Christian Schubert , Lennart Seizer , Nina Camille Sophia Lauby , Dietmar Fuchs
{"title":"Mixed-methods analysis of sickness behavior during a natural experiment: An integrative single-case study","authors":"Christian Schubert , Lennart Seizer , Nina Camille Sophia Lauby , Dietmar Fuchs","doi":"10.1016/j.cpnec.2025.100301","DOIUrl":"10.1016/j.cpnec.2025.100301","url":null,"abstract":"<div><div>Sickness behavior is a coordinated set of psychological changes mediated by immune system activity, e.g., during infection and wounding. It is an adaptive response to conserve energy and resources in support of immune activity and to protect the community by signaling others that one is ill. In this integrative single-case study, a 27-year-old healthy woman collected her entire urine over a period of 63 days in continuous 12-h intervals (126 measurements in total). In addition, among other regular psychological assessments, she completed an emotional state questionnaire (EWL) each morning and evening, and had an in-depth psychological interview once a week. In the urine samples, neopterin, cortisol, and creatinine were measured. Coincidentally, the subject experienced a period of sickness during the study period, lasting two days (from 12-h interval 21 to 24), accompanied by fatigue, vomiting, diarrhea, low-grade fever, and increases in urinary neopterin and cortisol concentrations. During this sickness period, structural breaks occurred in the time-series of two positive emotional states, i.e., performance-related activity and general feeling of comfort, with significant drops in their mean levels lasting for over 50 days until the end of the study. The intensive longitudinal data set collected in this integrative single-case study makes it possible to adopt a biopsychosocial meta-perspective (bottom-up, top-down) when interpreting the results.</div></div>","PeriodicalId":72656,"journal":{"name":"Comprehensive psychoneuroendocrinology","volume":"23 ","pages":"Article 100301"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Paralanguage as a tool for shaping stress response in Listeners: Multimodal physiological sensing study","authors":"Marina Saskovets , Mykhailo Lohachov , Zilu Liang","doi":"10.1016/j.cpnec.2025.100309","DOIUrl":"10.1016/j.cpnec.2025.100309","url":null,"abstract":"<div><h3>Background</h3><div>Sound is a powerful cue that can influence emotional and physiological states. While musical sounds have been widely studied for their stress-reducing effects, less attention has been given to the role of paralanguage. This study investigates whether a soothing vocal intonation beyond its semantic content can facilitate stress recovery by modulating neurophysiological and biochemical stress markers.</div></div><div><h3>Methods</h3><div>Thirty-five participants underwent a standardized stress induction task before being exposed to one of three conditions: a soothing voice narration, a robotic voice narration, or silence. Prefrontal cortex (PFC) hemodynamic activity was recorded using functional near-infrared spectroscopy (fNIRS), while stress biomarkers, including salivary cortisol and electrodermal activity (EDA), were measured at multiple time points. The Laterality Index Response (LIR) was computed to assess stress-related cortical asymmetry.</div></div><div><h3>Results</h3><div>Stress induction significantly increased cortisol levels, EDA, and right-lateralized PFC activation across all groups. During the recovery phase, the soothing voice group demonstrated a significantly faster cortisol reduction compared to both control groups. fNIRS data revealed distinct PFC hemodynamic patterns, with the soothing voice condition shifting activation toward Brodmann areas 45 and 9. However, EDA recovery patterns did not differ significantly across groups.</div></div><div><h3>Conclusion</h3><div>These findings highlight the potential of paralanguage, specifically soothing voice intonation, in accelerating physiological stress recovery. The observed modulation of cortisol and PFC activity suggests that auditory interventions incorporating emotional prosody could enhance stress regulation strategies. Future research should explore individual differences in response to paralanguage-based interventions and their broader clinical applications.</div></div>","PeriodicalId":72656,"journal":{"name":"Comprehensive psychoneuroendocrinology","volume":"23 ","pages":"Article 100309"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144471112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Systemic inflammatory indices and the risk of depression in individuals with sleep difficulties: A cohort study based on NHANES 2005–2020","authors":"Ruolin Zhu , Lu Wang , Xingqi Wu , Kai Wang","doi":"10.1016/j.cpnec.2025.100299","DOIUrl":"10.1016/j.cpnec.2025.100299","url":null,"abstract":"<div><div>Sleep difficulties are common and often precede depressive disorders. We aimed to explore the associations between systemic inflammatory markers and depression risk in individuals with difficulty sleeping. We utilized data from the National Health and Nutrition Examination Survey (NHANES, 2005–2020), encompassing 7916 participants who reported having difficulty sleeping. The systemic inflammation response index (SIRI) and neutrophil‒platelet ratio (NPR) were calculated using peripheral blood cell counts. Odds ratios (ORs) and 95 % confidence intervals (CIs) of the SIRI/NPR for depression risk were calculated via logistic regression models. Restricted cubic spline (RCS) analysis was used to examine the dose‒response relationships between these indices and depression risk, whereas receiver-operating characteristic (ROC) analysis was used to evaluate their prognostic accuracy for depression risk. Participants in the highest SIRI and NPR quartile groups had significantly greater depression risk than those in the lowest quartile group did (OR (SIRI): 1.50, 95 % CI = 1.10–2.04; OR (NPR): 1.49, 95 % CI = 1.04–2.13). Subgroup analyses revealed consistent associations across different demographics and clinical subgroups. RCS analyses revealed a nonlinear association between depression risk and the SIRI (J-shaped, P nonlinearity <0.001) but not the NPR (P nonlinearity >0.05). ROC analysis revealed moderate discriminative ability for both the SIRI (AUC = 0.66, 95 % CI = 0.64–0.68) and the NPR (AUC = 0.65, 95 % CI = 0.63–0.67) in predicting depression among individuals with difficulty sleeping. These findings suggest that the SIRI and NPR are independently associated with increased depression risk among individuals with difficulty sleeping.</div></div>","PeriodicalId":72656,"journal":{"name":"Comprehensive psychoneuroendocrinology","volume":"23 ","pages":"Article 100299"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144099413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yasmine Zerroug , Marie-France Marin , Mara Brendgen , Miriam Beauchamp , Jean R. Séguin , Sylvana M. Côté , Catherine M. Herba
{"title":"Sex differences in associations between hair glucocorticoids and internalizing symptoms in adolescents","authors":"Yasmine Zerroug , Marie-France Marin , Mara Brendgen , Miriam Beauchamp , Jean R. Séguin , Sylvana M. Côté , Catherine M. Herba","doi":"10.1016/j.cpnec.2025.100311","DOIUrl":"10.1016/j.cpnec.2025.100311","url":null,"abstract":"<div><div>From adolescence onwards, internalizing symptoms, such as depressive and anxiety symptoms, are twice as prevalent in adolescent girls than boys. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which controls production and regulation of glucocorticoids (cortisol and cortisone), is linked to depressive and anxiety symptoms. Findings on hair cortisol, cortisone and the cortisol/cortisone ratio in relation to these symptoms have been inconsistent, particularly in adolescent community samples. The ratio provides an indication of the active versus inactive balance of cortisol concentrations, as a proxy of 11-beta-hydroxysteroid dehydrogenase enzymes. In addition, few studies have investigated whether these associations are the same for adolescent girls and boys. Hair samples of 64 adolescent girls and 59 adolescent boys (aged between 14 and 15 years old) were analyzed using the liquid chromatography-mass spectrometry (LC-MS) extraction method. Internalizing symptoms were measured via validated self-reported online questionnaires. For adolescent boys, no associations between hair glucocorticoids and depressive or anxiety symptoms were found. For adolescent girls, the analyses revealed a positive association between hair cortisone concentrations and depressive symptoms. Our findings highlight significant sex differences in the mechanisms that might operate between glucocorticoid concentrations and internalizing symptoms. Future longitudinal studies could test the predictive, sex-dependent effect of hair glucocorticoids concentrations during adolescence on the development of internalizing disorders in adulthood. Gaining a deeper understanding of HPA axis functioning could help to identify youth who are at greater risk of developing stress-related psychopathologies.</div></div>","PeriodicalId":72656,"journal":{"name":"Comprehensive psychoneuroendocrinology","volume":"23 ","pages":"Article 100311"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrew El Alam , Mohamad Fleifel , Hicham Baba , Souha Bayda , Bertha Maria Nassani , Jocelyne Azar , Arnaud Monier
{"title":"A safe path to bariatric surgery: Mental health disorders in pre-operative patients","authors":"Andrew El Alam , Mohamad Fleifel , Hicham Baba , Souha Bayda , Bertha Maria Nassani , Jocelyne Azar , Arnaud Monier","doi":"10.1016/j.cpnec.2025.100300","DOIUrl":"10.1016/j.cpnec.2025.100300","url":null,"abstract":"<div><h3>Background</h3><div>Obesity is one of the most significant global health concerns. As per the World Health Organization (WHO), obesity currently affects nearly 1.9 billion individuals around the world. Patients suffering from such a metabolic disease exhibit multiple medical conjoint medical conditions, and are predisposed to future high-morbidity and mortality complications. In addition, such patients might suffer from psychiatric compromises, at any time during their lives, that might have contributed to obesity. For many of these patients, bariatric surgery remains one of the leading methodologies in facilitating weight loss.</div></div><div><h3>Aim</h3><div>To study the prevalence of selected mental health disorders history, including depression, childhood trauma, and eating disorders, plus abnormal eating behaviors in patients with obesity undergoing pre-bariatric surgery evaluation. In addition, we intended to find any inter-associations between different mental health disorders and demographics in such patients.</div></div><div><h3>Methods</h3><div>In this cross-sectional study, conducted at the Nutrition and Obesity Department at Louis Pasteur Hospital, France, we enrolled 234 patients with obesity undertaking pre-bariatric surgery evaluation.</div></div><div><h3>Results</h3><div>Around 31.2 % of participants had a history of depression, with 46.5 % receiving treatment. Childhood trauma was identified in 22.6 % of patients, and 12.8 % exhibited eating disorders, subclassified into binge eating disorder (6.4 %), bulimia (3.2 %), and night eating syndrome (3.4 %). Abnormal eating behaviors was also prominent in such patients, with 66.2 % engaging in activities such as snacking, hyperphagia, emotional eating, and compulsive eating. Sociodemographic associations showed that females were more likely to be diagnosed with depression, binge eating disorder, and compulsive eating, while males were more prone to hyperphagia. Childhood trauma was significantly associated with depression, binge eating disorder, bulimia, and abnormal eating behaviors. Multinomial logistic regression analysis revealed various predictors for depression, eating disorders, and abnormal eating behaviors across different categories. Notably, depression was associated with unemployment, trauma, and compulsions. Binge eating disorder showed significant associations with trauma and the female sex, while bulimia was notably associated with trauma. Night eating syndrome was inversely related to marriage status. Subgroup analysis further highlighted associations between depression, eating disorders, and abnormal eating behaviors in specific demographic groups.</div></div><div><h3>Conclusion</h3><div>There is a complex link between mental health disorders and eating patterns in individuals with obesity undergoing pre-bariatric surgery evaluation. Understanding this association is important for developing comprehensive preoperative care strategies that address both physica","PeriodicalId":72656,"journal":{"name":"Comprehensive psychoneuroendocrinology","volume":"23 ","pages":"Article 100300"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144106881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The psychedelic-peptide paradox: a hormetic hypothesis","authors":"C. Sue Carter","doi":"10.1016/j.cpnec.2025.100303","DOIUrl":"10.1016/j.cpnec.2025.100303","url":null,"abstract":"<div><div>The purpose of this narrative review is to examine the hypothesis that two neuropeptides, vasopressin (VP) and oxytocin (OT) and their receptors have central roles in the behavioral and physiological consequences of psychedelic interventions. Transient consequences of psychedelics can include anxiety and in some cases sickness responses such as nausea and vomiting, which may involve VP and other components of the hypothalamic-pituitary-adrenal axis. Stressful experiences are often followed by a pulsatile release of OT. The effects of OT depend on interactions with VP and may be more apparent following stressful experiences including those associated with psychedelic drugs. Effects of both the VP-OT system and psychedelics also are mediated through interactions with the autonomic nervous system and the immune system, contributing to a process called “stress response hormesis.” The hypotheses arising from a hormetic perspective could guide novel approaches to understanding dose- and time-dependent psychedelic functions and to the treatment of emotional and physical disorders.</div></div>","PeriodicalId":72656,"journal":{"name":"Comprehensive psychoneuroendocrinology","volume":"23 ","pages":"Article 100303"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Causality effect of 21 metals in plasma and serum, 731 immunocytes, and schizophrenia: an intermediary Mendelian randomization study in East Asian populations","authors":"Yunchang Yang, Yaofeng Wang, Yunqin Sun","doi":"10.1016/j.cpnec.2025.100304","DOIUrl":"10.1016/j.cpnec.2025.100304","url":null,"abstract":"<div><h3>Background</h3><div>Multiple clinical studies have observed a close relationship between metals in plasma and serum, immunocytes, and schizophrenia; however, it remains unclear whether there is a genetic causal effect between metals in plasma and serum,immunocytes, and schizophrenia.</div></div><div><h3>Objective</h3><div>This study aimed to investigate the causal effects of metals in the plasma and serum on schizophrenia and the mediating role of immunocytes using Mendelian randomization methods in an East Asian population.</div></div><div><h3>Methods</h3><div>Summary results for 21 metals in plasma and serum,731 immunocytes and schizophrenia were acquired from publicly available genome-wide association studies (GWASs). GWAS data for metals, immunocytes, and schizophrenia were accessed between 2024 and 11–26 and 2024-12-02,Authors had no access to identifiable individual participant data. This study utilized two-sample Mendelian randomization (MR) analysis to establish causal relationships, which was achieved by employing various statistical methods, including inverse variance-weighted, simple mode, MR–Egger, weighted median, and weighted mode. Multiple sensitivity analyses, including heterogeneity tests, horizontal pleiotropy tests, MR-PRESSO tests, and leave-one-out analyses, were performed to confirm the reliability of the MR data. Finally, mediation analysis was employed to ascertain the immunocyte pathway that leads to schizophrenia from the metals in the plasma and serum. The study used anonymized summary-level GWAS data from public databases (e.g., GWAS Catalog, iEU Open GWAS), which do not contain personally identifiable information.</div></div><div><h3>Results</h3><div>The data of the East Asian population were analyzed by Mendelian randomization and two serum metallic traits that may reduce the risk of schizophrenia were identified: Serum iron (odds ratio (OR):0.54, 95 % confidence interval (CI):0.30–0.96, p = 0.036) and serum molybdenum levels (odds ratio (OR):0.54, 95 % confidence interval (CI):0.34–0.87, p = 0.011) corresponds to a 46 % reduction in schizophrenia risk. A baseline lifetime risk of 1 % in the general population, this translates to an absolute risk reduction of 0.46 %, with a number needed to treat (NNT) of approximately 217 individuals to prevent one case. They exhibited a negative causal relationship with the risk of Schizophrenia. Through mediation analysis, we identified a specific immunocyte subtype, CD33dim HLA DR + CD11b- Absolute Count, that not only correlates with serum iron levels but also shows a strong association with schizophrenia risk, suggesting a potential pathway through which serum iron may influence schizophrenia development. Serum iron levels showed a negative causal relationship in schizophrenia through the mediation of immunocytes with CD33dim HLA DR + CD11b- Absolute Count (mediation proportion:21 %).</div></div><div><h3>Conclusions</h3><div>This study identified a causal relationship ","PeriodicalId":72656,"journal":{"name":"Comprehensive psychoneuroendocrinology","volume":"23 ","pages":"Article 100304"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144205593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ana Vanessa Costa Rodrigues da Silva , Sérgio Reis Soares , Rui Filipe Oliveira Miguelote
{"title":"Beyond ovarian Morphology: Integrative stress profiling for distinguishing polycystic ovary syndrome from functional hypothalamic amenorrhea","authors":"Ana Vanessa Costa Rodrigues da Silva , Sérgio Reis Soares , Rui Filipe Oliveira Miguelote","doi":"10.1016/j.cpnec.2025.100307","DOIUrl":"10.1016/j.cpnec.2025.100307","url":null,"abstract":"<div><h3>Introduction</h3><div>Polycystic Ovary Syndrome (PCOS) and Functional Hypothalamic Amenorrhea (FHA) are two prevalent causes of secondary oligo/amenorrhea (OA) in women. Women with polycystic ovarian morphology (PCOM) frequently exhibit features of both PCOS and FHA, creating diagnostic challenges in clinical practice. This exploratory study explores how psychological and metabolic stress markers, combined with hormonal profiling, can distinguish FHA-PCOM from PCOS-PCOM.</div></div><div><h3>Methods</h3><div>In this prospective observational exploratory study, ninety-one women with OA were recruited from the general population. They were classified into PCOM and non-PCOM groups using transvaginal ultrasonography (antral follicle number per ovary ≥20 or ovarian volume ≥10 cm<sup>3</sup>). Psychological stress was assessed using Perceived Stress Scale (PSS-10), Hospital Anxiety and Depression Scale (HADS), and State-Trait Anxiety Inventory (STAI). Clinical evaluations included physical examinations, transvaginal ultrasonography, and comprehensive biochemical analyses<strong>.</strong> Cluster analysis was performed to identify distinct phenotypic profiles.</div></div><div><h3>Results</h3><div>All women in the PCOM group met the Rotterdam Criteria for PCOS and two-thirds of them exhibited overlapping features of both FHA and PCOS. The cluster analysis identified three PCOM subgroups: PCOM–CL1 displayed classic PCOS traits, including elevated androgens and insulin resistance; PCOM–CL2 exhibited psychological stress with FHA-like features; PCOM–CL3 showed metabolic stress with higher engagement in physical activity (both in duration and intensity), low leptin, and reduced insulin resistance. Additionally, PCOM-CL3 exhibited the lowest levels of psychological stress compared to the other two clusters. Non-PCOM women formed two clusters, one dominated by psychological stress and the other by metabolic stress. STAI-Trait and HADS were validated as reliable tools for assessing psychological stress in OA-PCOM cases.</div></div><div><h3>Conclusions</h3><div>This study highlights the significant overlap between PCOS and FHA phenotypes in women with PCOM and emphasizes the utility of psychological assessments, physical activity metrics, and leptin levels in differential diagnosis. Integrating these diagnostic tools into clinical practice may enhance personalized management strategies for OA-PCOM women, addressing both hormonal and stress-related dimensions.</div></div>","PeriodicalId":72656,"journal":{"name":"Comprehensive psychoneuroendocrinology","volume":"23 ","pages":"Article 100307"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144240120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bob Weng , Reid Morrissey , Jenna Lehn , Mustafa Beidas , Tauseef Abubakar , Mohsin Mirza
{"title":"Influence of mood disorders on outcomes of polycystic ovarian syndrome - A national inpatient sample study - 2016–2020","authors":"Bob Weng , Reid Morrissey , Jenna Lehn , Mustafa Beidas , Tauseef Abubakar , Mohsin Mirza","doi":"10.1016/j.cpnec.2025.100305","DOIUrl":"10.1016/j.cpnec.2025.100305","url":null,"abstract":"<div><h3>Background</h3><div>Polycystic ovarian syndrome (PCOS) is a dysregulated metabolic disorder causing hyperandrogenism, oligomenorrhea/anovulation, and ovarian cysts. The effects of PCOS extend beyond the reproductive detriments, notably an association with mood disorders. Existing literature is limited but suggests comorbid mood derangements increase the severity of PCOS symptoms and comprise a significant portion of healthcare costs in the U.S. Our study aims to further examine the impact of PCOS on the hospitalization course and costs.</div></div><div><h3>Methods</h3><div>Using data for females ages 18–50 from the National Inpatient Sample (NIS) between 2016 and 2020, a PCOS group was compared to a non-PCOS group for women hospitalized with mood disorders. Length of stay (LOS), hospital costs, and demographic characteristics were analyzed.</div></div><div><h3>Results</h3><div>PCOS patients accumulated significantly higher LOS and hospital cost. They also were significantly younger, predominantly Caucasian, covered by private insurance, and earned more income. There was a disproportionate use of Medicare for both groups given the younger sample.</div></div><div><h3>Conclusion</h3><div>Further investigation of demographic nuances and a multidisciplinary approach to PCOS, including policy changes and patient education starting at a young age, should be taken to better understand disease impact on different communities and address the broad scope of the disease (i.e. psychosocial) to reduce its healthcare burden.</div></div>","PeriodicalId":72656,"journal":{"name":"Comprehensive psychoneuroendocrinology","volume":"23 ","pages":"Article 100305"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}