Latest research.
A closer look at everyday life.

Authors: Pono Pono, Alan M. Jones

Climate change and air pollution affect every major organ system, altering both the disease burden and patient responses to pharmaceutical treatments. However, current knowledge on how health systems, patients, healthcare professionals, and governments should prepare for these challenges remains fragmented. This review synthesises evidence on the potential impact of climate change on human health and pharmaceuticals, with the aim of identifying the diseases, populations, and medications most vulnerable, and assessing potential implications for pharmacotherapy. Emerging evidence shows that climate-related stressors, particularly extreme heat, contribute to increased morbidity and mortality and exacerbation of diseases affecting cardiovascular, cerebrovascular, gastrointestinal, renal, and respiratory systems. Furthermore, the review found that high temperature and humidity can affect drug stability, bioavailability, and pharmacokinetics by degrading active pharmaceutical ingredients and altering pharmaceutical formulations, potentially reducing efficacy and increasing the risk of adverse drug events. Older adults, patients with chronic diseases, and those taking medications that impair the thermoregulatory system are particularly at higher risk. In addition, extreme weather events may also disrupt pharmaceutical supply chains, further threatening access to essential medicines. This review finds that climate change has implications for healthcare through increasing disease burden and affecting the effectiveness and safety of medicines. Therefore, there is an urgent need for integrated research to explore the interplay between climate change, therapeutic response, and drug safety to support resilient, climate‑ready healthcare systems.

Source: PLOS Climate. DOI: 10.1371/journal.pclm.0001068. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Kobe Vandelanotte, Bram Du Moulin, Siebe Puynen, Thomas Vergauwen, Sara Top, Steven Caluwaerts

Heat stress is an increasing concern as climate change drives more frequent and intense extreme heat episodes. In particular, participants in outdoor endurance events face a high risk of heat stress related health issues due to prolonged exposure to heat and physical exertion. The Wet Bulb Globe Temperature (WBGT) is a widely used ISO-standard heat stress index that integrates air temperature, humidity, wind speed, and radiation (both shortwave and longwave) to assess heat stress. Meteorological heat stress metrics such as WBGT can be used to activate heat management plans and to guide or evaluate heat mitigation strategies. To this end, we present a modelling system that combines a numerical weather prediction (NWP) model with a micro-scale radiation model to simulate meter-scale heat stress. We conducted a mobile measurement campaign to collect spatio-temporal WBGT data along the 2024 Dodentocht, a 100-km ultra-endurance hiking event in Belgium. These observations were used to evaluate the modelling system, which demonstrated a reasonable approximation of the observed WBGT along the route and was able to capture some local shade-induced cooling effects. Finally, we used the modelling system as an adaptation tool to simulate various event-management scenarios, including alternative start times, routes, and walking speeds. For the 2024 Dodentocht, starting 3 hours earlier, at 18:00 local time (UTC + 2), would have reduced the cumulative heat-stress exposure, measured as degree hours above 20∘C WBGT, by 35%. The 2023 route exhibited 16.5% more cumulative degree hours above 20∘C WBGT than the 2024 route for the official 21:00 start time under identical meteorological conditions. Our findings demonstrate the potential of high-resolution heat stress modelling systems as reliable and actionable tools to support the development and implementation of effective heat management strategies for outdoor endurance events.

Source: PLOS Climate. DOI: 10.1371/journal.pclm.0001058. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Ngozi Murphy-Okpala, Charles Nwafor, Chinwe Eze, Martin Njoku, Okechukwu Ezeakile, Anthony Meka, Ngozi Ekeke, Francis Iyama, Daniel Egbule, Chukwuma Anyaike, Obioma Chijioke-Akaniro, Joseph Chukwu, Beatrice Kirubi, Jacob Creswell, Justus Uchenna Onu

This study determined the effectiveness of integrated TB and depression care compared to standard TB care in reducing depressive symptoms over time in persons treated for TB. This was a quasi-experimental, non-randomized controlled trial involving all TB cases with significant depressive symptoms (PHQ score ≥ 5) in ten already existing sites (i.e., eight intervention sites and two control sites) in Nigeria. At the intervention sites, non-specialist health workers (NSHWs) delivered treatment for both TB and depression while the NSHWs in the control sites delivered TB treatment and then referred patients with depression to a specialist in a different setting for treatment. Changes in depression symptom scores were measured at baseline, 2nd, 8th and 24th weeks using Patient Health Questionnaire (PHQ-9). Mixed-ANOVA design was used to determine changes in PHQ-9 scores between-subjects and within-subjects across intervals of follow-up using both the per protocol and intent-to-treat analyses while controlling for covariates such as age, social support, sex, education. There were no significant differences in the PHQ-scores between the two groups (F = 0.95, p = 0.32). In addition, across the intervals of follow-up, PHQ-scores (i.e., depressive symptom scores) decreased significantly with time in both the intervention and control arms (p < 0.001). Furthermore, the interaction between the study arms and time was not significant (F = 0.66, p = 0.57), indicating that the groups were changing over time in a similar way. Participants with marked decrease in depressive symptoms completed their TB treatment and achieved cure when compared to the higher scores seen in those who dropped out or died or were transferred (F = 25.78, p < 0.001). The findings indicated that TB and depression treatment delivered by NSHWs significantly reduced depressive symptoms across intervals of follow-up. In addition, relief from depressive symptoms was significantly associated with completing TB treatment and achieving cure. Clinical Trial Number: PACTR202501828312848.

Source: PLOS Mental Health. DOI: 10.1371/journal.pmen.0000636. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Gallen Mlenge, Odass Bilame, Lutengano Mwinuka

Formal healthcare utilisation remains persistently low across sub-Saharan Africa, yet utilisation patterns among individuals with mental health needs are poorly understood in low- and middle-income country contexts. Using data from the fifth wave of the Tanzania National Panel Survey (2020/21), this study examined patterns and determinants of formal healthcare utilisation among individuals aged 15 years and above with and without proxy-identified mental health need. A nationally representative cross-sectional sample of 11,891 individuals with non-missing outcome data was analysed. Proxy-identified mental health need was determined using the Washington Group Short Set item on difficulty remembering or concentrating at the severe threshold, a proxy associated with common mental disorders. The outcome was any formal provider visit in the four weeks prior to the interview, regardless of reason. Survey-weighted logistic regression estimated odds ratios and predicted probabilities within the Andersen Behavioural Model. Missing outcome data affected 505 individuals in a Missing Not At Random pattern; extreme bounds sensitivity analysis assessed implications for subgroup estimates. Overall weighted formal healthcare utilisation was 19.2%. Proxy-identified mental health need was observed in 54 individuals (weighted prevalence 0.45%). Female sex, older age (55 and above), and Southern Highlands zone residence were independently associated with higher utilisation. Household wealth showed a strong dose-response gradient: individuals in the richest quintile had 2.71 times higher adjusted odds than those in the poorest. Proxy-identified mental health need was not significantly associated with utilisation (adjusted odds ratio 1.27; 95% confidence interval: 0.53–3.04; p = 0.588). Extreme bounds analysis indicated that true utilisation could range from 2.0% to 92.7%, confirming subgroup findings are exploratory. Formal healthcare utilisation in Tanzania is strongly patterned by household wealth, sex, age, and geographic zone. Addressing wealth-related barriers and strengthening service availability in lower-utilisation zones should be the priorities for advancing equitable healthcare utilisation in Tanzania.

Source: PLOS Mental Health. DOI: 10.1371/journal.pmen.0000644. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Hongyu Xu, Zhiqiang Yan, Xinyi Kong, Shuang Wu, Fei Shi, Qiong Ye, Zijin Li, Jia Lu, Juan Fang, Kexin Chen, Jiajun Bao, Yiyao Huang

Globally, university students face substantial psychological pressures, and stress-related mental health disorders are recognized as major public health concerns. While biomarkers such as cortisol have been extensively studied, integrated analyses of neuroendocrine-immune-circadian interactions remain limited. In this cross-sectional study with two complementary components, psychometric assessments of 637 undergraduates revealed that 90.4% experienced moderate-to-high perceived stress. These stress levels correlated with fatigue (r = 0.41, p < 0.01) and poor sleep quality (r = 0.35, p < 0.01). A second component involved laboratory-based diurnal biomarker profiling of 33 high-stress and low-stress participants, revealing stress-dependent physiological patterns. Specifically, high stress was associated with sympathetic activation (α-amylase↑), HPA axis dysregulation (altered diurnal cortisol patterns), circadian disruption (melatonin↑), and mucosal immune activation (IgA ↑ , lysozyme↑). The coupling of α-amylase and lysozyme suggested neuro-immune coordination (r = 0.52, p < 0.001). These findings indicate that salivary biomarker profiles are associated with perceived stress. Sleep quality and fatigue warrant further investigation as potential intervention targets in future longitudinal studies.

Source: PLOS Mental Health. DOI: 10.1371/journal.pmen.0000717. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Kamrun Nahar Koly, Jobaida Saba, Fahmida Sarker, Elma Rudhsarah, Md Arif Billah, Rasma Muzaffar, Nafisa Mosaddek, Abu Syed Md. Mosaddek, Daniel D. Reidpath

Online mental health services (MH) are playing a pivotal role by increasing MH literacy, enabling accessibility, and reducing logistical barriers, especially for women from developing nations like Bangladesh. However, the psychological burden and service needs of women using online MH platforms remain understudied despite their heightened vulnerability. Therefore, this study investigated the prevalence and determinants of anxiety and depression among women who received counseling from the online MH service platform,Women Support Initiative Forum (WSIF)through a cross-sectional study conducted between 5th September 2023 and 26th August, 2024. Data were collected by WSIF psychologists using a structured client information form covering socio-demographics, history of MH condition, health conditions, and presenting MH symptoms. Anxiety and depression levels were assessed using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). Multivariate logistic regression was used to identify associated factors. Out of 375 women, 59.2% and 58.1% had experienced mild to severe anxiety and depression, respectively, with 25.6% having both conditions. Women with graduate-level education had 66% lower, and those with one or more siblings had 50–54% lower likelihoods of anxiety compared with women without graduate-level education and siblings. In contrast, women with graduate-level or postgraduate-level education and reporting hormonal conditions had 3.41 times, 2.63 times and over 10 times higher likelihoods of depression, respectively, compared with women who were not graduates and without a hormonal condition. Conversely, women with a history of MH and reported migraine, headache and allergic conditions had 52% and 65% lower odds compared with women without these conditions. Distress, negative thinking, and feelings of worry were highly prevalent among women with anxiety and among those with depression. Our findings highlight a significant MH burden among women who accessed online psychological counseling, indicating the importance of targeted actions in designing MH interventions by relevant stakeholders and policymakers.

Source: PLOS Mental Health. DOI: 10.1371/journal.pmen.0000715. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Shauna Clayton, Safoura Zangiabadi, Hossam Ali-Hassan

This study examines the association between healthcare delivery modality and Canadian nurses’ intentions to leave their job within two years due to stress, burnout, or mental health concerns during the COVID-19 pandemic. A secondary analysis was conducted on data from the cross-sectional Survey on Health Care Workers' Experiences During the Pandemic (SHCWEP), conducted by Statistics Canada between September and November 2021. The sample consisted of 3107 nurses, weighted to represent 353,980 Canadian nurses aged 18 and above. A multivariable logistic regression analysis was conducted to investigate the association between the mode of healthcare delivery (online, in-person, or blended) and the intention to exit the workforce due to mental health concerns, after adjusting for job, health-related, and sociodemographic factors. A desire to quit was reported by 33.5% of nurses, with 20.5% reporting mental health concerns as their reasoning. Online or blended modalities of care delivery yielded a decreased likelihood of reporting an intention to resign in comparison to in-person care delivery (OR =0.49, 95% CI: 0.45- 0.52; OR =0.81, 95% CI: 0.78- 0.84, respectively). Nurses are a critical asset to the medical field, and their retention impacts patient care directly and public health eventually. This study provides insight into nurses’ needs and can be informative for future implementation strategies that enhance existing training and education protocols and support nurses’ mental well-being.

Source: PLOS Mental Health. DOI: 10.1371/journal.pmen.0000692. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Paula Skye Tallman, Shalean M. Collins

Resource insecurity is a major concern for Indigenous populations worldwide who are often reliant upon local ecosystems for food, water, and livelihoods. This study examined the association between water insecurity, food insecurity, and dietary diversity among the Awajún, an Indigenous population in the Peruvian Amazon. Cross-sectional data from 212 Awajún adults were analyzed using linear and logistic regression models with robust standard errors. Both food and water insecurity were prevalent among the Awajún. In adjusted linear regression models, higher composite water insecurity scores were significantly associated with higher food insecurity scores (β = 0.24; 95% CI: 0.11, 0.36; p < 0.001), but not with dietary diversity. Importantly, indicators within the composite water insecurity score, were more strongly associated with food insecurity and dietary diversity outcomes, than the composite water insecurity score itself. This includes significant associations between food insecurity scores and being “unable to collect water due to distance” (β 0.61; 95% CI 0.19, 1.03 p = 0.005), being “unable to collect water due to illness or weakness” (β = 0.68; 95% CI: 0.20, 1.16; p = 0.006), and “not boiling water” (β = 0.60; 95% CI: 0.15, 1.05; p = 0.009). Going for “extended periods of time without drinking water” was associated with lower dietary diversity scores (β = -0.79; 95% CI: -1.43, -0.16; p = 0.01). The findings that constituent lived experiences of water insecurity—including barriers to water collection, water treatment practices, and extended periods of water deprivation—were more strongly associated with food insecurity and dietary diversity than composite water insecurity scores, suggests that attention to specific dimensions of water insecurity may improve efforts to identify, monitor, and address resource insecurity in vulnerable populations.These findings have implications for health surveillance efforts and interventions aiming to promote SDG 6 (Clean Water and Sanitation) and SDG 2 (Zero Hunger) among vulnerable populations.

Source: PLOS Water. DOI: 10.1371/journal.pwat.0000556. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Varsha Singh, Harish Chaudhury, Mahim Sagar

Adolescence is a turbulent period of rapid biopsychosocial changes that help transition to adulthood. Adolescence maladjustment shows sex-specific vulnerability such that internalizing pathologies are linked with depression-anxiety in females, whereas externalizing problems linked are with substance abuse and conduct disorders in males. Developing countries with patriarchal societies produce early gender-inequity that might impact physical health, family, and social environments of adolescents impacting adulthood. The link between sex-differences in physical health, social support (school & family) and adolescent problems in non-western context is unclear. Hence, adolescents from 19 schools (N = 5121, male = 48%, female = 39%, missing = 13%) filled Indian Adolescent Health Questionnaire to measure physical health, family, and social environment, Strengths and Difficulties Questionnaire was used for adjustment problems (internalizing-externalizing). Males reported better physical health and nutrition whereas females had better attitude towards safety, substance use, and academics. Physical health, family, school and social environment were correlated (p = .00), t-test showed sex-differences in all subdomains except hygiene and family environment. For adjustment problems, 22.8% of school students experienced borderline problems and 16% were categorized highly problematic, male students had higher maladjustment problems. Contrary to the West, internalizing problems showed no sex-differences, but male students’ internalizing problems were due to peers. Partial correlation controlling sex and class showed that family support negatively correlated with emotion problems (r = - .05, p < .05), hygiene attitude positively correlated with hyperactivity problems (r = .033, p < .05). School intervention involving families might shield adolescents from mental health problems, targeting sex-specific risks such as nutrition and physical activity for females or drugs and safety for males might improve health. Using standard health measures might allow follow-ups for comparing health gender-gap across the developmental phases of individuals accounting for urban-rural divide accentuated in developing countries and diverse population.

Source: PLOS Mental Health. DOI: 10.1371/journal.pmen.0000708. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Michael Christopher, Xander Kahle, Kaylia Pham

Individuals with physical disabilities experience higher rates of depression relative to the general population. Shame is a central mechanism linking disability status to poor mental health outcomes, including depression. Psychological flexibility and self-compassion have been shown to change one’s relationship to negative self-evaluations such as shame. The goal of this study was to determine if psychological flexibility and self-compassion negatively predict depression and buffer the impact of shame on depression in adults with physical disabilities. Adults with physical disabilities (n = 207) completed self-report measures of psychological flexibility, self-compassion, shame, and depression. Consistent with prediction, a series of multiple regressions indicated that psychological flexibility and self-compassion negatively predicted depression over and beyond shame, and they both mitigated the impact of shame on depression among adults with physical disabilities (all p’s < .05). These results suggest that psychological flexibility and self-compassion enhancing treatments, such as mindfulness-based interventions and acceptance and commitment therapy may be helpful in improving the mental health and wellbeing of adults with physical disabilities.

Source: PLOS Mental Health. DOI: 10.1371/journal.pmen.0000707. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.