BackgroundAdolescent suicide is a leading cause of death globally and remains a major public health concern in the United States. Chronic stress perspectives suggest that suicidal behaviors emerge from cumulative and interacting stress exposures that become biologically and psychologically embedded across development. This study applies an integrated chronic stress framework to examine how adverse childhood experiences (ACEs), victimization, and protective relational resources jointly shape suicide-related behaviors among U.S. high school students.MethodsWe conducted a cross-sectional analysis of the 2023 combined National Youth Risk Behavior Surveillance System dataset (N = 254,675). National-level proportional outcomes included serious suicidal ideation, suicide planning, suicide attempts, and medically treated suicide attempts. Standardized composite indices were constructed for ACEs, victimization, and protective resources (school connectedness and parental monitoring). Fractional logistic regression models estimated average marginal effects (AMEs), adjusting for persistent sadness/hopelessness, poor mental health, sleep duration, unstable housing, and demographic characteristics. Interaction terms tested cumulative and conditional stress processes.ResultsHigher ACE and victimization indices were independently associated with greater prevalence of all suicide-related outcomes. A one-unit increase in the ACE index was associated with increased ideation (AME = 0.0534, 95%CI [0.0411, 0.0656]) and attempts (AME = 0.0240, 95%CI [0.0148, 0.0332]). Victimization demonstrated comparable or stronger associations, particularly for planning (AME = 0.0723, 95% CI [0.0605, 0.0841]) and attempts (AME = 0.0571, 95%CI [0.0472, 0.0670]). Protective resources were inversely associated with planning (AME = −0.0130, 95%CI [−0.0192, −0.0067]) and attempts (AME = −0.0110, 95%CI [−0.0159, −0.0060]). Interaction analyses revealed diminishing marginal effects at higher combined levels of ACEs and victimization (eg, ACE × victimization for ideation AME = −0.0395, 95% CI [−0.0567, −0.0223]), indicating nonlinear accumulation of stress burden. A significant three-way interaction for ideation (AME = 0.0193, 95%CI [0.0045, 0.0342]) suggested conditional buffering by protective resources. Persistent sadness/hopelessness remained the strongest correlate across outcomes.ConclusionsAdolescent suicidality reflects cumulative and interacting stress processes rather than isolated risk factors. Early adversity establishes foundational stress load, ongoing victimization compounds risk, and protective relational assets provide partial—but not complete—buffering. These findings support multilevel prevention strategies that reduce chronic stress exposure while strengthening relational protection across developmental contexts.

This commentary highlights the significance of Patricio et al.'s (2025) findings on the mediating role of self-efficacy in the relationship between shyness and help-seeking among Filipino college students. The study challenges assumptions that shyness directly hinders help-seeking and emphasizes the cultural influence of hiya. Notably, self-efficacy mediates help-seeking for suicidal ideation, underscoring its importance in high-risk situations and its relevance for suicide-prevention initiatives in higher education. We further discuss the roles of stigma, social support, and cultural expectations, as well as the need for gender-sensitive research. The commentary advocates culturally grounded interventions to strengthen student mental-health help-seeking.

Objectives Current patient-facing health information may unintentionally reinforce unhelpful and less adaptive mindsets regarding musculoskeletal symptoms. This prospective randomized trial evaluated the impact of psychologically-informed educational material, explicitly designed to promote healthier interpretations of bodily sensations according to cognitive science principles, on patient experience when compared to standard professional society materials. Methods In this trial, 133 adults presenting to an upper extremity specialist with one of eight common non-traumatic musculoskeletal conditions were randomly assigned to review health information produced by either: 1) a professional musculoskeletal society or 2) revised material created by the authors and psychologist collaborators. Participants completed surveys containing validated measures assessing personal health agency (PAM-13), perceived clinician empathy (JSPPPE) and emotional response to the material. Results There were no significant differences based on the type of material reviewed. However, on multivariable analysis, participants diagnosed with rotator cuff tendinopathy, ganglion cyst, or carpal and cubital tunnel syndrome reported more negative emotional responses compared to those with lateral epicondylitis, regardless of the type of written material reviewed. Conclusions Cognitively-informed musculoskeletal health information was acceptable to patients but did not yield measurable improvements in emotional response, agency, or perceived empathy when compared to standard material. During the visit, diagnosis-specific factors may influence patient reactions more than information framing. Practice Implications Patients find clear, accessible material designed to cultivate the healthiest possible interpretation of bodily sensations acceptable and non-distressing. Future interventions should explore diagnosis-specific tailoring of information or repeated exposure to impact outcomes. Level of Evidence II.

Chronic stress disrupts the integrity of the gut environment, including leaking of the intestinal epithelium. Reelin, an extracellular matrix protein, is released from cells of the lamina propria and promotes epithelial cell proliferation and migration up the crypt-villus axis to facilitate renewal of the gut lining. In the present study, we evaluated Reelin expression and apoptosis in the small intestine of Long Evan's rats treated with recombinant Reelin (3 µg) or vehicle following 3 weeks of daily corticosterone (40 mg/kg/day) or vehicle injections. We show that Reelin- and cleaved caspase-3- immunoreactive cells are diminished in the lamina propria or epithelial cells of the gut lining following chronic stress (∼ 50% and 55%, respectively), and that a single injection of 3 µg of Reelin delivered intravenously can reverse these parameters. We also found Reelin cell counts in the small intestine did not correlate to counts in the hippocampus regardless of exposure to chronic stress or Reelin treatment. Our results suggest that Reelin may serve a protective function over gut barrier integrity through the restoration of epithelial cell turnover, and that Reelin may have a role in reversing chronic stress-induced changes to the gut environment.

Background Numerous man-made and naturally occurring incidents cause human suffering, both psychologically and mentally. Such circumstances endanger people's emotional, physical, and social well-being if left untreated or if appropriate intervention is delayed. This trial examines the effectiveness of an Eye Movement Desensitization and Reprocessing (EMDR) intervention on improving the subjective well-being of patients with post-traumatic stress disorder (PTSD) in Jordan. Methods The current trial employed the quasi-experimental, interrupted time series design. This includes measuring the subjective well-being (SWB) three times: once before intervention (pre-test) and twice after the intervention (post-tests), including immediately and one-month follow-ups for both the intervention and control group. 70 patients (35 patients for each group) were recruited from a specialized psychiatric trauma healing center in Jordan. The primary outcome variable was measured using the World Health Organization- Five Well-Being Index (WHO-5). Results The statistical analysis of repeated measures using ANCOVA revealed significant differences across all time points within subjects [F (1, 56) = 5.18, p = .027]. The covariate effect was not controlled and showed statistically significant differences in the SWB across all time points in both interventional and control groups (between subjects) (F1,56 = 12.41,p = .001). There were no statistical differences in the total mean score of SWB correlated with sociodemographics and health-related factors. Conclusion The results suggest that EMDR may be an effective, pragmatic, and acceptable intervention for increasing SWB in patients with PTSD in Jordan. Findings support the continued investment in and adoption of EMDR among participants affected by trauma in the Arab World.

Background Understanding distinct neurobiological mechanisms underlying bipolar disorder (BD) and major depressive disorder (MDD) is crucial for accurate diagnosis and the discovery of novel and more effective targeted treatments. Previous diffusion-weighted MRI studies have suggested some common frontotemporal corticolimbic system white matter (WM) abnormalities across the disorders. However, critical to the development of more precise diagnosis and treatment is identifying distinguishing abnormalities. Promising candidates include more prominent frontotemporal WM abnormalities observed in BD in the uncinate fasciculus (UF) that have been associated with frontal-amygdala functional dysconnectivity, and with suicide that is especially high in BD. Prior work also showed differentiation in metabotropic glutamate receptor 5 (mGlu5) abnormalities in BD versus MDD, which could be a mechanism affected in the frontotemporal system. However, associations between WM and mGlu5 have not been examined previously as a differentiator of BD. Using a multimodal neuroimaging approach, we examined WM integrity alterations in the disorders and their associations with mGluR5 levels. Methods Individuals with BD (N = 21), MDD (N = 10), and HC (N = 25) participated in structural and diffusion-weighted MRI scanning, and imaging with [18F]FPEB PET for quantification of mGlu5 availability. Whole-brain analyses were used to assess corticolimbic WM matter fractional anisotropy (FA) across BD and MDD relative to HC; abnormalities were tested for associations with mGlu5 availability. Results FA corticolimbic reductions were observed in both disorders and altered UF WM integrity was observed only in BD. In BD, lower UF FA was associated with lower amygdala mGlu5 availability (p < .05). Conclusions These novel preliminary findings suggest important associations between lower UF FA and lower amygdala mGlu5 levels that could represent a disorder-specific neural mechanism in which mGluR5 is associated with the frontotemporal dysconnectivity of the disorder.

Purpose: Currently, 1 in 5 college students struggle with suicidal ideation while 7% to 44% engage in nonsuicidal self-injury. Illinois has one of the highest teenage and college student suicide rates in the United States. This pilot study assessed suicide ideation and self-harm behaviors at a public Illinois university. This is the first study to use 5 standardized psychological instruments to investigate these 2 crises in freshmen college students who are all required to reside in dormitories. The main hypothesis was to determine if the independent effects of freshmen students’ depression, Five-Factor Model, and Reasons for Living affected the dependent variables, self-harm behaviors and suicide ideation. Methods: Forty first-year college dormitory students completed the Beck Depression Inventory-II, Scale of Suicidal Ideation, Five-Factor Model, Inventory of Statements About Self-Injury, and Reasons for Living Scale in person. Results: Participants were 18 to 19 years old, predominantly female (65%), and non-White (62%). Forty percent reported self-harm behaviors and 19% reported suicidal ideation. The top reasons for contemplated suicide attempts included the inability to solve problems (33%) and attention/revenge (28%). Students experienced high levels of anxiety (55%), self-consciousness (43%), and depression (18%). Depression was associated with suicide ideation (β = 0.05, P = .006), while neuroticism and openness were associated with self-harm behaviors (aOR = 3.36, P = .02, aOR = 0.48, P = .047, respectively). Ninety-five percent reported “responsibility to family” as a Reason for Living. Conclusions: Preliminary evidence necessitates an examination of self-harm and suicide ideation among all freshmen, investigating both risk and protective factors. In the future, a prevention intervention should be implemented campus-wide (and eventually nationwide) for all first-year dormitory students to enhance their mental well-being.

Oppression refers to systemic discrimination where the injustice targets or disproportionately impacts specific groups of people. The Trauma Symptoms of Discrimination Scale (TSDS) is a self-report measure designed to assess the traumatizing impact of discrimination broadly by measuring anxiety-related symptoms of trauma due to discriminatory experiences. This may include symptoms arising from racism, homophobia, sexism, poverty, or other forms of marginalization. Almost all studies of the TSDS have examined its use in marginalized ethnoracial groups, primarily African Americans. This paper will extend prior work to help us better understand racial trauma across groups by reporting and comparing TSDS mean scores across ethnoracial identities in a diverse national sample (n = 923). It also explores trauma with other marginalized identities and demographic dimensions, including gender, sexual minority/LGBQ status, education, and income. The relationship of TSDS scores to clinical psychopathologies are examined, including stress, depression, anxiety, and PTSD. We also examine the unique risks associated with intersectionality, and how having multiple marginalized identities may increase traumatization. Clinical implications and future directions are discussed.

Posttraumatic stress disorder (PTSD) is a prevalent psychiatric disorder that can result from experiencing traumatic events. Accurate diagnosis and optimal treatment strategies can be difficult to achieve, due to the heterogeneous etiology and symptomology of PTSD, and overlap with other psychiatric disorders. Advancing our understanding of PTSD pathophysiology is therefore critical. While functional connectivity alterations have shown promise for elucidating the neurobiological mechanisms of PTSD, previous findings have been inconsistent. Eleven patients with PTSD in our first cohort (PTSD-A) and 11 trauma-exposed controls (TEC) underwent functional magnetic resonance imaging. First, we investigated the intrinsic connectivity within known resting state networks (eg, default mode, salience, and central executive networks) previously implicated in functional abnormalities with PTSD symptoms. Second, the overall topology of network structure was compared between PTSD-A and TEC using graph theory. Finally, we used a novel combination of graph theory analysis and scaled subprofile modeling (SSM) to identify a disease-related, covarying pattern of brain network organization. No significant group differences were found in intrinsic connectivity of known resting state networks and graph theory metrics (clustering coefficients, characteristic path length, smallworldness, global and local efficiencies, and degree centrality). The graph theory/SSM analysis revealed a topographical pattern of altered degree centrality differentiating PTSD-A from TEC. This PTSD-related network pattern expression was additionally investigated in a separate cohort of 33 subjects who were scanned with a different MRI scanner (22 patients with PTSD or PTSD-B, and 11 healthy trauma-naïve controls or TNC). Across all participant groups, pattern expression scores were significantly lower in the TEC group, while PTSD-A, PTSD-B, and TNC subject profiles did not differ from each other. Expression level of the pattern was correlated with symptom severity in the PTSD-B group. This method offers potential in developing objective biomarkers associated with PTSD. Possible interpretations and clinical implications will be discussed.

Background Headache is a common symptom affecting children and adolescents. The medical literature over the last three decades reveals a variable prevalence and triggers in different countries, regions, circumstances and times. This study aims to assess the prevalence, frequency and quality of headaches in the Lebanese adolescent population under the COVID-19 confinement and study its triggers and relationship to screen time, self-reported anxiety, and sleep. Methods A cross sectional design was used to collect two survey results by snowball distribution using social media targeting adolescents aged 15 to 17 years of age. The first survey included 13 questions with a single best answer about screen time, feeling anxious, sleep time, schedule and consistency, and headaches. The second survey included 3 questions about the quality of the headaches, anxiety and its triggers. Results Among 433 responders to the first survey, the prevalence of headaches, especially pressure points and band-like pressure was higher than any previously reported among adolescents in the literature, reaching 93.4%. Screen time was also higher than any previous reports with 95.6% spending 9 hours or more on screen while 64% of adolescents spending at least 12 hours a day on screen. In addition, the majority (82%) don't have consistent sleep habits and 41.8% consider themselves anxious. School was considered the main source of stress by 82.8% of the responders. The frequency of headache correlated significantly with increased screen time, self-reported anxiety and inconsistent sleep habits. Conclusions Headaches among adolescents are associated with increased screen use, sleep disorders, and self-reported anxiety. It is one of the primary somatization symptoms in this group expressing their extreme stress under the current economic, political, and health crisis. The present trends are likely to have major long term implications on adolescents’ health and academic achievements and should alarm educators and health officials to intervene in this situation.