Up to 10–30% of stroke survivors develop dementia. Loneliness has been shown to be a psychosocial risk factor for developing stroke and cognitive impairment in the general population. Stroke survivors are more likely to experience loneliness. However, the contribution of loneliness to post-stroke dementia risk remains unclear.

We aimed to investigate the association between loneliness and incident dementia in stroke survivors.

We included 7,267 UK Biobank (No. 93604) participants with prior stroke (mean age =60.5 ±6.9 years, 55.6% male) without baseline dementia. Loneliness was assessed via two self-report questions (frequency of feeling lonely and frequency of confiding in someone close) and defined as a score of 2 (lonely) vs <2 (not lonely). Incident post-stroke dementia (all-cause) was ascertained from hospital records and death registries. We used Cox cause-specific hazards models to estimate hazard ratios (HRs) adjusted for demographics, socioeconomic status, comorbidities, health behaviours and physiological covariates. We also performed a relative importance analysis to rank risk factors. We calculated the Percentage of Excess Risk Mediated (PERM) by grouping explanatory covariates into categories, such as medication, behaviors, and comorbidities.

Over a median 10.2-year follow-up, 290 stroke survivors developed dementia. Loneliness was significantly associated with a higher risk of dementia (fully-adjusted HR 1.67, 95% CI: 1.12–2.49). In a risk-factor ranking, loneliness was the second most important predictor of post-stroke dementia, ranking ahead of conventional factors such as hypertension and obesity. The association between loneliness and post-stroke dementia was magnified in stroke survivors (HR: 1.67, 95% CI: 1.12–2.49) compared to individuals without stroke (HR: 1.22, 95% CI: 1.07–1.39). 25% of the excess dementia risk associated with loneliness was attributable to diabetes-related factors, with the remainder largely explained by medication, behaviors, comorbidities, and other covariates.

Loneliness is an independent risk factor for developing dementia among stroke survivors. This association is partly mediated by modifiable behavioral and physiological pathways. Our findings highlight loneliness as a prominent, yet addressable, risk factor for post-stroke dementia, underscoring the importance of screening for feelings of loneliness in stroke aftercare.

None Declared

Post-stroke depression, a prevalent and persistent neuropsychiatric complication, adversely affects stroke recovery outcomes. Almost half of stroke survivors experience social isolation. Yet the contribution of social isolation to post- stroke depression development remains unclear.

We investigate the association between social isolation and incident depression in stroke survivors.

We included 7,267 UK Biobank participants with prior stroke (mean±SD age =60.5 ±6.9 years, 55.6% male) without baseline depression. Degree of social isolation was assessed with three questions: 1) “Including yourself, how many people are living together in your household? (Include those who usually live in the house such as students living away from home during term, partners in the armed forces, or professions such as pilots)” (1 point for living alone); 2) “How often do you visit friends or family or have them visit you?” (1 point for answering rarely, never, or monthly); and 3) “Which of the following [leisure/social activities] do you engage in once a week or more often? You may select more than one” (1 point for none of the above). Incident post-stroke depression was ascertained from hospital records and death registries. We used Cox cause-specific hazards models to estimate hazard ratios (HRs) adjusted for demographics, socioeconomic status, comorbidities, health behaviours and physiological covariates. We also performed a relative importance analysis to rank risk factors. We calculated the Percentage of Excess Risk Mediated (PERM) by grouping explanatory covariates into categories, such as medication, behaviors, and comorbidities.

Over a median 10.2-year follow-up, 591 stroke survivors developed depression. Compared with the least isolated participants, the most isolated group showed a significantly higher risk of depression (HR: 1.35, 95% CI: 1.07-1.70). In a risk-factor ranking, social isolation ranks higher than traditional risk factors, including hypertension and obesity, as a predictor of post-stroke depression. Health behaviors mediated the association between social isolation and elevated depression risk most strongly, accounting for 32-44% (PERM) of the effect. This mediating effect was significantly greater than that explained by medication, comorbidities, and other covariates.

In this population-based cohort study of UK Biobank participants with stroke, social isolation was significantly associated with an increased risk of post-stroke depression. These findings suggest that interventions targeting social connectivity may improve clinical outcomes in stroke survivors.

None Declared

Psychological adaptability hinges on the dynamic balance between cognitive regulation (self-control) and emotional reactivity (impulsivity, reward/punishment sensitivity). However, traditional variable-centered approaches often fail to capture how these traits holistically co-occur, and the neural architectures predicting their longitudinal transitions in early adulthood remain under-explored.

This longitudinal study (N = 1,229 baseline; N = 432 2-year follow-up) integrated a person-centered behavioral approach with resting-state fMRI. We employed Latent Profile Analysis (LPA) to identify trait configurations based on self-control, impulsivity, and sensitivity to reward/punishment. Network-Based Statistic (NBS) analysis with family-wise error (FWE) correction was utilized to evaluate functional connectivity differences among groups. Finally, hierarchical regression and formal interaction models were conducted to test the prospective predictive validity of the identified neural circuits.

LPA delineated three distinct baseline profiles: Adaptive, Moderate, and Maladaptive. NBS analysis revealed that the ‘Adaptive’ profile is underpinned by robust cortico-striatal functional connectivity, integrating the medial prefrontal cortex and striatum. Longitudinally, initial regression models demonstrated that the baseline integrity of this circuit prospectively predicted behavioral adaptation at the 2-year follow-up. Furthermore, hierarchical regression and formal interaction analyses confirmed that this cortico-striatal circuit provided significant incremental predictive validity – above and beyond massive baseline behavioral stability – specifically in males.

These findings highlight cortico-striatal integration as a significant, gender-specific prospective predictor of longitudinal adaptation. By bridging person-centered profiling with network neuroscience, this study elucidates the neural correlates supporting future adaptive functioning and psychological resilience during the early adult transition.

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.

Emergency medical technicians (EMTs) often perform patient-handling tasks in emergency settings, posing a high risk of occupational injury. The prevalence of Work-Related Musculoskeletal Disorders (WRMSD) among EMTs has been underestimated due to the lower reporting rate of WRMSD events in Taiwan. This study employed a nationwide safety manual handling survey by integrating the health belief model (HBM) and the transtheoretical model (TTM) to examine behavioral factors influencing the adoption of safety manual handling skills among EMTs.

A cross-sectional study was conducted among frontline EMTs in Taiwan, including full-time and volunteer EMTs from fire departments in Taiwan. Data on individual characteristics, WRMSD experiences, six factors of measuring attitude toward safety handling, and behavioral change stages to adopting safety handling via a questionnaire were analyzed using descriptive statistics and multinomial logistic regression to determine the impact of each factor on adopting safe handling techniques.

A total of 761 participants completed the questionnaire. The lower back was the most frequent WRMSD body part among participants. The most frequent type of patient handling-related injuries was strain/sprain (88.4%). The patient handling-related injuries occurred within 5.3 years after career initiation in 76.9% of participants. The results also indicated that higher perceived benefits and lower perceived barriers increase the odds of being in all TTM stages. The cue to action level was also a predictor for investigating the likelihood of being in each stage of change compared to the reference category.

Promoting the adoption of safety handling skills is a long-term battle in improving occupational health and safety among EMTs. Perceived benefits, perceived barriers, and cues to action may be the critical factors for designing and implementing the interventions in the future. Future interventions should focus on letting EMTs understand the benefits and barriers of conducting safety manual handling and provide clear, real-world guidance.

Post-traumatic stress disorder (PTSD) may shorten life expectancy, but evidence for Asian populations and cause-specific mortality remains limited. The aim of this study is to investigate the association between PTSD and mortality risk in an Asian population.

We used Taiwan’s National Health Insurance Research Database (2000–2022) to assemble a cohort of 28,777 individuals with incident PTSD and 115,108 age- and sex-matched unexposed individuals, plus a sibling cohort of 13,305 affected patients and 22,030 unaffected siblings. Cox models estimated adjusted hazard ratios (AHRs) for all-cause, unnatural-cause (suicide and accidents) and natural-cause mortality, with progressive adjustment for sociodemographic factors, comorbidity and familial confounding. Subgroup analyses addressed five psychiatric comorbidities, sex and age (youth, adulthood and older adults).

Over a mean follow-up of 8 years, PTSD was associated with excess all-cause mortality (AHR = 1.32, 95% CI 1.24–1.41) driven by markedly increased unnatural deaths (AHR = 5.93, 5.13–6.85), especially suicide (AHR = 10.36, 8.41–12.76) and accidental deaths (AHR = 2.18, 1.67–2.86). Natural-cause mortality showed no consistent increase (AHR = 0.91, 0.85–0.98). In sibling analyses, excess risks persisted for all-cause (AHR = 2.48, 2.04–3.01), unnatural deaths (AHR = 4.76, 3.58–6.34) and suicide mortality (AHR = 7.90, 5.21–11.97), but not for accidents or natural causes. The risk patterns were similar across different psychiatric comorbidity strata and genders; suicide and unnatural-cause excess remained evident in all age groups.

PTSD was associated with elevated premature death risk in Taiwan, primarily through suicide and unnatural causes. Integrating targeted suicide-prevention into PTSD care pathways may be essential to reducing this avoidable mortality burden.