Diet is a modifiable factor that may affect sleep, but the associations of macronutrient intakes with insomnia are inconsistent. We investigated the associations of protein, fat, and carbohydrate intakes with insomnia symptoms. In this cross-sectional analysis of 4435 non-shift workers, macronutrient intakes were assessed by the brief-type self-administered diet history questionnaire, which requires the recall of usual intakes of 58 foods during the preceding month. Presence of insomnia symptoms, including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and poor quality of sleep (PQS) were self-reported. Logistic regression analysis was used to estimate odds ratios (ORs) and 95% CIs adjusted for demographic, psychological, and behavioral factors, as well as medical histories. Low protein intake (<16% vs ≥16% of total energy) was associated with DIS (OR 1.24, 95% CI 0.99–1.56) and PQS (OR 1.24, 95% CI 1.04–1.48), while high protein intake (≥19% vs <19% of total energy) was associated with DMS (OR 1.40, 95% CI 1.12–1.76). Low carbohydrate intake (<50% vs ≥50% of total energy) was associated with DMS (OR 1.19, 95% CI 0.97–1.45). Protein and carbohydrate intakes in the daily diet were associated with insomnia symptoms. The causality of these associations remains to be explained.

Stigma towards people with mental health problems (PMHP) is known to have substantial negative impacts on their lives. More in-depth exploration of the stigma and discrimination experienced by PMHP in low- and middle-income countries is needed. Previous research suggests that negative attitudes towards PMHP are widespread among the Filipino general public. However, no study has investigated PMHP’s own experiences of being stigmatised in the Philippines. A qualitative study was conducted on the stigma experienced by PMHP (including people with epilepsy) and its related factors in the Philippines, employing the constructivist grounded theory approach. We analysed data on 39 PMHP collected through interviews with PMHP, their carers, and community health volunteers who know them well. The findings highlight the culturally and socio-economically specific contexts, consequences, and impact modifiers of experiences of stigma. Participants emphasised that PMHP face stigma because of the cultural traits such as the perception of mental health problem as a disease of the family and the tendency to be overly optimistic about the severity of the mental health problem and its impact on their life. Further, stigma was experienced under conditions where mental health care was not readily available and people in the local community could not resolve the PMHP’s mental health crisis. Stigma experiences reduced social networks and opportunities for PMHP, threatened the economic survival of their entire family, and exacerbated their mental health problems. An individual’s reaction to negative experiences can be fatalistic in nature (e.g. believing in it is God’s will). This fatalism can help PMHP to remain hopeful. In addition, traditional communal unity alleviated some of the social exclusion associated with stigma. The study indicates that existing stigma-reduction strategies might have limitations in their effectiveness across cultural settings. Therefore, we propose context-specific practical implications (e.g. emphasis on environmental factors as a cause of mental health problems, messages to increase understanding not only of the possibility of recovery but also of challenges PMHP face) for the Philippines.

Functions of the orbitofrontal cortex include diverse social, cognitive and affective processes, many of which are abnormal in autism spectrum disorders (ASDs). Recently, altered orbitofrontal sulcogyral patterns have been revealed in several psychiatric conditions, such as schizophrenia, indicating a possibility that altered orbitofrontal sulcogyral morphology reflects abnormal neurodevelopment. However, the presence of sulcal alterations in ASD remains unexplored. Using structural magnetic resonance imaging, subtypes of the ‘H-shaped’ sulcus (Type I, II and III, in order of frequency), posterior orbital sulcus (POS) and intermediate orbital sulcus were identified in each hemisphere of adult males with ASD (n = 51) and matched normal controls (n = 55) based on the study by Chiavaras and Petrides. ASD showed a significantly altered distribution of H-shaped sulcal subtypes in both hemispheres, with a significant increase of Type III. A significant alteration in the distribution of sulcal subtypes was also identified in the right hemisphere POS of ASD. Categorical regression analysis revealed that Type I and II expressions predicted a reduced total Autism-Spectrum Quotient score. Furthermore, Type I expression was associated with a reduced ‘attention to detail’ subscale score. The results demonstrate that altered sulcogyral morphology can be a marker for abnormal neurodevelopment leading to the increased risk of developing autism.

Objectives The 1995 Great Hanshin-Awaji Earthquake had an enormous negative impact on survivors’ health. Many survivors experienced psychological distress and their long-term psychological recovery process remains unclear. Our objective was thus to explore this long-term psychological recovery process. Design Qualitative study. Setting From January to December 2015, face-to-face interviews were conducted in Kobe, Japan. Participants 20 affected survivors (55% female; ages ranged from 7 to 60 at the time of the disaster)—10 volunteer storytellers, six first responders (firefighters/public health nurses) and four post-traumatic stress disorder patients. Outcome measures We asked participants about their experiences and psychological distress relating to the earthquake and what facilitated or hindered their psychological recovery. We analysed interview data using constructivist grounded theory. Results Participants experienced diverse emotional reactions immediately after the disaster and often hyperfocused on what they should do now. This hyperfocused state led to both mental and physical health problems several months after the disaster. Months, and sometimes years, after the disaster, guilt and earthquake narratives (ie, expressing thoughts and feelings about the earthquake) played key roles in survivors’ psychological recovery: guilt suppressed their earthquake narrative; conversely, the narrative alleviated feelings of distress about the earthquake. In time, participants reconsidered their earthquake experiences both alone and through social interaction. This alleviated their emotional reactions; however, participants still experienced attenuated emotional reactions, and some hid their feelings of distress even 20 years postdisaster. Interpersonal relationships modified this psychological process both positively and negatively. Conclusions Future psychosocial support plans for disaster survivors may need to (1) include both mental and physical care in the transition from the acute phase to the recovery phase; (2) facilitate supportive interpersonal relationships for survivors during the mid-term recovery phase and (3) provide long-term psychological support to the most traumatised survivors, even if they appear to be functioning normally.