This paper studies the effect of mental health on employment and labour-force participation in China using nationally-representative China Family Panel Studies (CFPS) data. Utilising CFPS waves 2012, 2016, and 2018, we construct consistent measures of labour supply and mental health using the Center for Epidemiological Studies Depression (CES-D) scale. The panel structure enables us to control for unobservable time-invariant individual heterogeneity, in contrast to most prior studies from developing countries. To address concerns about reverse causality and omitted time-varying factors, we complement fixed-effects estimates with (i) Oster (2019) coefficient-stability bounds and (ii) robustness checks using respondents' reported reasons for non-employment. Our estimates reveal that experiencing severe depressive symptoms reduces the likelihood of employment and labour-force participation by, on average, 1.8-1.9 and 1.3-1.4 percentage points, respectively. These estimates are similar in magnitude to those from advanced economies, despite China substantially differing in terms of its development, labour market structure, and mental health provisions. Within China, the estimated effects are concentrated almost exclusively among older male workers, with limited evidence of comparable impacts for the broader prime-age workforce.

BACKGROUND: Pain is the most prevalent secondary condition in youth with Cerebral palsy (CP); yet existing research has consistently overlooked the dynamic nature of pain and its impact on functioning in youth with CP. Using a daily diary methodology, this study investigated the association between pain intensity and interference, as well as how mental health symptoms and quality of life (QoL) impact daily fluctuations, or the magnitude of daily changes in pain intensity and interference, in youth with CP. METHOD: Forty-five youth with CP, along with their caregiver, completed baseline measures of pain, depression, anxiety, and QoL. Youth completed daily measures of pain intensity and interference for seven days. Multi-level modelling investigated the bi-directional associations between pain intensity and same-day and next-day functioning interference. Hierarchical linear regressions examined if baseline mental health and QoL were associated with fluctuations in pain over the seven days. RESULTS: Forty percent (n = 18) of participants had chronic pain. Daily pain intensity was significantly associated with same-day and next-day pain interference. Lower baseline QoL was associated with greater fluctuations in both pain intensity and interference, above the effects of gross motor abilities and age. While higher baseline depressive symptoms were only associated with pain intensity, anxiety symptoms were not associated with any pain outcomes. CONCLUSIONS: As the first study to investigate the variable nature of pain in youth with CP, the findings provide critical information for targeted pain management interventions that can offset worsening mental health issues, reduced QoL, and impaired daily functioning.

BACKGROUND: Emerging perspectives suggest that parental eco-anxiety may influence youth mental health. Building on this framework and established models linking parental distress to child internalizing symptoms, this study examined associations between parental eco-anxiety and children's depression and anxiety, as well as the mediating role of hopelessness. METHODS: A cross-sectional study included 175 parent-adolescent dyads recruited from a general pediatrics outpatient clinic. Parents completed a measure of eco-anxiety, and children completed measures of hopelessness, depression, and anxiety. Correlational analyses and structural equation modeling with bootstrapping assessed direct and indirect pathways. RESULTS: Parental eco-anxiety was significantly associated with child depression, anxiety, and hopelessness after adjustment for sociodemographic variables (all p < .001). Mediation analyses showed that child hopelessness significantly mediated the associations between parental eco-anxiety and child depression (B = 0.124, 95% CI [0.065, 0.194]) and child anxiety (B = 0.172, 95% CI [0.084, 0.290]). Subdimension-based analyses further indicated that the behavioral symptoms component of eco-anxiety was significantly associated with child hopelessness (B = 0.661, p = .002) and with indirect associations with both child depression (B = 0.361, 95% CI [0.138, 0.668]) and child anxiety (B = 0.507, 95% CI [0.174, 1.001]). CONCLUSIONS: Our findings indicate that parental eco-anxiety is associated with children's depression and anxiety through a pathway involving child hopelessness, with the behavioral symptoms component of eco-anxiety playing a key role. These preliminary results highlight parental eco-anxiety and child hopelessness as relevant targets for preventive approaches to youth internalizing symptoms in the context of the climate crisis.

BACKGROUND: The prevalent childhood-onset disorder attention-deficit/hyperactivity disorder (ADHD) (5-7%) poses risks for adult functioning, which should be identified with long-term prospective follow-up studies including a broad range of outcomes. METHODS: Differences in outcomes (measures of psychiatric status, behavioural/emotional problems, academic/professional functioning, adaptive functioning, neurocognition, physical health, healthcare service use) were investigated in an 18-year follow-up study of adults with childhood ADHD (n=154, M±SD age=27.4±3.7, 68% males), their siblings without childhood ADHD (n=138, M±SD age=29.6±4.4, 35% males), and controls (n=129, M±SD age=28.2±3.5, 40% males). Post-hoc tests investigated whether observed differences between the ADHD group and controls may be driven by a current ADHD diagnosis, by comparing persistent ADHD, remitted ADHD, and control groups. RESULTS: Childhood ADHD was related to worse functioning in adulthood on >60% of outcomes across all domains with small to large-sized effects (e.g., moderate/large differences in increased rates of ADHD and depression, externalizing problems, autistic traits, and worse neurocognitive outcomes). Siblings showed comparable functioning to controls. Persistent ADHD showed worse functioning on specific outcomes in the psychiatric, behavioural/emotional, adaptive, and physical health domains, as compared to remitted ADHD. Both ADHD groups had worse functioning compared to controls. CONCLUSIONS: Childhood ADHD increased the risk for worse functioning in adulthood. Siblings of the childhood ADHD group were not at risk for adverse outcomes. The current study identifies childhood ADHD as a risk condition for poorer long-term functioning, although substantial heterogeneity in outcomes across groups was noted. Heterogeneity within the childhood ADHD group seemed partly attributable to a current ADHD diagnosis.

BACKGROUND: Early detection of treatment-resistant schizophrenia (TRS) is of substantial clinical importance. While TRS is heritable, the associated genetic variants have been difficult to identify. Cigarette smoking is associated with non-response to antipsychotics, and smoking behavior and schizophrenia have a shared genetic basis. Thus, TRS may also have a shared genetic basis with smoking behavior. OBJECTIVE: Here we aim to identify genetic variants associated with TRS, by leveraging overlapping genetic variants with smoking initiation to increase statistical power. METHODS: We analyzed genome-wide data for TRS and smoking initiation with the conditional/conjunctional false discovery rate (cond/conjFDR) to identify shared loci, and LD score regression to determine genetic correlations. To investigate potential causal effects of shared loci, we performed Mendelian randomization (MR) analyses. Shared loci were mapped to genes, which were further investigated for enrichment of drug target genes. RESULTS: We observed a significant positive genetic correlation between TRS and smoking initiation (rg = 0.47 p = 0.0002). Leveraging the genetic overlap between TRS and smoking initiation, we identified four novel loci jointly associated with TRS and smoking initiation. The condFDR results improved polygenic prediction of TRS. MR indicates putative evidence for a causal effect of genetic liability to TRS on smoking initiation. The functional genetic analyses suggest that alpha-1-adrenergic receptors may be involved in the pathophysiology of TRS and possibly related to the efficacy of clozapine versus other antipsychotic drugs. CONCLUSION: In conclusion, our results show that shared genetic mechanisms influence both TRS and smoking behavior, which provide new insights into the biological underpinnings of TRS.

Mental health practitioners assess and treat trauma and dissociation by considering the biopsychosocial factors influencing the symptomatology of clients. In this process, clinicians often default to a prescriptive model that inherently assigns generalized cultural values to certain marginalized groups. Particularly for Latines, clinicians may overaccentuate the cultural value of , the centering of family, for all Latine clients. These cultural values often translate into clinicians' expectations that their Latine clients will cherish their familial relationships in ways that make an asset in treatment. However, for multiply marginalized Latines who endure intersectionality, may not only be a detriment to trauma treatment, but the source of psychological distress itself. In this theoretical article, we center sexual and gender minoritized (SGM) Latines as we reconceptualize as a potentially oppressive cultural value that may additionally be a contributing structural factor to both betrayal trauma exposure and dissociation by way of double-consciousness (du Bois, 1903). We define and briefly review the literature on , intersectionality, and secondary marginalization. We also describe how intersectionality may contribute to dissociation and resistance through the framework of double-consciousness. We use a hypothetical case example to demonstrate the role of double-consciousness in dissociative responses to betrayal and discuss the implications for clinical practice and research.

OBJECTIVE: This study examined cortical thickness and appetite-regulating hormones-neuropeptide Y (NPY) and ghrelin-to better understand the neurobiological mechanisms underlying binge eating disorder (BED) and obesity in adolescence. We compared adolescents with BED and obesity, adolescents with obesity without BED, and healthy controls (HCs), and explored the relationships among these measures, BMI, and psychological symptoms. METHOD: Seventy adolescents (aged 12-18 years) were included: 24 adolescents with BED and obesity, 24 adolescents with obesity without BED, and 22 HC. Cortical thickness was measured using 3.0 T structural MRI with FreeSurfer-based analysis, and fasting serum levels of NPY and ghrelin were quantified by ELISA. Participants also completed the Eating Attitudes Test-40 (EAT-40), the Eating Disorder Examination Questionnaire (EDE-Q), the Children's Depression Inventory (CDI), and the State-Trait Anxiety Inventory for Children (STAI-C). RESULTS: Both groups with obesity showed significantly elevated NPY levels compared to HCs (p < 0.001), with no difference between adolescents with and without BED; fasting total ghrelin levels did not differ across groups. Adolescents with BED exhibited reduced cortical thickness in the right posterior cingulate cortex relative to both comparison groups (p = 0.002), while left posterior cingulate thinning was observed in both groups with obesity versus HCs (p = 0.004). No significant group differences were found in insular or anterior cingulate thickness. Both groups with obesity showed greater depressive symptoms, disordered eating attitudes, and eating-related psychopathology than HCs. In multiple regression analyses adjusted for diagnostic group membership, higher BMI (β = 0.47, p < 0.001) and lower left insular cortical thickness (β = -0.45, p = 0.031) were independently associated with elevated NPY levels. CONCLUSION: Findings suggest that elevated NPY levels may represent a shared neurobiological feature of adolescent obesity, whereas reduced right posterior cingulate cortical thickness may be more specifically associated with the diagnosis of BED. These findings contribute to understanding the neurobiological correlates of disordered eating behaviors during adolescence.

BACKGROUND AND OBJECTIVE: Corticosteroids (CSs) are widely prescribed but can induce psychiatric adverse effects (depressive, manic, psychotic, and anxiety symptoms). This systematic review aimed to quantify the association between CS use and psychiatric symptoms and to explore potential moderators across clinical contexts. METHODS: We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided systematic review and meta-analysis. MEDLINE and Embase were searched through 10 October, 2025, and 19 hand-searched records were also screened. We included observational studies in medical CS users and excluded sex steroids, neonatal exposure, prescription-only outcomes, purely objective outcomes, sleep/cognition/delirium-focused studies, CS deficiency, withdrawal, and studies confounded by co-medications; randomized controlled trials were excluded by design. Two reviewers screened studies, extracted data, and assessed risk of bias with the Newcastle-Ottawa Scale. Certainty of evidence for each pooled outcome was additionally evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Pairwise meta-analyses pooled standardized mean differences and odds ratios using random-effects models; I quantified heterogeneity. The acute phase was operationally defined as ≤ 8 weeks after CS initiation. An exploratory meta-regression across six studies (seven groups) examined dose, duration, cumulative dose, age, and sex. RESULTS: Seventy-three studies (total N = 3,759,659) were included (22 cross-sectional, 31 cohort, 12 pre-post, 2 case-control, 2 registry, and 4 prospective patient-as-own-control investigations comparing outcomes during on-CS vs off-CS periods). Compared with non-users, CS use was associated with higher depressive symptom scores (standardized mean difference = 0.92, 95% confidence interval [CI] 0.40-1.45; p < 0.001; I = 89%; seven studies; n = 1403; eight groups). During the operationally defined acute phase (≤ 8 weeks after CS initiation), manic symptoms were more frequent than depressive symptoms (six studies; n = 1086; odds ratio = 2.42, 95% CI 1.48-3.97; p < 0.001; I = 0%). A single-arm meta-analysis estimated psychotic symptoms in 2.4% of CS users (95% CI 0.76-7.26; six studies; n = 1206). Anxiety showed no significant association with CS use (standardized mean difference = 0.13, 95% CI - 0.24 to 0.51; p = 0.26; I = 7%; three studies; n = 1251). Overall study quality (Newcastle-Ottawa Scale) was generally moderate to high, whereas certainty of evidence according to GRADE was generally low to very low across pooled outcomes. The exploratory meta-regression suggested that higher daily dose and older age were associated with greater depressive severity; by contrast, cumulative dose, treatment duration, and sex showed no significant associations, and these moderator findings remain exploratory. CONCLUSIONS: Corticosteroid use is associated with more severe depressive symptoms, and manic symptoms may predominate during acute treatment; psychotic reactions are uncommon. Dose and age may modulate depressive severity, but these moderator findings should be interpreted cautiously. Routine monitoring for mood and psychotic changes, especially early after initiation and in higher-dose or older patients, is warranted.

INTRODUCTION/OBJECTIVES: This study aimed to evaluate social appearance anxiety in patients with systemic sclerosis compared with healthy controls and to examine its associations with anxiety, depressive symptoms, health-related quality of life, and disease-related clinical features. METHOD: This cross-sectional study included 71 patients with systemic sclerosis and 38 healthy controls. Social appearance anxiety was assessed using the Social Appearance Anxiety Scale. Anxiety and depressive symptoms were evaluated using the Hospital Anxiety and Depression Scale, and health-related quality of life was assessed using the Short Form-36. Disease-related variables, including modified Rodnan skin score and EUSTAR disease activity index, were recorded. RESULTS: Patients with systemic sclerosis had higher Social Appearance Anxiety Scale scores than healthy controls [32.0 (21.0-51.5) vs. 19.0 (16.25-34.0); p = 0.003]. Anxiety and depressive symptom scores were also higher in patients with systemic sclerosis. In systemic sclerosis, social appearance anxiety correlated positively with anxiety symptoms and negatively with several health-related quality-of-life domains. No significant association was observed between social appearance anxiety and modified Rodnan skin score or EUSTAR disease activity index. CONCLUSIONS: Social appearance anxiety is increased in systemic sclerosis and is associated with psychological distress and impaired health-related quality of life rather than conventional disease activity or skin thickness measures. These findings support incorporating psychosocial assessment into routine systemic sclerosis care. Key Points • Patients with systemic sclerosis had higher social appearance anxiety than healthy controls. • Social appearance anxiety was associated with anxiety symptoms and impaired health-related quality of life. • Social appearance anxiety was not significantly associated with skin thickness or EUSTAR disease activity. • Psychosocial assessment may provide clinically relevant information in systemic sclerosis care.

Opioid overdose deaths have devastated communities across the USA for over two decades. This study explores how Christian clergy in North Carolina perceive and respond to substance use issues, including opioid misuse. An anonymous online survey of clergy in 24 North Carolina counties was conducted from December 2020 to February 2021 (n = 105, response rate 7.6%). Nearly all respondents (98%) reported that their congregations offered at least one form of support for those affected by substance use issues. Over half (58%) reported someone seeking help for substance use in the past year, and clergy noted significant family impacts such as financial hardship, job loss, and overdose. Relative to evangelical Protestant congregations, mainline Protestant congregations were reported as more likely to view addiction as disease rather than sin and to support medication-assisted treatment and syringe exchange. Clergy expressed strong interest in practical resources that are more relational than educational. Limitations include a low response rate, a predominantly white, Christian sample, and pandemic-era timing. Findings highlight opportunities for trust-based partnerships between public health and faith communities that respect theological commitments while building on congregations' existing strengths and practices.

PURPOSE: Workers' compensation claims processes may exacerbate mental health symptoms for individuals with work-related mental health conditions (WR-MHCs). This study examined associations between mental health outcomes and contemporaneous claim status. METHODS: Data of this cohort study were drawn from 153 general practice patients with WR-MHCs providing 422 observations, enrolled in the IMPRovE trial across Australia. Workers' compensation claim status (accepted, rejected, being assessed, or no claim), working status, and mental health outcomes (Depression Anxiety Stress Scale-21 (DASS-21) and Short-form health survey) were assessed via 3-monthly surveys. Mixed-effects linear regression models were used to assess the relationship between claim status and outcomes, adjusting for intervention status, working status, time-point, state, clinic size, location, age, and gender. RESULTS: On the DASS-21, patients with a claim application being assessed reported significantly poorer overall mental health outcomes than those with accepted claims (e.g. stress: β = 5.73, 95% CI 1.69-9.77), rejected claims (e.g. depression: β = 5.88, 95% CI 1.12-10.63), or no claim (e.g. overall mental health: β = 6.14, 95% CI 2.87-9.42). No significant differences were found between patients with accepted, rejected, or no claim. CONCLUSION: In this cohort, poorer mental health outcomes were observed amongst individuals with work-related mental health conditions whose workers' compensation claims were being assessed, compared with other claim statuses. No differences were observed between accepted, rejected, or no-claim groups. These findings indicate that the adjudication phase of the claims process may be particularly challenging for some individuals and warrant targeted clinical and system-level attention. Further research is needed to establish causality and design interventions that can address causal mechanisms.

The objective of this study was to investigate the effects of pulsed magnetic field (PMF) at different frequencies on phagocytosis, migration, and the expression of inflammatory factors in microglia. BV2 microglia were subjected to PMF at different frequencies for 3 d, twice daily. The changes of cell viability, phagocytosis and migration after magnetic stimulation were detected. The mRNA and protein levels of TNF-α and IL-1β were determined using RT-PCR and ELISA. The nuclear translocation of NF-κB P65 and intracellular Ca2+ level was detected through immunofluorescence. PMF at different frequencies did not affect microglial viability. Stimulation at all frequencies enhanced the ability of microglia to phagocytosis and migration. The mRNA expression level of IL-1β and TNF-α was significantly decreased by magnetic stimulation at 20 Hz and 40 Hz. However, only the protein level of IL-1β was significantly reduced by magnetic stimulation at 20 Hz, while TNF-α remained unaffected. Magnetic stimulation at 20 Hz and 40 Hz inhibited the nuclear translocation of NF-κB P65 and increased the intracellular Ca2+ level. Repetitive magnetic stimulation can modulate the secretion of inflammatory cytokines and enhance the phagocytosis and migration capacity of microglia in a frequency-dependent manner. This variation may be linked to differences in the activation of NF-κB and calcium in microglia.

BACKGROUND: Posttraumatic stress disorder (PTSD) and major depressive disorder are often comorbid in humans. Psilocybin reportedly has beneficial therapeutic effects on depression, possibly by promoting neuroplasticity. PTSD is associated with the dysregulation of neuroplasticity in the hippocampus and medial prefrontal cortex (mPFC). We hypothesized that psilocybin might reduce fear memory by promoting neuroplasticity in the hippocampus and mPFC. AIMS: We investigated the effects of psilocybin on fear memory and explored its underlying mechanisms. We generated a mouse model of PTSD via auditory-cued fear conditioning and treated the mice with either vehicle or psilocybin (2.5 mg/kg, intraperitoneal) on day 0. Fear memory was assessed by the percentage of freezing time in response to conditioned stimuli. Fear memory tests were conducted on days 1, 6, and 7, after which the mice were sacrificed. To investigate the role of neuroplasticity in mediating the effects of psilocybin on fear memory, we assessed structural neuroplasticity and neuroplasticity-associated marker protein levels in the hippocampus and mPFC 7 days after a single dose of psilocybin. RESULTS: Psilocybin reduced the cue-induced fear response on days 1, 6, and 7. Psilocybin ameliorated the fear conditioning-induced decreases in neuroplasticity in the hippocampus and mPFC. Through Golgi-Cox staining, Western blotting, and immunofluorescence staining, we found that psilocybin increased dendritic branches and spine density, upregulated GluR1 and synapsin-1, enhanced brain-derived neurotrophic factor and mammalian target of rapamycin signaling, and promoted neurogenesis. CONCLUSIONS: A single dose of psilocybin reduces both the rapid and sustained fear memory in mice, at least in part by restoring neuroplasticity in the hippocampus and mPFC. These findings indicate that psilocybin has significant potential for use in the treatment of PTSD and other mental disorders characterized by fear memory.

BACKGROUND: This study aimed to examine multidimensional factors associated with self-reported Temporomandibular Disorders (TMD) symptom burden, assessed using the Fonseca Anamnestic Index (FAI), in young adults with myalgia defined according to the Diagnostic Criteria (DC) for TMD. METHODS: This cross-sectional study included 104 young adults with myalgia diagnosed according to the DC/TMD criteria. TMD symptom burden was assessed using the FAI. Clinical, psychosocial, and ultrasonographic variables were evaluated. Backward multiple linear regression was used to identify variables associated with higher FAI scores. RESULTS: The final model explained 53.0% of the variance in FAI scores (adjusted R = 0.530, p < 0.001). Higher activity-related pain, greater neck disability, elevated anxiety levels, and a higher number of parafunctional activities were positively associated with higher FAI scores, whereas greater right masseter muscle thickness was inversely associated with FAI scores (p < 0.05). CONCLUSIONS: Self-reported TMD symptom burden among young adults with DC/TMD-defined myalgia was associated with functional pain, cumulative parafunctional behaviors, neck disability, anxiety, and masseter muscle thickness. These findings support a multidimensional perspective in the assessment of TMD-related symptoms in individuals with myalgia and highlight the need for longitudinal studies using diagnostically grounded designs.

OBJECTIVE: This study aimed to evaluate the validity and reliability of the Turkish version of the Barcelona Bipolar Eating Disorder Scale (BEDS), which can facilitate screening for comorbid eating disorders (EDs) in bipolar disorder (BD) patients. METHODS: A total of 100 BD patients and 129 healthy controls (HCs) were included in the study conducted at Ankara Etlik City Hospital Psychiatry Clinic. These patients were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and the Structured Clinical Interview for DSM-5 (SCID-5). Sociodemographic forms, the Turkish version of the BEDS, the Young Mania Rating Scale (YMRS), the Hamilton Depression Rating Scale (HAM-D), the Brief Psychiatric Rating Scale (BPRS), the Bulimic Investigatory Test, Edinburgh (BITE), and the Dutch Eating Behavior Questionnaire (DEBQ) were used to assess validity and reliability. RESULTS: No statistically significant differences were found between the patient and control groups regarding the BITE and BEDS total scores. For the DEBQ, no significant group differences were observed in the total, restrained eating, or external eating scores, whereas the healthy control group had higher emotional eating scores. The correlation coefficient between each item and the total score ranged from 0.313 to 0.644. Cronbach's alpha for the scale was 0.821. The removal of any items from the original scale did not lead to an improvement in Cronbach's alpha. The BEDS score was found to be significantly correlated with the BITE score, DEBQ total score, emotional eating score, and external eating score (p < 0.001). There was no correlation between the BEDS score and the DEBQ restrictive eating subscale, YMRS, BPRS, or HAM-D scale scores. CONCLUSION: The Turkish version of the BEDS is a valid and reliable scale that can be used as an assessment tool in the evaluation of eating disorders in the Turkish BD population.

BACKGROUND: Care navigators are increasingly incorporated into medication for opioid use disorder (MOUD) treatment programs to address barriers to care and support patient engagement and retention. Prior research has largely focused on patient outcomes or program effectiveness, with limited attention to how frontline staff experience the integration of care navigators into routine treatment workflows. This study aimed to examine staff perceptions of care navigator roles and identify organizational and policy-relevant factors influencing their implementation. METHODS: We conducted a qualitative study of staff perceptions of care navigators embedded in medication for opioid use disorder treatment centers participating in the HEALing Communities Study in Kentucky, USA. Semi-structured interviews were conducted with clinical and administrative staff working in participating treatment centers. Interviews explored experiences with care navigator integration, perceived impacts on patient engagement and team functioning, and implementation challenges. Data were analyzed using thematic analysis guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework and the Practical, Robust Implementation and Sustainability Model. RESULTS: Staff described care navigators as filling critical service gaps by helping patients address practical challenges that commonly disrupt treatment engagement, including transportation barriers, housing instability, and navigating health and social services. These efforts were viewed as supporting sustained engagement in treatment with medication for opioid use disorder. Participants also reported improved team morale and reduced burnout following care navigator integration. However, staff identified persistent implementation challenges, including unclear role boundaries, scheduling constraints, and misalignment between organizational cultures. Clear differentiation between care navigators, targeted case managers, and peer support specialists was consistently identified as necessary to support effective collaboration. CONCLUSIONS: Findings suggest that care navigators may enhance engagement and workforce capacity in medication for opioid use disorder treatment settings, particularly when focused on addressing practical barriers to care. At the same time, variability in role definition and organizational fit limited effectiveness in some settings. These results highlight the importance of clear role delineation, stable funding, and implementation planning when integrating non-clinical navigation roles. Future research should incorporate patient perspectives and examine how policy and organizational contexts shape implementation and outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04111939 (registered March 26, 2019).

BACKGROUND: Survivors of critical illness commonly experience post-intensive care syndrome (PICS), including cognitive, mental health, physical, quality-of-life, and social impairments after discharge. Telemedicine may improve access to post-ICU recovery clinic care, but its feasibility and effect on recovery outcomes remain unclear. We evaluated the feasibility of a multidisciplinary telemedicine post-ICU recovery clinic and collecting 6-month outcome data. METHODS: We conducted a two-site pilot feasibility randomized controlled trial at an academic medical center and regional community medical center in the southeastern United States. Adults admitted to medical or surgical ICUs with sepsis and/or acute respiratory distress syndrome were randomized 1:1 to telemedicine ICU recovery clinic visits or standard care. The intervention included two multidisciplinary visits at 3 weeks and 3 months after hospital discharge; participants accessed visits via a secure web-based personal health portal, where they videoconferenced simultaneously with an ICU clinician, pharmacist, and psychologist. Participants in the standard of care group received usual post-discharge care. Feasibility outcomes included enrollment, retention, attendance, clinician fidelity, and participant ratings of acceptability, appropriateness, and feasibility. Exploratory outcomes included cognitive, mental health (i.e., depression, anxiety, PTSD), and physical health (i.e., activities of daily living, independent activities of daily living) composite scores measured at 1 week and 6 months after hospital discharge. RESULTS: Of 1,108 screened patients, 91 were randomized (telemedicine, n = 46; standard care, n = 45). Among 83 participants completing the 1-week assessment, median age was 56 years, 51% were male, and 91% were White. In the telemedicine arm, 23 participants (57.5%) attended at least one visit; attendance was 55% at 3 weeks and 42.5% at 3 months among eligible participants. Primary 6-month outcome assessment was completed by 31 participants in each group (67%). Clinician participation fidelity was high, and telemedicine attendees reported favorable acceptability, appropriateness, and feasibility ratings. Exploratory analyses of PICS composite outcomes did not differ significantly between groups. CONCLUSION: A multidisciplinary telemedicine post-ICU recovery clinic and associated trial procedures were feasible, with high clinician fidelity and favorable participant ratings. Larger trials are needed to explore engagement strategies and evaluate effectiveness on long-term recovery outcomes, prioritizing inclusion of more diverse and historically underrepresented populations. TRIAL REGISTRATION: NCT03926533 (posted 4/24/2019).

BACKGROUND: Anxiety disorders have a significant impact on youth globally; however, data from low- and middle-income countries such as Kenya are scant. This study aimed to determine the frequency and patterns of anxiety symptoms among Kenyan youth, as well as assess the relationships between anxiety symptoms and sociodemographic, economic, and comorbid mental health factors. METHODS: This was a cross-sectional study conducted in urban and peri-urban locations in the Nairobi Metropolitan area among 1,972 participants aged 14-25 years. The study used validated instruments, including the Anxiety Symptoms Questionnaire (ASQ), Beck Depression Inventory, and WHO-ASSIST. Descriptive statistics, t-tests, ANOVA, and Pearson correlations were used for statistical analysis, and a univariate GLM was used to determine the predictors of the anxiety symptoms. RESULTS: Anxiety symptoms were common, with the most reported cognitive symptoms being worry and nervousness. Females and participants from urban areas had significantly higher anxiety scores (p < 0.001), with mean differences ranging from 6 to 15 points across frequency, intensity, and total scores compared to males and peri-urban participants. Anxiety scores had a negative correlation (p < 0.01) with lower wealth index and moderate positive correlations with psychosis and bipolar disorder. Depression (r = 0.51; p < 0.01), PTSD, and substance use (i.e., alcohol and cannabis) were comorbid conditions. CONCLUSIONS: The study unearths the complexity of anxiety among Kenyan youth, with a nexus of social, economic, and psychological factors involved. These findings call for comprehensive mental health strategies focusing on reducing socioeconomic disparities and addressing comorbid conditions. Longitudinal trends and the efficacy of such interventions should be explored in future research for similar populations. CLINICAL TRIAL NUMBER: Not applicable.

BACKGROUND: The purpose of the research was to verify compensatory and protective models of resilience [14, 27] , among adolescents from Poland and war-affected Ukraine. Guided by the socio-ecological model of resilience theory, we examined the relationship between several psychosocial risk and protective factors and suicidal behaviour among adolescents. METHOD: Data were collected via online self-report questionnaires in Autumn 2024 from 14 to 15 year olds in Western Ukraine (N = 2179) and Warsaw, the capital of Poland (N = 1154). The response rate achieved was 75% in Lviv, 73% in Drohobych and 70% in Warsaw. Suicidal behaviour was measured by a 3-item Suicidal Thoughts and Behaviours scale adapted from the MINI Kid (Sheehan et al. 2010) (α = 0.87 - 0.90). Four groups of risk factors were examined: 1/ exposure to traumatic experiences, with a 9-item index, and victimization measured by two single questions; 2/ mental health problems (symptoms of depression measured by the shortened 4-item CES-D scale, non-suicidal self-injuries measured by a single question, problems of conduct measured with a 12-item index, problematic internet use measured with the Internet Disorder Scale - Short Form (IDS9-SF); 3/ substance use (alcohol, drug, cigarette and tranquiliser use, all measured with single questions); and 4/ personality characteristics that increase vulnerability (impulsiveness, measured by the Barratt Impulsiveness Scale-Brief (BIS-Brief), sensation seeking measured by a 6-item scale). Three groups of protective factors were also measured: 1/ parental/ familial (parental management, family relationships measured using the Brief Family Relationship Scale); 2/ school (school bonding measured with a 6-item scale, sense of safety at school measured by a single question); and 3/ individual (religiosity, measured by two single questions, individual physical activity measured by a single question, positive perception of the future, and five key aspects of positive youth development (connection, confidence, character, caring, competences), measured with the Positive Youth Development (PYD-VSF) scale. Hierarchical linear regression was conducted to test models of resilience. RESULTS: Descriptive analyses showed that significantly more teenagers in Warsaw (Poland) than in Lviv and Drohobych (Ukraine) had suicidal thoughts in the past 12 months (33.6% vs. 14.7%), had at some time planned suicide (35.5% vs. 16.9%), and had at some time attempted suicide (17% vs. 7.2%). In both countries, suicidal behaviours were significantly more prevalent among girls than boys. Further analyses also showed that adolescents in Warsaw were more exposed to significant risk factors than their peers in Lviv and Drohobych and, conversely, that youth in Lviv and Drohobych were more strongly protected against these risks than those in Warsaw. Regression analysis indicated that traumatic experiences, victimization, depressive symptoms, non-suicidal self-injury and the use of tranquilizers were associated with increased suicidal behaviour in both countries, whereas sensation seeking and drug use were associated with increased suicidal behaviour among Ukrainian youth. The results of regression showed also that a positive perception of the future and parental (on the part of the mother) management significantly reduced the risk of suicidal behaviour in both countries; however, a sense of safety at school proved to be a significant protective factor among Ukrainian adolescents, while self-confidence played that role in the Polish group. A block of four protective factors was associated with reduced risk of suicidal behaviour in both countries, supporting a compensatory model of resilience. Sense of safety at school moderated the relationship between traumatic experiences and suicidal behaviour in both countries, supporting a protective model of resilience, whereas self-confidence moderated this relationship in the Polish sample while parental management (on the part of the mother) moderated this relationship in in the Ukrainian sample. Overall, the regression model explained over 50% of the variance in suicidal behaviour in Ukrainian adolescents and 58.5% in Polish adolescents. CONCLUSIONS: This study supports the usefulness of resilience models, demonstrating that individual strengths, family resources, and a safe school environment can moderate the negative consequences of traumatic experiences on adolescent suicidal behaviour. A specific implication of these findings is the need for targeted interventions that strengthen family and school support systems to reduce the risk of suicidal thoughts and behaviours among adolescents.

BACKGROUND: Substance Use Disorder represents a complex global public health challenge, yet the effectiveness of treatment centers remains debated due to lack of consensus on standardized international indicators and heterogeneity of treatment modalities. This systematic review aimed to identify and synthesize key international indicators for measuring treatment success, compare effectiveness of different modalities, and assess impact on social reintegration. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 and Population, Intervention, Comparison, Outcome frameworks, we conducted systematic searches of PubMed, Scopus, Web of Science, and Cochrane Library. Two reviewers independently screened 4,234 records, extracted data from 28 included studies, and assessed quality using Cochrane Risk of Bias 2 and Newcastle-Ottawa Scale. Heterogeneity was quantified using I-squared and tau-squared statistics. RESULTS: Core indicators emerged in three domains: physiological (abstinence, daily functioning), psychological (reduced anxiety/depression, craving reduction), and social (employment, family relations). Medication-Assisted Treatment with methadone and buprenorphine demonstrated consistent effectiveness in reducing substance use and preventing relapse. Psychosocial interventions, particularly Cognitive Behavioral Therapy and Mindfulness-Based Relapse Prevention, significantly enhanced quality of life. Integrated models combining pharmacological and psychosocial approaches outperformed single-modality treatments. However, 78.6% of studies originated from four high-income countries, and only 17.9% reported outcomes beyond 12 months. CONCLUSIONS: Effective Substance Use Disorder treatment requires integrated models with standardized, multidimensional outcome indicators. Future research must prioritize long-term outcomes and address the substantial evidence gap in low- and middle-income countries. CLINICAL TRIAL NUMBER: Not applicable.

BACKGROUND: Major depressive disorder (MDD) is a highly prevalent psychiatric condition that frequently emerges during adolescence, a critical developmental stage characterized by heightened vulnerability to emotional dysregulation. Despite increasing evidence of large-scale brain network dysfunction in adult MDD, the static and dynamic connectivity alterations underlying adolescent MDD remain poorly understood. METHODS: We recruited 29 first-episode, treatment-naïve adolescents with MDD and 29 age- and sex-matched healthy controls (HCs). Resting-state functional magnetic resonance imaging (rs-fMRI) data were analyzed using group independent component analysis (ICA) combined with sliding-window clustering to evaluate both static functional network connectivity (sFNC) and dynamic functional network connectivity (dFNC) across the default mode network (DMN), salience network (SN), central executive network (CEN), and dorsal attention network (DAN). Correlation analyses were performed between connectivity metrics and clinical severity assessed by the 17-item Hamilton Depression Rating Scale (HAMD-17). RESULTS: Compared with HCs, adolescents with MDD exhibited significantly reduced intra- and inter-network connectivity within the DMN, SN, and CEN, alongside a trend toward increased DAN-SN connectivity. Dynamic analyses revealed reduced state transition frequency, shorter dwell time in low-connectivity states (e.g., DMN-CEN-SN interactions), and longer dwell time in high-connectivity states (e.g., DAN-SN coupling). Clinical analyses demonstrated that weaker intra-DMN and intra-DAN connectivity, as well as reduced DMN-CEN and DMN-SN connectivity, were negatively correlated with HAMD-17 scores. Conversely, prolonged dwell time in hyperconnected states positively correlated with greater symptom severity. CONCLUSION: Our findings highlight distinct static and dynamic network abnormalities in adolescent MDD, including disrupted DMN-CEN competitive balance and maladaptive DAN-SN hyperconnectivity. These alterations may hint at developmental-stage-specific neuropathological mechanisms that could differ from adult depression, although direct comparison with adult cohorts is lacking. Integrating static and dynamic FNC analyses may provide preliminary insights into candidate neuroimaging markers for early detection and intervention strategies in adolescent MDD, though these findings require validation in independent, larger cohorts.

BACKGROUND: Falls are a common occurrence among older adults and can pose serious health and financial burdens. Several studies have shown that a decline of ADL, cognitive decline, and depression are all associated with an increased risk of falls in older adults. However, there is currently a lack of research examining these three factors in conjunction and their combined effect on the risk of falls. Our study aims to examine the longitudinal associations between distinct trajectories of activities of daily living, cognition, and psychological status among adults and their risk of falls. METHODS: We conducted a longitudinal analysis using data from five waves (2011-2020) of the China Health and Retirement Longitudinal Study (CHARLS). A group-based multiple trajectory model (GBMTM) was employed to identify latent ADL-cognitive-Depression trajectories among 2,938 individuals aged 60 years. Multivariable logistic regression models were then used to assess the odds of experiencing falls between 2018 and 2020 across the identified trajectory groups, with sequential adjustment for demographics, health behaviors, comorbidities, and functional limitations. RESULTS: GBMTM identified five distinct trajectory subtypes: "Pervasive Decline (Severe-ADL-Decline)" (n = 378, 12.87%), "Pervasive Decline (Mild-ADL-Decline)" (n = 449, 15.28%), "Cognitive - Decline & Depressed" (n = 338, 11.50%), "Mild ADL Decline" (n = 351, 11.95%) and "Normal" (n = 1422, 48.40%). Compared to the "Normal" group, all other trajectory groups showed significantly elevated risks of falls in the fully adjusted model. The highest risk was observed in the "Pervasive Decline (Severe-ADL-Decline)" group (OR = 2.83, 95%CI: 2.12-3.77), followed by the "Pervasive Decline (Mild-ADL-Decline)" (OR = 2.13, 95%CI: 1.62-2.80), "Mild ADL Decline" (OR = 1.97, 95%CI: 1.47-2.63), and "Cognitive Decline & Depressed" (OR = 1.47, 95%CI: 1.07-2.02) groups. CONCLUSIONS: Five distinct trajectory groups of ADL, cognitive function, and depressive symptoms were identified. These groups exhibited significant differences in fall risk, with the "Pervasive Decline (Severe-ADL-Decline)" group presenting the highest risk, necessitating multidimensional comprehensive interventions for fall prevention.

OBJECTIVE: Based on the local context in China, this study systematically reviews and explores the prevalence of social frailty among community-dwelling older adults in China and its potential influencing factors. METHODS: A systematic search was conducted in databases including CNKI, VIP, Wanfang Data, the Chinese Biomedical Literature Database, PubMed, the Cochrane Library, Web of Science, and Embase, covering the period from the inception of each database to November 9, 2025. Two researchers independently performed the systematic literature search, data extraction, and article quality assessment. Meta-analysis was conducted using Stata 15.1 software, incorporating cross-sectional and cohort studies; a random-effects model was used to calculate the pooled prevalence of social frailty and pre-frailty; odds ratios (OR) and 95% confidence intervals (CI) were used to assess associated influencing factors; the Istatistic was used to assess heterogeneity, and subgroup analysis and meta-regression were performed. RESULTS: An initial search identified 5,488 articles; after screening, a total of 24 studies (n = 242,591) were ultimately included. The random-effects model showed that the pooled prevalence of social frailty among community-dwelling older adults in China was 25.0% (95% CI: 19.4%-31.0%, I = 99.47%, P < 0.001),and the prevalence of pre-social frailty was 42.0% (95% CI: 37.6%-46.3%, I = 94.80%, P < 0.001). Gender (female), advanced age (≥ 85 years), depression, physical frailty, housing satisfaction, marital status, and physical frailty were significantly associated with the risk of social frailty (OR: 1.36-4.15). CONCLUSIONS: Pre-social frailty and social frailty are common health challenges faced by community-dwelling older adults in China. Recent data indicate that the prevalence of these conditions remains high; although the prevalence is the very high heterogeneity and should be interpreted with caution, it nevertheless underscores the necessity and urgency of implementing effective interventions. Early identification and intervention for individuals at risk of social frailty are of critical importance for advancing the Healthy China strategy and achieving the goals of active aging. PROSPERO REGISTRATION NUMBER: CRD420251246136.

BACKGROUND: The utility of various cognitive assessment tools for distinguishing between mild impairment and dementia, as well as for determining cutoff values for specific populations, continues to be the subject of extensive research. Here, we assessed the utility and feasibility of these tools in the first Slovak memory clinic cohort. METHODS: We enrolled a Slovak memory clinic cohort of patients with MCI and dementia (MCI, n = 84; dementia, n = 55). The participants were characterized using a range of cognitive assessment tools-Auditory Verbal Learning (AVLT), Category and Letter Fluency (CFT, LFT), Digit Span (DSF, DSB), Digit-Symbol Coding (DS-C), Frontal Assessment Battery (FAB), MMSE, MoCA, Rey Osterrieth Complex Figure (ROCF), and Trail Making Test (TMTA, TMTB); clinical assessments-Amsterdam Instrumental Activities of Daily Living (A-IADL) and 5-level EuroQol questionnaire with 5 dimensions (EQ-5D-5 L); and scales for anxiety, dependency, depression, dignity, and MRI volumetry. The ability of the various assessments to distinguish between MCI and dementia was evaluated. RESULTS: Over the course of three years, at a single memory clinic, it was feasible to enrol and evaluate a total of 150 participants, 139 of whom fulfilled the definition of either MCI or nonvascular dementia. Of the employed cognitive and clinical assessment tools, the best differentiation between MCI and dementia was observed for the AVLT and A-IADL. The DSF and DSB tests did not reveal differences between the populations. No differences were observed in education, vital signs, or anthropometric measurements. Participants with dementia had greater degrees of brain atrophy in the hippocampi and frontal, parietal, and temporal cortex; lower total brain volumes; and greater ventricular dilation. CONCLUSIONS: This study confirms the utility of a range of cognitive assessment tools and scales for differentiating between MCI and dementia but reveals that some commonly employed tools, such as the DSF and DSB, may not be sensitive to these differences. This study highlights the importance of accurate assessment of the ability to perform activities of daily living and supports the development of objective, ecologically valid assessments of IADL.

BACKGROUND: Population ageing has become an immediate global imperative, with older adults disproportionately afflicted by multimorbidity, a complex interplay of co-existing chronic diseases that erodes health-related quality of life (HRQoL). Multimorbidity is associated with impairments in physical and mental functioning, which undermine older adults' autonomy and contributes to declines in HRQoL. However, vital data that explore these relationships remain absent for older populations residing in long-term care facilities (LTCFs) across sub-Saharan Africa. This study examines multimorbidity prevalence in LTCF residing older adults and its associations with depression, HRQoL outcomes and physical activity. METHODS: A cross-sectional study among 396 older adults from 17 randomly selected South African LTCFs employed the Geriatric Depression Scale, EQ-5D-3 L, and Weighted Functional Comorbidity Index. Descriptive statistics, correlation analyses and TwoStep cluster analysis elucidated multimorbidity patterns. RESULTS: Multimorbidity affected 76.77% of participants, with variation across four distinct clusters. The Cardiovascular-Respiratory cluster comprised 33.8% predominance. Multimorbidity was significantly predicted by poorer HRQoL and increasing age, χ²(140, n = 396) = 228.19, p < .001. Depression prevalence reached 35.10%, with higher scores associated with greater multimorbidity burden (ρ = 0.28, p < .01) and reduced HRQoL. An inverse correlation between the Weighted Functional Comorbidity Index and EQ-5D-3 L scores (ρ = -0.33, p < .001) reflected multimorbidity's negative impact on HRQoL. Multimorbidity was inversely associated with Short Physical Performance Battery scores, lower physical activity, and directly to waist-to-hip ratios. CONCLUSION: Advancing age is strongly associated with an increased burden of multimorbidity, which is intricately linked to depressive symptoms, diminished HRQoL, reduced muscular strength, central adiposity, and physical inactivity. These findings highlight the urgent need for integrated interventions in institutionalised older adults in sub-Saharan Africa and should inform policy reform aimed at strengthening long-term care and healthy ageing strategies.