Individual responses to stress are highly heterogeneous, resulting in diverse psychopathological outcomes. This variability poses challenges for traditional diagnostic frameworks and underscores the need for a transdiagnostic approach to guide interventions. This study aimed to identify distinct phenotypes within a stress-exposed population and to characterize their biological profiles using a multimodal machine learning framework.

A total of 809 stress-exposed adults (mean age 40.5 ± 8.74 years; 53.7% female) underwent clinical, laboratory, and structural MRI assessments. Data-driven clustering of clinical variables identified phenotypes, followed by machine learning classifiers trained on neuroimaging and laboratory data to predict phenotype membership. SHapley Additive exPlanations (SHAP) analysis was used to identify key biological features distinguishing each phenotype.

Three phenotypes were identified: a multi-risk group (n = 321) characterized by prominent depression, anxiety, and sleep disturbances; an alcohol-related risk group (n = 226) with high alcohol misuse and minimal comorbidity; and a resilient low-risk group (n = 262). Machine learning models accurately classified these phenotypes, indicating distinct biological profiles. SHAP analysis revealed phenotype-specific signatures: the multi-risk phenotype was associated with frontal-subcortical structural alterations and dysregulated cortisol, whereas the alcohol-related risk phenotype was characterized by frontal-insular structural alterations and metabolic abnormalities.

This study demonstrates the stratification of stress-exposed individuals into clinically and biologically distinct phenotypes. By integrating multimodal data with machine learning, we identified phenotype-specific neurobiological and metabolic profiles that extend beyond conventional diagnostic frameworks. These findings support a transdiagnostic, data-driven approach to improve risk stratification and inform personalized interventions in stress-exposed populations.

Substances, such as cannabis, alcohol, and nicotine, have each been associated with an increased risk of mental health concerns in adolescence. These substances are often taken concurrently and less is known about the effects of polysubstance use. We investigated the relationship between polysubstance use and psychopathology in adolescence including internalising, externalising behaviours, and psychotic experiences (PE). As a secondary analysis, we examined gender differences.

A sample of 4,404 15–16-year-old adolescents in 40 schools in Ireland was examined. Our exposure was single substance use (cannabis, alcohol, and nicotine) and polysubstance use within the past month. The outcome of interest was psychopathology, measured using the Strengths & Difficulties Questionnaire, and the Adolescent Psychotic Symptoms Scale. Associations were explored using mixed-effects logistic models.

Adjusted odds ratios were calculated to examine the associations between polysubstance use and each outcome, compared to substance-naive participants. A significant dose response relationship was observed, with increasing substance use associated with higher odds of general psychopathology (aOR range: 1.65–5.09), internalising behaviours (aOR range: 1.18–2.06), externalising behaviours (aOR range: 1.68–5.79), and PE (aOR range: 1.60–3.13). Females engaging in polysubstance use exhibited the poorest mental health outcomes.

This study highlights the strong associations between adolescent polysubstance use and emerging mental health problems. The findings reinforce the need for mental health services to take polysubstance use into consideration during intervention. Tailored public health messaging is required, acknowledging polysubstance use as a marker for poor mental health among adolescents and young adults.

Despite evidence of disparities in care received by Black communities, limited interventions exist to address them. The SEE ME training is a co-produced intervention using video testimonials to improve the care of Black individuals with psychosis within NHS early intervention in psychosis (EIP) services. This study explored mental health professionals’ experiences of the SEE ME training and its impact on addressing racial inequalities within EIP services. Semi-structured interviews were conducted with 21 mental health professionals, and the data were analysed with thematic analysis.

Thematic analysis identified six superordinate themes and 17 subthemes, encompassing the importance of adopting clients’ perspectives, prioritising individuals’ voices, enabling reflection, fostering shared humanity and creating psychological safety.

This is the first qualitative study exploring the impact of SEE ME training. Findings offer valuable insights for improving anti-racist practice and service development in mental healthcare.

To investigate whether socioeconomic deprivation is associated with residual or recurrent cholesteatoma following primary mastoidectomy.

A retrospective cohort study included all patients undergoing primary mastoidectomy for cholesteatoma in National Health Service Tayside between 2012 and 2020. Socioeconomic status was assessed using the Scottish Index of Multiple Deprivation 2020 and divided into quintiles. Patients were stratified into paediatric (≤16 years) and adult (>16 years) groups. Recurrence/residual rates across Scottish Index of Multiple Deprivation quintiles were compared using Fisher’s exact tests, and time to recurrence was analysed using Kaplan–Meier survival curves.

One hundred eighty-four patients were included (59 children, 125 adults). Recurrence/residual occurred in 39 per cent of children and 24 per cent of adults. In children, higher deprivation was significantly associated with risk of recurrence/residual disease (p = 0.0013). No significant association was observed in adults.

Socioeconomic deprivation is linked to higher recurrence/residual in children, highlighting disparities in postoperative outcomes and the importance of targeted follow-up.

Adults with intellectual disabilities who display behaviours that challenge (BtC) are more prone to poor health.

This study seeks to evidence the long-term health outcomes for those who display BtC.

We conducted a longitudinal cohort study of adults with intellectual disabilities aged ≥18 years in England, using data from the Clinical Practice Research Datalink Aurum (January 2003 to December 2023) linked to Hospital Episode Statistics and Office for National Statistics. Main outcome measures were annual health checks, general practitioner referrals, emergency visits, out-patient attendance, in-patient admissions and mortality.

Among 83 166 adults with intellectual disabilities (mean age 38.6 years), 18.5% had a record of BtC, with similar sociodemographic distributions to those without BtC, but higher rates of physical and mental health comorbidities and uptake of annual health checks. A total of 72.5% of participants with BtC were receiving psychotropic medication(s). Adults with BtC had higher rates of mental health out-patient attendance (odds ratio: 1.42, 95% CI 1.33–1.52) and in-patient admissions (incidence rate ratio (IRR): 1.19, 95% CI 1.09–1.29), but consistently lower rates of physical health out-patient attendance (IRR = 0.81, 95% CI 0.78–0.84) and in-patient admissions (IRR = 0.77, 95% CI 0.74–0.79), after adjusting for demographic and clinical characteristics. BtC were not associated with mortality after adjustment for comorbidities (hazard ratio: 0.97, 95% CI 0.93–1.00).

This longitudinal study not only corroborated the markedly elevated burden of physical and mental health comorbidities among individuals displaying BtC, but also indicated that repeated efforts to improve health outcomes have yielded minimal measurable benefit over time. The apparent absence of progress is likely underpinned by a combination of insufficiently effective or poorly tailored interventions and wider systemic constraints that limit the capacity of services to respond to the complex needs of this population.

This study aims to investigate the awareness, practices, needs, and challenges of hospital-based health technology assessment (HB-HTA) in China’s tertiary public hospitals, drawing on perspectives from both hospital management and clinical practice.

Semi-structured interviews were conducted with seventeen participants representing six major tertiary public hospitals in China. Respondents included vice presidents, clinical department directors, and heads of pharmacy. The questionnaire explored four dimensions consistent with China’s national performance appraisal framework: medical quality, operational efficiency, sustainable development, and satisfaction. Data were analyzed using NVivo 14 for qualitative responses and Excel 2021 for quantitative metrics.

The findings revealed that 82.35 percent (14/17) of hospitals lacked dedicated HB-HTA teams, with decisions made primarily by coordination between Medical Affairs Offices (28.89 percent, 13/45) and Pharmacy Departments (22.22 percent, 10/45). Safety (28.26 percent, 13/46), effectiveness (23.91 percent, 11/46), and cost-effectiveness (19.57 percent, 9/46) were prioritized criteria, yet only 29.41 percent (5/17) of institutions used formal HB-HTA tools. Divergence persisted between administrators’ organizational priorities and clinicians’ patient-centered perspectives. Despite barriers reported by 62.8 percent (27/43) of respondents’ institutions, 88.24 percent (15/17) expressed an urgent or recognized need for HB-HTA implementation.

For effective HB-HTA implementation in China, addressing capacity deficits and reconciling stakeholder perspectives is essential. A project-based strategy, supported by government real-world data platforms and interdisciplinary teams, is recommended for contextually-appropriate evaluation frameworks.