First responders (law enforcement officers, firefighters, and emergency medical personnel) are at high risk for traumatic brain injury (TBI) and other catastrophic injury (CI) requiring long-term caregiver support. The aim of this pilot survey was to investigate, via caregiver perception, the lived experiences and needs of: (1) US first responders who experienced TBI/CI, (2) the caregivers themselves, and (3) children living in the home.

Caregiver participants (n = 27) completed an online survey including closed and open-ended questions.

Results show first responders are living with adverse injury outcomes. Caregivers reported first responder suicidal ideation, suicide completion among their children, and a need for suicide risk support services. Four themes of most concern emerged. First responders are experiencing: (1) multiple challenges post injury (e.g., medical, benefits, vocational); (2) lack of support (e.g., state, departmental, peer, honor); (3) multiple adverse family impacts (e.g., relationship issues, family health); and (4) unmet/ongoing needs (e.g., education, alternative treatments, social support).

The results provide critical data on US first responders with TBI/CI, their caregivers, and children. Study results can assist in the development of evidence-based supports and interventions to meet the needs of this understudied and underserved population.

This editorial challenges the long-held neuron-centered view of brain metabolism, relying on ample evidence that it is a cooperative, multicellular process. Astrocytes, oligodendrocytes, and other glia play active roles providing lactate, antioxidant support, and substrate shuttles that fuel neuronal function and memory. Despite mounting data, some critics persist in refuting intercellular metabolic exchange, often guided more by entrenched creeds than concrete evidence, slowing constructive, hypothesis-driven discourse and delaying clinical and neuroprotective advances. The authors call for a rigorous research agenda: cell-type-specific manipulations, advanced biosensors, imaging and biomarkers, and integration with behavior and electrophysiology. They urge redirecting focus from outdated dogma to physiology-driven exploration of glia-neuron metabolic partnerships.

Insomnia disorder has a considerable effect on mental health, making its effective management crucial in clinical practice. An observational study was conducted on consecutive outpatients with insomnia disorder (DSM-5-TR criteria) attending the Insomnia Clinic of the Psychiatric Unit of the University Hospital of Pisa (Italy). Patients were treated according to insomnia guidelines with DORA Daridorexant. Evaluations were performed at baseline (T0), 1 month (T1) and 3 months (T2). Data collected included clinical assessments of insomnia severity (Insomnia Severity Index [ISI]), depressive and mixed symptoms (Beck Depression Inventory II [BDI-II], Young Mania Rating Scale [YMRS]) and emotional dysregulation (Difficulties in Emotion Regulation Scale [DERS], Frontal Assessment Battery [FAB]). Concurrent pharmacological treatments were collected. The study included 90 patients (mean age 53 ± 13.6 years, n° = 43 females). A significant proportion (63.3%) was comorbid with unipolar or bipolar depression and sedative-hypnotic use disorders. Repeated measures ANOVA analyses revealed a significant improvement for the ISI, DERS and FAB over time, with F-values of 24.23, 15.56 and 21.74 (p < 0.001). Additionally, BDI-II and YMRS scores showed significant decreases during the same period, with F-values of 10.24, 10.33 and 70.00 (p < 0.001). Multiple regression analyses indicated that improvements in depressive symptoms were best predicted by improvement in DERS and ISI, while mixed symptoms were predicted by ISI and FAB improvements. With the caution of a naturalistic design, this study may show that by treating insomnia comorbid to other mental disorders, it may be possible to improve not only insomnia symptoms but also emotion regulation and executive functions.

Work stress levels rose among health and educational workforces during the COVID-19 pandemic, and can affect employee well-being and organisational efficiency.

To explore the association of work stress with mental health, including suicidal ideation and physical health, as well as presenteeism, as aspects of organisational efficiency in UK healthcare and university workers.

A total of 328 UK participants completed self-report questionnaires between April 2022 and September 2023 in the context of the European Platform to Promote Wellbeing and Health in the Workplace (EMPOWER) study. Cross-sectional analyses were conducted.

Two hundred and ninety-two (90%) employees reported work-related stress (Mini-Psychosocial Stressors at Work Scale). Depressive, anxiety and somatic symptoms were reported (61, 55 and 75%, respectively); 11% of the participants reported suicidal ideation (Patient Health Questionnaire 9) and 56% reported presenteeism (iMTA Productivity Cost Questionnaire). Psychological and somatic symptoms were worse when suicidal ideation or presenteeism was reported. Stressful work factors included having too much work to do (63%), a bad working atmosphere (28%), poor work-home balance (32%) and working hours hindering private life (35%). Spearman correlations showed significant associations between work stress and suicidal ideation (0.225), depressive (0.290), anxiety (0.299) and somatic symptoms (0.245) and presenteeism (0.311), but not with having a chronic medical condition.

Given the association between work stress, suicidal ideation and presenteeism, research should explore how psychosocial risk factors linked to work stress could be reduced for healthcare and higher education employees. The findings warrant the development of policies to address work stress, and to provide employee support for suicidal ideation and presenteeism in the work setting.

There are few economic evaluations of adjunctive psychosocial therapies for bipolar disorder.

Estimate the cost-utility of in-person psychosocial therapies for adults with bipolar disorder added to treatment as usual (TAU), from an Australian Government perspective.

We developed an economic model, estimating costs in 2021 Australian dollars (A$) and outcomes using quality-adjusted life-years (QALYs) gained and disability-adjusted life-years (DALYs) averted. The model compared psychoeducation, brief psychoeducation, carer psychoeducation, cognitive-behavioural therapy (CBT) and family therapy when added to TAU (i.e. pharmacotherapy) over a year for adults (18-65 years) with bipolar disorder. The relative risk of relapse was sourced from two network meta-analyses and applied to the depressive phase in the base case. Probabilistic sensitivity analysis and one-way sensitivity analyses were conducted, assessing robustness of results.

Carer psychoeducation was preferred in the base case when the willingness-to-pay (WTP) threshold is below A$1000 per QALY gained and A$1500 per DALY averted. Brief psychoeducation was preferred when WTP is between A$1000 and A$300 000 per QALY gained and A$1500 and A$450 000 per DALY averted. Family therapy was only preferred at WTP thresholds above A$300 000 per QALY gained or A$450 000 per DALY averted. In sensitivity analyses, brief psychoeducation was the preferred therapy. Psychoeducation and CBT were dominated (more costly and less effective) in base-case and sensitivity analyses.

Carer and brief psychoeducation were found to be the most cost-effective psychosocial therapies, supporting use as adjunctive treatments for adults with bipolar disorder and their families in Australia.

Australian evidence on lived and care experiences of chronic musculoskeletal shoulder pain (CMSP), irrespective of disorder classification or disease, is limited. However, such evidence is important for person-centred care and informing local service pathways and care guidelines or standards. To address this gap, we explored i) lived experiences of adults with CMSP across domains of the International Classification of Function, Disability and Health (ICF) Framework, and ii) their care experiences, preferences and priorities for CMSP.

A qualitative study, applying a phenomenological approach and purposive sampling was conducted with adults experiencing CMSP. Individual semi-structured interviews, informed by ICF domains, explored lived and care experiences/preferences of participants. Data were analysed using an inductive approach, by objective.

Twenty adults (50% women) with diverse CMSP conditions/diagnoses, clinical profiles and age (21-76 years) participated. Five lived experience themes were identified: 1) impact on body functioning; 2) impact on sleep, energy and drive; 3) impact on mental well-being and evolving sense of self; 4) coping with CMSP; and 5) social support and participation. Four care experience themes included: 1) care seeking choices; 2) interactions with healthcare professionals (HCPs); and 3) values and preferences for components of CMSP care.

Adults with CMSP experience impacts across life stages in multiple domains of functioning (ICF categories) relating to personal and social dimensions. Clinical encounters, particularly interactions with HCPs, influence an individual's confidence and engagement in their care. Discussion, education and goal setting through shared decision-making are valued attributes of clinical encounters among people with CMSP.

This paper outlines a strategic approach to strengthen the expertise and skills of mental health nurses. It addresses the ongoing (r)evolutions in how generic nursing standards are being integrated into nursing curricula. Focusing on Flanders in Belgium, it explores the decline of specialised mental health nursing education and its implications for advanced practice nursing at the master's level. Central to this discussion is 'Letie', a newly established Belgian non-profit organisation founded in 2023. Letie aims to inspire and empower professional cohesion within mental health nursing by fostering collaboration, innovation, knowledge sharing, research and professional development. Reflecting on Letie's first year of operation, the paper draws on the author's experiences and vision to propose pathways for advancing the profession, while promoting resilience and adaptability in the face of educational and professional challenges. It seeks to engage mental health nursing professionals working in clinical practice, education and research in a meaningful dialogue about future directions for the discipline.

Orofacial pain (OFP) harms mental health and functionality. The Manchester Orofacial Pain Disability Scale (MOPDS) is a questionnaire for assessing OFP.

The purpose of this study was to examine the validity of the Chinese version of MOPDS in clinical populations, measurement invariance across different clinical statuses and sex cohorts.

This study recruited 387 OFP clinical patients. Confirmatory factor analysis (CFA) assessed the internal consistency and factor structure of the MOPDS. Pearson's correlation coefficient assessed external convergent validity. Composite reliability (CR), the average variance extracted (AVE) and the heterotrait-monotrait ratio (HTMT) were used to assess internal convergent and discriminate validity. Multigroup CFA explored the measurement invariance. T-test compared scores between sex groups across various clinical statuses.

MOPDS in the clinical sample (Cronbach's α = 0.975, McDonald's omega = 0.975) had an acceptable internal consistency. CFA supported the two-factor structure in clinical settings with physical and psychosocial dimensions, which was applicable among different sexes and clinical groups. CR, AVE, HTMT, and correlation coefficient results with other scales proved the convergent and discriminant validity of MOPDS. Multigroup CFA supported scalar measurement invariance across different clinical statuses and sex groups. The females did not have significantly higher average scores (p > 0.05), and clinical samples had significantly higher average scores (p < 0.01).

The Chinese version of MOPDS is a reliable and effective instrument in clinical settings for assessing the physical and psychosocial disabilities caused by OFP by helping to develop personalised treatment plans.

We aimed to assess the cost-effectiveness of non-pharmacological interventions for fatigue in patients with chronic conditions in the UK.

This systematic review of cost-effectiveness studies aligns with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 statement. Data sources: Electronic databases and citation searches. Inclusion criteria: Studies including adults with one or more long-term health condition, either physical or mental. Exclusion criteria: Studies associated with cancer, long-COVID, post-viral fatigue, medically unexplained conditions, developmental disorders and injuries. Assessment: A single reviewer completed a two-stage sifting process.

Four studies met the inclusion criteria. They included patients with either multiple sclerosis or inflammatory rheumatic conditions, and assessed either cognitive behavioral therapy (CBT) or a personalized exercise programme (PEP). CBT was either dominated by usual care or had an incremental cost-effectiveness ratio (ICER) over £30,000. PEP dominated CBT, with the ICER for PEP versus usual care ranging from £13,159 to £35,424.

The economic literature on this topic is much more limited than the clinical effectiveness literature, both in terms of interventions and populations covered. Future research should focus on a de novo economic evaluation to identify interventions with a high potential to be cost-effective across multiple conditions.

PROSPERO (CRD42023440141).