Roxanne C. Keynejad

The perinatal period (from conception to 12 months postpartum) is defined by major general medical and psychological transitions that may contribute to functional neurological disorder (FND). The authors examined symptoms and care pathways of FND during the perinatal period and relationships to maternal functioning, obstetric outcomes, and infant care. Through convenience sampling, data from 41 individuals with FND during the perinatal period were identified in neurology and perinatal mental health service clinical records in the United Kingdom and Australia. Anonymized data on FND symptom course, treatment, delivery mode, and impacts on infant care were extracted from the records. The most prevalent diagnosis was functional seizures only (46%) or combined with motor FND (24%). Worsening of symptoms was most frequently reported in late pregnancy and postpartum (32% in the early postnatal period), but a substantial number of individuals were lost to follow-up. Comorbid depression (51%), anxiety disorder (54%), and posttraumatic stress disorder (39%) were prevalent. Cesarean delivery was common (42%), but neither cesarean nor epidural anesthesia was associated with exacerbation of preexisting FND symptoms. Nearly half of participants reported difficulties with infant care (49%); taking safety precautions was documented for individuals with both motor and seizure presentations. By 6-12 months postpartum, 38% reported a return to prepregnancy functioning, whereas 41% had persistent limitations. FND symptoms fluctuate during the perinatal period and can affect infant caregiving. Prospective observational studies could help inform care pathways for individuals of childbearing age with FND.

Background: Tackling the global burden of mental health conditions and substance misuse is an international priority. In recent years, strategic work has begun to develop mental health services in Ethiopia and strengthen human rights protection for people with mental health conditions. To inform mental health service planning in the Somali region of Ethiopia, the extent of mental health conditions and substance misuse requires quantification. Objective: We aimed to investigate associations between problematic khat use and mental health conditions in Ethiopia’s Somali Regional State (SRS). Method: We carried out a quantitative household survey of 844 randomly selected residences in two cities in Ethiopia’s SRS: the regional capital, Jigjiga (55.1%, n=465), and third largest city, Kabridahar (44.9%, n=379). We used the culturally validated Problematic Khat Use Screening Test and Mini International Neuropsychiatric Inventory to assess the prevalence and factors associated with mental health conditions and problematic khat use. Findings: Out of 844 participants, 18.6% (n=156) met criteria for major depression, 11.1% (n=92) met criteria for post-traumatic stress disorder (PTSD) and 5.7% (n=48) expressed suicidal ideation. The combined prevalence of these mental health conditions was 21.8% (n=186). Men reported more aggregated mental health conditions than women (30.6%, n=97 vs 16.9%, n=89). Adjusted regression analyses showed that people with problematic khat use had more than twice the prevalence of major depression (prevalence ratio (PR) 2.5, 95% CI 1.7 to 3.5), recurrent depression (PR 2.8, CI 1.8 to 4.4), suicidal ideation (PR 2.4 CI 1.9 to 5.3), PTSD (PR 3.1, CI 1.9 to 5.3) and any mental health condition (PR 2.4, CI 1.7 to 3.4) compared with people without problematic khat use. Conclusion: This study provides the first data regarding population mental health needs and harms associated with problematic khat use in the SRS, to inform the design, development and prioritisation of mental health services and substance regulation and policy. Clinical implications: Associations between problematic khat use and a range of poor mental health outcomes demonstrate the importance of targeted services for this population. Further research is needed to explore causal pathways underlying these associations.

Background: The use of assisted reproductive technology (ART) to aid conception is increasing worldwide, yet little research has explored psychological outcomes following ART conception. Objective: To systematically review the prevalence and mean anxiety symptom scores among women who conceived following ART, from confirmed pregnancy until 12 months postpartum, compared to women who conceived without ART (spontaneous conception, SC). Methods: We searched MEDLINE, PsycINFO, and EMBASE from their start dates to 3 ^rd June 2024 using a piloted search combining keywords related to ART, anxiety symptoms, pregnancy or the postnatal period, using Boolean operators. We extracted data on prevalence and mean anxiety symptom scores in the ART and SC groups, along with study characteristics. Results: Twenty studies met inclusion criteria, comprising cohort (n=15), case-control (n=1), and cross-sectional (n=4) designs. Most studies measuring symptoms during the first (n=3) and second trimester (n=8) reported non-significant differences, apart from one second trimester study which reported elevated pregnancy-specific anxiety symptoms in the ART group. Studies measuring symptoms during the third trimester (T3) (n=16) and postnatal period (n=8) reported mixed findings of higher (T3:n=4; postnatal:n=2), lower (T3:n=1; postnatal:n=2), and no significant differences (T3:n=9; postnatal:n=4) anxiety in the ART group relative to SC. Two third trimester studies reported higher pregnancy-specific anxiety but lower or equivalent generalized anxiety symptoms in the ART group. Conclusions: While some studies reported elevated anxiety symptoms following ART, particularly in late pregnancy and postpartum, findings remain mixed, with others indicating no differences or lower symptom levels. Further longitudinal research is warranted to better understand the postpartum experiences of women with fertility difficulties.

BACKGROUND: The UK National Institute for Health and Care Excellence recommends routine enquiry about domestic violence and abuse (DVA) in maternity care. We aimed to explore patterns and predictors of DVA enquiry during routine first antenatal care (‘booking’) appointments with midwives in South East London. METHODS: We conducted an observational cohort study using cross-sectional data collected through the St Thomas’ Hospital midwifery service between 1st January 2019 and 31st March 2023. Pseudonymised data were extracted from maternity records, comprising demographics, mental and physical health information, social factors, and DVA enquiry. We used linear mixed modelling to test associations between predictors and DVA enquiry. RESULTS: The dataset comprised 7,932 booking appointments with 7,007 women (median age: 32 years; ethnicity: 52% White, 27% Black, 7% Asian, and 15% other). Enquiry was made about current experiences of DVA in 79.4% of appointments. Black-identifying women (OR=1.28, 95% CI [1.11,1.46]) and those born in Sub-Saharan Africa (OR=1.37 [1.14,1.64]) were more likely to be asked than white-identifying and UK-born women. Single women were more likely to be asked than married or cohabiting women (OR=1.22 [1.08,1.38]). Those living in more deprived neighbourhoods were more likely to be asked (OR=1.07 [1.01,1.14]). Multivariable modelling found that being born in Sub-Saharan Africa or Southern Europe, and living alone but with additional support were all associated with increased DVA enquiry, while being born in North America or requiring an interpreter were associated with decreased enquiry CONCLUSIONS: Despite recommendations for routine DVA enquiry during all booking appointments, a substantial proportion of pregnant individuals were not asked between 2019 to 2023. Predictors of DVA enquiry reflected practical barriers (e.g. language), and known or perceived predictors of DVA risk (e.g. deprivation). Our findings suggest that midwives consciously or unconsciously prioritise DVA enquiry for women they believe are at greatest risk, against national guidelines.

A range of quantitative studies has identified intimate partner violence (IPV) as a risk factor for perinatal mental health conditions, and adverse obstetr

Global health funding by the United States government declined precipitously in 2025, triggering a cascade of international disinvestment in women’s health in low and middle-income countries, followed by a new era of ‘America First’ aid policy. Successive budget cuts by other high-income countries compounded the effects of these abrupt policy and geopolitical changes on women’s health, safety, and access to life saving and health assuring prevention, care and treatment, worldwide. Abandonment of active programmes and research studies disproportionately harms women by disrupting employment, reversing progress in education, eroding essential services and undermining community partnerships. The global health funding crisis weakens systems and diminishes capacity, impacting women’s physical and mental health, economic survival, and equity of opportunity across the life-course. New proposals to tie aid funding to data sharing have disproportionate impacts on women, while continued hostility to gender diversity places non-binary and transgender people at increased risk of further marginalisation. The current moment of crisis also illuminates profound limitations of the international systems which previously governed global health, indicating opportunities for transformation. In this Essay, we outline the foreseeable, intergenerational harms of defunding initiatives which promote and enhance the health and safety of women everywhere or tie their funding to agendas which would erode women’s reproductive autonomy. Amid deliberate efforts to disorientate opposition through simultaneous and sequential upheavals and concerted censorship of academic freedom, we call for concerted outcry, organised resistance, and synchronous action to safeguard women’s health and rights before more damage is done.

Women's mental health is profoundly shaped by structural violence through housing, which impacts their experience of home and sense of belonging. This Perspective advances an integrative sociological framework across a continuum from the most concrete manifestation of shelter (housing) through symbolic representations of home, to the psychological experience of belonging to a place. We synthesize evidence for relationships between unstable, unsafe housing, abusive homes, social dislocation, and mental ill-health. Drawing on interdisciplinary scholarship, we specify how housing insecurity erodes community, relationships, and safety, generating ontological insecurity that amplifies vulnerability to interpersonal violence. We show that these dynamics are bidirectional: mental health conditions can impede access to resources and secure housing, reinforcing insecurity, while housing adversity is associated with worsened mental health. An intersectional lens reveals that minoritised women experience compounded harm through migration status, precarity, and policy regimes that limit protection and support. Our framework connects macro-level structures (national and international policy), meso-level institutions (welfare, health, and housing services), and micro-level lived experience, demonstrating how structural conditions become embodied as mental health symptoms. This Perspective situates ontological (in)security as central to the relationships between shelter, place, and women's mental health, identifying actionable leverage points for change. We argue for gender-sensitive, integrated interventions that expand access to safe, stable housing, co-locate mental healthcare with rights-based and anti-discrimination services, and address feedback loops between shelter, place, and mental health. By foregrounding housing as a key conduit of structural violence, this Perspective advances sociological understanding of how belonging and mental health are co-constituted and offers directions for research and policy to improve women's health and flourishing.

Background: The prevalence of common mental disorders (CMDs) in South Asia is higher among women than men. Reasons include lower socioeconomic status and greater exposure to social, economic and environmental disadvantage. Economic determinants are important, modifiable risk factors for CMDs. Aims: This systematic review aimed to evaluate the evidence for impacts of economic interventions on women’s well-being and CMD outcomes in South Asia. Method: We searched for peer-reviewed quantitative research studies in eight databases (3ie, EconLit, Embase Classic, Embase, Global Health, J-PAL, Medline, APA PsychInfo, Scopus) and studies included in relevant systematic reviews of economic interventions which measured CMDs and well-beingamong female participants in South Asia. We assessed the risk of bias of included studies using the Joanna Briggs Institute checklist. Following data extraction, we synthesised our findings through narrative synthesis. Results: We identified eight eligible studies evaluating five types of economic intervention: microfinance, employment, conditional cash transfers, self-help groups (SHGs) and economic empowerment programmes. Studies were conducted in Afghanistan ( n = 1), Bangladesh ( n = 2) and India ( n = 5). Approximately 60% of studies reported statistically significant associations between receipt of economic interventions and improved CMD symptoms or well-being among female participants. Risk of bias was moderate and study designs were heterogeneous. Attention to gendered risks of economic interventions in countries with strong patriarchal norms was limited. Conclusion: The limited published evidence suggests that economic interventions can have positive impacts on CMDs and well-being among women in South Asia. However, methodological limitations and lack of geographical representation mean that further research is needed to evaluate the risks and benefits of economic interventions for diverse women in South Asia.

Aim: To examine the implementation of evidence‐based psychotherapy across international healthcare contexts and identify barriers to clinical delivery. Methods: We conducted an international, cross‐sectional, web‐based survey of psychiatrists from October 2024 to March 2025. The questionnaire assessed familiarity with 10 evidence‐based psychotherapy modalities, frequency of use, delivery confidence, perceived barriers, and clinical workload. Responses from 16 countries were analyzed across five geographic regions using chi‐squared tests and effect sizes. Results: Among 424 respondents, 201 (47.4%) demonstrated low composite familiarity with evidence‐based psychotherapies. Cognitive behavior therapy maintained moderate familiarity across regions, while other modalities remained largely unfamiliar. Japan exhibited the most constrained practice environment, with 48.3% reporting consultations under 10 min compared to 15.1% in other regions, and 30.0% seeing 40 or more patients daily. Major time constraints were reported by 63.3% of Japanese psychiatrists, significantly higher than other regions ( P = 0.015). Frequent use of evidence‐based psychotherapy was lowest in Japan (20.0%) and highest in the Middle East (60.0%). Despite these challenges, 77.4% of all respondents rated these approaches as highly important. Respondents identified improved postgraduate training (54.0%), continuing education access (38.2%), and enhanced supervision (36.0%) as priorities. Conclusion: Implementation varies across healthcare contexts, with Japan exemplifying system‐level constraints where brief consultations and high patient volumes override practitioner knowledge and motivation. While psychiatrists value evidence‐based approaches and seek to implement them, organizational barriers ultimately determine actual practice patterns. Findings indicate that training initiatives without concurrent structural reforms cannot bridge implementation gaps. Effective integration requires alignment of education, healthcare delivery structures, and payment systems. Clinical Trial Registration: Not applicable.