Dissociation, as defined in the DSM-5-TR, is a disruption in the normally integrated functions of consciousness, memory, identity, emotion, and perception. It ranges from mild, everyday experiences such as highway hypnosis to severe psychopathology in which parts of the self operate outside awareness or even take executive control. Clinicians have long understood dissociation as a defense against overwhelming stress or abuse — a way of compartmentalizing experience to avoid psychological annihilation. But when these mechanisms persist, they can impair emotional processing, fragment identity, and, according to a growing body of evidence, feed directly into depressive illness. Roughly twelve percent of Australians experience a depressive episode in their lifetime, a figure strikingly close to the roughly ten percent lifetime prevalence of dissociative disorders, and the two conditions overlap far more often than diagnostic manuals acknowledge.

The new study, led by Mary-Anne Kate of Southern Cross University with colleagues Benjamin Dixon, David L. Hegarty, and Benjamin Buchanan, drew on de-identified routine clinical assessment data from the NovoPsych platform. Clients completed two well-validated instruments: the Depression Anxiety Stress Scales-21 (DASS-21), which grades depressive symptoms into normal, mild, moderate, severe, and extremely severe bands, and the Multidimensional Inventory of Dissociation-60 (MID-60), a 60-item measure adapted from Dell’s original 218-item diagnostic instrument. The MID-60 assesses eleven dissociative domains — from depersonalization and derealization to flashbacks, trance, persecutory intrusions, and identity confusion — and expresses scores as the percentage of time a person spends experiencing dissociative symptoms, with a score of 21 percent marking clinically significant dissociation and 31 percent suggesting a more complex dissociative presentation.

The headline result is stark. Depression and dissociation were strongly correlated (r = .50), and a Welch’s one-way ANOVA showed that depression severity category alone accounted for 23 percent of the variance in dissociation scores. Every severity group differed significantly from every other. Clients with moderate-or-above depression had fivefold greater odds of clinically significant dissociation than those with normal or mild symptoms (OR = 5.05). The average MID-60 score exceeded the clinical threshold in the moderate and severe groups, and the extremely severe group averaged in the range associated with complex dissociative disorder presentations. The gap between the normal and extremely severe groups was enormous: a difference of nearly 24 points on the MID-60 mean, an effect size of d = 1.51.

Perhaps most striking, 61.7 percent of clients with moderate-or-above depression scored at or above the MID-60 clinical threshold, and 68.8 percent met a probable symptom profile suggestive of a DSM-5-TR dissociative disorder or the dissociative subtype of PTSD. Overall, probable dissociative profiles rose from 27.4 percent in the normal depression group to 81.3 percent in the extremely severe group. The pattern was strongest for the more complex presentations — probable OSDD-1 profiles (24 percent) outnumbered probable DID profiles (14 percent) among those with moderate-or-above depression — while circumscribed profiles such as depersonalization/derealization disorder showed little or no elevation, likely because they are assigned only when broader post-traumatic configurations have been ruled out.

Which dissociative symptoms track depression most closely? Self-confusion topped the list (r = .56), followed by depersonalization/derealization (r = .45), flashbacks (r = .44), persecutory intrusions (r = .42), severe memory problems (r = .42), and trance (r = .39). Depression had only a very weak association with psychogenic seizures (r = .10), though even here moderate-or-above depression doubled the odds of the symptom. Nearly three-quarters of clients with moderate-or-above depression reported clinically significant flashbacks, 58 percent reported significant depersonalization or derealization, and half reported clinically significant somatic or conversion-type body symptoms. Notably, the profile analyses suggested that flashbacks and somatic symptoms were tied to depression primarily when they occurred within broader dissociative constellations, rather than as isolated PTSD-type or functional neurological presentations.

These findings land in the middle of a long-running scientific debate about what dissociation actually means within depression. Depersonalization and derealization were described as features of depression in psychiatric texts from 1900 to 1960 — including Petrilowitsch’s 1956 concept of “estrangement depression” — yet they vanished from modern classification systems. Recent evidence suggests that removal was premature. A five-year follow-up of a German population cohort found that depressed individuals with co-occurring depersonalization had markedly worse outcomes: only 6.9 percent achieved remission, and depersonalization more than doubled the risk of depression recurrence or persistence. A Serbian study found nearly half of depressed individuals had clinically significant depersonalization, with more severe and enduring illness. Phenomenological research has independently found that people with depression describe feeling disembodied, mechanical, estranged from the world, and cut off from their own narrative identity — experiences that map closely onto dissociation.

The Australian results also echo findings from around the world. In a large Chinese-speaking sample, 35 percent of depressed individuals showed clinically significant dissociation, with higher rates among those with childhood trauma. An international study found more than 60 percent of depressed participants had clinically significant dissociative symptoms, with 90.5 percent reporting at least one clinically significant symptom — and the dissociation-depression link persisted even after controlling for trauma. A Finnish general-population study using the DES-T found pathological dissociation in 1.6 percent of people with normal mood but 25 percent of those with moderate depression and 38 percent of those with severe depression — a ninefold increase. In Türkiye, over 40 percent of women with major depression had a lifetime dissociative disorder. The convergence across Finland, China, Serbia, Germany, Latvia, Taiwan, and now Australia, using different measures in different languages, suggests the association is not a cultural artifact.

The findings give fresh empirical support to the concept of “dissociative depression” proposed by Turkish researcher Vedat Şar — a chronic, complex mood disorder in which intermittent major depressive episodes intertwine with dissociative phenomena, identity disturbance, somatic symptoms such as pseudoseizures, severe concentration and memory impairments, and psychotic-like features, all rooted in high exposure to childhood abuse and neglect. A latent-class analysis of Chinese male inmates found a distinct “dissociative depression” class comprising about one-fifth of those with depressive symptoms, showing the highest levels of depression, dissociation, PTSD, borderline personality symptoms, and emotion-regulation difficulties. The new Australian data align with key elements of this picture: depression severity was linked most strongly to broad dissociative constellations — especially OSDD-1 and DID-type profiles — and to disturbances of self and agency such as persecutory and angry intrusions, rather than to narrow, circumscribed dissociative syndromes.

The authors are careful to note that three interpretations remain possible, and they are not mutually exclusive: dissociation and depression may simply co-occur as comorbid conditions sharing trauma-related vulnerabilities; dissociative features may be intrinsic, underrecognized aspects of some depressive presentations; or a distinct dissociative subtype of depression may exist. Longitudinal work hints at directionality — dissociation predicts later depressive symptoms, but not the reverse — and comorbid depression tends to persist when the underlying dissociation goes untreated. The clinical stakes are high: depressed individuals with co-occurring dissociation experience greater suicidality and poorer responses to conventional treatment, while trauma-focused therapies tailored for dissociative clients have been shown to reduce dissociation, depression, and suicidal ideation together. The study’s main limitation is that the MID-60 is typically administered when dissociation is suspected or before trauma-focused interventions such as EMDR, likely skewing the sample toward trauma histories. Even so, the message for clinicians is hard to ignore: routine screening for dissociation in depression — particularly when symptoms are treatment-resistant, complex, or trauma-related — could sharpen diagnosis and unlock more targeted, more effective treatment for millions of patients who feel, in their own words, that they no longer feel like themselves.

Subject of Research: The relationship between dissociative symptoms and depression severity in a clinical population

Article Title: I don’t feel like myself: mapping dissociative symptoms across depression severity in a clinical population

Article References: Kate, M.-A., Dixon, B., Hegarty, D. L., & Buchanan, B. (2026). I don’t feel like myself: mapping dissociative symptoms across depression severity in a clinical population. Current Psychology, 45(19), Article 1583. https://doi.org/10.1007/s12144-026-10128-2

Image Credits: AI Generated

DOI: 10.1007/s12144-026-10128-2

Keywords: dissociation, depression, dissociative disorders, depersonalization, derealization, trauma, MID-60, DASS-21, dissociative depression, clinical psychology, PTSD, screening

The research team anchored their investigation in the Job Demands-Resources model, a widely used framework in occupational health psychology first articulated by Demerouti, Bakker, Nachreiner, and Schaufeli in 2001. The model proposes that every job contains two categories of characteristics that operate along distinct pathways. Job demands, such as heavy caseloads, time pressure, and emotionally intense client contact, consume workers’ energy and can lead to the exhaustion component of burnout. Job resources, including supportive supervision, autonomy, and a healthy organizational climate, buffer those demands and fuel engagement. More recent extensions of the model add a third element: personal resources, which are psychological characteristics individuals bring to the job. Mindfulness, defined by Jon Kabat-Zinn as the awareness that arises from paying attention to the present moment without judgment, has emerged as one of the most studied personal resources, with evidence linking it to reduced stress reactivity and better mental health outcomes.

Using this framework, the researchers surveyed 50 frontline workers providing mobile crisis services across 11 community mental health centers in a single southern state. The sample is notable for its coverage: these 11 centers represented the complete set of organizations statewide that had received funding to operate mobile crisis services, meaning the pilot captured the entire funded network rather than a convenience sample. The survey instrument measured burnout symptoms, perceived work climate as an indicator of organizational resources, and individual mindfulness as an indicator of personal resources. The researchers also controlled for sex, race, and work experience in their statistical models, ensuring that the associations they observed were not simply artifacts of demographic differences or varying tenure among respondents.

The headline numbers are sobering. Among the 50 participants, 31.3 percent reported moderate to high degrees of exhaustion, the emotional depletion that characterizes the energy-depletion pathway of burnout. Meanwhile, 14.6 percent disclosed moderate to high levels of depersonalization, the cynical distancing from clients that represents the interpersonal dimension of burnout. Burnout researchers, including Christina Maslach and Michael Leiter, have long argued that these two symptoms are not interchangeable. Exhaustion reflects a depleted energy reservoir, while depersonalization reflects a shift in how workers relate to the people they serve, often described as treating clients as cases rather than persons. The fact that nearly one in three workers reported significant exhaustion in a workforce this new is a warning sign for a service model that is being scaled nationally.

The regression analyses revealed a striking asymmetry in what predicted each symptom. After controlling for sex, race, and work experience, individual mindfulness emerged as a significant predictor of exhaustion, while perceived work climate significantly predicted depersonalization. In other words, the personal resource appeared to protect workers against the energy-drain pathway of burnout, whereas the organizational resource appeared to protect against the disengagement pathway. This dissociation is theoretically meaningful. It suggests that interventions targeting only one lever, whether individual-level mindfulness training or organization-level climate improvement, would leave the other burnout dimension largely untouched. For administrators planning burnout prevention programs, the implication is that a two-pronged strategy is likely necessary.

The mindfulness finding aligns with a growing body of evidence on contemplative training in health care settings. Studies of mindfulness-based stress reduction among mental health professionals, such as a 2015 pilot by Raab and colleagues, have reported improvements in self-compassion and reductions in stress symptoms. A systematic review of ecological momentary assessment research by Enkema and colleagues in 2020 found consistent associations between momentary mindfulness and better mental health outcomes. Recent theoretical work by Lyddy and colleagues in 2025 has even proposed a mechanism within the Job Demands-Resources model itself: mindfulness may change how workers perceive job demands and resources, effectively reperceiving stressful situations in ways that reduce their emotional cost. The new study adds field-based correlational evidence from a crisis response workforce that has rarely been studied with this framework.

The work climate finding carries its own weight. Organizational climate, the shared perception of policies, practices, and interpersonal dynamics within a workplace, has repeatedly been linked to burnout in mental health services. A comprehensive review by Morse and colleagues in 2012 documented burnout as a pervasive problem in community mental health, with remediation strategies that often emphasized organizational change rather than individual resilience alone. Related research on psychiatric rehabilitation practitioners by Blau and colleagues found that burnout dimensions correlated with distinct workplace factors. The current study’s suggestion that climate specifically guards against depersonalization fits a logical mechanism: workers who feel supported, fairly treated, and connected to their organization may find it easier to remain empathically engaged with clients, whereas workers in a cold or unsupportive climate may retreat into defensive detachment.

Context matters for interpreting why this workforce is at risk in the first place. Mobile crisis services expanded dramatically following the launch of the 988 Suicide and Crisis Lifeline and federal guidance from the Substance Abuse and Mental Health Services Administration, which published a best practice toolkit for behavioral health crisis care in 2020. Research has supported the model’s promise: a 2022 study in Science Advances by Dee and Pyne found that community response approaches to mental health and substance abuse crises reduced crime, and a propensity score-matched analysis by Vakkalanka and colleagues showed that mobile crisis outreach was associated with reduced emergency department utilization. But rapid scaling can outpace workforce preparation. A 2026 study by Gupta and colleagues described mobile crisis workers as acting as the face of a broken system, encountering gaps in housing, treatment capacity, and follow-up care that no individual clinician can resolve. That structural strain is precisely the kind of chronic job demand the Job Demands-Resources model identifies as burnout fuel.

The study’s limitations are those expected of a pilot design. The sample of 50 participants, while covering the full funded network in one state, is small, and the cross-sectional survey design cannot establish whether mindfulness actually causes lower exhaustion or whether a positive climate causes lower depersonalization. Reverse causation remains plausible: workers who are less exhausted may find it easier to be mindful, and workers who feel less depersonalized may rate their workplace climate more favorably. Self-report measures introduce common method variance, and the single-state setting limits generalizability to regions with different funding structures and demographics. The authors also note that the research was supported by a Centers for Medicare and Medicaid Services planning grant for mobile crisis services, reflecting the policy moment in which the study was conducted. Longitudinal designs and intervention trials will be needed to confirm the causal pathways the model implies.

Even with those caveats, the practical implications are concrete. For crisis system administrators, the results argue for building mindfulness-based stress reduction or similar contemplative training into staff development, not as a substitute for structural fixes but as one component of a prevention portfolio. Simultaneously, the depersonalization findings point toward organizational interventions: supervision practices, team cohesion, fair workload distribution, and a climate in which frontline workers feel heard. As states continue to stand up mobile crisis infrastructure under 988, the workforce behind the model will determine whether it delivers on its promise. This pilot study provides an early, data-driven map of where that workforce is vulnerable, and a reminder that protecting the people who answer crisis calls requires attention to both the minds they bring to work and the environments they work in.

Subject of Research: Burnout risk factors among mobile crisis team mental health workers

Article Title: Risks of Burnout Among Mobile Crisis Team Workers in a Southern U.S. State: A Pilot Study of Work Climate and Mindfulness

Article References: Lu, J., Johnson, K. A., Parish, P., McIntosh, S., & Albright, D. L. (2026). Risks of Burnout Among Mobile Crisis Team Workers in a Southern U.S. State: A Pilot Study of Work Climate and Mindfulness. Community Mental Health Journal. https://doi.org/10.1007/s10597-026-01736-0

Image Credits: AI Generated

DOI: 10.1007/s10597-026-01736-0

Keywords: mobile crisis teams, burnout, mindfulness, work climate, mental health workforce, Job Demands-Resources model, exhaustion, depersonalization, community mental health, occupational stress, 988 crisis line, burnout prevention

The study focused on the three classic dimensions of burnout as defined by the Maslach Burnout Inventory: emotional exhaustion, the feeling of being drained and depleted by work; depersonalization, the development of cynical or detached attitudes toward patients; and reduced personal accomplishment, a diminished sense of competence and achievement. Nurses completed the Maslach Burnout Inventory–Human Services Survey for Medical Personnel, alongside the Nicholson McBride Resilience Questionnaire, which measures an individual’s capacity to bounce back from adversity. This dual assessment allowed the researchers to capture both the negative and positive sides of the psychological equation in a single cohort.

The headline numbers are striking. Among the 501 participants, 37.7 percent reported a moderate level of emotional exhaustion, 40.3 percent reported low depersonalization, and 41.9 percent reported a moderate level of personal accomplishment. In other words, while many nurses in this hospital are not yet in the severe burnout zone, a substantial minority are carrying significant emotional strain. The pattern matters because burnout rarely arrives all at once; it typically builds through the exhaustion dimension first, before spilling over into how nurses relate to their patients and how they judge their own professional worth.

One of the most technically interesting findings is the strength of the correlation between emotional exhaustion and depersonalization. The two dimensions showed a positive correlation coefficient of 0.626, highly statistically significant, indicating that nurses who feel emotionally drained are far more likely to develop detached, impersonal attitudes toward the people they care for. This is consistent with the theoretical model underlying the Maslach inventory, which posits that exhaustion acts as the core of burnout and drives the other dimensions. For hospital administrators, the implication is sobering: protecting nurses’ emotional energy may be the single most effective lever for preserving the quality of the nurse–patient relationship.

The study also quantified something more visceral: the dread of going to work. Perceived stress about going to work correlated positively with emotional exhaustion at 0.507, again highly significant. This correlation suggests that anticipatory stress, the psychological weight nurses carry before their shift even begins, is a meaningful signal of deeper exhaustion. It is the kind of measure that could, in principle, be monitored in real time through brief pulse surveys, giving occupational health teams an early warning system before full-blown burnout takes hold.

Where the study breaks new methodological ground is in its use of a multilayer perceptron, a type of artificial neural network, to classify nurses into burnout and resilience categories based on their demographic and work-related characteristics. The researchers trained the model with five-fold stratified cross-validation using scikit-learn in Python, a technique that divides the data into five subsets and repeatedly tests the model on unseen data to ensure its performance is not a fluke of a particular split. They evaluated the model using a battery of metrics: classification accuracy, precision, recall, F1-score, the area under the receiver operating characteristic curve, and calibration metrics including the Brier score and expected calibration error. This last pair is particularly important, because a model that predicts probabilities must not only rank nurses correctly but also assign probabilities that reflect reality.

The model’s performance varied considerably by outcome, and the authors are refreshingly candid about this. For distinguishing high versus low emotional exhaustion and high versus low depersonalization, the model achieved acceptable to good discrimination. But for personal accomplishment and for resilience, discrimination was weak, with area under the curve values hovering around 0.6, barely better than a coin flip. This asymmetry is itself informative. It suggests that exhaustion and depersonalization are more strongly patterned by the variables available to the model, while personal accomplishment and resilience may depend on psychological and social factors, such as coping style, social support, or professional identity, that a demographic survey simply cannot capture.

Within the exploratory models, age and marital status showed the highest normalized importance for predicting depersonalization, while age and night shifts ranked highest for personal accomplishment. The researchers are careful to frame these patterns as hypothesis-generating rather than inferential: permutation importance in a cross-sectional dataset cannot establish that being older, unmarried, or working nights causes burnout. Still, the signals are plausible and align with international literature. Night shifts disrupt circadian rhythms and social life, both known stressors; marital status may shape the availability of emotional support at home. These patterns now form a concrete agenda for longitudinal studies that can track nurses over time and test whether the associations hold.

The setting of the study gives its findings particular weight. Saudi Arabia’s hospitals rely heavily on expatriate nurses, a workforce that faces distinctive pressures: separation from family, cultural and linguistic adjustment, and in some cases limited long-term career security. Most burnout research has been conducted in settings where nurses are predominantly local, so the evidence base for expatriate-dominated workforces has been thin. By documenting burnout and resilience levels in this context, the study fills a genuine gap and raises questions about whether interventions designed for native-born workforces, such as peer support programs or resilience training, need to be adapted for nurses living far from their home countries.

The authors are explicit about the limits of what their work can support. Because the study is cross-sectional, it captures a single moment in time and cannot show whether the observed predictors precede the burnout outcomes or merely co-occur with them. The exploratory machine learning findings require external validation in other hospitals and other countries before they could guide targeted interventions, and longitudinal designs are needed to establish temporal order. What the study does deliver is a carefully calibrated baseline: a large, well-characterized sample of nurses in an understudied workforce, validated instruments, a transparent machine learning pipeline, and a set of testable hypotheses about who is most vulnerable. As health systems worldwide grapple with nursing shortages and post-pandemic attrition, that combination of honesty and methodological rigor may prove as valuable as any single statistic the study reports.

Subject of Research: Burnout and resilience among expatriate-dominated nursing staff in a Saudi tertiary hospital, analyzed with machine learning classification

Article Title: Burnout and resilience among healthcare nurses in Saudi Arabia: a cross-sectional study with exploratory multiclass classification approach

Article References: Burnout and resilience among healthcare nurses in Saudi Arabia: a cross-sectional study with exploratory multiclass classification approach. (n.d.). https://doi.org/10.1186/s40359-026-05716-7

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05716-7

Keywords: burnout, nurses, resilience, Saudi Arabia, machine learning, multilayer perceptron, emotional exhaustion, depersonalization, personal accomplishment, cross-sectional study, occupational health, expatriate workforce

The research team, led by Alfredo Verastegui of Mayo Clinic Florida and Tecnológico de Monterrey, together with Mauricio Gonzalez-Urquijo, Diego Maldonado, Adolfo Leyva-Alvizo and Mario Rodarte-Shade, set out to answer a deceptively simple question: how do the different dimensions of burnout actually change as residents move from their first to their fifth postgraduate year? Most previous studies have offered only snapshots, measuring burnout at a single point in time or comparing different cohorts of residents. What has been missing, particularly in Latin American contexts where surgical training conditions can differ substantially from those in the United States and Europe, is a complete picture of an entire residency program at every stage of training simultaneously.

To build that picture, the researchers surveyed all 37 general surgery residents at a Mexican academic institution in October 2025, spanning the full range from PGY1 to PGY5. The response rate was a perfect 100 percent, a methodological strength that eliminates the selection bias that plagues most burnout surveys, where the most distressed or the most disengaged residents are often the ones who decline to participate. The residents, whose mean age was 28.9 years, were 54.1 percent female, and 62.2 percent had relocated from other regions to train at the institution, a detail that allowed the team to test whether leaving home for residency shapes psychological outcomes.

Burnout was measured with the Maslach Burnout Inventory, the most widely used instrument in the field, which assesses three distinct domains: emotional exhaustion, the feeling of being drained and depleted by work; depersonalization, the development of cynical, detached attitudes toward patients; and personal accomplishment, the sense of competence and meaningful achievement in one’s work. Because these three dimensions can move in different directions, the researchers treated them separately rather than collapsing them into a single burnout score. They then applied a battery of statistical tests suited to the task: Kruskal-Wallis tests to compare the domains across training years, Jonckheere-Terpstra tests to detect monotonic trends, meaning steady increases or decreases from one year to the next, and linear regression models that examined the relationship between training year and burnout while adjusting for demographic factors and whether a resident was local or non-local.

The results were striking. Personal accomplishment was the only domain that differed significantly across training years in the between-group comparison, with a p-value of 0.023, and the scores climbed steadily from the first year to the fifth. The trend analyses reinforced the pattern with remarkable consistency. Emotional exhaustion showed a significant monotonic decrease across training years, with a correlation coefficient of -0.415 and a p-value of 0.011, while personal accomplishment showed an even stronger monotonic increase, with a coefficient of 0.530 and a p-value below 0.001. In plain terms, the longer residents stayed in the program, the less emotionally drained they felt and the more capable and fulfilled they became.

The prevalence figures tell the story in even more vivid terms. Among first-year residents, 37.5 percent reported high emotional exhaustion, 50 percent reported high depersonalization, and a staggering 75 percent reported low personal accomplishment. By the fifth and final year, those numbers had collapsed to 11.1 percent for emotional exhaustion, 22.2 percent for depersonalization, and exactly zero percent for low personal accomplishment. Not a single senior resident in the cohort reported a diminished sense of professional achievement. For a specialty in which burnout prevalence has been reported as persistently high across institutions and countries, the near-total disappearance of one burnout domain by the end of training is a finding that demands attention.

Equally notable is what the researchers did not find. Resident origin, whether a trainee had come from the local area or relocated from elsewhere, showed no significant association with any burnout domain or with the trajectories across training years. In a country where surgical residency often requires young doctors to move far from their families and support networks, the absence of an origin effect suggests that the program itself, rather than geographic circumstance, is the dominant influence on how residents weather the psychological demands of training.

The authors’ conclusion is deliberately provocative: burnout improves progressively during surgical residency, junior residents are the most vulnerable group, and senior residents demonstrate substantial recovery. This directly challenges the widespread assumption that residency is an unrelenting descent into exhaustion, an assumption embedded in much of the wellness literature and in the design of many burnout interventions. If burnout is not a uniformly worsening trajectory, then one-size-fits-all programs spread evenly across five years of training may be misallocating their resources. The data point instead toward targeted early support, concentrating mental health resources, mentorship and workload adjustments on the first years of training, when distress is at its peak.

The study also raises a subtler question about the nature of surgical training itself. The authors emphasize the importance of preserving the transformative aspects of residency, the demanding process through which medical graduates are forged into autonomous surgeons. Some degree of struggle may be intrinsic to that transformation, and the steady rise in personal accomplishment suggests that residents derive a growing sense of mastery from exactly the challenges that make training so hard. The goal, on this reading, is not to eliminate difficulty but to ensure that junior residents, who are simultaneously absorbing the steepest learning curve and the heaviest emotional load, have the scaffolding they need to get through the most vulnerable phase.

Context matters here. The study is cross-sectional, capturing all five training years at a single moment in October 2025 rather than following the same individuals over time, and it comes from one institution with 37 residents. Those limitations mean the trajectories should be interpreted as strong hypotheses rather than universal laws, and the authors themselves frame the work as a complete cohort analysis of a single Latin American program. Yet the 100 percent participation rate, the use of validated trend statistics, and the adjustment for demographics and resident origin give the findings unusual credibility for a study of this size. As residency programs expand across Mexico and Latin America, and as the global conversation about physician well-being intensifies, this complete snapshot from Monterrey offers something the field has lacked: evidence that the arc of surgical training may bend toward recovery, not ruin, and that the most effective interventions may be the ones aimed at the residents who need them most, in their earliest and hardest years.

Subject of Research: Burnout trajectories across the five years of general surgery residency in a Latin American training program

Article Title: Burnout trajectories across general surgery residency: a complete cohort analysis from a Latin American Institution

Article References: Verastegui, A., Gonzalez-Urquijo, M., Maldonado, D., Leyva-Alvizo, A., & Rodarte-Shade, M. (2026). Burnout trajectories across general surgery residency: a complete cohort analysis from a Latin American Institution. Global Surgical Education – Journal of the Association for Surgical Education, 5(1), Article 150. https://doi.org/10.1007/s44186-026-00557-9

Image Credits: AI Generated

DOI: 10.1007/s44186-026-00557-9

Keywords: burnout, surgical residency, general surgery, medical education, resident wellness, Maslach Burnout Inventory, emotional exhaustion, depersonalization, personal accomplishment, Latin America, Mexico, physician well-being

The research team, led by Guimei Chen, Songjie Wu and Xiaoxia Zhang, with Jie Ke and Ke Liang as corresponding authors, conducted a nationwide cross-sectional online survey between October and November 2024. A total of 1,887 public health workers from across China completed the survey. The sample was predominantly male, with 59.1 percent of respondents men, and 59.4 percent were older than 30 years. Just over half, 51.8 percent, were public health physicians, the professional group that carries much of the day-to-day burden of disease surveillance, prevention and health education in China’s public health infrastructure.

To measure burnout, the researchers used the Maslach Burnout Inventory, or MBI, the most widely used instrument in occupational health psychology. The MBI decomposes burnout into three dimensions: emotional exhaustion, the feeling of being drained by work; depersonalization, a cynical detachment from the people the work is meant to serve; and reduced personal accomplishment, a diminished sense of competence and meaning. Intent to leave was assessed with O’Reilly’s four-item scale, a compact measure of how seriously a worker is contemplating departure from their current position.

The methodological innovation of the study lies in its analytical approach. Instead of running a traditional regression that estimates the average effect of a burnout score on quitting intentions, the team estimated a regularized partial correlation network. In this framework, each burnout symptom and each intent-to-leave item is a node, and the statistical associations between them, after controlling for all other variables in the network, are the edges. The result is a map, not unlike a subway diagram, in which the busiest stations and the most heavily trafficked lines can be identified. Centrality indices quantify which nodes are most strongly connected to the rest of the network, while bridge centrality indices identify which symptoms connect otherwise separate communities of nodes, in this case the burnout cluster and the intent-to-leave cluster.

The network revealed dense interconnections between burnout symptoms and intent to leave, confirming that the two constructs are not merely correlated in the aggregate but are woven together at the level of individual symptoms. Three symptoms emerged as the most central in the entire network. The first was severe exhaustion, captured by item MBI5 of the Maslach Burnout Inventory. The second was declining work interest, item MBI6. The third was doubts about the value of one’s work, item MBI8. In network terms, these three nodes sat at the heart of the web, meaning they maintained the strongest direct associations with the surrounding symptoms even after the regularized estimation pruned weaker connections.

Perhaps the most striking finding concerned the bridge symptoms. Two items, MBI6 and MBI8, both of which belong to the depersonalization dimension of burnout, showed the strongest bridge centrality linking depersonalization to intent to leave. In plain terms, when a public health worker begins to lose interest in the work and to question whether the work has value at all, those two experiences appear to be the primary conduits through which burnout translates into a concrete intention to quit. Emotional exhaustion, by contrast, while highly central within the burnout community, did not serve as the strongest bridge to leaving, suggesting that feeling drained and wanting to leave are connected but not identical phenomena.

This distinction has real practical significance. Traditional burnout interventions often target exhaustion, on the assumption that reducing fatigue will reduce turnover. The network evidence suggests a more nuanced picture: exhaustion is a core symptom of the burnout syndrome, but the pathway from burnout to intent to leave appears to run primarily through the depersonalization symptoms of declining interest and doubts about work value. If the network structure reflects causal dynamics, as network theorists propose, then interventions that rekindle a sense of meaning and engagement in the work itself might do more to retain workers than interventions focused solely on workload reduction, although the authors are careful to frame these as candidate targets rather than proven causal levers.

The researchers took seriously the question of whether their network map was statistically trustworthy. Using bootstrap methods, they evaluated the stability and accuracy of the network across all indices, and the network demonstrated good stability and accuracy. This matters because network analyses can be sensitive to sample fluctuations; a network whose edge weights and centrality rankings shift dramatically under resampling would offer little guidance for intervention design. The reported stability indicates that the identification of severe exhaustion, declining work interest and doubts about work value as central nodes, and of MBI6 and MBI8 as bridge symptoms, is unlikely to be a statistical artifact of this particular sample.

The context of the study is important. The COVID-19 pandemic exacerbated burnout and intent to leave among public health workers worldwide, and China’s public health workforce was no exception, having borne an extraordinary burden during pandemic control efforts. Understanding which psychological states most strongly propel workers toward the exit is therefore not an academic exercise but a workforce security question. Attrition among public health physicians and allied professionals erodes institutional memory, weakens surveillance capacity and increases the load on those who remain, potentially feeding a self-reinforcing cycle of burnout and departure.

The authors conclude that the three central symptoms, severe exhaustion, declining work interest and doubts about work value, together with the bridging role of the two depersonalization symptoms, highlight specific symptom targets for intervention strategies aimed at reducing burnout-related intent to leave among public health workers. The study received no external funding, was approved by the Medical Ethics Committee of the Second Hospital of Changsha, and obtained electronic informed consent from all participants. As a cross-sectional survey, it captures associations at a single point in time and cannot by itself establish that treating a given symptom will prevent resignation; longitudinal and intervention studies will be needed to test that proposition. But by replacing the blunt question of whether burnout predicts quitting with the sharper question of which symptoms carry the strongest connections, the study offers workforce planners a more precise map of where to intervene, and it suggests that restoring meaning and interest in public health work may be as important as reducing the hours that drain it.

Subject of Research: Network analysis of burnout symptoms and intent to leave among Chinese public health workers

Article Title: Mapping the association between burnout and intent to leave: a network analysis of public health workers in China

Article References: Chen, G., Wu, S., Zhang, X., Xie, H., Zhu, S., Wan, L., Zou, S., Liu, J., Ke, J., & Liang, K. (2026). Mapping the association between burnout and intent to leave: a network analysis of public health workers in China. BMC Public Health. https://doi.org/10.1186/s12889-026-29427-1

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29427-1

Keywords: burnout, intent to leave, public health workers, network analysis, Maslach Burnout Inventory, depersonalization, emotional exhaustion, occupational health psychology, China, workforce attrition, BMC Public Health, cross-sectional survey

The album, largely conceived by bassist and lyricist Roger Waters, follows Pink, a rock musician who erects an imaginary wall brick by brick, each brick a loss, a humiliation or a costly adaptation: a father killed in the Second World War, an overprotective mother, an authoritarian teacher, the loneliness of fame. The story is partly autobiographical — Waters modeled the protagonist on himself and the dead father on his own. When the wall is complete, Pink is protected from everything and incapable of genuine contact. The narrative arc is cumulative and non-linear, assembling apparently disconnected events that only in retrospect reveal a logic of construction, a structure the author compares directly to the trajectory of professional formation. Each brick, he writes, is a unit of undeclared learning.

The conceptual anchor of the essay is the scholarship on the hidden curriculum, formalized by Frederic Hafferty and Ronald Franks in the 1990s. They proposed that medical schools teach through three simultaneous registers: the formal curriculum that institutions declare, the informal curriculum learned in everyday interactions outside structured spaces such as corridors and rounds, and the hidden curriculum transmitted through institutional culture — unwritten policies, implicit assessment criteria, resource allocation and the rituals regulating professional belonging. The hidden register is the hardest to reform precisely because it operates without its agents recognizing it as teaching. Reforms confined to the formal curriculum are necessary but insufficient, the author notes, when they do not address what operates beneath the surface. One of the phenomenon’s most-cited formulations, from William Gofton and Glenn Regehr, holds that the hidden curriculum is what teachers teach without knowing they teach and what students learn without knowing they learn.

Among the best-documented effects of this silent pedagogy is the erosion of empathy. A longitudinal study by Mohammadreza Hojat and colleagues found that empathy scores decline from the third year of medical school onward — when clinical activity with real patients begins — and continue falling through residency. The finding is contested: other researchers argue the decline is largely an artifact of self-report measurement and is small or absent in many countries. The essay adopts the concept with caution, emphasizing that the training environment acts upon empathy regardless of its measured trajectory. What distinguishes psychiatric training, the author argues, is the nature of its clinical material — delusion, suicidality, abuse, psychotic disorganization — and a peculiar reflexive bind: psychiatrists are trained to recognize in others precisely what they learn not to recognize in themselves. The unsaid lesson is that this material must be borne without the personal cost being named, and that naming the cost may be read as fragility rather than reflective competence.

The essay then maps four moments of the album onto four bricks of psychiatric formation. The first, drawn from the tracks Mother and The Thin Ice, concerns what students carry before they arrive. The literature documents a recurrent profile among medical entrants: high perfectionism, identity organized around performance, and an early relation to caring for others that precedes the choice of profession. The parentified child — who learns early that their value lies in caring — enters a profession organized around care and rediscovers a familiar position. Medicine does not create the compulsive caregiver; it inherits them. In psychiatry, the dynamic deepens, because specialty choice is rarely random: trainees who excel intellectually while carrying significant psychic suffering are more common than institutions perceive, and what is rarely asked is whether the brilliance exists despite the pain or because of it.

The second brick comes from the album’s school tracks and describes teaching by humiliation. The cruel teacher in the album teaches no content; he teaches that humiliation can be constitutive of the pedagogical relation and that bearing it is the price of belonging. In medical education the mechanism has a name in the literature, but the author insists Waters captures what empirical accounts describe: the cumulative effect. No single episode of humiliation builds the wall; the repetition does, each apparently innocuous episode adding to the last. A specific variant appears in psychiatric training: the supervisor who interviews an emergency-room patient without privacy never explicitly teaches that privacy is dispensable, yet the observing student learns both the interview technique and the silent, durable norm that certain conditions are tolerable.

The third brick, from Comfortably Numb, offers a phenomenology of depersonalization. In the narrative, Pink stops feeling — not by decision but by exhaustion, arriving at something that looks like peace and is anesthesia. The educational correlate is burnout, and particularly the depersonalization central to Christina Maslach’s account: an emotional distancing that lets the professional keep functioning. Those who numb do not decide to stop feeling; they stop because the environment teaches, without saying so, that feeling is an obstacle to efficiency. The essay’s sharpest observation here is the contradiction the formation produces: a psychiatrist who identifies dissociation in a patient but does not perceive their own depersonalization as a response to the work — clinical competence and personal blindness in the same person.

The fourth brick, from the album’s closing sequence The Trial, resonates with disproportionate self-criticism and the impostor phenomenon, widely documented among students and residents: not merely the feeling of inadequacy but the conviction that others will eventually discover the fraud. The concept has been justly criticized for individualizing what is structural, locating in the trainee a fault that belongs to the culture producing it. That criticism, the author writes, is the essay’s point: the self-judgment is a brick laid by the environment, internalized until it feels like one’s own. He is careful to add that none of this is destiny — the same hidden curriculum transmits much that is good, and many learners emerge determined not to repeat it. The most personal section of the essay discloses that the author himself stopped teaching the class in 2020, during the pandemic, describing what clinical language calls experiential avoidance: unelaborated personal material was being repeatedly enacted in front of students, and at some point the cost of re-exposure exceeded what he could sustain. He draws on Ronaldo Cassorla’s concept of enactment — unsymbolized emotional material acted out rather than thought — and observes that an educator withdrawing from a subject without explanation teaches students, silently, that certain subjects disappear from the curriculum for invisible reasons. That, too, is a brick.

What can be done? The essay is deliberately modest about dismantling and emphasizes the patient work of opening breaches. Formal curricular reform is necessary but not sufficient; the next step is institutional conditions in which what is felt during training can be said — not as complaint but as formative data. Balint groups, reflective portfolios and formative supervision are not new; what determines whether they work is the culture that sustains them. A portfolio read with care and answered with feedback is a device of elaboration, while a portfolio filled in by obligation and ignored is another brick. Within such spaces, art can accomplish what no didactic lecture on professional distress can: it lets the subject recognize themselves without feeling diagnosed. Drawing on Parker Palmer’s idea of a third thing, introduced into medical education by Elaine Gaufberg and colleagues, the author describes The Wall as an oblique mirror that shows what is felt without demanding it be said. He also invokes institutional enactment — the collective acting-out of unthought material transmitted between generations of formators — to argue that reform demands educators recognize the wall built in themselves, and that institutions make such recognition possible. The album ends not with triumph but with the fragile voices outside the wall; in medical education, the author concludes, those voices are the students who write in portfolios what they actually felt, the faculty who admit that the material affects them, and those who ask how someone else is and wait for the real answer.

Subject of Research: The use of Pink Floyd's The Wall as a phenomenological model of the hidden curriculum in psychiatric and medical education

Article Title: Another Brick in the Wall: Pink Floyd’s The Wall as a Phenomenological Model of the Hidden Curriculum in Psychiatric Education

Article References: dos Santos Júnior, A. (2026). Another Brick in the Wall: Pink Floyd’s The Wall as a Phenomenological Model of the Hidden Curriculum in Psychiatric Education. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02423-8

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02423-8

Keywords: hidden curriculum, medical education, psychiatric training, Pink Floyd, The Wall, empathy decline, burnout, depersonalization, impostor phenomenon, teaching by humiliation, educator distress, medical humanities

The review, led by Qing Huang and colleagues, synthesizes epidemiological data, neuroimaging findings, electrophysiological studies, and treatment reports to build an integrated framework for the syndrome. Its central claim is provocative: the anxiety, depression, depersonalization, fatigue, and sleep disturbances that so often accompany visual snow may not simply be psychological reactions to a chronic and distressing symptom. Instead, they may be intrinsic expressions of the same underlying neurobiology, reflecting dysfunction in the shared circuits that govern perception, emotion regulation, and salience attribution. This reframing has significant implications for how clinicians diagnose, investigate, and ultimately treat the disorder.

Epidemiologically, visual snow syndrome appears to be far from rare. Cross-sectional studies conducted in Italy, the United Kingdom, and Russia have estimated prevalence at between 0.7 and 4.4 percent, using symptom-based screening questionnaires followed by clinical validation. An online survey found that 41.9 percent of respondents had experienced visual snow phenomena at some point, yet only 4.49 percent met the full diagnostic criteria of the International Classification of Headache Disorders, third edition. Most affected individuals screened in prevalence studies had never received a formal diagnosis before enrollment, underscoring how frequently the condition escapes clinical recognition. Cohorts typically show a female predominance and a mean age of roughly 25 to 30 years, although one large study of more than 1,100 patients found no significant sex difference and a mean age of 29.

Onset patterns are strikingly variable. Reported proportions of childhood-onset cases, in which symptoms have been present for as long as the patient can remember, range from 17.2 percent in a hospital-based outpatient study to 89.6 percent in an online survey, with two large cohorts suggesting approximately 40 percent. The review cautions that this phrase should not be equated with a truly congenital condition, although the data raise the possibility of a genetically predisposed congenital subtype whose true prevalence remains unknown. In other patients, onset follows a precipitating event: 42.3 percent of patients in one study reported a triggering event or associated comorbidity. Migraine is the most common, affecting roughly 50 to 70 percent of patients, and the likelihood of developing the syndrome is significantly elevated among people with migraine. Case reports implicate occipital ischemic stroke, hallucinogen persisting perception disorder associated with substances such as LSD and delta-8-tetrahydrocannabinol, selective serotonin reuptake inhibitor exposure, mild traumatic brain injury, infection, idiopathic intracranial hypertension, and ocular abnormalities. The emerging picture is of a disorder triggered by multiple environmental or pathological factors in genetically susceptible individuals.

The mechanistic evidence reviewed by the authors is where the network concept gains its force. Ultra-high-field 7 Tesla structural MRI has revealed that, despite the absence of gross morphometric abnormalities, patients show reduced T1 values following a clear caudorostral gradient, most pronounced in the occipital cortex and diminishing toward parietal, temporal, and prefrontal regions. Significant T1 reductions across multiple thalamic nuclei suggest alterations in neuronal density, membrane integrity, or microstructural organization, while voxel-based morphometry has documented increased gray matter volume at the right lingual gyrus–fusiform gyrus junction and in temporal and limbic lobes, alongside reduced volume in the superior temporal gyrus. Together, these findings map a distributed visual–thalamic–limbic architecture rather than a single lesioned locus.

Functional studies reinforce this distributed view. Magnetoencephalography has demonstrated increased gamma-band power in the primary visual cortex, a signature of cortical hyperexcitability, together with reduced alpha-phase-to-gamma-amplitude coupling, indicating impaired top-down inhibitory modulation from higher-order visual areas. Resting-state EEG shows reduced alpha-band power spectral density in the parietotemporal region, corresponding to secondary visual cortex dysfunction, and abnormally enhanced activity-dependent neuroplasticity has also been reported. Positron emission tomography reveals hypermetabolism in the right extrastriate cortex accompanied by hypometabolism in temporoparietal regions involved in auditory processing and attentional control. Functional MRI demonstrates abnormal connectivity within the visual network and disrupted connections involving the thalamus, basal ganglia, default mode network, and salience-attention systems, both at rest and during stimulation. EEG microstate analyses add evidence of unstable large-scale network dynamics, with reduced microstate duration and amplitude and abnormal transitions among auditory–visual, visual, and salience-related states. In this model, patients cannot effectively suppress internally generated visual noise, allowing it to enter conscious awareness as continuous static.

Crucially, the same circuitry offers a bridge to the psychiatric dimension. Neuroimaging has identified increased gray matter volume in bilateral limbic structures, including the anterior cingulate cortex, insula, and prefrontal cortex, along with hypometabolism in the hippocampal–parahippocampal region. Reduced parahippocampal–occipital connectivity correlates significantly with subjective distress, suggesting disruption of a perception–emotion–inhibition loop. Receptor-enriched connectivity analyses point to abnormalities in glutamatergic and serotonergic pathways within the anterior cingulate, insula, orbitofrontal cortex, and visual association areas. Notably, psychiatric symptom severity does not differ between childhood-onset and later-onset patients, and longitudinal studies show that anxiety and depressive symptoms remain stable over time, patterns more consistent with shared neurobiology than with purely reactive distress. Familial aggregation adds a genetic dimension: 2.4 to 10 percent of first-degree relatives are affected, and migraine prevalence among relatives ranges from 9.4 to 56 percent, hinting at shared vulnerability, though no genome-wide association or linkage studies have yet been performed.

The clinical burden is substantial. Depressive symptoms affect between 14.1 and 53 percent of patients depending on the instrument and design, while anxiety symptoms range from 15.4 to 49 percent; longitudinal assessments found lifetime rates of 41.4 percent for depression and 44.8 percent for anxiety, and symptom severity correlates with visual symptom severity. Approximately 45 percent of patients experience depersonalization, with a quarter reaching clinical threshold. Sleep is frequently disrupted, with 44.8 percent reporting difficulty initiating sleep due to visual interference in darkness, and 49.6 percent meeting criteria for clinically significant fatigue. Quality of life is markedly impaired across mental health, social functioning, and role-emotional domains, and recent work shows that self-efficacy and quality of life sequentially mediate the relationship between symptom burden and adverse outcomes including depression and suicidal ideation, identifying psychosocial mechanisms as actionable intervention targets.

Treatment remains the weakest link. Pharmacological options are largely empirical and modestly effective: lamotrigine produced partial improvement in 19.2 percent of patients in one study with no complete remissions and adverse reactions in half of users, while topiramate response rates range from 15.4 to 28.5 percent. A survey of 400 patients found that antidepressants, antiepileptic drugs, antibiotics, and benzodiazepines were generally ineffective and often poorly tolerated. By contrast, non-pharmacological approaches show encouraging preliminary signals. Tinted lenses, particularly yellow and blue spectral filters, reduce the intensity, duration, and frequency of visual snow in 80 to 92 percent of individuals and improve palinopsia and photophobia by roughly 50 percent on average. Repetitive transcranial magnetic stimulation targeting the visual cortex or bilateral lingual gyri has shown favorable safety and preliminary efficacy, and prolonged exposure to high-contrast dynamic visual noise can reduce or temporarily eliminate symptoms. Mindfulness-based cognitive therapy has demonstrated dual benefits for visual symptoms and psychological distress, plausibly by modulating visual network connectivity through enhanced attentional flexibility and non-reactive awareness. Patients also report that darkness, bright light, stress, alcohol, sleep deprivation, and prolonged screen exposure worsen symptoms, while adequate sleep, stress reduction, meditation, and regular exercise help.

The review’s authors are careful to note that much of the current evidence derives from cross-sectional, retrospective, or uncontrolled studies, so causal relationships among visual symptoms, network dysfunction, and psychiatric manifestations must be interpreted cautiously. Yet the convergence of structural, functional, electrophysiological, and neurochemical findings on a single integrated model is difficult to ignore. They call for multidisciplinary research integrating neurology, psychiatry, neuroimaging, electrophysiology, and genetics, including Mendelian randomization, polygenic risk scoring, and multi-omics approaches, to identify biomarkers linking symptom dimensions to specific network and molecular alterations. For a condition that affects as many as one in twenty-five people by some estimates yet remains routinely missed, recognizing visual snow syndrome as a genuine neuropsychiatric network disorder may be the first step toward precision diagnosis and, eventually, effective therapy.

Subject of Research: Visual snow syndrome as a neuropsychiatric network disorder involving visual cortical hyperexcitability, thalamocortical dysrhythmia, and limbic dysfunction

Article Title: Visual snow syndrome as a neuropsychiatric network disorder: clinical features, mechanisms, and therapeutic perspectives

Article References: Huang, Q., Wang, J., Zhao, L., Yu, X., Wang, W., Wang, Z., & Liu, Y. (2026). Visual snow syndrome as a neuropsychiatric network disorder: clinical features, mechanisms, and therapeutic perspectives. Journal of Neurology, 273(10), Article 610. https://doi.org/10.1007/s00415-026-14137-w

Image Credits: AI Generated

DOI: 10.1007/s00415-026-14137-w

Keywords: visual snow syndrome, neuropsychiatric disorders, thalamocortical dysrhythmia, functional connectivity, migraine, depersonalization, neuroimaging, transcranial magnetic stimulation, tinted lenses, mindfulness-based cognitive therapy, anxiety, depression