Women with disabilities worldwide face barriers to reproductive healthcare, including accessibility challenges and negative attitudes from medical professionals. These issues reflect multiple intersecting forms of discrimination.

This study aims to examine how women with various disabilities in Lithuania access reproductive healthcare services, evaluate their experiences with these services, and explore the related attitudes of clinicians.

This cross-sectional study employs a mixed-methods convergent design. Quantitative and qualitative data were collected through an online survey (n = 154) and two focus groups with medical professionals (n = 12). Statistical and thematic analyses were performed using SPSS and MAXQDA.

Over half of the women rated their reproductive healthcare experiences as average to very bad. Issues spanned preventive, general, pregnancy, labour, childbirth, and postpartum care. Participants with hearing, mobility, physical disabilities, and autism reported more issues, often citing inaccessible infrastructure, lack of Sign language interpretation, written consultations, or Easy-to-Read materials. Intellectual disabilities were also associated with reports of negative attitudes from medical professionals, highlighting widespread communication and support inadequacies.

Improving reproductive healthcare for women with disabilities in Lithuania and globally requires educating medical professionals on the human rights-based model of disability and accessibility. Implementing individual accommodations in healthcare is essential and should involve medical staff, administrators, and policymakers. Ensuring access to sex education for women with disabilities and addressing societal stereotypes about their sexuality and motherhood are also vital. Further research with larger sample sizes is needed to evaluate and enhance the accessibility and quality of reproductive healthcare services for women with disabilities.

Although serum carotene may contribute to dementia prevention, there is a lack of longitudinal evidence for early cognitive decline before dementia symptoms. The aim of this study was to examine whether serum carotene levels were associated with annually evaluated cognitive trajectories among the Japanese general population.

Among 581 baseline participants, 199 individuals (83 males; mean age [min, max], 62.7 [39, 90] years) who underwent cognitive assessments more than twice after baseline were analyzed. "Attention" levels were assessed using one- and three-target Digit Cancellation Tests (D-CAT1 and D-CAT3). "General cognitive ability" was assessed by the short version of Mini-Mental State Examination (SMMSE). Serum carotenes (α-carotene, β-carotene and lycopene) were measured by high-performance liquid chromatography. After the measurements, we calculated total carotene levels by summing up the levels of all measured carotene. Carotene levels were categorized into three groups for analysis (low: 0%-25%, middle: 25%-75%, and high: 75%-100%). A linear mixed model was used to estimate the slope of the D-CAT score trajectory and to compare it between three categories.

Compared with the middle carotene group, decline of attention was faster in the D-CAT1 for low β-carotene (β = -3.48, p = 0.035), lycopene (β = -3.10, p = 0.062), and total carotene (β = -4.75, p = 0.003), but not for α-carotene (β = -2.60, p = 0.111). For the D-CAT3, decline of attention was faster in the group of low lycopene (β = -3.17, p = 0.002) and total carotene (β = -2.17, p = 0.037) compared with the middle carotene group, while no clear association for α-carotene (β = -0.67, p = 0.521) and β-carotene (β = -0.64, p = 0.639). There were no clear associations between serum carotene and the SMMSE score.

These findings suggest low levels of serum lycopene are associated with a decline of attention in the setting of the general population.

Eating disorders (EDs) are serious mental illnesses that affect youth of all socioeconomic backgrounds. However, low-income, publicly insured youth with EDs face substantial barriers to adequate treatment and often experience repeated hospitalizations with significant costs to families and care systems. We examined whether increased outpatient psychotherapy following hospitalization could break these "revolving door" cycles of admissions.

Participants were California Medicaid enrollees aged 7 to 18 years with diagnosed EDs who were hospitalized at least once (N = 920). We used Cox proportional hazard models to examine whether the amount of outpatient therapy youth received in the 90 days after hospitalization predicted rehospitalization in the subsequent 90 days, covarying demographic characteristics, ED diagnosis, admission length and type (primarily medical/psychiatric), and amount of outpatient therapy in the 90 days preceding admission.

Relative to youth who received 0 to 3 sessions of outpatient therapy in the 90 days after hospitalization, those who received 4 to 7 sessions had significantly reduced readmission risk in the subsequent 90 days (hazard ratio [HR] = 0.46; 95% CI, 0.23-0.91; P = .026). Risk was further reduced for youth who received 8 or more sessions (nearly weekly) (HR = 0.04; 95% CI, 0.004-0.34; P = .003). Cost savings associated with 8 or more therapy sessions were estimated at nearly $70 000 per youth. However, only a small minority of the population (4.5%) received at least 8 sessions, with the modal number of sessions being zero.

Even a moderate amount of outpatient therapy may substantially reduce rehospitalization in publicly insured youth with EDs, decreasing morbidity and costs.

Previous studies have reported an increase in new-onset adolescent eating disorder (ED) patients during the COVID-19 pandemic, with some studies showing a change in illness presentation. This study aimed to replicate and expand on previous work by further examining changes in illness and demographic characteristics.

Changes in the number of new ED referrals to a Child and Adolescent Mental Health Service were examined between 2019 and 2022. Additional analyses explored changes in duration of symptoms, weight-for-height, the need for more intensive care, age, and socioeconomic status. All analyses were conducted within the Bayesian framework.

A total of 371 new ED referrals were seen during the study period, and a significant increase in new ED cases was observed during COVID-19. This increase was not driven by any particular diagnostic group. There was no evidence for meaningful changes in demographic or illness characteristics.

These findings replicate previous work demonstrating a steady increase in ED patients during the pandemic. We did not find an accompanying change in illness characteristics. There was no significant change in the measure of patients' deprivation, suggesting that the pandemic did not widen the service access gap.

Neuropsychiatric symptoms are common clinical features of Huntington disease (HD) that can result in mental health emergencies. However, there are no established guidelines for inpatient psychiatric treatment in HD. In this study, the investigators reviewed psychiatric hospitalizations in a large medical center to better understand the mental health needs of patients with HD and identify potential gaps in care.

Charts were reviewed to identify patients with HD at Vanderbilt University Medical Center who were admitted to psychiatry between 2013 and 2020. Clinical data and demographic information were obtained from the electrical health record along with the indication for each psychiatric admission, actions taken during the admission, and follow-up care.

Among this cohort, 32 of 287 patients (11.1 %) were admitted to inpatient psychiatry at least once. Age at first admission ranged from 17 to 74 years, with 84.4 % of patients in the motor-manifest stage. The most common reasons for admission were suicidal ideation or attempt (57.6 %), psychosis (39.4 %), and aggression (36.4 %). Most patients were able to return to their previous level of care, although readmissions were common.

These results emphasize the frequency and severity of psychiatric crises in HD and support the need for expanded access to emergency psychiatry care across the disease course. Further research is warranted to develop an integrated, disease-specific approach to early recognition and management of psychiatric symptoms in HD.

People living with multiple sclerosis (plwMS) face numerous symptoms that may progressively worsen and impact daily living activities. PlwMS adhering to healthy lifestyle, appear to have fewer MS symptoms, slowed disease progression, and better quality of life. However, MS symptoms may prevent long-term adherence to healthy lifestyle. For example, fatigue, depression, and disability are reported to limit physical activity. We assessed symptoms identified as most important to plwMS and whether these symptoms impacted their adherence to healthy lifestyle.

Data from 671 plwMS from the longitudinal HOLISM observational study were analysed. Of 22 queried symptoms, participants ranked the top three most important to them. Lifestyle factors assessed were high-quality diet, vitamin D supplementation, meditation, physical activity, and non-smoking. Associations between top symptoms and lifestyle were assessed using log-binomial regression adjusted for appropriate confounders.

Top three important symptoms were fatigue, mobility, and cognitive function. Cross-sectional associations were observed between fatigue and physical activity (aRR=0.73, 95 %CI=0.59-0.91) and ≥3 lifestyle factors (aRR=0.82, 95 %CI=0.67-0.99), mobility with vitamin D supplementation (aRR=1.29, 95 %CI=1.01-1.65) and physical activity (aRR=0.72, 95 %CI=0.55-0.94), and cognitive function with diet (aRR=0.75, 95 %CI=0.59-0.94). Prospective associations were found between mobility and physical activity (aRR=0.73, 95 %CI=0.54-0.99), and cognitive function with non-smoking (aRR=1.03, 95 %CI=1.00-1.06).

Fatigue, mobility, and cognitive function are important symptoms for plwMS. These symptoms generally are not barriers to healthy lifestyle, except for mobility for physical activity. Determining barriers and facilitators for long-term adherence to healthy lifestyle may inform efforts to support plwMS improve lifestyle engagement.

The accurate diagnosis of mental disorders, such as depression, requires comprehensive, valid, and reliable tools to ensure evidence-based treatments and effective outcome monitoring. Existing diagnostic practices often lack standardization, leading to missed comorbidities and variable diagnostic accuracy. The Klenico system is an innovative, web-based diagnostic tool that integrates patient self-reports with clinical validations by mental health professionals. This system covers a broad spectrum of mental disorders, including depression.

This research aimed to evaluate the psychometric properties of the Klenico Depression Domain (KDD), the component of the Klenico system that measures depressive symptomatology, in a real-world clinical setting. Specifically, the evaluation focused on the assessment of its construct validity, internal consistency, and sensitivity to change in symptom severity.

Anonymized data from 496 inpatients with mental disorders collected between 2019 and 2022 were analyzed. Patients completed the KDD alongside parts of the Patient Health Questionnaire (PHQ), Beck Depression Inventory (BDI-II), and Satisfaction With Life Scale (SWLS) at both admission and discharge. Internal consistency was measured using Cronbach α. Exploratory factor analysis was conducted to examine the factor structure. Construct validity was assessed via Pearson correlations with PHQ-9 and BDI-II, while divergent validity was tested against the PHQ Somatic Symptoms Scale (PHQ-15), PHQ-Generalized Anxiety Disorder-7, and SWLS. Sensitivity to change was evaluated using paired 1-tailed t tests, effect sizes, and repeated measures correlations.

The KDD demonstrated excellent internal consistency (Cronbach α=0.91 at admission and 0.93 at discharge). Factor analysis revealed a 7-factor structure encompassing dimensions like "inadequacy," "anhedonia," and "self-hatred," aligning with core depressive symptoms outlined in the International Statistical Classification of Diseases, Tenth Revision. The correlations with the convergent questionnaires PHQ-9 (r=0.68; P<.001) and BDI-II (r=0.70; P<.001) were high. While the KDD showed a moderate correlation with the divergent PHQ-15 (r=0.35; P<.001), it was more strongly associated with the divergent SWLS (r=-0.51; P<.001) and Generalized Anxiety Disorder-7 (r=0.51; P<.001). Sensitivity to change was high, with significant reductions in KDD scores for patients with improved symptoms (t₂₇=5.36, P<.001; Cohen d=0.79) and high repeated measures correlation with both the BDI-II (r=0.61; P<.001) and the PHQ-9 (r=0.59; P<.001).

The KDD shows promise as a reliable and valid instrument for diagnosing depression and monitoring treatment outcomes in psychotherapeutic settings. Its alignment with International Statistical Classification of Diseases, Tenth Revision diagnostic criteria and sensitivity to symptom change underlines its potential utility. These findings highlight the Klenico system's potential to enhance clinical diagnostics by addressing current gaps in mental health care, thus improving diagnostic accuracy and consistency. Further research is recommended to validate its performance across different populations and settings.

Digital mental health interventions (DMHIs) have the potential to expand treatment access for anxiety but often have low user engagement. The present study analyzed differences in psychosocial outcomes for different behavioral engagement patterns in a free web-based cognitive bias modification for interpretation (CBM-I) program. CBM-I is designed to shift interpretation biases common in anxiety by providing practice thinking about emotionally ambiguous situations in less threatening ways. Using data from 697 anxious community adults undergoing five weekly sessions of CBM-I in a clinical trial, we extracted program use markers based on task completion rate and time spent on training and assessment tasks. After using an exploratory cluster analysis of these markers to create two engagement groups (whose patterns ended up reflecting generally more vs. less time spent across tasks), we used multilevel models to test for group differences in interpretation bias and anxiety outcomes. Unexpectedly, engagement group did not significantly predict differential change in positive interpretation bias or anxiety. Further, participants who generally spent less time on the program (including both training and assessment tasks) improved in negative interpretation bias (on one of two measures) significantly more during the training phase than those who spent more time (and post hoc tests found were significantly older and slightly less educated). However, participants who generally spent less time had a significant loss in training gains for negative bias (on both measures) by 2-month follow-up. Findings highlight the challenge of interpreting time spent as a marker of engagement and the need to consider cognitive and affective markers of engagement in addition to behavioral markers. Further understanding engagement patterns holds promise for improving DMHIs for anxiety.

To evaluate the effects of formulary-related rejections of initial adjunctive cariprazine (Vraylar) claims on health care resource utilization (HCRU) among patients with major depressive disorder (MDD).

Retrospective claims-based analysis.

Using data from Symphony Health Integrated Dataverse from March 2015 through October 2020, we identified adults with MDD who were being treated with antidepressants and had an initial cariprazine claim that was either rejected for a formulary-related reason (eg, noncoverage, prior authorization requirement, step therapy requirement) or approved; rejected patients were required to receive a subsequent atypical antipsychotic (which helps balance the health status across cohorts but may induce bias and affect generalizability). Rejected and approved cohorts were matched (1:2) using propensity scores. Outcomes included all-cause and mental health (MH)-related HCRU (hospitalizations, emergency department [ED] visits, outpatient visits) and treatment patterns. HCRU was compared between cohorts using rate ratios (RRs), with 95% CIs and P values. Treatment patterns were analyzed using descriptive statistics.

The rejected cohort comprised 566 patients, with 1132 matched patients in the approved cohort. All-cause and MH-related hospitalization rates were 61% and 89% higher, respectively, for the rejected vs approved cohort (all-cause: RR, 1.61; 95% CI, 1.15-2.32; P = .012; MH related: RR, 1.89; 95% CI, 1.18-2.89; P = .016). ED and outpatient visit rates were similar. Patients in the rejected cohort often never received cariprazine (68.4%), and those who did received it after a 6-month delay on average.

Patients with MDD who had an initial adjunctive cariprazine claim rejected for a formulary-related reason and subsequently received an atypical antipsychotic experienced significantly higher hospitalization rates than those with approved initial cariprazine claims, suggesting that formulary restrictions on adjunctive cariprazine may be associated with negative downstream effects.

Pathways to care are the steps individuals went through before finally consulting formal psychiatric services. In developing countries, people with mental disorders (PWMDs) often first consult traditional or religious healers, which may delay treatment. Although studies from different part of Ethiopia confirm this trend, factors influencing indirect pathways remain insufficiently explored.

This study aimed to identify pathways to psychiatric care and factors associated with indirect pathways among PWMDs who received psychiatric care from Debre Berhan Comprehensive Specialized Hospital, Ethiopia.

We enrolled 446 PWMDs and used the World Health Organization pathway to psychiatric care encounter form to elicit the pathways to psychiatric care. We conducted a multivariable binary logistic regression analysis to identify factors significantly associated with indirect pathways.

Most of the PWMDs in the study (72.9%) went through indirect pathways. From sociodemographic characteristics, being in the age group between 41-50 years (AOR = 8.27; 95% CI (2.94, 23.18)) and over 50 years (AOR = 6.46; 95% CI (2.00, 20.82)), being female (AOR = 2.51; 95% CI (1.34, 4.73)), being primary school attendees (AOR = 3.00; 95% CI (1.20, 7.40)), being farmer (AOR = 13.00; 95% CI (3.11, 54.31)), and living in the same house with 4-8 people (AOR = 2.77; 95% CI (1.11, 6.95)) were found to be significantly associated with indirect pathways. While from clinical characteristics, a diagnosis of bipolar disorder (AOR = 2.66; 95% CI (1.10, 6.50)) and anxiety (AOR = 3.94; 95% CI (1.37, 11.34)), perceived stigma (AOR = 5.86; 95% CI (3.00, 11.45)), and facing problems during the help-seeking process (AOR = 0.44; 95% CI (0.21, 0.90)) were found to be significantly associated with indirect pathways.

In this population, PWMDs primarily used indirect pathways as their first point of contact. Several demographic and clinical factors were significantly associated with utilizing indirect pathways. This study has implications for reducing delays by enhancing psychiatric service integration and establishing effective referral systems.