The COVID-19 pandemic disrupted medical education and mental health. This multicenter study examined factors associated with insomnia among medical students from 13 Latin American countries during the first pandemic wave. A cross-sectional analytical study was conducted using an online questionnaire. Insomnia was measured with the Insomnia Severity Index. Exposures included physical activity, eating disorder symptoms, burnout, resilience, smoking and alcohol risk, and sociodemographic, educational, and clinical variables. Prevalence ratios with 95% confidence intervals were estimated through regression. Among 2,019 students, the prevalence of insomnia symptoms according to the ISI cutoff was 46.9% (95% CI: 44.7–49.1). Higher prevalence was observed among students who reported being a son or daughter within their family, those with relatives diagnosed or deceased from COVID-19, prior mental health problems, eating disorder symptoms, or smoking risk. Lower prevalence was found among seventh-year students, those with children, those perceiving the pandemic as serious, and students reporting high physical activity or resilience. Almost half of medical students screened positive for insomnia symptoms during the early pandemic. Family COVID-19 impact, prior mental health problems, eating disorder symptoms, and smoking risk were associated factors, while advanced training level, parenthood, physical activity, and resilience were associated with a lower prevalence of insomnia symptoms. These findings provide evidence for sleep health in Latin American medical students and may guide post-pandemic comparisons and interventions.
Background Prolonged deployments, hybrid warfare, and expanding disaster-response missions expose service members to cumulative occupational stress that erodes readiness, retention, and long-term health. Between universal resilience training and formal clinical care lies a persistent gap: practical actions that peers and leaders can take when a coworker is strongly affected by stress. Stress First Aid (SFA) is a flexible, peer- and leader-delivered framework derived from the U.S. Navy and Marine Corps Combat and Operational Stress First Aid program and organized around five empirically supported protective elements in the recovery from ongoing adversity—safety, calming, connectedness, self-efficacy, and hope—translated into seven core actions. Methods This commentary summarizes the conceptual foundations of SFA and reviews published evaluations of SFA adaptations conducted between 2022 and 2025, encompassing 17 studies and over 3,000 participants across healthcare, fire service, nursing education, and related high-stress occupations, together with implementation findings relevant to military adoption. Results Across designs ranging from cluster randomized trials to a 12-month multi-hospital longitudinal evaluation, SFA shows consistent improvements in proximal outcomes—stress recognition, peer-support self-efficacy, group cohesion, perceived organizational support, and use of well-being resources—with more modest and less consistent effects on distal outcomes such as posttraumatic stress symptoms and burnout. Benefits appear strongest among younger workers and in settings with higher implementation fidelity. Conclusion SFA offers military organizations a scalable, low-burden, culturally adaptable layer of stress-injury care that complements both momentary acute stress protocols and formal treatment. Rigorous effectiveness trials in military settings are the priority next step.
Objective The 23-item Clinician Administered Dissociative States Scale (CADSS) has been widely used as a repeated measure of dissociative symptoms. A shortened version of the CADSS would be useful as a time-saving measure, especially for neurobiological studies of dissociation at multiple time points before and after an intervention. The purpose of this study was to assess the psychometric properties of two versions of a short form of the CADSS in a sample with and without posttraumatic stress disorder (PTSD). Methods Participants with (N=200) and without (N=315) the diagnosis of PTSD were assessed with the 23-item CADSS and/or the 3-item CADSS, the 6-item CADSS, and other psychometric and neuropsychological assessments. Analyses were performed to examine internal consistency, validity as measured by correlation with measures of PTSD and trauma, and sensitivity to change following exposure to personalized scripts of traumatic memories. Results Both the 3-item CADSS (Cronbach’s alpha 0.82) and the 6-item CADSS (Cronbach’s alpha 0.81) showed good internal consistency. Validity for all versions was demonstrated based on correlations with other psychiatric symptom measures and ability to differentiate PTSD and non-PTSD participants. The 3-item CADSS demonstrated sensitivity to change based on a significant increase in scores after exposure to personalized traumatic scripts. Conclusion Both short form versions of the CADSS have acceptable psychometric properties.
Background Dissociative disorders (DD) are associated with substantial functional impairment and psychiatric burden. Epidemiologic evidence of DD, in terms of trends in prevalence, incidence, demographic patterns, psychiatric comorbidities, and medication utilization in the United States remains poorly understood. Methods Using the TriNetX US Collaborative Network, this retrospective study identified 60,362 patients aged ≥5 years with a diagnosis of DD between 2016 and 2025. Annual prevalence and incidence were calculated from a base population of 103,712,997 patients from the platform. Temporal trends were evaluated using joinpoint regression analysis, stratified by sex, race, and age group. Psychiatric comorbidities and psychotropic medication use were assessed during the 1-year and 5-year periods after DD diagnosis. Results Among 60,362 patients with DD (mean age, 50 years; 69.8% female), annual prevalence increased from 57 to 120 per 100,000 between 2016 and 2025. Incidence showed modest increase (11 to 16 per 100,000). While prevalence increased across both sexes, all racial groups, and all age groups, the largest increases were observed among females, individuals aged 15 to 44 years. Other anxiety disorders (37.81%), depressive episode (28.51%), substance use disorders (21.47%), and posttraumatic stress disorder (16.02%) were the most common psychiatric comorbidities within 1 year of DD diagnosis and increased further during follow-up. Antidepressants, sedative-hypnotics, anticonvulsants, and antipsychotics were frequently prescribed and showed increasing use over time. Conclusion The prevalence of DD increased substantially in the United States from 2016 to 2025, whereas incidence showed modest changes. DD were associated with a high burden of psychiatric comorbidities and extensive psychotropic medication use, underscoring their clinical complexity and unmet mental health needs. These findings highlight the growing public health relevance of DD and the need for improved recognition and early intervention.
Background Climate change is increasingly recognized as a source of significant psychological distress. How can we best minimize its mental health impacts? This study examines community-grounded theories of change by modelling how cognitive, emotional, and social processes shape climate-related psychological distress and adaptation. Methods This cross-sectional study surveyed Canadian adults, measuring climate change perceptions (reality, causes, consequences, and psychological distance), climate worry, psychological distress, climate change anxiety, resilience, social support, belonging, and pro-environmental behaviour. Structural equation modelling (SEM) was used to test three theoretically informed models: (1) a cascade from climate perceptions to distress via worry and impairment, (2) a social-ecological model of support, resilience, and belonging, and action and (3) a combined model integrating cognitive, emotional, and social pathways. Results Of 840 participants, 665 completed the survey. The mean sample age was 45·3 years (SD = 18·17). 70·3% identified as women, 18·3% as men, and 11·4% as gender diverse. Model 1 and Model 2 showed excellent fit. Model 3, which had a strong fit, showed that greater climate change perceptions predicted higher climate worry (β = 0·46, p <0·001), which led to greater impairment (β = 0·91, p <0·001), which led to distress (β = 0·32, p <0·001). Greater climate change perceptions had a buffering effect on impairment (β = -0·21, p < 0·001) and predicted distress (β = 0·55, p < 0·001). Stronger social networks predicted increased belonging (β = 0·85, p <0·001) and resilience (β = 0·61, p <0·001), each of which buffered psychological distress (resilience: β = -0·29, p <0·001; belonging: β = -0·06, p = 0·028). Resilience was a buffer against climate change perceptions (β = -0·43, p <0·001) and climate change worry (β = -0·28, p <0·001). Pro-environmental action predicted stronger climate change perceptions and climate worry (perceptions: β = 0·38, p <0·001; worry: β = 0·33, p <0·001). Conclusion These findings support the value of community-based and psychologically informed approaches for minimizing climate-related psychological distress. Interventions that prioritize social support and emotional skills, together with accurate climate communication, may be critical for fostering mental health and collective resilience in a changing climate.
