BACKGROUND AND PURPOSE: Low back pain (LBP) is becoming increasingly common and has a significant negative impact on the physical and mental health of patients. A certain number of studies have been conducted on traditional Chinese exercises (TCEs) to treat LBP. However, the optimal treatment remains uncertain. The aim of this study was to systematically review the literature and perform a network meta-analysis (NMA) to compare the efficacy of different TCE and combination therapies for clinical practice. METHODS: We systematically searched 8 databases from inception to February 2025 for randomised controlled trials (RCTs) of TCE for LBP. The risk of bias was evaluated using the RoB 2.0 tool, and the overall quality of evidence was assessed using the GRADE approach. NMA was conducted using Bayesian theory-based R 4.5.1 and STATA 16.0 software, focusing on pain and dysfunction. In addition, we critically reviewed the methodological limitations and potential bias of the included studies. RESULTS: This NMA included 38 eligible studies involving 2944 patients and 10 interventions: four standalone TCEs, four TCE combined with conventional treatment (CT), CT alone, and no intervention. Key findings indicated that: (a) wuqinxi was most effective for pain reduction [Visual Analogue Scale (VAS)]; (b) yijinjing + CT, taiji + CT, and yijinjing alone showed superior improvement in dysfunction [Oswestry Disability Index (ODI)/Japanese Orthopaedic Association (JOA)/Roland-Morris Disability Questionnaire (RMDQ)]; (c) yijinjing optimized lumbar flexion and extension range of motion (ROM), while baduanjin + CT enhanced lateral flexion ROM; and (d) taiji + CT achieved the highest total effective rate. CONCLUSION: TCEs and their combinations with CT may effectively improve pain, dysfunction, joint movement and overall efficacy in LBP. Wuqinxi, yijinjing + CT, taiji + CT, baduanjin + CT and yijinjing appear to be the most beneficial interventions. However, this study has limitations including notable heterogeneity and potential publication bias across some included studies. High-quality RCTs with standardized protocols and long-term follow-up are needed to validate these results and address clinical uncertainty.

Major depressive disorder (MDD) is a highly prevalent and disabling psychiatric condition characterized by varying degrees of affective, cognitive, somatic, and psychomotor symptoms. Neuroimaging studies have identified dysfunctional connections of several large-scale brain networks in MDD that have been associated with its various symptoms. Given the involvement of multiple brain networks, we hypothesized that MDD could be driven by connectivity impairments of key regions involved in the brain's integrative processes called connector hubs. MRI data from 255 patients with MDD and 255 matched healthy controls were used in the analysis. A network metric called functional connectivity overlap ratio, computed from resting-state functional MRI, was used to identify affected hub regions. Our results showed that connector hubs located in the sensorimotor cortex, thalamus, cerebellum, and limbic regions exhibited altered connections across multiple networks in patients compared to controls. Specifically, sensorimotor connector hubs had significantly less connections with primary processing (sensorimotor, visual, and auditory), default mode, and visuospatial networks, but more widespread connections with the anterior salience and basal ganglia networks. Cerebellar and thalamic connector hubs exhibited less connections with the core neurocognitive (default mode, executive control, and salience), language, and basal ganglia networks, whereas limbic connector hubs had impaired connections with salience, language, and basal ganglia networks. Additionally, some of these altered connections correlated with depression scores in patients. Together, these findings suggest that MDD is characterized by a more widespread impairment of the brain's integrative functions involving sensory, motor, cognitive, and affective processes, reflecting its diverse symptoms.

OBJECTIVE: To characterize the distribution, data completeness, and temporal trends of notifications of Work-Related Mental Disorders (WRMD) in Brazil from 2007 to 2023. METHODS: Cross-sectional and time-series study analyzing 22,378 notifications recorded in the Notifiable Diseases Information System (SINAN). Notifications were characterized according to demographic and clinical variables. Temporal trends were evaluated using the Joinpoint Regression Mode. RESULTS: WRMD notifications increased from 0.13 per 100,000 employed working-age individuals in 2007 to 3.51 in 2023, with an average annual percent change of 18.24%, and peaks in 2009, 2017, and 2021. Most notifications involved women (64.86%), predominantly aged 35-49 years (49.27%). The Southeast and Northeast accounted for most cases, and anxiety and mood disorders were the most frequent diagnoses. Data completeness was excellent for sex and age group, fair for race/skin color and education, and insufficient for clinical variables related to substance use Temporary disability was reported in 56.38% of cases. CONCLUSIONS: WRMD notifications increased substantially over the study period, particularly after 2021. Notifications predominated among women and workers aged 35-49 years, were concentrated in the Southeast and Northeast, and most frequently involved anxiety, stress-related, and somatoform disorders and mood disorders, with temporary disability reported in over half of cases.

INTRODUCTION: Personal technology might offer effective and efficient options for supporting successful self-management following mild traumatic brain injury (mTBI). Its use in UK rehabilitation remains unclear. This study explores healthcare professionals' (HCPs) experience and attitudes towards using personal technology for self-management following mTBI. METHODS: A cross-sectional online survey of UK HCPs working in mTBI services was conducted, recruiting via social media, professional networks and snowball sampling. Quantitative data were analysed using descriptive statistics and frequencies. Free text responses were analysed using inductive thematic analysis. RESULTS: Ninety-two HCPs responded representing a range of professions and mTBI services; not all services were mTBI specific. A variety of self-management interventions and outcome measures were reported. Among HCPs who offered self-management interventions ( = 55), 75% reported developing their own materials instead of using evidence-based resources. Fewer than half ( = 43, 47%) reported using personal technology to support self-management. Of those who did, most emailed resources or signposted patients to websites. Most (95%) participants agreed personal technology should be used in rehabilitation. Barriers included cost to patients and services, HCP/patient confidence with technology and concerns about losing face-to-face interactions. CONCULSIONS: Despite HCPs receptiveness to digital self-management interventions, findings suggest personal technology is not routinely used in UK mTBI services. Personal and organisational implementation barriers need to be addressed to ensure people with mTBI benefit from personal technology for self-management. Further work should identify and test adoption strategies.

BACKGROUND: Older adults with type 2 diabetes mellitus (T2DM) are at high risk of both cardiovascular complications and cognitive decline, with major implications for independence and self-management. Endothelial dysfunction and impaired angiogenic capacity may play a key role. This study investigated the association between circulating angiogenic T cells (Tang cells) and cognitive function in older adults with T2DM and explored the potential impact of glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy. METHODS: A cross-sectional study was conducted on 154 T2DM patients aged 60-80 years, treated either with GLP-1 receptor agonist (GLP-1RA) plus metformin or metformin alone. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Circulating CD3+CD31+CXCR4+ Tang cells were quantified by flow cytometry. Propensity score matching was applied to control for age, body weight and HbA1c. RESULTS: In the overall cohort, higher Tang cell levels were significantly associated with better cognitive performance (MoCA, r = 0.423; MMSE, r = 0.428; both P < 0.001). After matching, 35 patients in each treatment group were included in the comparative analysis. The GLP-1RA + MET group showed significantly higher circulating Tang cell levels than the MET group, both in absolute counts and as percentage of CD3+ T cells (P < 0.001). CONCLUSIONS: Circulating Tang cell levels are positively associated with cognitive function in older adults with T2DM. GLP-1RA therapy is associated with higher Tang cell levels compared with metformin alone, suggesting a potential association with mechanisms related to endothelial repair in diabetes-related cognitive impairment in older age.

Prolonged exposure (PE) is an evidence-based treatment for PTSD. However, the imaginal exposure portion of PE can be distressing for patients, and despite many service members reporting multiple traumatic events, traditional PE focuses solely on the most distressing event. This article evaluates a modified version of PE that considers the need for distress-reduction in trauma-focused treatments. We compared distress during two methods of imaginal exposure: (1) standard exposure, where participants focused on their most distressing event; and (2) graduated exposure, where participants focused on their top three most distressing events, from third most distressing to most distressing. Mean peak subjective units of distress scores (SUDS) were compared across groups. Participants were 199 active duty personnel and veterans (79.9% men; mean age 38.5 years). There was a significant overall effect of group on peak SUDS, F(3,359) = 12.46, p < .001. Participants receiving standard exposure reported an average peak SUDS of 88.1/100 (SD = 13.4), compared to 75.2 (SD = 22.5) for graduated imaginal exposure participant's most distressing event. Participants in the graduated group also reported significantly lower peak SUDS for their second (M = 72.23, SD = 20.6; t(183) = 5.49, p < .001, d = .81) and third most distressing events (M = 74.63, SD = 21.1; t(183) = 466, p < .001, d = .69) compared to mean SUDS rating for the standard exposure group. Incorporating a graduated approach appears to mitigate average peak distress from participating in the imaginal exposure component of PE.Trial registration These data were collected as part of a larger, randomized clinical trial that was registered with ClinicalTrials.gov (Identifier NCT03529435).

In this commentary on Morland et al. (2026)'s recent State of the Science article on 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for posttraumatic stress disorder (PTSD), we aim to emphasize both MDMA's therapeutic promise and its unresolved scientific challenges. Although recent trials on MDMA-assisted interventions have reported encouraging reductions in PTSD symptoms, the current evidence base remains constrained by several major limitations, including difficulties in blinding, expectancy effects, the absence of robust active comparator conditions, limited mechanistic clarity, and concerns regarding safety monitoring and sample generalizability. This letter argues that these issues are not peripheral but central to the interpretation and future translation of MDMA-assisted psychotherapy. It further highlights the need to move beyond symptom reduction as the primary outcome and incorporate broader indicators of recovery, such as functioning, quality of life, relational restoration, and long-term durability of treatment gains. In addition, we call for stronger attention to equity, scalability, therapist training, and ethical safeguards, particularly if MDMA-assisted psychotherapy is to be considered within a global mental health framework. The discussion aims to stimulate deeper debate on how innovation in trauma treatment should be evaluated before widespread clinical adoption.

BACKGROUND: Ultra-processed foods comprise a majority of the American diet and have been linked to increased risk for depression. In response, minimally processed dietary interventions are increasingly being evaluated as tools to improve mental health, including within the growing "Food Is Medicine" movement. However, because these approaches emphasize reducing ultra-processed foods, they raise concerns that dietary restriction may inadvertently increase disordered eating-related outcomes. This paper reports an exploratory analysis of data from a randomized pilot trial that tested two minimally processed dietary interventions designed to reduce depressive symptoms among adults with moderate to moderately severe depression. This analysis focused specifically on safety, examining whether these interventions were associated with unintended increases in disordered eating-related outcomes. METHODS: Participants (N = 31) were randomly assigned to either implement dietary change via self-implemented nutritional guidance or a commercial meal delivery service for 2 weeks. Disordered eating-related outcomes were assessed using the Eating Disorder Examination Questionnaire (EDE-QS) and Dutch Eating Behavior Questionnaire (DEBQ) at intake, pre-intervention, post-intervention, and 1- and 6-month follow-ups. RESULTS: Across dietary conditions, no increases were observed in DEBQ restrained or external eating following the intervention. EDE-QS and DEBQ emotional eating decreased post-intervention, and DEBQ emotional and external eating were lower at follow-up. Changes in outcomes were not moderated by intervention condition. CONCLUSIONS: These findings provide preliminary evidence of short-term safety, suggesting that certain dietary interventions emphasizing minimally processed foods are feasible and may not elicit immediate increases in disordered eating-related thoughts and behaviors among adults with depression and without active eating disorders. Larger and longer-term studies are needed to evaluate safety in more diverse and higher-risk populations. Trial registration The parent pilot study is pre-registered on ClinicalTrials.gov (https://clinicaltrials.gov/study/NCT06242665) on January 16th, 2024.

BACKGROUND: Intimacy, feeling close to others, and mutual trust and regard are important aspects of a secure attachment style that contributes to stable relationships. Difficulties experiencing intimacy have been linked to traumatic childhood experiences, such as abuse and neglect, rejection sensitivity (RS), and borderline personality disorder (BPD). In experimental studies, patients with BPD perceived unfamiliar faces as less trustworthy and detected less positive cues of happiness, social affirmation, and inclusion. However, it remains unclear whether social-cognitive judgments of unfamiliar faces predict attachment-related intimacy beyond BPD features, childhood trauma, and RS. OBJECTIVE: This study aimed to simultaneously investigate the predictive effects of BPD features, childhood trauma, RS, and first-impression social-cognitive judgments of trustworthiness and happiness on intimacy in close relationships, beyond romantic relationships. Additionally, we investigated whether the association between BPD features and attachment-related intimacy is moderated by childhood trauma, RS, and first-impression social judgments. METHODS: In an online study, 509 women completed questionnaires on intimacy in close relationships (subscales of the Adult Attachment Scale Revised), BPD features (Personality Assessment Inventory Borderline Features Scale), childhood trauma (Childhood Trauma Questionnaire Short Form), and RS (Adult Rejection Sensitivity Questionnaire). Additionally, they evaluated happiness and trustworthiness in unfamiliar female faces. Hierarchical linear regression analysis with intimacy as outcome tested the predictive strengths of all variables including interactions with BPD features. RESULTS: Higher BPD features, childhood trauma, particularly emotional neglect, and RS, as well as lower trustworthiness impressions predicted less intimacy in close relationships. Despite their interrelations, all predictors except happiness ratings showed unique predictive effects on intimacy. Interaction effects were not significant. DISCUSSION: Findings support the importance of BPD features, childhood trauma, and RS for experiences of closeness and connection in adult attachment relationships. Additionally, findings provide first evidence for a small direct link between trustworthiness evaluations of unfamiliar faces and lower experiences of intimacy. Future research should investigate these associations in clinical samples including both women and men to further understand whether trustworthiness impressions could be an important socio-cognitive mechanism and potential treatment target.

BACKGROUND: Stuttering has traditionally been conceptualized as a motor speech disorder; however, accumulating evidence suggests that auditory processing differences and emotional factors may also contribute to its clinical presentation. Despite increasing interest in these domains, the interplay between auditory cortical processing, stuttering severity, and anxiety in adults remains incompletely understood. OBJECTIVE: This study aimed to examine auditory evoked cortical responses (P1, N1, P2, and mismatch negativity [MMN]) in adults who stutter compared with fluent-speaking controls, and to explore how neurophysiological measures vary in relation to stuttering severity and state-trait anxiety levels. METHODS: Auditory event-related potentials were recorded using pure-tone stimuli in adults who stutter and age-matched control participants. Latency and amplitude measures of the P1, N1, P2, and MMN components were analyzed. Anxiety was assessed using the State-Trait Anxiety Inventory (STAI). Group comparisons and correlational analyses were performed to characterize neurophysiological, clinical, and psychological patterns. RESULTS: Compared with controls, adults who stutter exhibited significant alterations in both early (P1, N1) and later (P2, MMN) stages of auditory cortical processing. Increasing stuttering severity appeared to be associated with a pattern of variation in ERP latencies and amplitudes, accompanied by parallel changes in state, trait, and total anxiety scores. CONCLUSIONS: These findings suggest that stuttering in adulthood is associated with widespread differences in auditory cortical processing that co-vary with both anxiety levels and clinical severity. The results support a multidimensional framework in which sensory, emotional, and speech-related processes interact, highlighting the importance of integrated neurophysiological and psychological assessment approaches in stuttering research and clinical practice.

BACKGROUND: According to the World Health Organization, approximately one in eight people is diagnosed with mental disorders globally. Patient-reported outcomes and quality of life assessments are essential tools for evaluating patient outcomes. This study aimed to identify, characterize, and summarize the literature focusing on quality of life or patient-reported outcomes among patients with mental disorders in the Kingdom of Saudi Arabia undergoing pharmacological treatment. METHODS: This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 item checklist applicable for Systematic reviews. Searches were run in the following databases: PubMed, MEDLINE via Ovid, MEDLINE via EBSCO, and ProQuest. Databases were searched from January 1, 2000, to July 31, 2025. RESULTS: Ten articles that explored the quality of life of patients undergoing mental disorders treatment in the Kingdom of Saudi Arabia since 2000 met the inclusion criteria. A total of 3,773 patients included, and fifteen different quality of life questionnaires and patient-reported outcome measures were used. One-third of the reviewed articles used the Morisky Medication Adherence Scale (MMAS) and consistently reported low to moderate levels of adherence. CONCLUSIONS: This study highlights the need for further research in the mental health field, with a focus on enhancing patients' quality of life and reporting outcomes.

BACKGROUND: Domestic abuse (DA) is a public health problem with wide-ranging impacts for victim-survivors and services responding to it. The purpose of the current study was to explore relationships between victim-survivors' experiences of abuse, additional needs/vulnerabilities and sociodemographic characteristics, and physical and mental health outcomes and health care help-seeking behaviours following DA. METHODS: Secondary analysis was conducted using Women's Aid Federation of England's (Women's Aid) case management and outcomes measurement system, On Track, the largest national dataset on DA. To understand the relationship between abuse types (physical, sexual, emotional, financial, coercive control, technology-facilitated abuse (tech abuse) and threats to kill), needs/vulnerabilities (disability; offending, drug and alcohol-related support needs; pregnancy, recourse to public funds and accessing by-and-for services) and health outcomes (perpetrator caused harm to or loss of unborn child, attempted strangulation, self-harm (disclosed), feeling depressed or suicidal, injury requiring GP treatment and injury requiring Accident and Emergency (A&E) treatment), we used a series of logistic regression models, controlling for potentially confounding variables (including accommodation status, sexual orientation and ethnicity). Stakeholders from Women's Aid and five other third sector organisations input into the study design and interpretation of results. RESULTS: Ninety-six percent of victim-survivors accessing DA services (n = 77,785) were female. Almost half (41.24%) had felt depressed/suicidal, while 5.59% disclosed having self-harmed. Almost one quarter (23.41%) had suffered a strangulation attempt, and 2.54% had suffered harm to or loss of their unborn child caused by the perpetrator. Just under 10% had an injury requiring A&E treatment and slightly less (7.33%) had an injury requiring GP treatment. Associations with the type of abuse varied by health outcome, for example physical abuse followed by threats to kill were most strongly associated with attempted strangulation and injuries requiring GP and A&E treatment, whilst tech abuse was most strongly associated with self-harm and feeling depressed/suicidal. Vulnerabilities/needs were more consistently associated with health outcomes, with those with a disability; drug, alcohol or offending support needs, or living in temporary/unstable accommodation more likely to experience negative outcomes across the board, and almost all needs/vulnerabilities being associated with adverse mental health outcomes (with the exception of pregnancy and accessing specialist by-and-for services, which appeared to have a protective effect). CONCLUSIONS: Our findings highlight the almost inevitable harms to mental health for victim-survivors of DA, the dangers of non-physical types of abuse such as threats to kill and tech abuse and the heightened risk of attempted strangulation. These findings have particularly important and timely implications for the training of health care professionals. Alongside improvements in health care settings, health care professionals, specialist support workers, researchers and policymakers must continue to explore more integrative and collaborative ways of working to further improve the response to DA and intervene before irreversible damage is done.

BACKGROUND: School absenteeism is closely associated with adolescent mental health problems, yet little is known about the covariation patterns between the short-term, mild attendance fluctuations commonly observed among community adolescents and their psychological distress. This study aimed to combine network analysis with simulated intervention methods to explore the conditional dependence network among absenteeism, depression, and internalizing/externalizing problems, and to preliminarily identify potential intervention targets. METHODS: Data were drawn from the 2022 wave of the China Family Panel Studies (CFPS), including 2,734 community adolescents. The sample was first randomly split into an exploratory sample (N = 1,367) and a validation sample (N = 1,367). Exploratory and confirmatory factor analyses were conducted to examine the reliability and validity of the CES-D-8 and the internalizing/externalizing scales. After controlling for covariates, the EBICglasso method was used to estimate the network structure in the effective sample (N = 1,894), and expected influence (EI) and bridge expected influence (bEI) were calculated. To evaluate the sensitivity of results to dichotomization cut-points, Ising models were constructed using both lenient and strict cut-points. The NodeIdentifyR algorithm was then applied to perform simulated interventions (node thresholds shifted by ± 2 standard deviations), with the network's overall expected total score serving as the outcome measure. RESULTS: After removing seven low-loading items, the measurement model showed good overall fit (CFI = 0.979, RMSEA = 0.031). Network analysis identified CESD5 ("I felt lonely"), CESD7 ("I felt sad"), and CESD2 ("I felt that everything I did was an effort") as central nodes. Bridge nodes included CESD2 ("I felt that everything I did was an effort"), CESD3 ("My sleep was restless"), and N (absenteeism frequency), with 84% of participants reporting zero absences. In worsening simulated interventions, results were highly consistent across both cut-points: CESD5 (loneliness) produced the largest increase in the network's overall expected total score. In easing simulated interventions, the node with the largest decrease differed by cut-point: Q6 ("I got distracted easily") under the lenient cut-point, and CESD1 ("I felt depressed") under the strict cut-point. CONCLUSIONS: This study revealed a covariation network among short-term absenteeism fluctuations, depression, and internalizing/externalizing problems in community adolescents. Loneliness was not only a central node in the network but also a strong predictor in worsening interventions, whereas being easily distracted and depressed mood emerged as candidate directions for easing interventions that warrant further investigation. Given the cross-sectional design, the merging of different reasons for absenteeism into a single indicator, and the zero-inflated skewed distribution of the data, all conclusions should be regarded as exploratory hypotheses pending validation through future longitudinal studies or experimental designs.

BACKGROUND: Anxiety disorders are among the most prevalent mental health issues faced by young adults, who experience the highest lifetime prevalence of these conditions. Despite the increasing rates of anxiety disorders, mental health service utilization within this demographic remains notably low. This study aims to analyze the factors influencing mental health service utilization among young adults with anxiety disorders, distinguishing between early young adults (19-29 years) and late young adults (30-39 years), to propose tailored support strategies. METHODS: Data from the 2021 National Mental Health Survey of Korea, which included 395 adults diagnosed with anxiety disorders, were analyzed. Complex sample logistic regression was used to assess how sociodemographic characteristics, health behaviors, and comorbid mental health issues impact service utilization. RESULTS: Among early young adults, higher education (odds ratio [OR] = 6.57), being married (OR = 7.02), and suicidal thoughts (OR = 29.42) were significantly associated with increased mental health service utilization. For late young adults, suicidal thoughts (OR = 10.79) and post-traumatic stress disorder (OR = 15.87) were significant predictors of higher service use, while alcohol use disorder was associated with lower service utilization (OR = 0.07). CONCLUSIONS: This study highlights the need to prioritize support for early young adults with lower education, single status, and suicidal thoughts, as well as late young adults with alcohol use disorder, post-traumatic stress disorder, or suicidal thoughts. Implementing these strategies may enhance mental health management and improve the overall quality of life for young adults.

BACKGROUND: Efforts to address gambling harm often rely on narrow definitions of help seeking that focus on professional treatment. This approach overlooks the many other ways people seek support, use tools, or take action to reduce or control their gambling. This study aimed to examine the uptake of a broader range of help seeking and self-management approaches among people who gamble, across priority populations, including Māori, Pacific, Asian and Australian Aboriginal and Torres Strait Islander (ATSI), and among people experiencing different levels of gambling harm. METHODS: A 58-item checklist on help seeking options contained three domains: People and Places (n = 33 items), Tools and Resources (n = 12 items) and Self-Help Strategies (n = 13 items). It was administered online to 514 adults in New Zealand and Australia, using quota sampling for ethnicity and gambling severity (75% past or current problems, 25% regular gamblers). Respondents indicated how often they had engaged in each help-seeking behaviour over the past 12 months. RESULTS: Overall, 97% of participants reported using at least one help-seeking option. People and Places were widely used (80.5%) with the most frequently endorsed items being partner, family member, or friend (62.3%), peers in social or cultural groups (44.9%), general practitioners (44.6%) and mental health counsellors (44.4%). Tools and Resources were used by 87.0% and included time-outs (64.8%), reading online information (63.0%), and spending limits (62.5%). Self-Help Strategies were used by 95.5% including lifestyle change (84.2%), setting time or money limits (83.3%), thinking differently about gambling (80.9%), and self-monitoring thoughts, feelings, or behaviours (77.0%). Priority populations had higher uptake of help-seeking options across each of the three domains than non-priority populations. Help seeking increased across levels of gambling severity. Eighty percent of people with no gambling problems reported using any option, compared with 97.9% at low risk and 100% among those with moderate risk or problem gambling. CONCLUSIONS: Help seeking extended well beyond specialist gambling services and included family, community and general health settings. This suggests that responses to gambling harm already occur across a wide range of everyday settings and highlights the need to better understand and strengthen these community responses. Future research should examine how different options connect to form pathways of support and how effective these pathways are over time.

BACKGROUND: The prevalence and severity of perinatal common mental disorders (CMDs) are disproportionately high in India and other low- and middle- income contexts. Since social determinants strongly influence perinatal CMDs, they represent promising targets for alleviating the burden of disease in these countries. This study aimed to understand (1) social determinants of perinatal mental health and their concepts, context, interactions, facilitators, and impact and (2) how interventions targeting these determinants should be designed and implemented in Telangana and similar regions across rural South India. METHODS: Nine focus group discussions and eight individual interviews were conducted to capture perspectives from a total of 65 stakeholders, including community health workers, women at risk for perinatal CMDs, their caregivers, treatment providers, and village leaders in eight villages across the Siddipet district of Telangana, India. Social determinants were derived from the resulting narratives through a thematic analysis with a hybrid inductive and deductive approach. RESULTS: Thirty-six social determinants of perinatal mental health were identified and mapped onto the six levels of influence (individual, interpersonal relationships, organizations, community, policy, society) within the socio-ecological model of perinatal mental health. Across these six levels, five themes regarding these social determinants and their relationships, context, and influence on perinatal mental health in Telangana emerged: attitudes about pregnancy outcomes, gender inequity, relationships and support, mental health stigma, and mental healthcare access. Considerations for perinatal CMD interventions that participants proposed are also presented, along with our practical suggestions to address them. CONCLUSIONS: A wide range of social determinants impact perinatal mental health within Telangana. Since these factors often have impacts across multiple levels of influence, interventions should employ a multi-faceted, intersectoral approach to effectively prevent, recognize, and treat perinatal CMDs in Telangana and similar regions across rural South India. CLINICAL TRIAL NUMBER: Not applicable.

BACKGROUN: The Coronavirus Disease 2019 (COVID-19) pandemic has substantially disrupted the lives of children and adolescents, raising concerns about increased psychiatric morbidity. This study examined post-COVID psychiatric symptoms in a pediatric population and explored associated risk factors. METHODS: This follow-up study enrolled 107 children and adolescents (6-18 years) with laboratory-confirmed COVID-19, retrospectively identified from Gülhane Training and Research Hospital records, contacted via telephone, and invited for in-person pediatric examination and Revised Child Anxiety and Depression Scale (RCADS) screening. Participants with T-scores ≥65 were referred to Gazi University for face-to-face psychiatric evaluation by child psychiatrists using DSM-5 criteria. Sociodemographic and clinical variables were analyzed for associations with elevated RCADS scores. Receiver operating characteristic (ROC) analyses were performed using DSM-5-based clinical diagnoses as the reference standard. RESULTS: The cohort included 62 females (57.9%) and 45 males (42.1%), with a mean age of 12.3±3.1 years. Most participants were symptomatic during infection (90.7%), and 35.5% developed at least one COVID-related complication, most commonly taste loss (29.0%). Post-COVID psychiatric symptoms were reported in 56.1% of cases, predominantly attention difficulties (28.9%) and irritability (23.3%). Approximately half (52.2%) of children without prior history of psychiatric symptoms developed at least one new symptom. Higher anxiety and depression scores were significantly associated with prematurity, birth complications, and pre-existing psychiatric symptoms. In ROC analyses, the parent-reported total anxiety score showed an area under the curve (AUC) of 0.92 with an optimal cut-off of 60 (sensitivity 81.5%, specificity 93.8%), while the child-reported score showed an AUC of 0.90 with an optimal cut-off of 65 (sensitivity 70.4%, specificity 93.8%). Children without psychiatric history had significantly lower scores (p < 0.001). CONCLUSIONS: COVID-19 was linked to increased psychiatric symptoms in children, with prematurity, birth complications, and prior history as key risks. RCADS proved sensitive for screening, emphasizing targeted interventions post-infection. CLINICAL TRIAL NUMBER: Not applicable.

BACKGROUND: Tuberculosis (TB), a highly stigmatized disease, remains a major public health challenge globally, with stigma and mental health issues such as depression significantly impacting patient outcomes. TB-related stigma undermines patient engagement with testing and treatment, driven by factors at the individual, community, and health-system levels. In Pakistan, particularly in the Khyber Pakhtunkhwa region, the interplay between TB-related stigma and depression is underexplored. Understanding these relationships is critical to improving patient engagement, treatment adherence, and overall TB control efforts in this context. AIMS AND OBJECTIVES: To investigate the frequency of depression among TB patients, assess the level of TB stigma, and examine the association between stigma and depression in Districts Peshawar and Haripur. DESIGN & METHODS: A cross-sectional study was conducted, from June to December 2023, in Khyber Pakhtunkhwa Province. Non-random convenience sampling was used to recruit 349 participants, of whom 311 were from Peshawar and 38 from Haripur. All participants were evaluated for tuberculosis stigma using the Van Rie TB Stigma Scale. Patients were initially screened for depression via Patient Health Questionnaire-2. A severity assessment was done on 159 depressed participants, using Patient Health Questionnaire-9. RESULTS: Patient and community perspective stigma were reported as 64.8% and 49.9% in the participants. The frequency of depression among all participants was 45.6%. To evaluate predictors of depression, logistic regression was applied at 5% significance level using STATA 18. In the multivariable analysis, community perspective stigma and residence showed a significant association with depression. However, residence lost its significance when the model was adjusted for patient perspective stigma. Notably, as both patient and community perspective stigma increased, the severity of depression also rose, underscoring the strong association between TB stigma and poor mental health outcomes. CONCLUSIONS: Depression is highly prevalent among tuberculosis patients, and it has a strong relationship with both patient and community perspective stigma. The findings indicate that the higher levels of stigma are associated with greater depression severity while residence shows a context-specific association with mental health outcomes. Integrating stigma reduction and mental health interventions into TB care is essential to improve psychological wellbeing and treatment outcomes among affected individuals.

BACKGROUND: Adolescents are highly vulnerable to mental health conditions, yet traditional counseling models may not fully address their evolving needs. The rise of artificial intelligence (AI) has created new opportunities and challenges for supporting adolescent mental health. OBJECTIVE: This scoping review evaluates the current applications, outcomes, strengths, drawbacks, and technical and ethical challenges of AI in adolescent mental health. METHODS: The review adopted the PCC framework and was conducted in accordance with JBI guidelines, with reporting following the PRISMA-ScR framework. A systematic search was performed across PubMed, Embase, Web of Science, and ScienceDirect for peer-reviewed studies and grey literature published in English between 2015 and July 24, 2025. Title, abstract, and full-text screenings were independently conducted by two reviewers, with disagreements resolved by consensus or consultation with a third reviewer. RESULTS: Of the screened records, 24 studies met the eligibility criteria, all of which were published between 2020 and 2025. USA and China were the leading contributors. AI was primarily applied to address depression, anxiety, stress, suicidal ideation, and other mental health conditions. AI demonstrated promise in accurate risk prediction, enhanced clinical and self management, personalized care, expanded service access, and stigma reduction. However, persistent technical challenges included potential algorithmic diagnostic errors, reliance on self-reported and screen-based data, and complex interface design. Ethical concerns included data security, privacy, limited transparency, attribution of responsibility, and deficiencies in informed consent processes. CONCLUSIONS: AI can accurately identify and predict mental health risks, overcome geographical and temporal barriers in adolescent mental healthcare, enable efficient and personalized support, facilitate clinical management, and expand access for emergency crises, marginalized populations, and underserved areas. However, complex study protocols and severe mental health conditions may reduce adolescent engagement. The long-term sustainability of AI's therapeutic effects requires further validation. Future efforts should focus on expanding the evidence base, validating interventions in real-world settings, strengthening regulatory frameworks, and enhancing the digital competencies of healthcare providers. REVIEW REGISTRATION: Open Science Framework https://osf.io/79wya. TRIAL REGISTRATION: Not applicable.

BACKGROUND: Pharmacogenomic (PGx) testing holds promise for personalized psychiatry, but its clinical utility in real-world inpatient settings remains inadequately established. Using real-world data, this study investigated whether PGx testing is associated with improved treatment outcomes in hospitalized patients with schizophrenia (SCZ), major depressive disorder (MDD), and bipolar disorder (BD). METHODS: A retrospective cohort study was conducted, enrolling inpatients with SCZ, MDD, and BD from January 2022 to March 2024. Patients were divided into a PGx group or a treatment-as-usual (TAU) group based on whether they received PGx testing. The primary outcomes were disease-specific scale scores (PANSS for SCZ; HAMD/HAMA for MDD; YMRS/HAMD for BD). Demographic characteristics, length of hospital stay, and hospitalization costs were also compared between the two groups. RESULTS: In total, 3,942 patients were included (SCZ: 1,328; MDD: 1,143; BD: 1,471). Linear mixed model analyses revealed significant negative interaction effects between PGx testing and treatment duration across all three disorders (SCZ-PANSS: -0.86, p < 0.001; MDD-HAMD: -0.49, p < 0.001; MDD-HAMA: -0.32, p < 0.001; BD-YMRS: -0.25, p = 0.025; BD-HAMD: -0.39, p < 0.001). This indicates that symptom improvement over time was significantly faster in the PGx group. Furthermore, for MDD and BD, the PGx group had more severe baseline symptoms (MDD: HAMD score 2.77 points higher, p < 0.001; HAMA score 1.79 points higher, p < 0.001. BD: HAMD score 2.16 points higher, p < 0.001) and higher hospitalization costs (MDD: ¥8,730.06 higher, p < 0.001; BD: ¥2,902.78 higher, p = 0.025). Additionally, MDD patients in the PGx group had a significantly longer hospital stay (mean difference: 4.25 days, p = 0.02). CONCLUSION: In the real-world inpatient setting, PGx testing was associated with a steeper slope of clinical symptom improvement in patients with SCZ, MDD, and BD. It is important to note that PGx testing was used more often for patients with more severe baseline conditions who also required more healthcare resources. Nevertheless, PGx may help optimize treatment regimens and enhance therapeutic efficiency. Overall, these findings provide practical evidence supporting PGx as a useful clinical decision-support tool for hospitalized psychiatric patients. CLINICAL TRIAL NUMBER: Not applicable. This study is a retrospective observational study using real-world clinical data and did not involve a prospective intervention requiring trial registration.

BACKGROUND: High-intensity interval training (HIIT) is an effective exercise modality in cardiac rehabilitation; however, participation in conventional centre-based programs remains suboptimal due to barriers such as limited accessibility and adherence. Mobile health (mHealth) technologies may improve accessibility and supervision of exercise training. While previous studies have primarily focused on training modality, evidence comparing different delivery models of HIIT-based cardiac rehabilitation remains limited. This study aimed to compare the effectiveness and safety of mHealth-supported versus centre-based delivery of a standardized HIIT cardiac rehabilitation program in patients with stable coronary heart disease (CHD). METHODS: Between December 2024 and April 2025, 98 adults with stable CHD eligible for Phase II cardiac rehabilitation were enrolled and randomly assigned to either the control group (n = 49) or the intervention group (n = 49). Both groups performed the same standardized HIIT protocol; the control group received supervised centre-based rehabilitation, whereas the intervention group performed mHealth-supported home-based training with real-time monitoring and individualized feedback via the Xin'ankang mHealth platform. Primary outcomes included the six-minute walk distance (6MWD), cardiopulmonary exercise testing (CPET) parameters, and SF-36 quality of life scores. Secondary outcomes included anxiety, depression, and sleep quality. RESULTS: Baseline characteristics were generally comparable between groups, although minor differences were observed in certain SF-36 domains. After adjustment for baseline values, the intervention group demonstrated significant improvements compared to the control group in sleep quality scores (3.17 ± 2.09 vs. 4.83 ± 2.09), peak METs (5.83 ± 0.09 vs. 4.94 ± 0.09), anaerobic threshold METs (4.29 ± 0.07 vs. 3.53 ± 0.07), peak VO₂ (20.12 ± 0.30 vs. 16.70 ± 0.30 ml/kg/min), and 6MWD (563.83 ± 3.21 vs. 531.49 ± 3.21 m) (all P < 0.05). Improvements in SF-36 scores were observed in several domains, although no significant difference was found in vitality or mental health. Subgroup analyses revealed consistent improvements across age groups, while a sex-specific difference was observed for changes in VO₂ peak. CONCLUSION: Compared with centre-based delivery of the same HIIT program, mHealth-supported HIIT was associated with greater improvements in cardiopulmonary function, exercise capacity, and quality of life in patients with CHD. These findings suggest that delivery modality may influence the effectiveness of HIIT-based cardiac rehabilitation. TRIAL REGISTRATION: Clinical Trial Registration Number: ChiCTR2500104462, June 17, 2025.

Recalling either a specific (unique, 24 h or less) turning point memory narrative or a turning point with greater episodic detail (who, when, where and what happened) has been shown to predict higher youth depressive symptoms. The current research with emerging adults ( = 195,  = 20.5 years), therefore examined first the relationships of specific and detailed turning points with depressive symptoms, and second, whether recollective memory qualities moderated the association. We hypothesised that both a specific turning point and greater episodic detail would each predict depressive symptoms when rated as more vivid, emotionally intense, intrusive, negative valence for self, and recalled with greater negative emotions. Moderation results partially supported our predictions. The positive association between specific turning points and depressive symptoms was significant only under high ratings of intrusiveness, negative valence for self, and a greater proportion of negative emotions during recall. In addition, the positive association between episodic detail and depressive symptoms was significant only under greater negative emotions during recall, whereas other self-ratings were not significant moderators. These findings shed light on the critical role of negative affect in the relationship between specific and detailed turning point narratives and higher concurrent depressive symptoms in emerging adults.

Subthreshold depression (SD) is highly prevalent among adolescents and increases the risk of developing major depressive disorder. Exergaming, an interactive form of digital physical activity, may enhance engagement and improve adherence compared with traditional exercise, making it a promising approach for adolescent mental-health promotion. This randomized controlled trial investigated the effects of an eight-week exergame intervention on depressive symptoms, anxiety, and sleep quality among adolescents with SD. A total of 51 students were randomly assigned to an exergame group (n = 26) or a control group (n = 25). Participants in the exergame group completed moderate-intensity exergaming for 40 min, two to three times per week, while the control group continued routine school activities. Mental-health outcomes were assessed before and after the intervention using validated self-report questionnaires, including the Self-Rating Depression Scale (SDS), the Self-Rating Anxiety Scale (SAS), and the Pittsburgh Sleep Quality Index (PSQI) for subjective sleep quality. After the 8-week intervention, the exergame group showed significantly greater improvements than the control group in depressive symptoms, anxiety, and sleep quality (all p < 0.05). These findings indicate that exergames are an engaging, feasible, and effective school-based strategy for improving mental health in adolescents with SD. As a low-threshold and scalable digital exercise modality, exergaming may offer meaningful benefits for early intervention and mental-health promotion in youth populations.

Though depression impacts over 10% of the oldest-old, the contribution of brain health on changes in depression is unknown. This study included 225 participants from LifeAfter90 with magnetic resonance imaging, amyloid positron emission tomography (PET), and repeated Geriatric Depression Scale (GDS) data. We fit linear mixed-effects models for associations of neuroimaging markers with depressive symptom change adjusted for age, gender, race and ethnicity, and education. At baseline, average GDS scores were 2.6 (SD = 2.3) out of 15 possible points, average age was 93.3 (SD = 2.3) years, 56% female, and 22% Black, 25% Asian, 18% Hispanic/Latino, 28% Non-Hispanic White, and 7% as Multiracial/other. Greater baseline occipital volume was associated with slower GDS increase (β = - 0.29; 95% CI - 0.54, - 0.05). Greater baseline free water was associated with faster GDS increase (β = 0.31; 95% CI 0.05, 0.57). Estimates for other neuroimaging biomarkers leaned towards slower, but non-significant, increases in GDS. Estimates were not in the expected direction for amyloid PET and null for frontal cortex volume. Our findings suggest that lower cortical volume and greater white matter injury is associated with increases in depressive symptoms among the oldest old, even for those with low levels of baseline depressive symptoms.