Weight gain is a common, distressing side-effect of antipsychotic medication prescribed for people with severe mental illness. National guidance for antipsychotic-induced weight gain (AIWG) encourages early intervention and physical health monitoring; healthcare professionals (HCPs) often struggle to implement these recommendations in routine care.

To explore how HCPs understand and respond to AIWG for patients.

This realist evaluation, part of the RESOLVE project, builds on a realist synthesis. Thirty HCPs participated in realist interviews. A programme theory with nine context–mechanism–outcome configurations (CMOCs) was generated, explaining how HCPs perceive non-pharmacological care provision for patients with AIWG. Clinical and lived experience stakeholders reviewed and refined the theory and CMOCs.

The nine CMOCs spanned three areas: (a) systemic and professional challenges; (b) strategies to enhance individualised and meaningful support; and (c) the role and limitations of non-professional support. HCPs described how lack of training, siloed services and system-level constraints limited their ability to offer integrated care. They highlighted the importance of relational continuity, early and tailored conversations, and alignment with patients’ values and motivations. Peer and family support were valued, but structural barriers undermined their consistent implementation.

AIWG was experienced as compromising professional values for HCPs working in mental health settings. Person-centred care was often undermined by fragmented systems, role ambiguity and insufficient training. These issues require investment in professional development, structural integration, and relationship-based approaches that support timely, collaborative action.

This study examined the associations among supportive care needs, perceived social support, and quality of life among family caregivers of patients with advanced cancer and explored caregivers’ lived experiences of the caregiving process.

A convergent mixed-methods study was conducted at a university oncology center in Türkiye. Quantitative data were collected from 328 family caregivers of patients with advanced cancer using the Supportive Care Needs Survey–Caregivers (SCNS-C), the Multidimensional Scale of Perceived Social Support (MSPSS), and the SF-12 Health Survey. Qualitative data were obtained through semi-structured interviews with 22 caregivers and analyzed using Colaizzi’s phenomenological approach.

Higher supportive care needs were significantly associated with poorer physical and mental quality of life, whereas higher perceived social support was significantly associated with better quality of life. Supportive care needs demonstrated negative correlations with both physical and mental health-related quality of life, while perceived social support demonstrated positive correlations with these outcomes (all p < .05).

Impacts of the Caregiving Process and Emotional and Psychological Dimensions of Caregiving. Caregivers described disruptions in family and social life, financial strain, unmet support needs, emotional distress, reliance on family and community support, religious coping, and fluctuating feelings of hope and despair.

The findings suggest that supportive care needs and perceived social support are associated with caregiver well-being. Integrating caregiver assessment, psychosocial support, and interventions into palliative care services may help address unmet needs and improve quality of life among caregivers of advanced cancer patients.

Millions of Ukrainians displaced since 2022 experience high rates of depression, anxiety and distress, with major barriers to in-person mental healthcare. Immersive avatar-based virtual reality environments may offer scalable psychosocial support while preserving key therapeutic elements.

To evaluate the efficacy of avatar-based virtual reality support groups versus in-person support groups and a waitlist control among Ukrainian refugees in Romania.

In this 3-arm randomised controlled trial, 156 participants were assigned to avatar virtual reality groups, in-person support groups or a waitlist control. Assessments were conducted at baseline, mid-intervention, post-intervention and at 3-month follow-up. Primary analyses used clustered intention-to-treat longitudinal mixed models with cluster-robust standard errors. Complementary baseline-adjusted analysis of covariance and sensitivity analyses were also performed.

Most between-group comparisons favoured the interventions but many lacked statistical significance, probably owing to attrition and clustering. In-person groups showed the strongest benefits, in particular, they were associated with greater perceived social support versus waitlist at post-intervention and reduced anxiety in end-point analyses. Avatar virtual reality effects were smaller and non-significant. Effects were largely attenuated at follow-up. Sensitivity analyses excluding participants with high levels of baseline trauma identified stronger treatment effects.

In-person support groups demonstrated the strongest short-term psychosocial benefits, especially for perceived social support. Delivery of the avatar virtual reality intervention proved feasible, but the intervention did not show consistent superiority or equivalence to in-person groups. The findings support further refinement of immersive interventions with improved retention strategies and trauma-sensitive adaptations, particularly across populations with varying digital familiarity.

Once-daily INGREZZA® (valbenazine), a selective vesicular monoamine transporter 2 (VMAT2) inhibitor, is approved for tardive dyskinesia (TD) and Huntington’s chorea. KINECT-PRO™ (NCT05859698) is currently the only study to assess the effects of a VMAT2 inhibitor (valbenazine) on quality of life (QoL) and functionality in patients with TD using multiple validated patient-reported outcomes (PROs).

Adults with mild-to-severe TD movement severity (per Abnormal Involuntary Movement Scale [AIMS] item 8) and awareness of TD with mild-to-severe associated distress (per AIMS item 10) received open-label valbenazine (40, 60, or 80 mg) for 24 weeks. Primary endpoints included changes from baseline (CFBs) at Week 24 in 3 validated QoL/functionality PROs: Tardive Dyskinesia Impact Scale (TDIS), the only psychometrically validated PRO developed specifically for TD; Sheehan Disability Scale (SDS); and EuroQoL Group’s EQ-Visual Analogue Scale (EQ-VAS). Secondary endpoints included CFB in AIMS total score.

Substantial and clinically meaningful improvements in patient-reported QoL/functionality and clinician-reported TD severity were observed throughout treatment with valbenazine in the overall study population and regardless of psychiatric diagnosis (mood disorders, psychotic disorders) or TD severity at baseline (mild, moderate/severe). At Week 24 (N = 45), mean CFBs were: TDIS (−8.0); SDS Social/Leisure (−2.3); SDS Family/Home (−1.6); EQ-VAS (+13.1); AIMS (−6.8). Previously established minimal clinically important difference (MCID) thresholds for TD were exceeded for TDIS and AIMS. Safety and tolerability were consistent with valbenazine’s known profile.

KINECT-PRO is the first study of its kind, and valbenazine is the only VMAT2 inhibitor to demonstrate QoL/functional improvements in patients with TD across multiple validated PROs.

Knowledge of one’s defect is fundamental in optimising outcomes in adults with CHD. We aimed to assess factors associated with defect knowledge and how that knowledge may impact outcomes.

We performed a cross-sectional cohort study of adults with CHDs aged 18–82 years with intervention between 1982 and 2003 at one of 11 US centres in the Pediatric Cardiac Care Consortium. Participants completed a survey in 2021–2023 regarding disease knowledge and various health and quality of life outcomes. After comparing participants’ self-identification of their defect to that recorded in the medical record, we identified demographic factors associated with correct identification and assessed the association of correct identification with outcomes.

Among 2747 respondents with one of the 18 types of CHDs on the survey, 2271 (83%) correctly identified their defect. Those who correctly identified their defect were more likely to be non-Hispanic White (84% correct), were <25 years of age (89%), have a higher level of education (86% for a bachelor’s degree and 87% for a graduate degree), and have higher household income (85% for income ≥$60,000). Those with severe two-ventricle disease were most likely to correctly identify their defect (88% correct); those with moderate disease were least likely (80% correct). Correct identification was associated with seeing a cardiologist in the last 5 years (74% vs. 63%, p < 0.001) but was mixed for other outcomes.

Improving a person’s knowledge of their CHD may be an effective strategy for maintaining continuity of care.

To translate the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-ELD14 (EORTC QLQ-ELD14) into Chinese and validate its effectiveness in China.

The Chinese version was developed through a rigorous translation and back-translation process based on the Brislin model, followed by cross-cultural adaptation through expert consultation. A total of 260 elderly cancer patients from a tertiary hospital in Tianjin were recruited between June 2024 and February 2025 to evaluate the instrument’s reliability and validity.

Among the 248 completed responses, the Chinese version of the EORTC QLQ-ELD14 demonstrated robust psychometric properties. The questionnaire comprises 7 dimensions (14 items), with item-level content validity indices ranging from 0.800 to 1.000 and a scale-level content validity index of 0.980. Exploratory factor analysis identified 7 underlying factors, accounting for 82.913% of the cumulative variance. Internal consistency was excellent, with a Cronbach’s α of 0.958 for the total scale and dimension alphas exceeding 0.800. Test–retest reliability was 0.849 for the total scale and ranged from 0.813 to 0.856 across dimension.

The Chinese version of the EORTC QLQ-ELD14 has good reliability and validity, which is suitable for evaluating the quality of life of elderly cancer patients within Chinese cultural contexts.

Homelessness is a complex, multidimensional and often underrecognised public health concern. Women experiencing homelessness are often vulnerable to chronic stress, violence, mental health problems, substance use and poorer quality of life. Despite these vulnerabilities, research on substance use and psychological well-being among homeless women are limited in the Indian scenario.

This study aimed to evaluate the patterns and proportion of substance use, as well as the psychological well-being and quality of life, among homeless women utilising services from shelter homes in Delhi.

A cross-sectional observational study was conducted across five urban shelter homes in Delhi, providing a sample of 152 homeless women. Participants were interviewed using a semi-structured questionnaire designed for the survey, the Perceived Stress Scale, Patient Health Questionnaire-9 and -15, Generalised Anxiety Disorder-7, World Health Organization Quality-of-Life Scale and World Health Organization Alcohol, Smoking and Substance Involvement Screening Test Version 3.0. Statistical analysis was done using SPSS version 29.

Among 152 homeless women, lifetime use of substances was reported as tobacco (48%), alcohol (9.2%), inhalant (4.6%), opioid (2.0%) and cannabis (0.7%). Tobacco was the most common substance used followed by alcohol. Only 4.2% of the participants had ever sought treatment for substance use. A higher percentage of homeless women reported intimate partner violence in the form of emotional abuse (60.9%), physical violence (59.6%) and sexual violence (41.7%). Clinically relevant symptoms of depression and anxiety were observed in approximately a quarter of the participants. Furthermore, over 80% of the participants exhibited moderate-to-severe perceived stress.

Homeless women are considered a hard-to-reach and vulnerable population. Although residing in shelter homes may alleviate some difficulties, challenges still persist. The study emphasises the need for integrated, gender-sensitive and context-specific interventions. To effectively address the multifaceted issues by this population, tailored intervention programmes and policies should be designed unique to this population.

Children with cyanotic CHD experience chronic hypoxaemia and recurrent medical interventions that may adversely affect health-related quality of life.

To compare health-related quality of life between children with cyanotic CHD and healthy peers in Sulaimani, Iraq.

A hospital-based case–control study was conducted between October 2023 and April 2024, including 200 children with cyanotic CHD and 200 age- and sex-comparable healthy controls aged 3–13 years. Quality of life was assessed using the Pediatric Quality of Life Inventory (PedsQL™), including the Generic Core Scale Version 4.0 and the Cardiac Module Version 3.0, through parent-reported interviews. Group differences were examined using independent-samples t-tests and analysis of covariance, adjusting for age, sex, peripheral oxygen saturation (SpO2), and educational level.

Children with cyanotic CHD had significantly lower health-related quality-of-life scores across all domains compared with healthy children (all p-values < 0.001). After adjustment, the largest differences were observed in physical functioning and total quality of life, with large effect sizes (partial η2 = 0.50 and 0.63, respectively). Mean SpO2 levels were also significantly lower among children with cyanotic CHD (p < 0.001).

Cyanotic CHD was independently associated with substantial impairment in quality of life across physical and psychosocial domains. Lower peripheral oxygen saturation (SpO2) was independently associated with poorer health-related quality of life. These findings support integrating health-related quality-of-life assessment and multidisciplinary care into the routine management of children with cyanotic CHD.

Tinnitus is a common and potentially distressing symptom associated with chronic ear disease. Its burden in patients with chronic suppurative otitis media in low-resource settings is not well characterised.

A cross-sectional study was conducted during an ear surgery camp in Nepal. One hundred patients with chronic suppurative otitis media completed the validated Nepali Tinnitus Handicap Inventory. Severity was categorised using established grading systems. Associations between sex and severity were assessed using chi-squared analysis.

Nepali Tinnitus Handicap Inventory scores ranged from 0 to 94. Overall, 62 per cent of patients reported moderate or worse tinnitus, and 36 per cent reported severe or catastrophic symptoms. Female patients demonstrated a greater burden, with a higher proportion in severe and catastrophic categories. This difference was statistically significant (χ2 = 11.05; df = 4; p = 0.026).

Patients undergoing surgery for chronic suppurative otitis media experience a substantial and under-recognised tinnitus burden. Routine assessment may support more comprehensive, patient-centred care.

This study examined longitudinal associations between spirituality and quality of life (QoL) in women newly diagnosed with breast cancer and undergoing chemotherapy at a large tertiary cancer center.

Women (N = 114) completed measures of spirituality (3 subscales of the Functional Assessment of Chronic Illness Therapy – Spiritual Well-Being Scale: Meaning, Peace, and Faith) and health-related QoL (36-Item Short Form Health Survey) at study entry and 3- and 15-months later. Bias-corrected bootstrap tests were used to examine whether baseline Faith was indirectly associated with mental and physical QoL 15 months later via Meaning and Peace at 3 months.

Baseline Faith was positively associated with Meaning (β = .31, p = .001) and Peace (β = .38, p < .001) at 3 months. Both Meaning [n = 94, effect = .07 (95% CI: .002, .17)] and Peace [n = 93, effect = .13 (95% CI: .02, .28)] mediated the association between Faith and mental QoL at 15 months. When baseline Meaning was controlled, the indirect effect of baseline Faith on mental QoL remained significant, [n = 94, effect = .07 (95% CI: .001, .18)], and increases in Meaning over the first 3 months became an even stronger predictor of later mental QoL (β = .36, p = .004), suggesting that change in meaning during active treatment is an especially important predictor of mental QoL.

Overall, findings demonstrate that Faith is indirectly associated with long-term QoL through early increases in Meaning and Peace. Because 90% of participants were within 6 weeks of diagnosis, the study provided a unique perspective on spirituality during the early treatment period. Clinically, results highlight the importance of early assessment of spiritual well-being and suggest that meaning-focused interventions may enhance long-term QoL for women undergoing chemotherapy.

The primary effect parameter in depression trials is usually a measure of depressive symptoms, e.g. the Hamilton Depression Rating Scale (HDRS). Such measures have been criticised for not covering patient-relevant domains, such as quality of life, and hence not accurately reflecting patient-experienced efficacy.

To investigate the relation between clinician-rated depressive symptoms and patient-reported quality of life measured by the Quality-of-Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF).

We included data from six acute-phase trials (n = 918) comparing mirtazapine to another antidepressant (amitriptyline, fluoxetine, paroxetine or venlafaxine) where both HDRS and Q-LES-Q-SF had been administered. No study included a placebo arm. Correlations between instruments (scales, subscales and items) were assessed after six weeks. Q-LES-Q-SF outcomes for participants who were in HDRS-defined remission were contrasted to those from participants with more severe depressive symptoms.

Q-LES-Q-SF ratings correlated strongly with HDRS-17 (r = −0.73, p < 0.0001) and HDRS-6 (r = −0.72, p < 0.0001), but somewhat weaker to HDRS-11 (r = −0.64, p < 0.0001). Depressed mood (r = −0.66, p < 0.0001) and work and activities (r = −0.65, p < 0.0001) showed the strongest item-level correlations to Q-LES-Q-SF. Participants in HDRS-remission had average Q-LES-Q-SF scores on the lower end of those reported by healthy controls, whereas patients with mild depressive symptoms (or worse) had average life-quality scores corresponding to severe impairment.

HDRS and Q-LES-Q-SF showed considerable agreement in depressed study participants treated with antidepressants, suggesting that HDRS meaningfully reflects patient-reported improvement.

Cancer-related fatigue (CRF) is a distressing symptom in terminally ill patients with cancer. While many studies have been conducted on the relationship between fatigue and quality of life (QOL) among patients undergoing treatment, only a few have been conducted to measure fatigue from multiple perspectives or clarify its impact on patients in advanced stages or those receiving palliative care.

To examine the impact of fatigue on QOL in terminally ill patients with cancer, using a questionnaire that measures CRF from 3 perspectives.

CRF and QOL were measured using the Cancer Fatigue Scale (CFS) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative (EORTCQLQ-C15-PAL), respectively, and the correlation between them was evaluated. Web-based questionnaires were completed by patients receiving hospice and palliative care.

Twenty-nine participants provided valid responses. Median CFS and global health status/QOL scores were as follows: total fatigue 25.0, physical fatigue 11.0, affective fatigue 9.0, cognitive fatigue 5.0, and global health status/QOL 50.0. QOL showed significant correlations with total fatigue (rs = −0.44, p = 0.017, 95% CI: −0.70, −0.09) and physical fatigue (rs = −0.38, p = 0.038, 95% CI: −0.66, −0.02), but none with affective fatigue (rs = −0.02, p = 0.917, 95% CI: −0.38, 0.35) and cognitive fatigue (rs = −0.33, p = 0.074, 95% CI: −0.63, 0.03).

Of the 3 aspects of fatigue, physical fatigue may be most closely related to QOL; however, its accurate assessment may depend on the scale used. Therefore, it is necessary to select an appropriate scale for patients with terminal cancer.

AWARE (Approaches for Wellbeing and Mental Health Literacy: Research in Education) is a three-arm, parallel-group, cluster randomised controlled trial. It assessed the effectiveness of two interventions – the Youth Aware of Mental Health (YAM) programme and Mental Health and High School Curriculum Guide – in addressing emotional well-being, compared with usual practice, among year 9 students in England.

To evaluate the cost-effectiveness of YAM and The Guide to inform policy decisions regarding the implementation of these mental health interventions in schools.

Cost-effectiveness was assessed using self-reported information from participants in the trial at baseline and two follow-ups – at 3–6 months after the start of intervention, and at 9–12 months post-intervention. Quality of life was measured with the Child Health Utility Index. Intervention delivery costs were calculated with data provided by the delivery teams. Service use costs were calculated with a short version of the Client Service Receipt Inventory, with unit costs obtained from publicly available sources.

For both interventions, difference in outcomes (change in quality-adjusted life-years over time) between the intervention group and control group were close to zero, with the largest change being an improvement of 0.0055 quality-adjusted life-years at the second follow-up for students in schools randomised to YAM. Changes in costs were likewise small.

At first follow-up, neither intervention is likely to be considered cost-effective. At second follow-up, YAM has a high probability of being considered cost-effective, with an incremental cost-effectiveness ratio of around £23 000 per unit of improvement in the quality-of-life measure, which falls within the threshold (£20 000 to £30 000) as used by the National Institute for Health and Care Excellence.

Depression and psychosocial sequelae are common after aneurysmal subarachnoid hemorrhage (aSAH), yet the extent to which aSAH survivors are at increased risk of suicide remains unclear. This systematic review and meta-analysis evaluated whether aSAH is associated with death by suicide and sought to identify potential patient-level risk factors.

Following PRISMA guidelines, MEDLINE, Embase and PsycINFO were searched from inception until April 1, 2025, for studies reporting suicide rates in adults with aSAH. Pooled relative risks (RRs) were calculated using a simple model adjusted for age, sex, year of event and a comprehensively adjusted model for age, sex, year of event, living status, region, socioeconomic status, physical comorbidity and psychiatric hospitalization.

Of 294 unique studies identified, 2 met the inclusion criteria, yielding 20,661 aSAH survivors. Median age was 55 years (IQR: 44–64) years, and 47.4% were male. Ninety deaths by suicide were reported. Pooled analysis demonstrated increased risk of suicide among aSAH survivors compared with non-aSAH controls in both the simple model (RR 1.79, 95% CI 1.46–2.19) and comprehensively adjusted model (RR 1.42, 95% CI 1.09–1.86). Insufficient data prevented the identification of independent patient-level risk factors for suicide.

Survivors of aSAH have a small but significantly increased risk of death by suicide compared to the general population, although suicide remains a rare cause of death following aSAH. Clinicians involved in the subacute and long-term care of aSAH survivors should maintain awareness of this increased risk and routinely screen for depression and suicidal ideation in aSAH survivors.