Around 140 million births occur worldwide annually. For some women, childbirth is traumatic and can lead to childbirth-related post-traumatic stress disorder (CB-PTSD), with adverse consequences for both women and their families. However, international evidence remains limited.

To estimate the international prevalence of traumatic birth and CB-PTSD.

The International Survey of Childbirth-Related Trauma (INTERSECT) is a cross-sectional survey conducted in 31 countries. Women were eligible if they were 6–12 weeks postpartum, legally adults and provided informed consent. Recruitment was through routine maternity services and data were collected from April 2021 to January 2024. Outcomes were assessed using the City Birth Trauma Scale. Traumatic birth was coded using DSM-5 criteria for a traumatic stressor, and CB-PTSD classified when all PTSD criteria were met. Dissociative subtype and differential diagnoses were also assessed.

A total of 11 302 women from 31 countries took part. Most participants were married, aged 30–34 years, with average household income and higher education, and 9.7% identified as being from ethnic or racial minority groups. The prevalence of traumatic birth and CB-PTSD varied across countries: traumatic birth ranged from 7 to 69% (mean 23.3, 95% CI 22.4–24.0), and CB-PTSD ranged from 1 to 36% (mean 6.7, 95% CI 3.7–9.7). CB-PTSD subtypes also varied: the dissociative subtype ranged from 1 to 24% (mean 3.8, 95% CI 2.1–5.4) and acute CB-PTSD from 0 to 7% (mean 1.3, 95% CI 0.7–1.9). Removal of participants with potential differential diagnoses did not affect prevalence rates in most countries. Many participants reported distress and impairment from symptoms, even when they did not meet CB-PTSD diagnostic criteria.

Results show that a notable proportion of women experience traumatic birth and CB-PTSD. The wide variation in prevalence suggests that cultural and healthcare factors unique to each country are important. Results emphasise the importance of routine trauma-informed assessment and culturally informed support in perinatal mental healthcare.

Childbirth-related post-traumatic stress disorder (CB-PTSD) is an underrecognized condition with consequences for mothers and infants. This study aimed to determine risk factors for CB-PTSD symptoms across countries within a stress–diathesis framework, focusing on antenatal, birth-related, and postpartum predictors.

The INTERSECT cross-sectional survey (April 2021–January 2024) included 11,302 women at 6–12 weeks postpartum. The study was carried out across maternity services in 31 countries. Outcomes were CB-PTSD diagnosis, symptom severity, and perceived traumatic birth, assessed with the City Birth Trauma Scale. Multiple risk factors were assessed, including preexisting vulnerability, pregnancy, birth, and infant-related factors. All models were adjusted for country-level variation as a random effect.

Models explained substantial variance across all outcomes (conditional R2 = 0.53–0.58). Negative birth experience was the strongest predictor (e.g. odds ratio [OR] = 0.82, 95% confidence interval [CI] = 0.80–0.84 for diagnosis). Ongoing maternal complications predicted both CB-PTSD diagnosis and symptoms (e.g. OR = 1.61, 95% CI = 1.41–1.84), and major infant complications were associated with CB-PTSD diagnosis (OR = 1.63, 95% CI = 1.29–2.07). Reports of perceived danger to self or infant (criterion A) were linked to higher CB-PTSD symptoms and traumatic birth ratings (e.g., β =0.25, 95% CI = 0.21–0.29). Other predictors reached significance but showed small effects.

Findings support a stress–diathesis framework, showing that while pre-existing vulnerabilities contribute, birth-related stressors exert the strongest influence. Trauma-informed maternity care should prioritize these factors, with attention to women’s appraisals of birth.

Obsessive–compulsive disorder (OCD) is a neuropsychiatric disorder characterized by recurrent intrusive thoughts and ritualized behaviors, often aimed at reducing distress. OCD is heterogeneous in its presentation and many patients with OCD experience a variety of different symptoms throughout their course of illness. Efforts to understand symptom domains in OCD have typically identified three to five symptom domains, such as the domains of doubt/checking, contamination, superstitions/rituals, symmetry/hoarding, and taboo thoughts. Recent studies in the genetics of OCD have suggested a common OCD dimension may provide additional information above and beyond the previously identified symptom domains. Thus, we sought to test a hierarchical model of lifetime OCD symptoms and evaluate the utility of the inclusion of a common OCD dimension.

Participants included 999 individuals participating in the OCD Collaborative Genetics Study (OCGS) and an additional 2363 individuals participating in the OCD Genetic Association Study (OCGAS). We evaluated unidimensional, 5-factor, and hierarchical models of lifetime OCD symptom presentation using confirmatory factor analysis.

Results suggested that the hierarchical model best fit the data. Further evaluation of these models using a Bayesian testlet response model showed that lifetime presence of specific OCD symptoms was differentially associated with lifetime OCD severity. Moreover, symptoms associated with greater lifetime severity were generally reported less frequently than symptoms present at lower levels of lifetime severity. Implications of these findings and future directions are discussed.

Drug use Disorder (DUD), the risk for which is substantially influenced by both genetic and social factors, is geographically concentrated in high-risk regions. An important step toward understanding this pattern is to examine geographical distributions of the genetic liability to DUD and a key demographic risk factor – social deprivation.

We calculated the mean family genetic risk score (FGRS) for DUD ((FGRSDUD) and social deprivation for each of the 5983 areas Demographic Statistical Areas (DeSO) for all of Sweden and used geospatial techniques to analyze and map these factors.

Using 2018 data, substantial spatial heterogeneity was seen in the distribution of the genetic risk for DUD in Sweden as a whole and in its three major urban centers which was confirmed by hot-spot analyses. Across DeSOs, FGRSDUD and s.d. levels were substantially but imperfectly correlated (r = + 0.63), with more scattering at higher FGRSDUD and s.d. scores. Joint mapping across DeSOs for FGRSDUD and s.d. revealed a diversity of patterns across Sweden. The stability of the distributions of FGRSDUD and s.d. in DeSOs within Sweden over the years 2012–2018 was quite high.

The geographical distribution of the genetic risk to DUD is quite variable in Sweden. DeSO levels of s.d. and FRGSDUD were substantially correlated but also disassociated in a number of regions. The observed patterns were largely consistent with known trends in the human geography of Sweden. This effort lays the groundwork for further studies of the sources of geographic variation in rates of DUD.

The prevalence of mild to moderate cognitive impairment, including episodic memory deficits, in people living with HIV (PLWH) remains high despite the life-extending success of antiretroviral pharmacotherapy. With PLWH now reaching near-normal life expectancy, questions concerning a potential synergy between age- and HIV disease-related effects, including degradation in fronto-limbic circuits, neural systems also compromised in Parkinson’s disease (PD), have emerged.

This cross-sectional study examined the similarities and differences in component processes of verbal episodic memory and their neural correlates in 42 PLWH, 41 individuals with PD, and 37 controls (CTRL) (all participants aged 45-79 years). Learning over five trials, short-delay (SD) and long-delay, (LD), free-recall (FR) and cued-recall (CR) indices were assessed using the California Verbal Learning Test-2. Retention scores for FR and CR were derived adjusting for Trial 5 performance. All memory scores were age- and education-corrected based on the control group and reported as Z-scores. Regional brain volumes were calculated using 3T MRI data and the SRI24 atlas to delineate frontal (precentral, superior, orbital, middle, inferior, supplemental motor, and medial) and limbic (hippocampus, thalamus) regions. Brain volumes were age- and head-sized corrected based on 238 controls (19-86 years old).

Compared with the CTRL group, the HIV and PD groups were impaired on learning across trials and on SD and LD free- and cued-recall, with no group difference between the HIV and PD groups on any score. All three groups benefited similarly from cues compared with free-recall. The HIV and PD groups did not differ from CTRL on retention scores. Regarding brain volumes, the HIV group had smaller middle frontal volumes than the PD or CTRL groups and smaller thalamic volumes than the PD group. Correlational analyses (Bonferroni correction for 8 comparisons, p<.01) indicated that fewer total number of words recalled on Trial 5, learning over Trials 1-5, total words recalled on SD-CR, LD-FR, and LD-CR were associated with smaller orbitofrontal volume in the HIV but not the PD group; the correlations between orbitofrontal volume and memory scores were significantly different between the HIV and PD groups. In PD, but not HIV, lower retention scores on SD-FR and LD-CR correlated to smaller hippocampal volume.

Impairment in learning and cued recall performance indicate that both encoding and retrieval processes are affected in PLWH and PD. Neural correlates of verbal memory differed between groups, with orbitofrontal volume associated with learning and recall in PLWH, whereas hippocampal volume was associated with retention scores in PD. Together, these results suggest that different nodes within the fronto-limbic mnemonic circuitry underlie the mutual verbal episodic memory deficits observed in older PLWH and PD. Support: AA023165, AA005965, AA107347, AA010723, NS07097, MH113406, and the Michael J. Fox Foundation for Parkinson’s Research

To estimate the association between in situ steroids and spine surgical-site infections (SSIs), assessing spinal instrumentation as an effect modifier and adjusting for confounders.

Case–control study.

Rural academic medical center.

We identified 1,058 adults undergoing posterior fusion and laminectomy procedures as defined by the National Healthcare Safety Network without a pre-existing SSI between January 2020 and December 2021. We identified 26 SSI as cases and randomly selected 104 controls from the remaining patients without SSI.

The primary exposure was the intraoperative administration of methylprednisolone in situ (ie, either in the wound bed or as an epidural injection). The primary outcome was a clinical diagnosis of SSI within 6 months of a patient’s first spine surgery at our facility. We quantified the association between the exposure and outcome using logistic regression, using a product term to assess for effect modification by spinal instrumentation and the change-in-estimate approach to select significant confounders.

Adjusting for Charlson comorbidity index and malignancy, in situ steroids were significantly associated with spine SSI relative to no in situ steroids for instrumented procedures (adjusted odds ratio [aOR], 9.93; 95% confidence interval [CI], 1.54–64.0), but they were not associated with spine SSIs among noninstrumented procedures (aOR, 0.86; 95% CI, 0.15–4.93).

In situ steroids were significantly associated with spine SSI among instrumented procedures. The benefits of in situ steroids for pain management following spine surgery should be weighed against the risk of SSI, especially for instrumented procedures.

People working in long-term care homes (LTCH) face ethical dilemmas about how to minimize the risk of spread of COVID-19, while also minimizing psychological hardship and other harms of infection control measures on residents. The Dementia Isolation Toolkit (www.dementiaisolationtoolkit.com; DIT) was developed to address the gap in ethical guidance for LTCH on how to safely and effectively isolate people with dementia while supporting the personhood and well-being of residents. In this presentation, we will present the DIT and report on the results of a survey of LTCH staff in Ontario, Canada on their experiences isolating residents in LTCH and the use of the DIT in supporting person-centred isolation care.

A link to an online survey was distributed to LTCH staff through provincial organizations and agencies as well as through social media and the DIT website. Inclusion criteria were LTCH staff working on-site at a LTCH since March 1, 2020, who had direct or indirect experience with the isolation/quarantine of LTCH residents. Results were summarized descriptively.

A broad sample of LTCH staff (n=207) participated in the survey, most of whom had experienced an outbreak in their LTCH. Dementia (96%) was the most important barrier to implementation of infection control measures in LTCH, followed by staff distress about the effects of isolation on residents (61%). Important facilitators for isolation included delivery of 1:1 activities in the resident’s room (81%) and designating essential caregivers to provide support (67%), while inadequate staffing levels were reported as a barrier (55%). 65% of respondents indicated some familiarity with the DIT, and of those who had used the toolkit, 62% found it helpful in supporting isolation care, particularly in developing care plans and making and communicating decisions. Of those who had used the DIT, 48% found it fairly or very helpful at reducing their level of distress.

Isolation as an infection control and prevention (ICP) measure in LTCH environments can be harmful to residents and create moral distress in staff. ICP guidance and support of LTCH needs to address how to minimize these harms by providing dementia-specific guidance such as in the DIT.