People with functional disorders often receive high levels of healthcare resource use yet have poor outcomes. The health service costs and productivity losses of functional cognitive disorders (FCD) is unknown.

This study aims to report the cost to health services and productivity losses of FCD.

Examination of healthcare service use and productivity losses in a sample of individuals with FCD who had attended a specialist out-patient clinic in south London.

The findings revealed high rates of healthcare use, including frequent contact with general practitioners, psychologists and hospital services, as well as work absences. The total estimated cost of healthcare and productivity losses per individual over 6 months was £1114.

These results highlight the need for effective and efficient diagnostic pathways, targeted and effective interventions, and improved support for individuals with FCD.

The macro-social and environmental conditions in which people live, such as the level of a country’s development or inequality, are associated with brain-related disorders. However, the relationship between these systemic environmental factors and the brain remains unclear. We aimed to determine the association between the level of development and inequality of a country and the brain structure of healthy adults.

We conducted a cross-sectional study pooling brain imaging (T1-based) data from 145 magnetic resonance imaging (MRI) studies in 7,962 healthy adults (4,110 women) in 29 different countries. We used a meta-regression approach to relate the brain structure to the country’s level of development and inequality.

Higher human development was consistently associated with larger hippocampi and more expanded global cortical surface area, particularly in frontal areas. Increased inequality was most consistently associated with smaller hippocampal volume and thinner cortical thickness across the brain.

Our results suggest that the macro-economic conditions of a country are reflected in its inhabitants’ brains and may explain the different incidence of brain disorders across the world. The observed variability of brain structure in health across countries should be considered when developing tools in the field of personalized or precision medicine that are intended to be used across the world.

The impact of chronic pain and opioid use on cognitive decline and mild cognitive impairment (MCI) is unclear. We investigated these associations in early older adulthood, considering different definitions of chronic pain.

Men in the Vietnam Era Twin Study of Aging (VETSA; n = 1,042) underwent cognitive testing and medical history interviews at average ages 56, 62, and 68. Chronic pain was defined using pain intensity and interference ratings from the SF-36 over 2 or 3 waves (categorized as mild versus moderate-to-severe). Opioid use was determined by self-reported medication use. Amnestic and non-amnestic MCI were assessed using the Jak-Bondi approach. Mixed models and Cox proportional hazards models were used to assess associations of pain and opioid use with cognitive decline and risk for MCI.

Moderate-to-severe, but not mild, chronic pain intensity (β = −.10) and interference (β = −.23) were associated with greater declines in executive function. Moderate-to-severe chronic pain intensity (HR = 1.75) and interference (HR = 3.31) were associated with a higher risk of non-amnestic MCI. Opioid use was associated with a faster decline in verbal fluency (β = −.18) and a higher risk of amnestic MCI (HR = 1.99). There were no significant interactions between chronic pain and opioid use on cognitive decline or MCI risk (all p-values > .05).

Moderate-to-severe chronic pain intensity and interference related to executive function decline and greater risk of non-amnestic MCI; while opioid use related to verbal fluency decline and greater risk of amnestic MCI. Lowering chronic pain severity while reducing opioid exposure may help clinicians mitigate later cognitive decline and dementia risk.

Haemolysis is developing prominence in the setting of supporting increasingly complex children with heart failure with a ventricular assist device. The goal of this study is to better characterise haemolysis and its implications in children supported with pulsatile ventricular assist devices.

This is a single-centre retrospective review of 44 children who were supported by Berlin Heart EXCOR between January 2006 and June 2020. Patients were divided into major haemolysers and non-major haemolysers. Major haemolysers were defined as patients with lactate dehydrogenase > 500U/L (2.5x the upper limits of normal) with either total bilirubin > 2mg/dL (with predominantly indirect hyperbilirubinemia) or anaemia out of proportion to the clinical scenario more than three days following implantation of the ventricular assist device(s). Patient demographics, ventricular assist device factors, and outcomes, including end-organ function and mortality, were compared between major haemolysers and non-major haemolysers.

Forty-four patients supported by the Berlin EXCOR were included in the analytic cohort of the study: 27 major haemolysers and 17 non-major haemolysers. Major haemolysis was more common in those supported with single-ventricle ventricular assist device (i.e., VAD in the context of functionally univentricular anatomy) compared to those with biventricular hearts, p = 0.01. There were no patients with an isolated left ventricular assist device or isolated right ventricular assist device in our analytic cohort of 44 patients. Of the 19 patients with single-ventricle ventricular assist device, 84% (16/19) were major haemolysers. Of the 25 patients with a biventricular assist device, 44% (11/25) were major haemolysers. Major haemolysers and non-major haemolysers had a body surface area of 0.28 and 0.40, respectively (p = 0.01). Overall, survival to discharge from the hospital was 66% (n = 29/44). Survival to discharge from the hospital was 52% (14/27) in major haemolysers versus 88% (15/17) in non-major haemolysers, p = 0.02. Only 3 of the 27 with major haemolysis had severe haemolysis, that is, lactate dehydrogenase > 2000 and bilirubin above 10. Non-major haemolysers had a better improvement in creatinine clearance during ventricular assist device support, p < 0.0001. (During the same era of this study, 22 patients who were supported with Berlin Heart were excluded from the analytic cohort because they did not have any recorded measurement of lactate dehydrogenase. Seventeen of these 22 patients had no clinical evidence of haemolysis. Survival to discharge from the hospital in this excluded cohort was 86% [19/22].)

Major haemolysis in patients with pulsatile ventricular assist device is more likely with single-ventricle ventricular assist device support and smaller body surface area.

The quality of news reports about suicide can influence suicide rates. Although many researchers have aimed to assess the general safety of news reporting in terms of adherence to responsible media guidelines, none have focused on major US cable networks, a key source of public information in North America and beyond.

To characterise and compare suicide-related reporting by major US cable television news networks across the ideological spectrum.

We searched a news archive (Factiva) for suicide-related transcripts from ‘the big three’ US cable television news networks (CNN, Fox News and MSNBC) over an 11-year inclusion interval (2012–2022). We included and coded segments with a major focus on suicide (death, attempt and/or thoughts) for general content, putatively harmful and protective characteristics and overarching narratives. We used chi-square tests to compare these variables across networks.

We identified 612 unique suicide-related segments (CNN, 398; Fox News, 119; MSNBC, 95). Across all networks, these segments tended to focus on suicide death (72–89%) and presented stories about specific individuals (61–87%). Multiple putatively harmful characteristics were evident in segments across networks, including mention of a suicide method (42–52%) – with hanging (15–30%) and firearm use (12–20%) the most commonly mentioned – and stigmatising language (39–43%). Only 15 segments (2%) presented a story of survival.

Coverage of suicide stories by major US cable news networks was often inconsistent with responsible reporting guidelines. Further engagement with networks and journalists is thus warranted.

This study presents the most recent data on the incidence, prevalence, and years lived with disability (YLDs) due to anxiety disorders across the Middle East and North Africa (MENA) region from 1990-2021, analysed by sex, age, and sociodemographic index (SDI).

We assessed the burden of anxiety disorders using data sourced from the Global Burden of Disease 2021 study. The estimates of prevalence, DALYs, and YLDs are provided as numbers and age-standardised rates, accompanied by their 95% uncertainty intervals (UIs).

In 2021, the age-standardised point prevalence of anxiety disorders in the region was 5.95 thousand, with an incidence rate of 883.4 per 100,000. The number of YLDs in 2021 reached 4.5 million. From 1990 to 2021, the burden of anxiety disorders increased significantly. Lebanon had the highest burden in 2021. Among both sexes, the 10–14 age group had the highest incidence rate, while the 15–19 age group had the highest prevalence and YLD rates. In 2021, most age groups in the MENA region had YLD rates that were higher than the global average.

This study highlights the urgent need for a multidisciplinary approach to prevent and manage anxiety disorders. Ensuring accessible and affordable treatment options for all affected individuals is crucial. Governments should prioritise supporting programmes to effectively address mental health issues, given the unique socioeconomic and geopolitical challenges in the MENA region. By including effective preventive methods alongside treatment in healthcare strategies, the burden of anxiety disorders can be significantly reduced.

Posttraumatic stress disorder (PTSD) has been associated with advanced epigenetic age cross-sectionally, but the association between these variables over time is unclear. This study conducted meta-analyses to test whether new-onset PTSD diagnosis and changes in PTSD symptom severity over time were associated with changes in two metrics of epigenetic aging over two time points.

We conducted meta-analyses of the association between change in PTSD diagnosis and symptom severity and change in epigenetic age acceleration/deceleration (age-adjusted DNA methylation age residuals as per the Horvath and GrimAge metrics) using data from 7 military and civilian cohorts participating in the Psychiatric Genomics Consortium PTSD Epigenetics Workgroup (total N = 1,367).

Meta-analysis revealed that the interaction between Time 1 (T1) Horvath age residuals and new-onset PTSD over time was significantly associated with Horvath age residuals at T2 (meta β = 0.16, meta p = 0.02, p-adj = 0.03). The interaction between T1 Horvath age residuals and changes in PTSD symptom severity over time was significantly related to Horvath age residuals at T2 (meta β = 0.24, meta p = 0.05). No associations were observed for GrimAge residuals.

Results indicated that individuals who developed new-onset PTSD or showed increased PTSD symptom severity over time evidenced greater epigenetic age acceleration at follow-up than would be expected based on baseline age acceleration. This suggests that PTSD may accelerate biological aging over time and highlights the need for intervention studies to determine if PTSD treatment has a beneficial effect on the aging methylome.

In the past decade, no meta-analytical estimates of the prevalence of post-traumatic stress disorder (PTSD) among children and adolescents have been published, despite a host of new prevalence studies and updated DSM-5 criteria.

We set out to estimate the prevalence rates of PTSD in trauma-exposed children and adolescents on the basis of DSM-IV and DSM-5 criteria, and investigate differences in prevalence across trauma type, gender, time since exposure, type of informant and diagnostic measures.

Studies identified in a previous meta-analysis were combined with more recent studies retrieved in a new systematic literature search, resulting in a total of 95 studies describing 64 independent samples (n = 6745 for DSM-IV, n = 12 644 for DSM-5) over a 30-year period. Three-level random-effects models were used to estimate prevalence for DSM-IV and DSM-5 criteria separately, and for testing coded variables as moderators.

The DSM-IV meta-analysis estimated a PTSD prevalence of 20.3% (95% CI 14.9–26.2%) using 56 samples with age range 0–18 years, and revealed moderating effects of gender, trauma type and diagnostic interview type. The DSM-5 meta-analysis found an overall prevalence of 12.0% (95% CI 3.7–24.2%) using eight samples with age range 1–18 years. There was insufficient data for moderation analyses.

Although most trauma-exposed children and adolescents do not develop PTSD, a significant proportion (20% under DSM-IV criteria and 12% under DSM-5 criteria) do, particularly girls and individuals exposed to interpersonal trauma. These findings highlight the urgent need of continuous efforts in prevention, early trauma-related screening, and effective diagnostics and treatment to address the substantial burden of PTSD.