2% (95% CI 11.6%-19.6%, I2 = 72.8%, 3 studies) in the gym subgroup and 13.3% (95% CI 9.9%-17.7%, I2 = 73.1%, 2 studies). The difference in lifetime prevalence between gym and community-recruited SSM was not statistically significant (p = 0.676). The non-medical use of AAS among SSM is higher than general global estimates, with some evidence that use may be higher among gym users.

Introduction Promoting modern contraceptive use among adolescents in low- and middle-income countries is essential to address high rates of unintended pregnancies, unsafe abortions, and sexually transmitted infections. Perceived self-efficacy is a key determinant of contraceptive behavior among adolescents. This study assessed the prevalence of modern contraceptive use, perceived self-efficacy, and associated factors among adolescent girls in the Techiman North District, Ghana. Methods A cross-sectional quantitative study design was employed involving 228 senior high school (SHS) female day students selected through proportionate stratified random sampling. A pretested, self-administered questionnaire was used, and data were analyzed using Statistical Package for Social Sciences (SPSS) version 23. Descriptive statistics, binary, and multiple linear regression analyses were conducted with significance set at p &lt; .05. Results The mean age of participants was 18.3 years (standard deviation [SD] ± 2.59), and the mean age at sexual debut was 16.3 years (SD ± 1.9). Lifetime and current contraceptive use prevalence were 27% ( n = 61) and 16% ( n = 36), respectively. Additionally, 35.5% reported penetrative vaginal intercourse in the past 12 months. Participants in SHS 2 were 0.15 times (adjusted odds ratio [AOR] = 0.147; 95% confidence interval [CI] = 0.046–0.466; p = .001) and 0.14 times (AOR = 0.139; 95% CI = 0.036–0.544; p = .005) less likely to use modern contraceptives compared to those in SHS 1. Conversely, those in SHSs 2 and 3 were 8 times (AOR = 8.09; 95% CI = 3.444–19.022; p = .000) and 7 times (AOR = 7.15; 95% CI = 2.641–19.377; p = .000) more likely to have high perceived self-efficacy. Cohabiting participants were twice as likely to have high perceived self-efficacy than singles (AOR = 2.48; 95% CI = 2.453–170.929; p = .005). Conclusion Comprehensive, empowerment-focused sexual and reproductive health education is urgently needed to increase contraceptive use.

Substance abuse among adolescents remains a pressing public health concern in Nigeria, with limited community-based data to inform interventions. This study assessed the prevalence and predictors of substance abuse among adolescents aged 10–19 in Yaba Community Development Area of Lagos State using a mixed-methods cross-sectional design from November 2024 to April 2025. Among 286 participants, the mean age was 16.82 years, and over 90% were in-school adolescents. Lifetime prevalence of substance use was 81.1%, with 59.3% reporting use in the past 30 days. Alcohol, tobacco, and cannabis were the most commonly abused substances. Significant predictors of substance abuse included age, gender, educational status, parental education, living arrangement, community of residence, and peer influence (p&lt;0.05). Qualitative findings highlighted peer pressure, curiosity, and community availability as major contributors, with adolescents frequently accessing substances from local shops and gathering in public spaces for consumption. Despite awareness of the risks, many adolescents continued their usage. The study concludes that substance abuse among adolescents in Yaba is alarmingly high, necessitating urgent, targeted community-based interventions, stricter regulation, and peer-focused preventive strategies to curb this growing trend.

Sexual violence (SV) against men remains an underexplored issue in research. This study aims to estimate the lifetime prevalence of SV among Brazilian adult men and identify associated factors using data from the 2019 National Health Survey, a nationally representative household-based survey. We conducted a cross-sectional analysis including men aged 18 years or older. SV was assessed through questions addressing unwanted sexual contact and coercion. The lifetime prevalence of SV among Brazilian men was 5.56%. Most reported incidents occurred within domestic environments and were perpetrated by someone known to the victim. Victims were predominantly young, white, and had completed secondary education. The prevalence of SV among men varied widely across Brazilian states. While some states, such as Amapá, Maranhão, and Acre, reported prevalences below 1%, others, including Rondônia (10.9%), São Paulo (8.3%), Goiás (7.6%), and Bahia (7.1%), exhibited substantially higher rates. Logistic regression analysis revealed that homosexual orientation (OR = 4.67; 95% CI [1.41, 15.45]), diagnosis of depression (OR = 3.33; [1.70, 6.50]), and anxiety disorders (OR = 2.24; [1.13, 4.41]) were independently associated with increased odds of SV. Men identifying as Asian also showed elevated risk (OR = 8.13; [2.69, 24.54]). This study provides the first nationally representative estimates of lifetime SV among adult men in Brazil, addressing an important gap in the literature. Findings support the need for targeted surveillance systems, preventive interventions, and health services that are responsive to male sexual victimization. Public health policies should integrate gender-sensitive approaches that recognize male vulnerability to SV, and health professionals must be equipped to screen, identify, and respond appropriately to cases of male sexual victimization.

The prevalence of mental ill health is increasing in young people worldwide, with rising referrals to child and adolescent mental health services (CAMHS). The numbers and proportions of the youth population who present to CAMHS, however, including how those figures are changing over time, are unclear. Understanding trends in mental health service contacts for young people over time is crucial mental health surveillance data. Our aim was to calculate both the lifetime and annual prevalence of CAMHS contact in Wales for young people up to age 18 years. Using linked Welsh administrative healthcare records, we calculated the annual prevalence of CAMHS contacts between 2004 and 2023. We also calculated the lifetime prevalence of CAMHS contacts for sequential annual birth cohorts born between 1991 and 2005 and followed to age 18 (between 2009 and 2023). In 2004, 0.8% (n = 4665) of the total child and adolescent population were in contact with CAMHS. By 2022, this had risen nearly five-fold to 3.9% (n = 19 870) of the total child and adolescent population. Among the 1991 birth cohort who turned 18 in 2009, 5.8% had contact with CAMHS at some stage in childhood or adolescence. For individuals born in 2005 who turned 18 in 2023, this figure had risen to 20.2%. The number of the young people in contact with CAMHS has increased dramatically over the past 15 years, from 1 in 17 young people who turned 18 in 2009 to 1 in 5 young people who turned 18 in 2023.

BackgroundAnxiety disorders represent highly prevalent mental health conditions globally (lifetime prevalence: ~7–14%). Current pharmacological treatments carry risks of dependence and metabolic side effects, while psychological therapies face accessibility limitations. There is an urgent need to develop safe, accessible non-pharmacological interventions. This single-blind randomized controlled trial systematically evaluated the efficacy and sustainability of an 8-week standardized abdominal breathing training program in alleviating anxiety symptoms and modulating autonomic nervous function in patients with anxiety disorders.MethodsA total of 120 outpatient participants (aged 18–65 years) meeting ICD-10 diagnostic criteria for Generalized Anxiety Disorder were recruited. Participants were randomly assigned to either an intervention group (abdominal breathing training, n = 60) or a control group (treatment-as-usual, n = 60). The intervention group received professionally supervised training consisting of 3–4 daily sessions of 10–15 min each (inhale:exhale ratio = 1:2; inhalation 3–5 s/exhalation 5–7 s). Adherence was monitored via respiratory sensors (mean adherence rate: 92.4%). Assessments using the Self-Rating Anxiety Scale (SAS) and physiological measurements—including heart rate (HR), respiratory rate (RR), blood pressure (BP), and heart rate variability (HRV-LF/HF ratio)—were conducted at baseline, post-intervention (8 weeks), and at 4-week follow-up (intervention group only).ResultsAnxiety symptom improvement: Two-way repeated measures ANOVA revealed a significant group × time interaction effect on SAS scores (p < 0.05). Post-intervention, the intervention group exhibited a significant reduction in SAS scores compared to baseline (67.57 ± 8.88 vs. 71.80 ± 3.99, p < 0.001), reflecting a 5.9% decrease, and scores were significantly lower than the control group (70.43 ± 4.33, p = 0.027). At 4-week follow-up, despite a slight rebound, SAS scores in the intervention group remained significantly below baseline (68.57 ± 8.11, p < 0.05). Physiological optimization: For physiological indicators, significant group × time interaction effects were observed (all p < 0.05). Post-intervention, the intervention group showed significant reductions in heart rate (77.08 ± 10.30 vs. 83.37 ± 9.67 bpm), respiratory rate (17.37 ± 1.78 vs. 18.60 ± 1.83 breaths/min), systolic blood pressure (114.12 ± 11.97 vs. 122.63 ± 12.18 mmHg), and diastolic blood pressure (74.40 ± 6.75 vs. 80.28 ± 7.58 mmHg) (all p < 0.05). Concurrently, the HRV-LF/HF ratio increased significantly (p = 0.008).ConclusionStandardized abdominal breathing training significantly alleviates anxiety symptoms (effect size Cohen’s d = 0.61) and induces sustained physiological improvements in autonomic regulation (effects maintained 4 weeks post-intervention). As a cost-free, non-pharmacological intervention devoid of adverse effects, it provides an effective adjunctive treatment option for anxiety disorders, particularly benefiting medically underserved populations and individuals with medication intolerance, suggesting significant clinical potential.