{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T20:22:58Z","timestamp":1793910178076,"version":"4.8.0"},"reference-count":63,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2025,5,24]],"date-time":"2025-05-24T00:00:00Z","timestamp":1748044800000},"content-version":"unspecified","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,4,27]]},"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Rapid urbanisation and the dense population of Bangladesh foster the growth of slum settlements, where poverty and food insecurity are magnified by economic instability and inflationary pressures, adversely affecting psychological health.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>This study aimed to assess household food security and its influence on psychological well-being among adults living in urban slums of Bangladesh.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross-sectional study using convenient sampling was conducted among 300 adults in slums in Dhaka, Bangladesh, using a semistructured questionnaire to collect data on sociodemographics, food security and mental health status. Multivariable logistic regression analyses were conducted to observe the influence of food insecurity on mental health status, controlling for other covariates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The majority of the participants experienced food insecurity, with 38.0% expressing severe food insecurity. High levels of psychological distress were observed, including stress (54.7%), anxiety (63.3%) and depression (73.3%). Older adults (aOR 4.5, 95%\u2009CI 1.3 to 15.5) and females (aOR 4.1, 95%\u2009CI 2.0 to 8.4) had higher odds of experiencing anxiety. Single individuals were more prone to experience depression, while homemakers exhibited elevated levels of both depression and anxiety. Furthermore, moderate to severe food insecurity was significantly associated with higher odds of depression (aOR 2.8, 95%\u2009CI 1.2 to 6.7) and anxiety (aOR 8.2, 95%\u2009CI 3.3 to 20.3) compared with no or mild food insecurity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study highlights the pervasive influence of household food insecurity on urban slum dwellers\u2019 psychological well-being. Addressing vulnerabilities tied to age, marital status and occupation is crucial for alleviating mental health burdens.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2024-091640","type":"journal-article","created":{"date-parts":[[2025,5,25]],"date-time":"2025-05-25T01:35:20Z","timestamp":1748136920000},"page":"e091640","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Household food security and its influence on psychological well-being: a cross-sectional study among adults in slums in Bangladesh"],"prefix":"10.1136","volume":"15","author":[{"given":"A B M Nahid","family":"Hasan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mst Ishrat Jahan","family":"Luky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahmida","family":"Rashid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Most Mahfuja","family":"Khanam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamal","family":"Hossain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mst Rokshana","family":"Rabeya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9929-1236","authenticated-orcid":false,"given":"Azaz Bin","family":"Sharif","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,5,24]]},"reference":[{"key":"2025053123004126000_15.5.e091640.1","unstructured":"Rural U , Source T . Chapter I urban demographic issues and challenges for a new urban Agenda. 2021."},{"key":"2025053123004126000_15.5.e091640.2","doi-asserted-by":"crossref","unstructured":"Panday PK . The face of urbanization and urban poverty in Bangladesh: explaining the slum development initiatives in the light of global experiences, face urban urban poverty Bangladesh explain slum. Dev Initiat Light Glob Exp 2020;1\u2013151. doi:10.1007\/978-981-15-3332-7_1","DOI":"10.1007\/978-981-15-3332-7_1"},{"key":"2025053123004126000_15.5.e091640.3","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.jum.2018.03.002","article-title":"Assessing urban sustainability of slum settlements in Bangladesh: Evidence from Chittagong city","volume":"7","author":"Uddin","year":"2018","journal-title":"J Urban Manag"},{"key":"2025053123004126000_15.5.e091640.4","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph15030495"},{"key":"2025053123004126000_15.5.e091640.5","unstructured":"Global economy set for weakest half-decade performance in 30 years, Available: https:\/\/www.worldbank.org\/en\/news\/press-release\/2024\/01\/09\/global-economic-prospects-january-2024-press-release"},{"key":"2025053123004126000_15.5.e091640.6","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1108\/14468950710830554","article-title":"Poverty and vulnerability in urban Bangladesh: the case of slum communities in Dhaka City","volume":"6","author":"Hossain","year":"2007","journal-title":"Int J Development Issues"},{"key":"2025053123004126000_15.5.e091640.7","doi-asserted-by":"crossref","first-page":"106918","DOI":"10.1016\/j.eneco.2023.106918","article-title":"Inflation, oil prices, and economic activity in recent crisis: Evidence from the UK","volume":"126","author":"Ahmed","year":"2023","journal-title":"Energy Economics"},{"key":"2025053123004126000_15.5.e091640.8","unstructured":"Summary | Effects of Inflation on the Livelihoods of Poor Households in Bangladesh \u2013 SANEM, Available: https:\/\/sanemnet.org\/summary-effects-of-inflation-on-the-livelihoods-of-poor-households-in-bangladesh\/"},{"key":"2025053123004126000_15.5.e091640.9","unstructured":"Poverty: An in-depth Guide. Definition, types and many facts - Richmond Vale Academy, Available: https:\/\/richmondvale.org\/poverty\/"},{"key":"2025053123004126000_15.5.e091640.10","unstructured":"National Estimate of \u201cNew Poor\u201d Remains High in May 2022 Due to Inflation and Slower-Than-Expected Recovery \u2013 Power and Participation Research Centre (PPRC), Available: https:\/\/www.pprc-bd.org\/national-estimate-of-new-poor-remains-high-in-may-2022-due-to-inflation-and-slower-than-expected-recovery\/"},{"key":"2025053123004126000_15.5.e091640.11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2023\/6691810","article-title":"Determinants of household food insecurity and depression in mothers: evidence from Ghana","volume":"2023","author":"Wemakor","year":"2023","journal-title":"Adv Public Health"},{"key":"2025053123004126000_15.5.e091640.12","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-12-177","article-title":"Mental health in the slums of Dhaka - a geoepidemiological study","volume":"12","author":"Gruebner","year":"2012","journal-title":"BMC Public Health"},{"key":"2025053123004126000_15.5.e091640.13","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyt.2023.1160955","article-title":"Suicide stigma and suicide literacy among Bangladeshi young adults: a cross-sectional study","volume":"14","author":"Jahan","year":"2023","journal-title":"Front Psychiatry"},{"key":"2025053123004126000_15.5.e091640.14","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1177\/0706743717752879","article-title":"The relation between food insecurity and mental health care service utilization in Ontario","volume":"63","author":"Tarasuk","year":"2018","journal-title":"Can J Psychiatry"},{"key":"2025053123004126000_15.5.e091640.15","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/j.ssmph.2017.05.013","article-title":"The household food insecurity gradient and potential reductions in adverse population mental health outcomes in Canadian adults","volume":"3","author":"Jessiman-Perreault","year":"2017","journal-title":"SSM Popul Health"},{"key":"2025053123004126000_15.5.e091640.16","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyt.2021.769048","article-title":"Anxiety and insomnia among urban slum dwellers in Bangladesh: the role of COVID-19 and its associated factors","volume":"12","author":"Koly","year":"2021","journal-title":"Front Psychiatry"},{"key":"2025053123004126000_15.5.e091640.17","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-021-10631-0","article-title":"The association between food insecurity and mental health during the COVID-19 pandemic","volume":"21","author":"Fang","year":"2021","journal-title":"BMC Public Health"},{"key":"2025053123004126000_15.5.e091640.18","doi-asserted-by":"crossref","first-page":"8993","DOI":"10.1038\/s41598-023-36299-7","article-title":"Perceived barriers to maintain physical activity and its association to mental health status of Bangladeshi adults: a quantile regression approach","volume":"13","author":"Hasan","year":"2023","journal-title":"Sci Rep"},{"key":"2025053123004126000_15.5.e091640.19","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0254954","article-title":"Food insecurity during COVID-19 pandemic: A genuine concern for people from disadvantaged community and low-income families in Province 2 of Nepal","volume":"16","author":"Singh","year":"2021","journal-title":"PLoS ONE"},{"key":"2025053123004126000_15.5.e091640.20","unstructured":"Korail . Rail tickets 2014 2022."},{"key":"2025053123004126000_15.5.e091640.21","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(15)70048-3","article-title":"The psychological toll of slum living\u2014an assessment of mental health, disability, and slum-related adversities in Mumbai, India","volume":"2","author":"Subbaraman","year":"2014","journal-title":"Lancet Glob Health"},{"key":"2025053123004126000_15.5.e091640.22","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0259098","article-title":"Household food insecurity, income loss, and symptoms of psychological distress among adults following the Cyclone Amphan in coastal Bangladesh","volume":"16","author":"Hossain","year":"2021","journal-title":"PLoS ONE"},{"key":"2025053123004126000_15.5.e091640.23","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0001017","article-title":"Knowledge, attitude, and practice of Bangladeshi urban slum dwellers towards COVID-19 transmission-prevention: A cross-sectional study","volume":"2","author":"Hasan","year":"2022","journal-title":"PLOS Glob Public Health"},{"key":"2025053123004126000_15.5.e091640.24","doi-asserted-by":"publisher","DOI":"10.1186\/1471-244X-8-1"},{"key":"2025053123004126000_15.5.e091640.25","doi-asserted-by":"crossref","unstructured":"Coates J , Swindale A , Bilinsky P . Household Food Insecurity Access Scale (HFIAS) for measurement of food access: indicator guide. Food Nutr Tech 2007.","DOI":"10.1037\/e576842013-001"},{"key":"2025053123004126000_15.5.e091640.26","doi-asserted-by":"publisher","DOI":"10.1016\/0005-7967(94)00075-U"},{"key":"2025053123004126000_15.5.e091640.27","doi-asserted-by":"crossref","DOI":"10.1186\/1471-244X-13-24","article-title":"Validation of the depression anxiety stress scales (DASS) 21 as a screening instrument for depression and anxiety in a rural community-based cohort of northern Vietnamese women","volume":"13","author":"Tran","year":"2013","journal-title":"BMC Psychiatry"},{"key":"2025053123004126000_15.5.e091640.28","doi-asserted-by":"crossref","first-page":"67","DOI":"10.3329\/bjpsy.v28i2.32740","article-title":"Translation of DASS 21 into Bangla and validation among medical students","volume":"28","author":"Alim","year":"2017","journal-title":"Bang J Psychiatry"},{"key":"2025053123004126000_15.5.e091640.29","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1016\/j.chest.2018.12.010","article-title":"Validity and Responsiveness of the Depression Anxiety Stress Scales-21 (DASS-21) in COPD","volume":"155","author":"Yohannes","year":"2019","journal-title":"Chest"},{"key":"2025053123004126000_15.5.e091640.30","unstructured":"Depression Anxiety Stress Scales \u2013 Short Form (DASS-21) \u2013 NovoPsych, Available: https:\/\/novopsych.com.au\/assessments\/depression\/depression-anxiety-stress-scales-short-form-dass-21\/"},{"key":"2025053123004126000_15.5.e091640.31","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-138-8-200304150-00012"},{"key":"2025053123004126000_15.5.e091640.32","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s41043-024-00546-y","article-title":"Assessing the mental health of slum dwellers: an ordinal logistic approach","volume":"43","author":"Hijol","year":"2024","journal-title":"J Health Popul Nutr"},{"key":"2025053123004126000_15.5.e091640.33","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-043365","article-title":"Acute food insecurity and short-term coping strategies of urban and rural households of Bangladesh during the lockdown period of COVID-19 pandemic of 2020: report of a cross-sectional survey","volume":"10","author":"Das","year":"2020","journal-title":"BMJ Open"},{"key":"2025053123004126000_15.5.e091640.34","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1111\/jpm.12969","article-title":"Food insecurity in adults with severe mental illness: A systematic review with meta-analysis","volume":"31","author":"Smith","year":"2024","journal-title":"J Psychiatr Ment Health Nurs"},{"key":"2025053123004126000_15.5.e091640.35","doi-asserted-by":"crossref","DOI":"10.3390\/nu16132036","article-title":"The intersection of food security and mental health in the pursuit of sustainable development goals","volume":"16","author":"Onyeaka","year":"2024","journal-title":"Nutrients"},{"key":"2025053123004126000_15.5.e091640.36","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0255392","article-title":"Food insecurity and mental health of women during COVID-19: evidence from a developing country","volume":"16","author":"Rahman","year":"2021","journal-title":"PLoS ONE"},{"key":"2025053123004126000_15.5.e091640.37","doi-asserted-by":"crossref","first-page":"1700","DOI":"10.1016\/S0140-6736(21)02143-7","article-title":"Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic","volume":"398","author":"Santomauro","year":"2021","journal-title":"The Lancet"},{"key":"2025053123004126000_15.5.e091640.38","doi-asserted-by":"crossref","first-page":"49","DOI":"10.20896\/saci.v2i4.116","article-title":"Achieving millennium development goals and India vision 2020: evidences from slums of Varanasi City","volume":"2","author":"Jha","year":"2015","journal-title":"SACI"},{"key":"2025053123004126000_15.5.e091640.39","doi-asserted-by":"publisher","DOI":"10.1002\/wps.21160"},{"key":"2025053123004126000_15.5.e091640.40","doi-asserted-by":"crossref","DOI":"10.1017\/gmh.2024.37","article-title":"Gender differences in the prevalence of anxiety and depression and care seeking for mental health problems in Nepal: Analysis of nationally representative survey data","volume":"11","author":"Shawon","year":"2024","journal-title":"Glob Ment Health (Camb)"},{"key":"2025053123004126000_15.5.e091640.41","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1111\/issj.12267","article-title":"Addressing work\u2010life balance challenges of working women during COVID\u201019 in Bangladesh","volume":"71","author":"Uddin","year":"2021","journal-title":"Int Social Sci J"},{"key":"2025053123004126000_15.5.e091640.42","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/S2215-0366(16)30263-2","article-title":"Why is depression more common among women than among men?","volume":"4","author":"Kuehner","year":"2017","journal-title":"Lancet Psychiatry"},{"key":"2025053123004126000_15.5.e091640.43","first-page":"399","article-title":"Gender roles and mental health in Mexico: A review","volume":"65","author":"V\u00e1zquez","year":"2019","journal-title":"Int J Soc Psychiatry"},{"key":"2025053123004126000_15.5.e091640.44","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-038954","article-title":"Prevalence and associated factors of depression among adolescent boys and girls in Bangladesh: findings from a nationwide survey","volume":"11","author":"Mridha","year":"2021","journal-title":"BMJ Open"},{"key":"2025053123004126000_15.5.e091640.45","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph18105090","article-title":"A Study of Older Adults\u2019 Mental Health across 33 Countries during the COVID-19 Pandemic","volume":"18","author":"Tyler","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"2025053123004126000_15.5.e091640.46","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1093\/geront\/gnaa204","article-title":"Age differences in stress, life changes, and social ties during the COVID-19 pandemic: implications for psychological well-being","volume":"61","author":"Birditt","year":"2021","journal-title":"Gerontologist"},{"key":"2025053123004126000_15.5.e091640.47","unstructured":"Ali R . Changing expectations of gender roles in Bangladesh: the case of female field staff of BRAC. 2012."},{"key":"2025053123004126000_15.5.e091640.48","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1037\/fam0000913","article-title":"Happy, healthy, and wedded? How the transition to marriage affects mental and physical health","volume":"36","author":"Huntington","year":"2022","journal-title":"J Fam Psychol"},{"key":"2025053123004126000_15.5.e091640.49","doi-asserted-by":"crossref","first-page":"100631","DOI":"10.1016\/j.jadr.2023.100631","article-title":"The social cost of depression: Investigating the impact of impaired social emotion regulation, social cognition, and interpersonal behavior on social functioning","volume":"14","author":"Kupferberg","year":"2023","journal-title":"J Affective Disorders Reports"},{"key":"2025053123004126000_15.5.e091640.50","doi-asserted-by":"crossref","DOI":"10.1186\/s40359-022-00974-7","article-title":"Job insecurity and mental health related outcomes among the humanitarian workers during COVID-19 pandemic: a cross-sectional study","volume":"10","author":"Sultana","year":"2022","journal-title":"BMC Psychol"},{"key":"2025053123004126000_15.5.e091640.51","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1016\/j.jadohealth.2021.07.023","article-title":"How Has COVID-19-Related Income Loss and Household Stress Affected Adolescent Mental Health in Kenya?","volume":"69","author":"Pinchoff","year":"2021","journal-title":"J Adolesc Health"},{"key":"2025053123004126000_15.5.e091640.52","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1016\/j.neubiorev.2021.05.019","article-title":"Explaining socioeconomic disparities in health behaviours: A review of biopsychological pathways involving stress and inflammation","volume":"127","author":"Kraft","year":"2021","journal-title":"Neurosci Biobehav Rev"},{"key":"2025053123004126000_15.5.e091640.53","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0002096","article-title":"Changes in dietary habit and physical activity among the diabetic patients of Bangladesh during COVID-19: A cross-sectional study","volume":"3","author":"Jahan","year":"2023","journal-title":"PLOS Glob Public Health"},{"key":"2025053123004126000_15.5.e091640.54","doi-asserted-by":"publisher","DOI":"10.1007\/s13668-020-00309-1"},{"key":"2025053123004126000_15.5.e091640.55","doi-asserted-by":"crossref","first-page":"114042","DOI":"10.1016\/j.socscimed.2021.114042","article-title":"Unpacking the \u201cblack box\u201d of global food insecurity and mental health","volume":"282","author":"Weaver","year":"2021","journal-title":"Soc Sci Med"},{"key":"2025053123004126000_15.5.e091640.56","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.puhe.2015.11.014","article-title":"Food insecurity and mental illness: disproportionate impacts in the context of perceived stress and social isolation","volume":"132","author":"Martin","year":"2016","journal-title":"Public Health (Fairfax)"},{"key":"2025053123004126000_15.5.e091640.57","doi-asserted-by":"crossref","DOI":"10.3390\/nu16040501","article-title":"Nourishing the mind: how food security influences mental wellbeing","volume":"16","author":"Ejiohuo","year":"2024","journal-title":"Nutrients"},{"key":"2025053123004126000_15.5.e091640.58","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph15071424","article-title":"Food Insecurity and Mental Health among Females in High-Income Countries","volume":"15","author":"Maynard","year":"2018","journal-title":"Int J Environ Res Public Health"},{"key":"2025053123004126000_15.5.e091640.59","doi-asserted-by":"crossref","unstructured":"Pineau C , Williams PL , Brady J , et al . Exploring experiences of food insecurity, stigma, social exclusion, and shame among women in high-income countries: A narrative review. CanFoodStudies 2021;8. doi:10.15353\/cfs-rcea.v8i3.473","DOI":"10.15353\/cfs-rcea.v8i3.473"},{"key":"2025053123004126000_15.5.e091640.60","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0301046","article-title":"The impact of food insecurity on mental health among older adults residing in low- and middle-income countries: A systematic review","volume":"19","author":"Osei-Owusu","year":"2024","journal-title":"PLoS One"},{"key":"2025053123004126000_15.5.e091640.61","doi-asserted-by":"crossref","DOI":"10.1186\/s40795-024-00922-1","article-title":"Focusing attention on the important association between food insecurity and psychological distress: a systematic review and meta-analysis","volume":"10","author":"Jandaghian-Bidgoli","year":"2024","journal-title":"BMC Nutr"},{"key":"2025053123004126000_15.5.e091640.62","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.socscimed.2014.01.029","article-title":"Proceduralism and its role in economic evaluation and priority setting in health","volume":"108","author":"Jan","year":"2014","journal-title":"Soc Sci Med"},{"key":"2025053123004126000_15.5.e091640.63","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph15081585","article-title":"Household food insecurity and mental health among teenage girls living in urban slums in Varanasi, India: a cross-sectional study","volume":"15","author":"Rani","year":"2018","journal-title":"Int J Environ Res Public Health"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-091640","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T06:01:39Z","timestamp":1748757699000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-091640"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5]]},"references-count":63,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5,24]]},"published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1136\/bmjopen-2024-091640"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-091640","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5]]}}}