To analyse the impact of a comprehensive range of menstrual symptoms-including various physical and psychological symptoms associated with menstruation-on work productivity and quality of life (QoL). A cross-sectional study. A menstrual cycle tracking application in Japan; current app users were recruited via in-app notification provided electronic informed consent from June to August 2022. Japanese women who have experienced menarche. Menstrual Distress Questionnaire (mMDQ) was used to determine severity of menstrual symptoms, and participants with mMDQ score ≥ 103 were grouped as severe. Work productivity was assessed using the Work Productivity and Activity Impairment Questionnaire: General Health (WPAI-GH), and QoL was measured using the 36-Item Short Form Survey version 2 (SF-36v2). Differences in absenteeism, presenteeism, overall work impairment and activity impairment on the WPAI-GH between the severe and normal groups; differences in the summary scores of the SF-36v2; correlation coefficients between scores of symptom groups of the mMDQ, WPAI-GH and the summary scores of the SF-36v2. Overall, 456/1988 (23.0%) women had severe mMDQ scores (≥ 103). The median overall work impairment was 30% higher in the severe group than in the normal group. In multiple regression analysis, mMDQ severity was significantly associated with increased absenteeism, presenteeism and activity impairment, as well as reduced mental and social QoL. Negative affect, impaired concentration and behaviour change were associated with greater presenteeism, while pain showed weaker correlations. Negative affect was strongly associated with reduced mental QoL. Our findings demonstrate that, in addition to pain, mental and psychosocial symptoms are significantly associated with both work productivity and QoL.

Research suggests that elite female-athletes report elevated levels of mental ill-health, particularly, anxiety, depression and disordered eating, in comparison to male-athletes. However, to date, there has been no systematic review or meta-analysis that has quantified the prevalence of clinically significant symptoms of these disorders in elite female-athletes. We searched three electronic databases from inception to May 2025. Eligible articles had to include: a sample of elite female athletes; quantitative data on clinically significant symptoms of anxiety, depression, and/or disordered eating; and prevalence data. Through the systematic search process, we identified 4321 potentially relevant articles. Following screening against the eligibility criteria, we included 122 articles in the systematic review and meta-analyses. We performed three proportional meta-analyses for studies investigating clinically significant symptoms of anxiety, depression, and disordered eating. 19.4, 18.7 and 18.6% of elite female-athletes reported clinically significant symptoms of anxiety (n=37 studies), depression (n=56 studies) and disordered eating (n=57 studies) respectively. By comparison, research into anxiety, depression and eating disorders in women in the general population suggests global prevalence rates of 7.3%, 7.8% and 5.7% respectively, suggesting substantial prevalence of clinically significant mental ill-health symptoms in elite female-athletes. As such, sporting organisations should be aware of the extent of these challenges, with robust systems in place to support prevention, management, intervention and recovery from mental ill-health in elite female-athlete populations.

The relationship between mental toughness, rumination, and depressive symptoms in athletes: A preliminary cross-sectional study

To explore nurse perceptions of perinatal cannabis use, current nurse and patient education on perinatal cannabis use, and educational needs for nurses and patients on perinatal cannabis use. We conducted a multiple-case qualitative case study. Using convenience and snowball sampling, we recruited perinatal nurses who worked in U.S. hospitals to complete an online interview. We identified themes and subthemes using Braun and Clarke's method of thematic analysis. Between July 2023 and February 2024, we interviewed 22 perinatal nurses divided almost equally among states where recreational cannabis was illegal (n = 12, 54.5%) and legal (n = 10, 45.5%). We identified five themes under the category of nurse perceptions of cannabis use: adverse maternal outcomes during pregnancy, maternal risks during labor, adverse neonatal health outcomes, acceptance of perinatal cannabis use, and management of physical and mental symptoms. Nurses reported on existing nurse education and patient education, with only nurses in states with recreational cannabis legalization citing specific patient educational needs. Our findings indicate an urgent need for development and implementation of nurse and patient education about perinatal cannabis use, particularly in states with recreational cannabis legalization.

Despite known dermatologic risks from sustained mouthpiece contact, the prevalence, clinical presentation, care-seeking patterns, and hygiene practices related to mouthpiece-associated dermatitis and cheilitis in brass musicians remain poorly understood. To characterize mouthpiece-related dermatitis/cheilitis symptoms, performance impact, care-seeking behavior, and hygiene practices among brass musicians. Brass musicians aged ≥15 completed an anonymous 18-item survey. Quantitative data were analyzed with descriptive statistics and logistic regression. Open-ended responses underwent thematic analysis. Of 228 respondents, 48.2% (95% confidence interval [CI]: 41.8-54.7) reported any mouthpiece-related symptoms and 28.1% (95% CI 22.6-34.3) reported definite symptoms. The most common symptoms were redness (67.6%), lip swelling (53.7%), and dryness (52.8%), with impacts on performance quality (47.2%) and the need for playing breaks (46.2%). 80.0% of respondents indicated hygiene familiarity, but only 38.1% cleaned their mouthpiece at least weekly. Symptom reporting varied by age (P = 0.010) and professional level (P = 0.002), though multivariable estimates were imprecise. Qualitative themes highlighted physical and mental symptoms, mouthpiece materials, and self-management. Mouthpiece-related dermatitis and cheilitis are prevalent among brass musicians, frequently impacting performance, yet care-seeking remains limited and symptoms are often self-managed outside formal health care settings.

Postoperative pain is not only a primary source of physical discomfort but also a significant risk factor that can trigger or exacerbate mental and psychological symptoms such as anxiety and depression. This study aimed to explore the interrelationship between postoperative pain and mental psychological symptoms, such as anxiety and depression, and analyse the risk factors influencing postoperative mental psychological symptoms. This study retrospectively collected clinical data of 411 surgical patients from March 2023 to April 2025 through an electronic medical record system. The Numeric Rating Scale (NRS) was used to assess preoperative and postoperative pains during rest and exercise. Postoperative pain was defined as a resting or exercise-evoked NRS score > 3 (moderate to severe pain). The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety (Hospital Anxiety and Depression Scale-Anxiety [HADS-A]) and depression (Hospital Anxiety and Depression Scale-Depression [HADS-D]). The relationship between postoperative pain and psychological symptoms, such as anxiety and depression, was explored through Spearman's correlation analysis and univariate and multivariate logistic regression analysis. After surgery, 59.12% (243/411) of patients had chronic postsurgical pain (CPSP), 36.25% (149/411) had anxiety symptoms (HADS-A > 7) and 31.63% (130/411) had depression symptoms (HADS-D > 7). Regarding surgical specialty, orthopaedic surgery patients had the highest proportion of CPSP, accounting for 63.64% (91/143) of orthopaedic cases, which represented 22.14% (91/411) of the total cohort. Gynaecologic surgery patients showed the highest rates of postoperative anxiety (41.76%, 38/91) and depression (45.05%, 41/91) within their specialty. After surgery, the average resting and exercise NRS scores of patients were significantly reduced compared with preoperative levels (both p < 0.01). However, the average HADS-A and HADS-D scores were significantly higher than before surgery (p < 0.01). Spearman's correlation analysis showed that postoperative resting NRS score was positively correlated with exercise NRS, HADS-A and HADS-D scores (p < 0.01). The correlation between HADS-A score and HADS-D score was not strong, whereas the correlation between exercise NRS score and these psychological indicators was strong. Multivariate logistic regression analysis showed that postoperative pain is an independent risk factor for the occurrence of mental symptoms. A statistically significant mutual association exists between postoperative pain and psychological symptoms in surgery.

Postorgasmic illness syndrome (POIS) is a rare and heterogeneous condition characterized by local and/or systemic symptoms following ejaculation. However, whether distinct clinical phenotypes exist remains unclear. We aimed to identify symptom-dominant phenotypes among men with self-reported POIS-like symptoms and to explore variations in the history of allergic diseases across the resulting phenotypes. An online cross-sectional survey was conducted via social media from December 2020 to August 2021 using the WenJuanXing web application. A two-step cluster analysis was performed using 26 variables from POIS-related symptoms and history of allergic diseases. A total of 2,443 men completed the survey, including 770 with self-reported POIS-like symptoms. A four-cluster solution (BIC = 39,404.98; ratio of distance measures = 1.42; ratio of BIC changes = 0.34) was selected. Cluster 1 represented the generalized type (81 patients, 10.5%) characterized by longer spontaneous recovery time with widespread disorders, including mental, flu-like, head, muscle symptoms and mostly reported atopic status. Cluster 2 represented the neuropsychiatric type (235 patients, 30.5%) comprised subjects with fewer atopic symptoms and predominantly mental symptoms, particularly concentration and memory difficulties. Cluster 3, or the nasal type (185 patients, 24.0%) mainly showed atopic and nasal symptoms, while cluster 4, or the oligosymptomatic type (269 patients, 34.9%) had fewer symptoms, faster symptom onset after ejaculation, shorter spontaneous recovery time, and fewer atopic symptoms. All 26 variables included in the clustering model differed significantly across clusters (P <0.001). Recruitment via social media may have introduced selection bias, potentially limiting the generalizability of these findings. The four identified phenotypes reflect the clinical variability of POIS and offer a preliminary framework for future phenotype-based investigations.

Objective: Parkinson’s disease (PD) is characterized by motor and non-motor symptoms. Among non-motor symptoms, neuropsychiatric symptoms (NPS), including depression, anxiety, cognitive decline and psychosis, are common and affect quality of life. The present study investigates gait patterns in PD patients with and without NPS, focusing on kinematic, kinetic, and spatio-temporal variables extracted from gait analysis. Notably, the assessments were carried out in a real-world outpatient clinical environment, which strengthens the translational value of the findings. Method: Overall, 104 PD patients were assessed using an optoelectronic system to record spatio-temporal parameters, kinematic and kinetic signals during a single task and two different dual tasks. First, a preliminary statistical analysis was carried out and then, several machine learning algorithms were applied to classify patients with and without NPS based on gait data. Results: Statistical analyses revealed that PD patients with NPS had slower gait, greater instability and reduced movement control. Decision Tree and Support Vector Machine classifiers showed promising results, particularly for kinematic and kinetic features (with an accuracy of 91.3% and 80.3%, respectively). The most recurrent features on which the classifiers were trained almost entirely matched the significance found by statistical analyses. Conclusion: The present findings further expand the relationship between motor and non-motor symptoms in PD highlighting that the relationship between gait and mental symptoms may extend beyond cognitive status. Clinical Impact—The study highlights the value of gait analysis as a promising, non-invasive surrogate biomarker for the early identification of a distinct clinical phenotype characterized by an increased burden of neuropsychiatric symptoms in Parkinson’s disease. The high accuracy achieved by machine learning models trained on gait features for distinguishing Parkinsonian patients with and without neuropsychiatric symptoms supports the development of assistive diagnostic tools that can enhance clinical decision-making, reduce subjectivity in patient assessments, and enable personalized monitoring of disease progression. Since the analyses were carried out in a real-world outpatient setting, the proposed approach naturally lends itself to integration within multidisciplinary clinical workflows, fostering synergistic collaboration among neurologists, physiotherapists and biomedical engineers, and contributing to a more personalized, precise, and proactive model of care.

ABSTRACTBackground Post–COVID-19 syndrome (PCS) is an emerging public health issue characterized by persistent symptoms, including anxiety. Anxiety is the most frequent mental health persistent symptom among patients with PCS, with global prevalence ranging from 6.5% to 63%. It negatively impacts people’s functioning, productivity, and daily routine beyond recovery. This study aimed to examine the prevalence, determinants, and health impact of anxiety symptoms among adults with post–COVID-19 in Qatar during 2022. Methods A cross-sectional study was conducted in Qatar between January and July 2022, utilizing data from the Primary Health Care Corporation’s Business Intelligence Unit. Out of 368 eligible individuals, 159 adults with confirmed PCS lasting more than 12 weeks were randomly selected and interviewed by telephone after providing consent. Anxiety levels were assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale.Results Out of 159, the prevalence of anxiety symptoms was 50.3% (n = 80) based on GAD-7. Most of the participants were female, Qatari, married, and unemployed. Hospitalization and functional impairment were also higher in the anxiety group compared to those without anxiety. Depression, disability, and cognitive dysfunction were strongly associated with the post–COVID-19 anxiety group compared to the non-anxiety group, with P < 0.05.Conclusion Post–COVID-19 anxiety is prevalent among PCS patients in Qatar and linked to worse mental and physical health outcomes. Routine screening and integrated care approaches are essential to support recovery.

This study aimed to explore the employment trajectories of individuals with mental disorders, including those with a substance use disorder, who received individual placement and support (IPS) services. A growth mixture modeling analysis of Supported Employment Demonstration study data was used to identify distinct employment trajectories. The analysis focused on determinants of variations in work participation across different trajectories of 1,656 study participants. Five distinct employment trajectories were found, with work history, educational attainment, and approval for disability benefits emerging as significant predictors of employment outcomes. Mental disorder symptom severity and presence of a substance use disorder were not related to negative work trajectories, highlighting the robustness of IPS for supporting diverse populations. Individuals receiving IPS services as part of the treatment group and with recent work history, higher levels of formal education, and better general medical health had more positive work trajectories that ended in higher employment rates compared with others. Participants with co-occurring mental and substance use disorders had similar employment trajectories compared with other participants. The findings suggest that individuals with more severe psychiatric or substance use symptoms can benefit from IPS. Factors such as approval for disability benefits, previous work experience, and higher levels of education were significant in determining employment outcomes among these populations.

Vision Impairment and Falls Among Older Mexican Americans Over 16 Years Follow-Up.

How personality functioning shapes symptom development during and after treatment: A random intercept cross lagged panel analysis.

BackgroundCaregivers of patients with major depressive disorder (MDD) frequently experience significant mental health and social burdens, yet evidence among Asian caregivers remains limited. This study aimed to identify factors associated with caregiver burden in the Taiwanese population.MethodsA cross-sectional survey of 150 caregiver–patient pairs was conducted in a psychiatric outpatient clinic in Taiwan. Caregiver burden, common mental symptoms, and depressive symptoms were assessed using validated instruments. Correlation and hierarchical regression analyses were performed to determine factors related to total and subdomain caregiver burden.ResultsCaregivers reported a mild to moderate level of burden, with the highest index score in caregiver strain, and lowest in stigma. Both common mental symptoms and depressive symptoms were significantly correlated with total burden. Regression analyses showed that caregiver educational attainment and depressive symptoms were the strongest factors related to total burden, together explaining 43.7% of the variance. Depression severity also emerged as the key factor across several burden subdomains.ConclusionCaregivers of MDD patients experience meaningful levels of burden, largely influenced by their mental health status, particularly depressive symptoms. These findings emphasize the need for targeted mental health assessment and supportive interventions to reduce caregiver burden and promote caregiver well-being.

Research is limited as to how physical and mental symptoms may relate to emotional social support in health profession students, who often experience social isolation. The ORBIT Model Phase Ia was used to guide this proof-of-concept study. Surveys were distributed at two timepoints to preclinical medical, dental, veterinary, and physical therapy students at a health sciences university. Surveys included the Perceived Stress Scale, the Generalized Anxiety Disorder scale, the Patient Health Questionnaire scales for depression and somatization, and the NIH Toolbox: Emotional Social Support subscale. N = 38 separate individuals completed the timepoints. The outcome measures appeared tolerable and acceptable to the participants at two time-points. Emotional social support was below recommended levels, particularly among Hispanic/Latino students. Social support was significantly negatively correlated with perceived stress (rho = -0.43, p < 0.01), anxiety (rho = -0.34, p < 0.01), and depression (rho = -0.40, p < 0.01) at T1, and depression (rho = -0.43, p < 0.01) and physical symptoms (rho = -0.46, p < 0.01) at T2. Results support proof-of-concept for an association between these variables in health profession students. Further investigation into emotional support among health profession students in a larger sample is warranted.

The climate crisis is not only an environmental issue but also a growing challenge to biopsychosocial well-being. This study examined the association between climate crisis awareness and mental health-related indicators, specifically eco-anxiety and depressive symptoms, among healthcare professionals. This cross-sectional study was conducted between June and September 2023 using an online survey in Türkiye. A total of 301 healthcare professionals-including physicians, psychologists, nurses, and allied health personnel-participated using snowball (non-probability) sampling. Data were collected using a sociodemographic questionnaire, the Beck Depression Inventory (BDI), the Ecological Awareness and Consciousness Scale (EACS), and the Eco-Anxiety Scale (EAS). The EACS was adapted from an existing instrument and applied for exploratory purposes. Statistical analyses were conducted using SPSS 25.0, employing nonparametric tests (Mann-Whitney U and Spearman's correlation). Results showed that 71.4% of participants were female and 28.6% were male, with a mean professional experience of 10.96 ± 6.9years. Most participants (87%) reported being informed about climate change, primarily through media sources. Climate crisis awareness was positively correlated with eco-anxiety (r = 0.339, P < 0.001), and eco-anxiety was positively associated with depressive symptom severity (r = 0.482, P < 0.001). In secondary analyses, male participants reported higher levels of eco-anxiety and depressive symptoms than females (P < 0.01). These findings highlight the psychological correlates associated with climate crisis awareness among healthcare professionals and underscore the importance of integrating mental health support and resilience-building strategies into climate-related education and awareness initiatives. Given the cross-sectional design, the findings reflect associations rather than causal effects.

This study investigates how individuals across different age groups use and perceive AI chatbots for health and fitness management. A quantitative survey (n = 180) examined usage frequency, perceived trust, relevance and satisfaction among users. Findings reveal that younger users, especially females aged 18-27, are the most frequent adopters, primarily engaging with chatbots for mental health, symptom checking and general wellbeing. Trust and behavioural intention were strongly correlated with perceived relevance and usefulness, aligning with the Technology Acceptance Model (TAM) and Unified Theory of Acceptance and Use of Technology (UTAUT). However, concerns about accuracy, privacy and empathy persist, particularly among older users. The study concludes that while AI chatbots are emerging as valuable health management tools, their design must prioritise ethical transparency, contextual accuracy and emotional sensitivity to foster sustained adoption and trust.

ABSTRACT This paper introduces the concept of the functional ambivalence of mental symptoms as a contribution to Enactive Psychiatry. Drawing on the autonomy-centered foundations of the enactive approach, we argue that mental disorders are not purely dysfunctional, but complex, multi-scale patterns of organization that can display functional and dysfunctional aspects at once. Functionality is understood as graded and context-dependent, emerging from interactions among multiple domains of normativity and across temporal scales. In dialogue with Russell’s perspective problem, we argue that the ambiguity of functional evaluation is not a shortcoming but a predictable consequence of plural autonomy. Our proposal is intended to be complementary to related theses developed in other frameworks. These perspectives can help clarify why certain symptoms persist and which meaningful and self-regulatory roles they may serve. Using anorexia, self-harm, and dietary restraint as examples, we show how behaviors typically treated as dysfunctional can play functional roles even as they generate harm. Clinically, the framework supports interventions that identify what symptoms do for the person while fostering alternative and more sustainable forms of regulation. Ethically, it promotes a less pathologising understanding of mental disorder by integrating first-person perspectives that can disclose functional dimensions often missed by third-person evaluation.

BackgroundSomatic symptom disorder (SSD) is a mental disorder marked by persistent somatic symptoms and maladaptive health-related thoughts, feelings, or behaviors. Cognitive behavioral therapy has been shown to be effective in treating SSD, reducing patients’ somatic symptoms, depressive symptoms, and anxiety symptoms. However, challenges remain—including limited access to treatment. Videoconference-based cognitive behavioral therapy (vCBT) has emerged as a promising approach, offering flexible and tailored treatment while addressing the shortage of medical resources and potentially reducing patient dropout.ObjectiveThis study examined the feasibility of vCBT for patients with SSD and explored secondary outcomes related to the physical component of health-related quality of life (HRQOL) as assessed using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) physical component summary (PCS) score and other exploratory clinical outcomes.MethodsThis single-arm pilot trial evaluated feasibility as the primary outcome assessed via recruitment rate, retention rate, session completion rate, and safety. Ten participants with SSD were enrolled, and all received 6 weekly 50-minute vCBT sessions. Secondary outcomes included physical HRQOL (SF-36 PCS) as the key secondary outcome, as well as mental HRQOL, depressive symptoms, somatic symptom severity, anxiety symptoms, health anxiety, pain, insomnia, and generic HRQOL. These outcomes were measured at the preintervention (week 0) and postintervention (week 6) time points and 1-month follow-up (week 10) and were analyzed using 2-sided paired t tests.ResultsAll feasibility criteria were met, with a recruitment rate of 83.3% (10/12), a retention rate of 100% (10/10), a session completion rate of 100% (10/10), and no adverse events reported. The SF-36 PCS score improved by 4.99 points at the postintervention time point, representing a large within-group effect (Cohen d=0.99, 95% CI 0.21‐1.74). Medium to large improvements were also observed in mental HRQOL, depressive symptoms, anxiety symptoms, health anxiety, pain, insomnia, and generic HRQOL, and most of these improvements were observed at the 1-month follow-up.ConclusionsOur findings indicate that vCBT is a feasible and safe approach for SSD, with findings suggesting acceptability and preliminary evidence of effectiveness.

An externally validated machine learning algorithm for predicting mental and physical health outcomes three months post-hospitalization for severe viral infection with SARS-CoV-2

Cases of uterine leiomyoma are frequent in clinical practice. Clinical symptoms and indications range from no symptoms to acute abdominal pain. Notably, pain in the abdominal flanks can also be associated with renal calculi. This case report is unique because it documents the successful management of subserosal uterine leiomyoma and renal calculi in a 19-year-old female patient using individualized Homoeopathic medicines, highlighting a holistic mind-body approach. The patient presented with irregular menses for 1-year, dark clotted menstrual flow, lower abdominal pain, loose stools, anxiety before defecation, and fatigue on minimal exertion. Ultrasonography of the abdomen and pelvis revealed a 5 cm × 4.2 cm subserosal uterine leiomyoma and a 7 mm right renal calculus. Individualized Homeopathic treatment was prescribed, starting with Pulsatilla nigricans 200 C, followed by Calcarea Carbonicum 200 C, along with Saccharum lactis as a vehicle for dose administration. The patient experienced progressive relief in menstrual irregularity, abdominal and lumbar pain, gastrointestinal complaints, and overall fatigue. Follow-up ultrasonography of the abdomen and pelvis demonstrated resolution of the renal calculus and normalization of uterine structure. This case report demonstrates the potential of individualized Homoeopathic medicines in addressing both uterine fibroids and renal calculi. A holistic approach considering mental, physical, and constitutional symptoms may contribute to favourable outcomes in similar cases. Subserosal uterine leiomyoma, renal calculi, Homoeopathy, Pulsatilla nigricans, Calcarea Carbonicum, Constitutional medicine, nanomedicine.