Social functioning is a crucial aspect of psychosocial adaptation following forced displacement. Yet, it has received far less attention than understanding and addressing mental health problems among refugees and asylum-seekers. This study aimed to extend the ecological model of refugee distress – one of the most widely used frameworks in refugee mental health – to social functioning, and to identify direct and indirect pathways from established conflict- and displacement-related factors to social functioning alongside mental health problems.

An online study with 1,235 refugees in Indonesia was conducted over a 2-year period. Conflict-related traumatic experiences before arrival in Indonesia, post-displacement stressors in the past 12 months, were measured at the onset of the study, while social functioning and mental health outcomes (symptoms of posttraumatic stress disorder, depression, and anger) were assessed 1 year later.

Longitudinal Structural Equation Modelling analysis revealed that diversity of conflict-related trauma predicted more post-displacement stress (β = 0.45, SE = 0.03, p < 0.001), higher mental health problems (β = 0.13, SE = 0.05, p = 0.004), but increased social functioning 1 year later (β = 0.10, SE = 0.04, p = 0.011), while post-displacement stressors predicted poorer mental health (β = 0.46, SE = 0.05, p < 0.011) and reduced social functioning (β = −0.09, SE = 0.04, p = 0.041). The indirect pathway from traumatic experiences via post-displacement stressors was positive for mental health (β = 0.21, 95% CI = 0.162–0.257) and negative for social functioning (β = −0.04, 95% CI = −0.082 to −0.003).

This study conceptually and empirically extended the ecological model of refugee distress to social functioning by highlighting the dual influences of conflict-related traumatic experiences. The findings provide a springboard for advancing research and practice in the mental health and psychosocial field.

Working memory (WM) impairment is a core cognitive deficit in schizophrenia, associated with dysfunction of large-scale brain networks, particularly the triple-network system comprising the default mode, frontoparietal, and salience networks. Given the role of environmental risks like childhood trauma (CT) in cognitive deficits, we investigated whether trauma relates to altered triple-network flexibility and WM in schizophrenia.

We enrolled 190 patients with schizophrenia (SZ) and 117 healthy controls (HCs). Among them, 162 SZ and 99 HCs underwent n-back task-based functional magnetic resonance imaging. We computed temporal variability (TV) in the triple-network connectivity, defining ΔTV as the change between 0-back and 2-back conditions. Subgroup comparisons of ΔTV were conducted within each group based on trauma status. Associations of ΔTV with WM performance and clinical symptoms were examined in SZ, followed by mediation analyses testing whether ΔTV mediates the relationship between trauma and WM.

Among HCs, individuals with childhood trauma showed reduced ΔTV across triple-network connections, whereas no such differences appeared in SZ. In SZ, greater ΔTV within the frontoparietal network (FPN) was correlated with lower positive symptom severity (r = −0.211, p-fdr = 0.046) and better n-back target accuracy (r = 0.303, p-fdr = 0.002). Furthermore, ΔTV within the FPN partially mediated the association between trauma and n-back accuracy.

Our findings highlight the central role of FPN flexibility in mediating childhood trauma’s effect on working memory in schizophrenia. This outlines a key pathway through which an early environmental risk (trauma) translates into cognitive and clinical manifestations in schizophrenia.

Significant sex disparities in mental health have been observed amongst resettled refugees, yet how these disparities and their determinants evolve over time remains unclear. This study sought to quantitatively unravel determinants and changes in mental health disparities by sex.

Data were drawn from Waves 1 (2013–2014), 5 (2017–2018) and 6 (2023) of the 10-year Building a New Life in Australia (BNLA) cohort. Post-traumatic stress disorder (PTSD) and high risk of severe mental illness (HR-SMI) were measured using the PTSD-8 and Kessler-6 scales. Fairlie method was used to quantify the disparity (total predicted probability difference by sex) and the contribution proportion of individual determinants (explained difference/total predicted probability difference × 100%).

A total of 2261 refugees were included at Wave 1, with 1833 (81.1%) and 905 (40.0%) followed up at Waves 5 and 6. Female refugees consistently experienced poor mental health, with the total predicted probability difference decreasing from the initial (Wave 1, 8.3%) to middle stage (Wave 5, 4.6%), then increasing in the long term (Wave 6, 6.3%). Determinants of disparities varied across waves, but poor status of physical health was a persistent contributor of disparities in PTSD (contribution proportion: 57.2%, 71.5% and 63.0% at each wave). Family conflict contributed at the initial (HR-SMI: 4.5%) and long-term stages (PTSD: 8.7%), while financial hardships (PTSD: 13.2%; HR-SMI: 23.2%), marital status (HR-SMI: 24.8%) and family concerns (PTSD: 8.0%) were key determinants at the middle stage. Unmet support or help during COVID-19 was a major contributor at Wave 6 (PTSD: 22.7%; HR-SMI: 8.0%).

Sex disparities exist in refugees’ mental health and require sustained attention and tailored strategies. To promote mental health equity, there is a long-term need to provide essential physical healthcare and financial assistance and address family-related stressors. Additionally, it is important to identify and address the specific psychosocial needs of women in times of crisis such as the COVID-19 pandemic.

Spiritual care is a core element of palliative care, addressing religious, spiritual and existential concerns and enhancing quality of life. In Finland, systematic assessment of patients’ spiritual needs is limited due to the lack of a validated instrument. This study aimed to develop and psychometrically validate the Spiritual Needs in Palliative Care (SNPC) questionnaire for Finnish palliative care patients.

A prospective, multi-phase validation study, included item generation, expert review, pilot testing, and psychometric evaluation. Content and construct validity, as internal consistency and Cronbach’s alpha values were assessed using explorative factor analysis (EFA). For convergent and divergent, validity Pearson’s correlations were calculated for Edmonton Symptom Scale (ESAS), WHO Performance Status Scale, and the Spiritual Well-being Questionnaire (EORTC QLQ-SWB32).

The SNPC included 28 items covering existential, emotional, religious, and spiritual distress domains, with sections for importance and fulfillment of each need. A total of 116 patients (mean age 71 years; 61.2% female; 88.8% with cancer)), were recruited from 10 oncology and palliative care units across Finland. EFA supported an 8-factor structure – Communication and Preparation for Death; Meaning and Continuity; Emotional and Inner Peace; Artistic and Quiet Comfort; Religious Needs; Ritual Participation; Freedom from Guilt and Shame; Fear and Survival – explaining 71% of variance, with good reliability (Cronbach’s α = 0.63–0.93). The most important needs were safety in care, peace of mind, and participation in care decisions, while religious rituals and visits by clergy were less important. Significant gaps emerged between perceived importance and fulfilment of needs, regarding being heard, hope, peace, and the presence of loved ones. Fulfilled spiritual needs correlated well with SWB32 but not with ESAS.

The SNPC is a valid and reliable instrument for assessing the spiritual needs of Finnish palliative care patients. It could support systematic identification of unmet spiritual needs of palliative care patients.

Mental–physical multimorbidity is an emerging prevalent global health challenge. This study aims to examine reciprocal relationships between depressive symptoms and multimorbidity, with the mediation role of functional dependence in activities of daily living.

Data were derived from the China Health and Retirement Longitudinal Study, which included 11,572 Chinese residents aged 45 years and older, surveyed in 2011, 2013, 2015 and 2018. Depressive symptoms were assessed using the Chinese version of the Center for Epidemiologic Studies Depression Scale (CESD-10) at baseline and each follow-up survey. Multimorbidity was operationalized as the condition count and the patterns identified via exploratory factor analysis. Four-wave cross-lagged panel models (CLPM) with bootstrapping were employed to estimate the path coefficients and the mediation effect of functional dependence.

Multimorbidity (cardiometabolic and respiratory-degenerative) and depressive symptoms exhibited bi-directional associations. Multimorbidity had a stronger impact on later depression (β: 0.042–0.130) than depression on multimorbidity (β: 0.005–0.064). Associations were stronger for respiratory-degenerative (β: 0.027–0.104) than cardiometabolic diseases (β: 0.005–0.065). Functional dependence partially mediated these links, with higher mediation for cardiometabolic (9–21%) than respiratory-degenerative diseases (4-6%). Additionally, some sex- and age-specific differences were identified in these dynamic associations.

The study revealed bi-directional links between multimorbidity and depressive symptoms among Chinese adults. Functional dependence was a significant pathway in the cycle of multimorbidity and depressive symptoms, especially for cardiometabolic diseases. These insights suggest that interventions aimed at preventing functional dependence may be beneficial in mitigating the risk of coexisting mental and physical disorders.

Mental stress-induced myocardial ischemia (MSIMI) is common in women with angina with no obstructive coronary artery disease (ANOCA) and is associated with adverse cardiovascular outcomes. Interleukin-6 (IL-6), a central mediator of chronic inflammation, predicts future cardiovascular risk, but its relationship with MSIMI remains unclear.

Eighty women with ANOCA underwent 13N-ammonia positron emission tomography/computed tomography to assess myocardial perfusion and myocardial blood flow (MBF) at rest, during mental stress, and during adenosine-induced stress. Resting inflammatory biomarkers were measured, and multivariable logistic and linear regression models were used to evaluate associations with mental stress-induced perfusion defects. Proteomic profiling was performed in a selected subset to explore potential underlying mechanisms.

Mental stress induced significantly greater myocardial perfusion defects in MSIMI+ patients. Resting IL-6 levels were significantly higher in MSIMI+ patients (3.20 versus 1.80 pg/mL, p = 0.024). Although baseline CRP, hsCRP, and complement C3 levels were also higher in MSIMI+ patients, only resting IL-6 remained independently associated with both the presence of MSIMI and the severity of mental stress-induced myocardial perfusion defects after adjustment for demographic, clinical, and psychosocial factors, and resting MBF. Proteomic analyses demonstrated enrichment of innate immune–hemostatic pathways and mitochondrial oxidative phosphorylation in MSIMI+ patients with high IL-6 levels.

Elevated resting IL-6 is independently associated with the presence and severity of MSIMI in women with ANOCA. These findings suggest that IL-6 may serve as a biomarker of MSIMI and support IL-6-related inflammation as a key pathophysiological pathway underlying MSIMI, with potential implications for targeted therapeutic strategies.

Postnatal depression (PND) can disrupt maternal communication during early interactions, affecting infant socioemotional development. Singing is a natural form of caregiver–infant communication and a promising intervention to enhance maternal well-being and bonding. However, its effects on observed communication and perceived attachment in clinical PND populations remain underexplored.

Within the Scaling-Up Health-Arts Programs: Postnatal Depression trial, 199 mothers with PND were randomized 2:1 to a 10-week group singing intervention (Breathe Melodies for Mums) or a non-singing community activity. One hundred participants (singing = 70; control = 30) completed video-recorded interactions at baseline, week 10, and week 36. Maternal speech was coded using the Parental Cognitive Attributions and Mentalization Scale (PCAMS) for mentalization, affective tone, and attentional focus. Perceived maternal attachment was assessed separately via self-report using the Maternal Postnatal Attachment Scale.

At week 10, singing mothers showed greater improvement in communication with their infants than controls, with about 1.7-fold higher proportions of mentalizing comments (p = 0.01), 1.4-fold more infant-focused speech (p < 0.001), 2.4-fold less parent-focused speech (p < 0.001), and fivefold less negative speech (p < 0.001). These effects were maintained at week 36. Perceived attachment improved significantly across both groups (p < 0.001), but only singing mothers showed further gains from week 10 to week 36 (p = 0.02), indicating continued strengthening of attachment perceptions.

Group singing enhanced maternal communication and perceived attachment in mothers with PND. Findings support community-based, arts-informed interventions as accessible approaches to strengthen early relational health and complement perinatal mental healthcare.