Depression as a mental illness is commonly observed to co-occur with various somatic diseases, such as gastrointestinal diseases. However, previous studies have primarily focused on the risk of mental disorders following physical illnesses. Our study took depression as a risk factor, attempting to explore its relationship with gastrointestinal diseases.

A total of 457,940 participants (aged 37–73 years) in the UK Biobank were included. The Cox proportional hazards model was used to assess the relationship between depression and gastrointestinal diseases. Mendelian randomization assessed the causal link between depression and gastrointestinal disorders, and seven machine learning algorithms (including LightGBM, XGBoost, and Random Forest) were trained in the total population to develop predictive models for incident gastrointestinal diseases, with model performance evaluated using the area under the receiver operating characteristic curve (AUC).

During a median follow-up period of 13.7 years, 9563 esophagitis events, 36,420 gastroesophageal reflux disease events, 5469 gastric ulcer events, 3096 duodenal ulcer events, 37,225 gastritis and duodenitis events, and 9153 dyspepsia events were recorded. After adjusting for covariates, depression was associated with increased risk of all six diseases. Two-sample MR analysis supported a causal association. Machine learning models demonstrated good discrimination, with the highest predictive accuracy observed for duodenal ulcer (AUC = 0.76) and gastric ulcer (AUC = 0.75).

Addressing depression as a modifiable risk factor may reduce gastrointestinal disease risk, especially in disadvantaged populations, by integrating mental health care into primary care and using predictive models for early intervention.

To examine the Indigenous Nourishment Scales (INS), a set of community-developed strengths-based measures of nourishment, for psychometric validity and reliability through community-based research with two urban American Indian/Alaska Native (AI/AN) communities.

Cross-sectional survey of health measures and INS. Descriptive statistics, exploratory factor analysis (EFA), correlation analysis and regression were used to determine the psychometric properties of the INS and their relationship with Physical (Fruit and Vegetable Intake), Spiritual (Spiritual Well-being), Emotional (Emotional Well-being) and Relational (Social Well-being) health outcomes.

Two urban cities in the USA.

249 urban AI/AN adults.

EFA revealed two unidimensional scales (Connectedness to Food; Indigenous Food Identity) and one two-factor scale (Access to and Participation in Indigenous Foodways). The INS demonstrated strong internal consistency reliability and convergent construct validity as evidenced by their association with fruit and vegetable intake and other related concepts. Regression models showed that Access to Indigenous Foodways and Participation in Indigenous Foodways were significantly and positively associated with all four domains of well-being. Food Connectedness was positively and significantly associated with spiritual, emotional and relational well-being, while Indigenous Food Identity was positively and significantly associated with spiritual and emotional well-being.

Positive associations between scale scores and multiple domains of well-being indicate the potential relevance of Indigenous nourishment as a meaningful determinant of health. By establishing the psychometric validity of community-developed measures, this study offers a pathway for Indigenizing assessments of nutrition and well-being among AI/AN peoples.

The comorbidity of psychiatric and metabolic conditions is prevalent and poses a heavy burden on public health. Several biopsychosocial factors are known to influence both metabolic and psychiatric health, including inflammation, eating behavior, physical activity, and early life stress. Few studies, however, have examined the constellation of interrelationships among multiple risk domains simultaneously.

Using a sample of 200 medically healthy adults enrolled in a parent study, we used Gaussian Graphical Modeling, a type of network analysis, to characterize interdependent cross-sectional associations between early life stress (childhood trauma), health behaviors (diet quality and physical activity), blood-based biomarkers of metabolic functioning (insulin resistance, HDL cholesterol, triglycerides) and inflammation (C-reactive protein [CRP]), and three domains of mental health symptoms (depressive, anxious, and post-traumatic stress symptoms). We hypothesized that the network structure would highlight a pattern whereby higher CRP, poorer diet quality, lower physical activity, and higher childhood trauma would associate with increased risk for both metabolic and psychiatric impairments.

Findings revealed a positive conditional association between CRP and childhood trauma, which may function as an intermediary process to increase risk for both metabolic impairments and psychiatric symptoms in adulthood. Further, higher physical activity was associated with lower insulin resistance and fewer depressive symptoms, and better diet quality was associated with lower CRP levels.

Results highlight potential avenues for interventions aimed at reducing inflammation, improving health behavior, and addressing the effects of childhood trauma to improve physical and mental health comorbidities.

This study aimed to culturally adapt the Self-Blame Attributions for Cancer Scale (SBAC) into Turkish and evaluate its psychometric properties, including validity and reliability.

This methodological study enrolled 161 patients from both inpatient and outpatient oncology departments of a university hospital during a 1-year observation period (March 2024–March 2025). Participant data were obtained by using 2 instruments: a demographic questionnaire and the adapted Turkish version of “the SBAC.”

Confirmatory factor analysis revealed strong factor loadings ranging from 0.670 to 0.850, indicating good item reliability. Model fit statistics demonstrated excellent psychometric properties (χ2/df = 2.00; root mean square error of approximation = 0.079; Comparative Fit Index = 0.99; standardized root mean square residual = 0.042; Tucker–Lewis Index = 0.98; root mean square residual = 0.042). The scale showed high internal consistency, with a total Cronbach’s α of 0.93 and subscale α coefficients ranging from 0.85 to 0.90. The original 2-factor structure of the SBAC was supported.

The study confirmed the bidimensional structure (11 items) of SBAC’s Turkish version with excellent validity and reliability indices, supporting its cultural and psychometric adequacy for Turkish samples.

The Mediterranean Diet (MedDiet) and physical activity (PA) can enhance mood and support psychological wellbeing in adults. However, the combined effect is relatively unknown. MedWalk aimed to determine the combined effect on wellbeing, psychological health and quality of life (QoL), compared to a control group.

This is an analysis of secondary outcomes from the MedWalk 12-month cluster-randomised controlled trial. Participants completed the Total and Secure Flourishing Index (FI), the four domain General Health Questionnaire (GHQ-28) and the 8-domain Assessment of Quality of Life (AQoL-8D). Data were analysed using general linear models using change scores (FI and AQoL-8D) or generalised linear mixed models with a time × group interaction effect (GHQ-28).

Independent living facilities across South Australia and Victoria in 2021–2022.

One hundred and sixty-one older men and women.

Participants were 74·9 ± 5·9 years of age and predominantly female (74 %). A greater improvement was found for the MedWalk group (marginal means (MM) = 1·65, se = 1·36) than the control group (MM = –2·50, se = 1·32) for the Total Flourish score (P = 0·003) and Secure Flourish score (P = 0·009) ((MM = 1·06, se = 1·65) v. (MM = –3·34, se = 1·61)) from baseline to 6 months. The MedWalk group (MM = 0·021, se = 0·014) had more positive changes (P = 0·048) to the Mental Health AQoL-8D domain than the control group (MM = –0·007, se = 0·014). No significant group × time interactions were identified for the GHQ-28.

Combined MedDiet and walking interventions can modify psychological health, wellbeing and QoL in relatively healthy populations.

As patients progress through single-ventricle palliation, changing haemodynamics and patient conditions can prevent progression to Fontan. We sought to determine the incidence of Fontan completion at our institution and to investigate the reasons for non-Fontan candidacy.

Patients who underwent superior cavopulmonary anastomosis from 2010 to 2020 at a single institution were included. Pre-Fontan testing was reviewed for all patients, and the primary reason for non-candidacy was determined based on a review of the electronic medical records.

Of the 427 patients included, 396 (93%) underwent Fontan or were referred for Fontan at the time of the study. Reasons for non-Fontan candidacy in the remaining 31 patients included cardiac reasons (n = 26), mainly univentricular dysfunction or atrioventricular valve regurgitation, respiratory conditions (n = 3), or miscellaneous reasons (n = 2). The patients who were non-Fontan candidates due to respiratory conditions and miscellaneous reasons are all alive without further palliation at the time of the study. There are 17 patients (17/31; 55%) in the non-candidacy group who had a heart transplant or were listed for transplant at the time of the study. Non-Fontan candidates had a higher incidence of moderate or severe atrioventricular valve regurgitation prior to superior cavopulmonary anastomosis.

Thirty-one patients (31/427; 7%) were not Fontan candidates at our centre. Our results demonstrate that the reasons for non-Fontan candidacy after completion of stage 2 are broadly due to echocardiographic findings and respiratory concerns. Predicting non-Fontan candidacy prior to superior cavopulmonary anastomosis remains difficult.

Information about a treatment’s benefits and harms available to a patient often relies on text. However, for many medical conditions, patients must trade off benefits and harms across multiple competing treatments. It remains unknown how to appropriately communicate information on benefits and harms to patients.

We compared three communication tools using textual information (Cochrane summary of findings table) or increasing combinations of textual and graphical information (Kilim and Vitruvian plots, respectively) to convey the available evidence.

Communication of Benefit–Risk Information, an online randomised controlled trial, is a three-group, parallel, open-label, automated, randomised controlled trial (no. NCT05917639). We recruited participants aged between 18 and 65 years from the general population. Participants were randomly allocated (1:1:1) to one of the three communication tools providing information on competing fictional treatments for social anxiety, and were asked to choose one based on externally provided preferences. The primary outcome was the perceived level of decisional conflict when selecting a treatment (decisional conflict scale (DCS): 0 = best, 100 = worst). Because this was an all-or-nothing, single-visit trial, only those participants providing data contributed to the primary analyses (modified intention to treat).

We recruited 2178 adults between 1 June and 27 November 2023. Vitruvian and Kilim plots outperformed the Cochrane summary of findings table on the primary outcome (adjusted mean difference −10.9, 95% CI −13.5 to −8.2, P < 0.0001 and −9.7, 95% CI −12.4 to −7.1, P < 0.0001), respectively). Results varied by participants’ literacy and numeracy skills, lived experience of the condition of interest, ethnic group, gender assigned at birth and age.

Combining graphical and textual information, as opposed to text only, improved communication and reduced decisional conflict when choosing across multiple competing medical interventions. Organisations involved in disseminating scientific evidence should consider endorsing a combined graphical and textual approach and adopting more intuitive and accessible communication methods. We identified several prognostic factors that should inform the development of future patient decision aids and communication of scientific findings.

NCT05917639.

Antidepressants are pivotal in treating major depressive disorder and other psychiatric conditions. However, despite their widespread use, evidence regarding the serious adverse effects of prolonged antidepressant use and withdrawal in complex older-adult populations remains limited.

We aimed to investigate the association between phases of antidepressant treatment with emergency hospital admission and hospital admissions related to adverse drug reactions in older adults with polypharmacy in English primary care.

We conducted a case–control study using linked primary and secondary care electronic health record data from the Clinical Practice Research Databank GOLD and Aurum. We included individuals aged 65–100 years with polypharmacy (i.e. those who were prescribed five or more medicines). We used conditional logistic regression to investigate the associations between the phases of antidepressant treatment and hospital admission risks.

We found 626 199 emergency hospital admission cases and matched with 3 639 740 controls. The initiation phase of antidepressants was associated with the greatest increase in the risk of emergency hospital admission (adjusted odds ratio 2.30, 95% CI 2.23–2.38), followed by short treatment gap or early discontinuation after short-term use (adjusted odds ratio 1.41, 95% CI 1.37–1.45). We found that patients had a higher risk of serotonin-related symptoms, falls and trauma, and cardiovascular events during antidepressant use phases, and the risks tend to decrease in past exposure phases for most conditions.

Individuals who are on the initiation and short treatment gap or early discontinuation after short-term use of antidepressant treatment are associated with a higher risk of hospital admission. This study highlights the need for vigilant monitoring of antidepressant initiation and withdrawal in older-adult polypharmacy patients.