Adult cohorts with generalised joint hypermobility (GJH) report higher rates of neurodevelopmental problems (NDPs). However, the prevalence of GJH in community-dwelling children and its association with NDPs remains unexplored.

This study aimed to (a) assess the prevalence of GJH, (b) examine its link to musculoskeletal pain and (c) explore associations with NDPs in 11-year-old Swedish children.

An in-school study was conducted as part of the 4th grade health check-up. It included a structured physical examination using the Beighton score (range 0–9) and a comprehensive neurodevelopmental assessment based on behavioural ratings, maternal interviews, medical records and academic performance.

Of 348 eligible children from eight schools, 223 (64%) participated, with Beighton scores measured in 207 (59%). The median Beighton score was 1 (interquartile range 0–2), with no significant gender differences (Wilcoxon test, P = 0.17). A Beighton score of ≥6 approximated the 95th percentile in both sexes. No significant association was found between high Beighton scores and NDPs. Few children with GJH reported weekly pain, indicating a low prevalence of hypermobility spectrum disorders in this age group.

Our findings validate the age-specific Beighton score cut-off and suggest that GJH in children of this age is not linked to NDPs, differing from findings in adults. This may reflect developmental changes during puberty. Additionally, the high prevalence of weekly pain (42%) in the cohort warrants further investigation into its causes and impact.

People with severe COVID anxiety have significant fears of contagion, physiological symptoms of anxiety in response to a COVID stimulus and employ often disproportionate safety behaviours at the expense of other life priorities.

To characterise the long-term trajectory of severe COVID anxiety, and the factors that influence recovery.

This prospective cohort study followed 285 people with severe COVID anxiety in the UK over 18 months. A nested randomised feasibility trial tested an online cognitive–behavioural therapy (CBT)-based intervention (no. ISRCTN14973494). Descriptive statistics and linear regression models identified factors associated with change in COVID anxiety over 18 months.

Most participants experienced major reductions in COVID anxiety over time (69.8% relative cohort mean decrease, P < 0.001), but a quarter of people (23.7%, 95% CI: 17.8–30.1) continued to worry about COVID every day, and for 13% symptoms remained severe even after the ending of all public health restrictions. Increasing age, being from a minority ethnic background that confers greater risk from COVID-19, and the persistence of high levels of health anxiety and depressive symptoms, predicted slower improvements in severe COVID anxiety after adjusting for other clinical and demographic factors. Neither a trial CBT-based intervention, nor contextual factors including daily case rates, vaccination status or having contracted COVID-19, appeared to affect the trajectory of severe COVID anxiety.

For most people severe COVID anxiety improves significantly with time. However, interventions treating depression and health anxiety, and targeting older people and those from greater-risk minority backgrounds, warrant further investigation in future pandemics.

Psilocybin-assisted psychotherapy (PAP) has gained attention as a promising intervention for conditions including depression, anxiety and post-traumatic stress disorder, but understanding of its side-effects is limited. This review evaluates the quality of side-effects reporting in PAP trials, to guide treatment, policy and research.

To assess side-effects reporting quality in PAP trials for psychiatric conditions, comparing published articles and ClinicalTrials.gov records.

A PROSPERO-registered review (no. CRD42023458960) included English-language PAP trials (2005–2024) identified via Embase, CENTRAL, PubMed and reference searches. Reporting quality was assessed using the CONSORT Harms extension, categorised as either high (17–21), moderate (12–16), low (7–11) or very low (0–6). Randomised controlled trials underwent risk of bias analysis, and descriptive statistics compared side-effects across sources.

Twenty-four trials were included. Reporting quality was high in six studies, moderate in four, low in nine and very low in five. All randomised controlled trials (n = 9) showed high risk of bias for side-effects outcomes. Variability in reporting hindered comparisons between articles and ClinicalTrials.gov, underscoring the need for standardisation. Overall, there was no evidence of systematic underreporting of side-effects in published articles compared with trial registers.

Side-effects reporting in PAP trials is inconsistent but is improving over time. Existing evidence has a high risk of bias. Future trials should align with best-practice guidelines for side-effects reporting. Discussions with patients should prioritise findings from high-quality studies and emphasise the current uncertainty regarding PAP side-effects.

Trends in the US and Australian suicide mortality have shifted over the last 100 years, with notable differences between age groups and genders.

This study compared overall and gender- and age-specific suicide rates from 1921 to 2020 in the USA and Australia to determine long-term variation for each country.

Suicide data (1921–2020, inclusive) were obtained from the US Centers for Disease Control and Prevention and the Australian Institute of Health and Welfare. Poisson regression was used to assess whether suicide rates between groups were significantly different.

Overall suicide rates were higher in the USA compared to Australia, from 1921 to the 1940s, but were similar from the 1950s onwards. While male suicide rates fluctuated, female suicide rates were relatively stable (except for Australian women in the 1960s). In the USA and Australia, suicide rates for young males have significantly increased since the 1950s, while they have decreased for the older male population since the 1940s.

While overall national suicide rates were relatively stable over 100 years apart from during war and economic depression, male suicide rates in the USA and Australia experienced significant age-related changes over the century. These include major declines in males aged over 65 years but also an increase in suicides for those aged between 15 and 44. Suicide rates across age groups have therefore converged, regressing towards the mean for all age groups combined.

Prolonged grief disorder (PGD) is a chronic, impairing state of intense grief that is responsive to specialised intervention. Online journalling has the potential to reduce PGD symptoms.

To assess whether reminiscence via online journalling facilitates bereavement adjustment – specifically, to identify key themes in online grief journals and examine associations between types of reminiscence and changes in PGD symptom severity.

A cohort of 96 bereaved adults completed 7 days of online journalling on the Living Memory Home (LMH) bereavement website. Participants were recruited from clinics, bereavement support groups and a National Institutes of Health-funded, web-based platform. The Prolonged Grief Disorder-Revised scale (PG-13-R) was administered at baseline and at 1-week and 1-month follow-up.

Descriptive analysis revealed a reduction in PG-13-R scores from baseline to 1-week follow-up (mean difference −3.7, 95% CI: −4.9, −2.5, P < 0.001) and 1-month follow-up (mean difference −5.0, 95% CI: −6.4, −3.7. P < 0.001). Mixed-methods analysis revealed significant negative associations between reflection on negative traits of the deceased and PG-13-R score at all three time points, and between reflection on past experiences with the deceased and PG-13-R score at baseline. Expression of regret and guilt was significantly associated with reduction in PG-13-R scores from 1-week to 1-month follow-up.

Engagement in the LMH website demonstrated significant declines in PGD symptom severity after 1 week of online journalling and at 1-month follow-up. Guided reflection on memories of the deceased, and even on negative or emotionally challenging memories, shows potential for reducing symptoms of PGD.

Understanding gender identity in transgender and gender-diverse (TGD) individuals is crucial for effective care. The Gender Preoccupation and Stability Questionnaire (GPSQ) measures the preoccupation and stability of gender identity, but no Italian validation is available.

This study aimed to translate, culturally adapt and validate the Italian version of the GPSQ in a clinical sample of TGD adults.

The GPSQ was translated with a forward–backward method and completed by 151 TGD adults at a gender clinic. Participants also filled out the Symptom Checklist-58 and Body Uneasiness Test. We assessed structural validity (EFA), internal consistency, test–retest reliability, and examined known-groups and predictive validity.

The EFA supported a four-factor structure – Gender Identity Instability, Cognitive-Affective Salience, Preoccupation, and Distress/Intervention-Oriented Reflection – with good fit (root mean square error of approximation 0.06; Comparative Fit Index 0.95; Tucker–Lewis Index 0.93; standard root mean square residual 0.04). The GPSQ showed solid internal consistency (α = 0.78; ω = 0.73) and excellent test–retest reliability (r = 0.98; intraclass correlation coefficient 0.98). Higher scores correlated with psychological distress (r = 0.55, p < 0.001) and body image concerns (r = 0.48, p < 0.001). Preoccupation was most linked to obsessive–compulsive symptoms, and Cognitive-Affective Salience to body image concerns. Participants not on hormones scored higher (p = 0.010, Cohen’s d = 0.36).

The Italian GPSQ is a reliable and valid tool to assess gender-related preoccupation and identity instability in TGD individuals. Its multidimensional structure makes it useful in both clinical practice and research in the Italian context.

Attention deficit hyperactivity disorder (ADHD) is often associated with psychosocial functioning difficulties and valid measures of disability are needed for this population. The 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is widely used to measure disability but has not been validated in the adult ADHD population.

This study aims to assess the psychometric properties of the WHODAS 2.0 in adults with ADHD, and to examine differences in disability levels between ADHD subtypes and gender.

A cross-sectional study was conducted with 577 adults with ADHD (mean age: 38.24, s.d = 12.23; 52.3% male). ADHD severity was assessed using the ADHD Rating Scale (ADHD-RS) and Clinical Global Impression-Severity (CGI-S) Scale, while functionality was measured with the WHODAS 2.0 and the Functioning Assessment Short Test (FAST). Analyses included: (a) Cronbach’s α for internal consistency, (b) Pearson’s correlation for convergent validity, (c) Confirmatory Factor Analysis (CFA) for factor structure and (d) t-tests to compare disability levels across ADHD subtypes and gender.

The WHODAS 2.0 demonstrated good internal consistency (Cronbach’s α = 0.89). Scores were significantly correlated with psychosocial functioning (FAST, r = 0.476, p < 0.001) and clinical measures. CFA supported the original six-factor structure (root mean square error of approximation 0.039, Comparative Fit Index 0.998, Tucker–Lewis Index 0.996). When comparing ADHD subtypes, participants with the combined subtype had higher WHODAS 2.0 total scores than those with the inattentive subtype (p = 0.006). Additionally, gender differences were identified, with females displaying higher disability levels (p = 0.005).

The WHODAS 2.0 demonstrates psychometric properties that suggest it is a valid and reliable tool for assessing disability in adults with ADHD.

Behaviours that challenge are highly prevalent in children with an intellectual disability and can be detrimental to their quality of life and opportunities.

The systematic review aimed to investigate the effectiveness of current interventions in reducing behaviours that challenge in children with an intellectual disability (≤18 years-old).

We searched five databases (PsychINFO, MEDLINE, Embase, Web of Science and CINAHL) on 26 April 2022 and 1 July 2024, and identified 18 randomised controlled trials (1443 participants) eligible for inclusion since 2014 – 11 investigated non-pharmacological and 9 investigated pharmacological interventions. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool.

Non-pharmacological interventions (mostly psychosocial) were significantly effective (Hedges’ g = −0.20; 95% CI [−0.35, −0.05]), whereas pharmacological interventions (including a wide range of drug classes and substances) were not (g = 0.03; 95% CI [−0.17, 0.24]). Studies using the Child Behaviour Checklist reported significant reductions (g = −0.18; 95% CI [−0.34, −0.02]), whereas studies using the Aberrant Behaviour Checklist did not (g = 0.04; 95% CI [−0.16, 0.25]). A random-effects meta-analysis indicated no overall significant reduction in behaviours that challenge (g = −0.12; 95% CI [−0.24, 0.00]).

It is important to note that most studies included were conducted in Western countries and had small sample sizes, and findings may be due to the outcome measures used. Findings support current recommendations that non-pharmacological interventions should be first-line treatment for behaviours that challenge in this population. Evidence highlighted the need for better quality, adequately powered randomised controlled trials.

Withania somnifera (WS) is considered an adaptogen agent with reported antistress, cognition facilitating and anti-inflammatory properties, which may be beneficial in the treatment of mental disorders.

This systematic review investigated the efficacy and tolerability of Withania somnifera for mental health symptoms in individuals with mental disorders.

The protocol of this review was registered with PROSPERO (CRD42023467959). PubMed, Scopus, PsycINFO, CINAHL, Embase and CENTRAL were searched for randomised controlled trials comparing Withania somnifera to any comparator, in people of any age, with any mental disorder. The meta-analyses were based on standardised mean differences (SMDs) and odds ratios with 95% confidence intervals, estimated through frequentist and Bayesian-hierarchical models with random-effects.

Fourteen studies, corresponding to 360 people treated with Withania somnifera and 353 controls were included. Anxiety disorders were the predominant diagnostic category. Thirteen trials administered Withania somnifera orally (median dose 600 mg/day), one with Shirodhara therapy. The median follow-up time was 8 weeks. Although limited by the small number of studies, substantial between-study heterogeneity, and outlier effects, our investigation showed Withania somnifera effectiveness in improving anxiety (outlier-corrected SMD: −1.13 (95% CI: −1.65; −0.60), pooled SMD: −1.962 (95% CI: −2.66; −0.57)), depression (SMD: −1.28 (95% CI: −2.40; −0.16) and stress (SMD: −0.95 (95% CI: −1.46; −0.43) symptoms and sleep quality (SMD: −1.35 (95% CI: −1.79; −0.91). The effect size was confirmed using the Bayesian for anxiety but not for depression. No significant difference between Withania somnifera and the comparators was found for safety and tolerability.

We found evidence supporting the effectiveness of Withania somnifera in treating anxiety symptoms. Future trials should replicate this finding in larger samples and further clarify a possible Withania somnifera role in depression and insomnia treatment.

Financial strain is increasingly recognised as a contributor to psychological distress, which may in turn elevate the risk of developing mental disorder. However, few large-scale longitudinal studies have investigated its predictive role using diagnostic outcomes among higher education students.

To examine whether financial strain predicts a major depressive episode (MDE) one year later among Norwegian students, and whether associations are explained by sociodemographic factors or baseline psychological distress.

Data were drawn from the national Students’ Health and Wellbeing Study 2022 (SHoT2022) survey (N = 53 362), with a diagnostic follow-up one year later (N = 10 460) using the self-administered Composite International Diagnostic Interview version 5.0 (CIDI 5.0). Inverse probability weighted Poisson regression with robust standard errors estimated the risk of 30-day DSM-5-defined MDE for each financial indicator.

Financial strain was widespread: 6% reported frequent financial difficulties, 27% were unable to cover an emergency expense of 5000 Norwegian kroner (NOK; approximately €450/$500, and 35% spent 60% or more of their income on housing. Several indicators significantly predicted later MDE. Students frequently experiencing financial difficulties had a 3.55-fold increased risk (95% CI:2.97–4.22), attenuating to 1.53 (1.28–1.83) after full adjustment. Similar patterns emerged for most indicators. Associations were largely unaffected by sociodemographic adjustment, but were substantially reduced after accounting for baseline psychological distress.

Financial strain was associated with increased risk of MDE one year later, although much of the association was explained by baseline distress. Policies should address both financial and psychological vulnerabilities through strengthened financial support, alignment with living costs and targeted measures such as financial counselling and housing assistance.

Depression is the most common psychiatric disorder among patients with end-stage renal disease (ESRD), yet the risk factors for mortality in this population remain unclear.

To identify risk factors for mortality in ESRD patients with depression and assess the incidence of suicide attempts.

We used Taiwan’s National Health Insurance Research Database to identify adult patients who initiated maintenance dialysis between 1997 and 2012. Two ESRD cohorts were established at a depression-to-non-depression ratio of 1:8, matched by age and gender (n = 3289 with depression; n = 26 312 without depression). Outcomes included all-cause mortality and suicide attempts, with additional subgroup analyses by baseline depression severity.

ESRD patients with depression had a higher mortality risk (hazard ratio 1.15, 95% CI: 1.10–1.21) than those without. Risk factors for mortality included male gender, older age, diabetes and cardiovascular disease. Patients with depression also had a higher risk of suicide attempts (hazard ratio 3.02, 95% CI: 1.68–5.42). ESRD patients with severe depression had a significantly higher rate of hospital admissions for depression compared to those with non-severe depression (incidence rate ratio (IRR): 1.82, 95% CI: 1.14–2.93). Furthermore, patients with severe depression were associated with a significantly higher mortality rate compared to those without depression (IRR: 1.42, 95% CI: 1.15–1.76).

Depression is linked to poor survival in ESRD patients, with underlying comorbidities playing a key role in mortality. Given the increased risk of mortality, suicide attempts and hospital admissions, these high-risk patients require enhanced medical attention, particularly those with severe depression.

Schizophrenia is associated with premature mortality, but most evidence comes from high-income regions.

This study aimed to estimate the excess mortality associated with schizophrenia in southern China.

We linked register data from a nationwide information system for psychosis to death registers. Individuals diagnosed with schizophrenia and residing in Guangzhou between 2014 and 2021 were included. Standardised mortality ratios (SMRs) were calculated to compare the mortality of people with schizophrenia with that of the general population. Life expectancy, potential years of life lost (PYLL) and years of life lost (YLL) were estimated for all-cause mortality and specific causes of death. Gender difference in these metrics was examined.

There were 3684 deaths (11.3%) during the study period. The leading causes of death were circulatory, neoplastic and respiratory diseases. The mortality rate among people with schizophrenia was twofold greater than in the general population, with a greater risk associated with unnatural causes than natural causes. The risk of mortality due to suicide was 15-fold higher than that of the general population. The life expectancy in schizophrenia was around 60 years, which is 21 years shorter than that for the general population. Schizophrenia was associated with substantial premature mortality burden, showing greater impact in men than women.

Schizophrenia is associated with increased premature mortality, reduced life expectancy and substantial PYLL. The enduring disparity in mortality underscores an imminent call for targeted interventions aimed at suicide prevention and enhancement of the physical well-being of people with schizophrenia.

Off-licence psychotropic use in people with intellectual disability and/or autism, in the absence of psychiatric illness, is a major public health concern in England.

To ascertain and compare views of psychiatrists and non-psychiatrists working with people with intellectual disability and/or autism on psychotropic medication optimisation for this population.

A cross-sectional survey of 13 questions was disseminated online among psychiatrists and other health professionals working with people with intellectual disability and/or autism across England, using a non-discriminatory exponential snowballing technique leading to non-probability sampling. The questionnaire covered demographic characteristics, perceived barriers/benefits of psychotropic optimisation (including ethnicity) and views on implementation of a national medicine optimisation programme. Quantitative analysis used chi-squared, Mann–Whitney and unpaired t-tests, with significance taken as P < 0.05. Thematic analysis of free-text responses was undertaken with Braun and Clarke’s methodology.

Of 219 respondents, significant differences in attitudes to most issues emerged between psychiatrists (n = 66) and non-psychiatrists (n = 149). Psychiatrists had less optimism of a successful national medication optimisation programme if commissioned, or achieving 50% reduction in psychotropic overprescribing and inappropriate psychotropic prescribing generally. Perceived barriers to reducing overmedication differed significantly between the psychiatrists and non-psychiatrists, Thematic analysis identified five themes (system issues, resources, medication challenges, family and carers, and training and alternatives/structure).

This is the first study to highlight important differences between psychiatrists and non-psychiatrists’ attitudes to psychotropic optimisation despite respondents overall being broadly supportive of its need. A major finding is the hitherto unquantified concerns of patient ethnicity and its impact on psychotropic optimisation principles.

Early Intervention Psychosis Services (EIPS) provide multimodal interventions for young people who are at risk of, or have experienced, a first episode of psychosis. Although recent studies have begun to examine this critical period in a young person’s personal recovery in more depth, little is known about how young people experience EIPS in general, and its influences on their clinical and psychosocial recovery in particular.

This study aimed to explore young people’s experience of EIPS, specifically the factors that have affected their (a) clinical and (b) psychosocial recovery.

This study purposively sampled 27 young people from a range of backgrounds at 6 community-based EIPS in Australia. Audio-recorded, semi-structured interviews were conducted and reflexive thematic analysis was used to analyse this data-set.

Four themes of how EIPS enabled recovery were identified. The first three - a safe space, unconditional support and active involvement – were foundational to a fourth theme of gradual self-management. In earlier-stage self-management, participants relied on practical supports to make connections and find education and employment opportunities. By later-stage self-management, they had developed the tools to do these things for themselves. Participants’ movement between earlier- and later-stage self-management was connected to their overall EIPS engagement and, for some, to their engagement with peer support.

Providing a safe space, unconditional support and active involvement for clients and their families created the foundational conditions for improved clinical and psychosocial recovery. Peer support programmes, increasing engagement when situational changes such as employment occur and the provision of culturally sensitive care appeared valuable to this process.

Previous research has demonstrated that the COVID-19 pandemic led to a global increase in mental distress. However, few studies have examined the impact of the pandemic on mental health stigma.

To investigate changes in measures of mental health stigma, including knowledge, attitudes and behavioural intentions, in 2021 and 2023 in Hong Kong; to examine the mediating role of attitudes on the relationship between knowledge and behavioural intentions; and to explore how disclosure of mental illness contributes to enhanced overall well-being.

Data were collected as part of a larger research project focusing on mental well-being in Hong Kong. A total of 1010 and 1014 participants were surveyed in 2021 and 2023, respectively. The participants were Hong Kong residents aged 18 years and above.

Our findings demonstrate that all measures of mental health stigma showed increases in severity between 2021 and 2023. In addition, our mediation analyses observed both full and partial mediation effects of attitudes on the relationship between knowledge and behavioural intentions. The results also showed that mental illness disclosure was associated with higher well-being; however, despite these benefits, there was a decrease in willingness to disclose in 2023 compared with 2021.

This study highlights the ongoing issue of mental health stigma in Hong Kong. Future mental health programmes and interventions should aim to address various facets of mental health knowledge, including symptom recognition, access to support resources and the deleterious consequences of mental health stigma.

Trauma- and stressor-related disorders (TSRD) are debilitating mental health conditions. Given the barriers to traditional services, remote and online technologies are increasingly used in treating TSRD.

This mixed-methods systematic review aimed to identify remote technologies and assessed their feasibility and acceptability in treating adults with post-traumatic stress disorder (PTSD), acute stress disorder and adjustment disorder (AjD).

The databases MEDLINE, CINAHL, Embase, PsycInfo, PubMed and the Cochrane Library were screened to identify studies investigating the feasibility and acceptability of remote interventions for PTSD, acute stress disorder and AjD in adults. Studies that obtained poor-quality ratings on critical appraisal tools were excluded. Results were synthesised using a narrative review approach.

In total, there were 74 studies evaluating 27 remote interventions for TSRD: online interventions (k = 47, 63.51%), mobile applications (k = 17, 22.97%), video conferencing (k = 9, 12.16%) and message-based systems (k = 1, 1.35%). Findings from the review showed higher feasibility and acceptability for interventions with an interactive clinician–patient component. Among self-directed interventions, only two applications and eight online interventions provided a clinician component. Most studies targeted PTSD, with few targeting other diagnoses.

Recommendations related to remote interventions for TSRDs should be broadened to include AjD and other underrepresented diagnoses, and tailored to individual patients’ profiles, including their ability to sustain engagement and clinical needs, using a stepped-care approach.

Mental health disorders such as depression and anxiety are highly prevalent among ophthalmic patients, particularly those with progressive vision impairment. Despite the strong interconnection between mental health and vision-related disabilities, mental health support remains underintegrated into ophthalmic care. The economic burden of untreated mental health conditions in visually impaired patients is understudied, particularly in middle-income countries such as Turkey and Bulgaria.

This study aims to examine the economic impact of untreated mental health disorders among ophthalmic patients, focusing on financial burden, healthcare access disparities and quality of life outcomes. In addition, the study compares barriers to mental healthcare across ophthalmic conditions and between Turkey and Bulgaria.

A qualitative study was conducted using structured surveys and in-depth interviews with 214 ophthalmic patients (107 in Turkey, 107 in Bulgaria). Mental health symptoms were assessed using the Patient Health Questionnaire-9 (for depression) and Generalized Anxiety Disorder-7 (for anxiety) scales. Thematic analysis was applied to qualitative responses.

Over 50% of participants exhibited moderate-to-severe depression and anxiety, with diabetic retinopathy and retinal disease patients experiencing the highest distress levels. Financial barriers were more pronounced in Bulgaria, whereas long psychiatric wait times disproportionately affected retinal patients. Mental health stigma was higher in Bulgaria, limiting care access.

Findings underscore the urgent need for integrating mental health services into ophthalmic care. Policy interventions should focus on financial support, stigma reduction and improved interdisciplinary care models to enhance mental health outcomes for visually impaired individuals.

Benzodiazepine use among physicians is an important public health issue related to physicians’ well-being and patient safety.

This study aimed to evaluate the patterns and correlates of benzodiazepine use in physicians by comparing the characteristics of heavy users with those of low-dose users.

We identified 4844 physicians with a history of benzodiazepine use as the benzodiazepine cohort from 32 080 physicians from the population-based Taiwan National Health Insurance Research Database from 2014 to 2020. Benzodiazepine users were divided into low-dose, intermediate and heavy users based on their yearly equivalent dosage of <20, 20–150 and >150 defined daily dose (DDD) per year, respectively. Differences in demographic characteristics and specialities between the benzodiazepine and control cohorts were compared via univariate and multivariate logistic regression models. A generalised estimating equation was used to investigate the relationship between benzodiazepine use and comorbidities.

Among all of the physicians, 15.1% used benzodiazepine. Male physicians were more likely to use benzodiazepines and become heavy users. Older age, sleep disorders and depression were significantly associated with heavy benzodiazepine use. Regarding physician specialities, the highest prevalence of benzodiazepine use was observed in otorhinolaryngology (19.8%), followed by family medicine (19.1%). Odds of benzodiazepine use were 2.20 and 2.90 times greater in physicians with sleep disorders and depression, respectively.

Comorbidities of depression and sleep disorders are associated with increased probability of benzodiazepine use. Providing stress-coping strategies and appropriate treatment for mental disorders is recommended to support the overall well-being of physicians.

Postpartum depressive symptoms (PPDS) are mental health concerns, characterised by sadness, anxiety and suicidal ideation.

We aimed to estimate the prevalence of PPDS, identify its associated factors and explore the lived experiences of individuals with PPDS, to understand the psychosocial mechanisms involved.

We surveyed 400 women aged 18 years and above and conducted in-depth interviews among 19 women who screened positive for PPDS at two urban hospitals and one peri-urban polyclinic in Ho, Ghana. We used multivariable binomial generalised linear models to identify factors independently associated with PPDS. We used thematic analysis (qualitative) to identify themes that highlight pathways through which these factors influence PPDS.

Overall, 117 (29.3%) women screened positive for PPDS. Being unmarried (adjusted prevalence ratio (aPR) 1.33, 95% CI 1.02–1.72), lack of partner support (aPR 1.60, 95% CI 1.21–2.12), history of depressive or psychiatric disorders (aPR 2.44, 95% CI 1.84–3.25), unplanned pregnancy (aPR 1.63, 95% CI 1.18–2.25), low self-esteem (aPR 2.38, 95% CI 1.79–3.16) and low birth weight (aPR 1.87, 95% CI 1.33–2.65) were independently associated with PPDS. The thematic analysis revealed four key themes: (a) social isolation and limited support, (b) emotional stress and vulnerability, (c) self-image and identity challenges, and (d) resilience resources.

PPDS were common in our sample and were significantly associated with modifiable factors such as prior mental health history and low self-esteem. These findings underscore the importance of prioritising maternal mental health through the integration of depression screening and psychosocial care into routine antenatal and postnatal services.