To develop an evidence-based, consensus-driven service model for the identification, assessment and treatment of tic disorders in children and young people (CYP) in England, addressing the absence of dedicated pathways and national clinical guidance.

Two-stage consensus study comprising a Delphi survey, expert/patient and public involvement (PPI) review and regional stakeholder workshops.

UK healthcare and community settings relevant to tic disorder assessment and management (primary care, neurodevelopmental services, child and adolescent mental health services).

Stage 1: UK-based clinicians, researchers and practitioners with expertise in tic disorders (Delphi panel; n=49; 98% retention across rounds). Stage 2: regional stakeholders including clinicians, commissioners, service managers, third-sector representatives and parents/carers (n=36). Eligibility required relevant professional or lived experience; no exclusions applied beyond this criterion.

Identification of a consensus-based component of a best-practice service model for tic disorders and barriers and facilitators to implementation across regional pathways.

The Delphi process generated consensus on 40 core components, refined to 43 following expert and PPI review. Agreed features included referral criteria, comprehensive assessment, psychoeducation, behavioural interventions, pharmacological options and integrated cross-service working. Stakeholder workshops highlighted key implementation challenges, including workforce training, funding constraints and coordination across neurodevelopmental and mental health services, informing practical adaptations to the model.

This consensus-informed service model provides structured, UK-specific guidance to support earlier identification, appropriate intervention and improved care coordination for CYP with tic disorders. Future research should assess real-world implementation and impact.

The model offers actionable recommendations for referral pathways, intervention provision and service configuration. Adoption may reduce diagnostic delays, minimise misdiagnosis and strengthen collaboration between primary, neurodevelopmental and mental health services, leading to improved outcomes for CYP with tic disorders.

Lesbian, gay, bisexual and transgender (LGBT) individuals have faced marginalisation and discrimination despite legal advancements, such as those in Nepal. While Nepal has constitutional protections for LGBT rights, the community still deals with social stigma, harassment and mental health challenges. Limited research exists on LGBT mental health in Nepal, with studies mostly focusing on sexual health. This study aims to assess the prevalence of depression and anxiety among LGBT individuals of Kathmandu Valley, focusing on the factors associated with anxiety and depression.

A community-based cross-sectional descriptive quantitative study.

Conducted in urban areas of Kathmandu Valley, Nepal, from January to May 2018.

Data were collected from 197 LGBT individuals aged 18 and above using snowball sampling, whereas individuals unable to complete the questionnaire due to language barriers were excluded.

The primary outcomes were depression and anxiety, assessed using the Centre for Epidemiological Studies Depression Scale and Beck Anxiety Inventory respectively. Secondary measures included sociodemographic and behavioural factors. Multivariable logistic regression analysis was performed to estimate adjusted ORs (aORs) with 95% CIs.

The study found 18.27% LGBT individuals were depressed and 25.38% of LGBT individuals had anxiety. Individuals from minority ethnic groups had higher odds of depression compared with Brahmin/Chhetri (aOR=4.31, 95% CI (1.02 to 18.20)). A history of suicide attempts was strongly associated with both depression (aOR=11.20, 95% CI (3.94 to 32)) and anxiety (aOR=3.27, 95% CI 1.46 to 7.33; p<0.01). Above-average self-rated health was associated with lower odds of depression (aOR=0.34, 95% CI (0.14 to 0.87)) and anxiety (aOR=0.333, 95% CI (0.149 to 0.743)).

A substantial proportion of LGBT individuals in Nepal experience depression and anxiety, with disparities linked to ethnicity, self-rated health and history of suicide attempts. These findings highlight the need for inclusive and culturally sensitive mental health interventions and targeted support strategies for this population. Further research using representative sampling and longitudinal designs is recommended.

Positive health behaviours during pregnancy are essential for maternal, fetal, and child wellbeing but can be compromised by poor maternal mental health. Pregnancy-related anxiety (PRA) - including concerns about bodily changes across pregnancy, childbirth fears, and worries about fetal/infant health - reduces positive health behaviours in studies of mostly low-risk women.

It is unclear whether this relation between PRA and positive health behaviours exists in lower-income women with barriers to engaging in positive health behaviours, or how it is influenced by other mental health concerns sometimes not considered in prior studies.

This is a longitudinal study of 270 women from the community oversampled for economic vulnerability and high stress assessed three times across pregnancy [weeks 17.4 (SD 2.3), 24.1 (SD 1.5), and 33.1 (SD 1.3)] for PRA (PRAQ-R2), other mental health concerns (depression - EPDS, anxiety - STAI, PTSD - PCL-5), and positive health behaviours (PHBS). Multivariate latent growth curve modeling was used for data analyses.

There was a significant negative relation in the full sample between PRA and positive health behaviours only at our earliest timepoint. However, further analysis comparing women below and above the clinical cutoffs for the frequency and severity of other mental health concerns and also including covariates identified that PRA was associated with lower concurrent positive health behaviours only in the group with high levels of other mental health symptoms.

PRA is not necessarily related to positive health behaviours in low-income and vulnerable women, and other mental health concerns must be considered. Earlier pregnancy PRA screening and support could increase positive health behaviours particularly for women with high levels of other mental health symptoms.

Climate change is an escalating global health threat with significant implications for the field of psychiatry. This narrative review explores the anticipated psychiatric consequences of climate change over the next three decades, highlighting emerging challenges and potential opportunities for mental health care. Evidence links extreme weather events, heatwaves, and environmental degradation to increased rates of anxiety, depression, post-traumatic stress disorder, and suicide. Vulnerable groups include rural women, youth, and individuals with pre-existing mental disorders. The rise of eco-anxiety and climate-related depression points to the emergence of new clinical presentations that may warrant future inclusion in diagnostic frameworks such as the DSM and ICD. The review emphasizes the urgent need to adapt psychiatric training, strengthen healthcare systems, and implement climate-informed policies. Digital solutions, especially telepsychiatry, are vital for maintaining care delivery amid climate disruptions. Concurrently, advances in stress-related biomarkers offer promising avenues for early detection and prevention. Psychiatry must engage proactively in climate change mitigation and adaptation, promoting climate justice and equitable access to care. Addressing the mental health dimensions of climate change is crucial to building resilient psychiatric services capable of responding to the evolving environmental and societal landscape.

Adolescents living with HIV face higher rates of mental health morbidity compared to other age groups, particularly depressive symptoms, while access to specialized services remains limited in many low- and middle-income countries. Chatbots offer a promising, low-cost approach to delivering structured mental health support in resource-constrained settings; however, practical guidance on how to develop such tools with end-user involvement remains scarce. This tutorial provides a step-by-step guide to the human-centered design and development of a mental health chatbot for adolescents living with HIV, illustrated through the creation of EVA (Educación, Vinculación, y Autoayuda), a chatbot cocreated with adolescents living with HIV in Peru. Guided by human-centered design principles, the tutorial covers three key steps: (1) understanding user needs through qualitative research, (2) iterative chatbot development with a Youth Advisory Board across five structured sessions, and (3) external review and testing before launch. Throughout the process, adolescents contributed to defining the chatbot's tone, visual identity, navigation structure, and content priorities. The chatbot was built using a low-cost messaging platform and incorporated multimedia components, including brief animated videos, to enhance engagement. Throughout development, iterative testing with the Youth Advisory Board and external health care professionals informed refinements in usability, content clarity, emotional tone, and accessibility. This tutorial synthesizes key methodological decisions, lessons learned, and challenges encountered, providing practical guidance for researchers and practitioners seeking to develop similar adolescent-centered digital mental health tools in low- and middle-income countries. Key takeaways include the importance of early and sustained adolescent involvement, the value of iterative prototyping, and the feasibility of building functional chatbots with limited resources to help address the health service gap experienced by adolescents living with HIV.

Aim: This study aimed to assess levels of perceived stress, psychological resilience and job satisfaction among Emergency Department (ED) healthcare professionals in Attica, Greece, and examine the correlations among them.

Materials and Methods: A cross-sectional study was conducted in 12 public hospitals in Attica, Greece, using self-administered questionnaires: Perceived Stress Scale (PSS-10), Connor-Davidson Resilience Scale (CD-RISC-10), and Job Satisfaction Survey (JSS). Descriptive statistics, Pearson correlations, and multiple linear regression analyses were performed using SPSS v30.

Results: Participants reported moderate levels of perceived stress (M=17.72, SD=6.30) and psychological resilience (M=27.18, SD=6.01), while job satisfaction appeared variable, with an overall mean score indicating low to moderate satisfaction (M=113.10, SD=23.41). A significant negative correlation was found between perceived stress and job satisfaction (r=-0.36, p < .001), as well as between stress and resilience (r=-0.53, p < .001). A positive but weaker correlation was observed between resilience and job satisfaction (r=0.14, p < .001).

Conclusions: Psychological resilience plays a critical protective role against stress and positively influences job satisfaction among ED healthcare professionals. Resilience-enhancing interventions may reduce stress and improve satisfaction among ED staff.

The need for improved mental and behavioral health training for pediatric residents has been recognized for over 40 years. During this time, the prevalence of child behavioral health issues has steadily increased, culminating in the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children's Hospital Association declaring a national emergency in children's mental health in 2021. In response, the Accreditation Council for Graduate Medical Education (ACGME) implemented new mental health training requirements for pediatric residents beginning in July 2025. A core group of Brown University Health faculty designed and launched a structured rotation with milestone-informed goals and objectives, clinical experiences, and didactic components. These efforts align with Brown's longstanding commitment to address child and family mental health within a pediatric context. Pre- and post-surveys, qualitative data, and participant feedback were collected. Over 40 residents have participated in the rotation, appreciating the opportunity to tailor experiences to their individualized learning goals. A survey evaluating knowledge and comfort in assessing, diagnosing and treating common mental health conditions was administered before and after the didactic curriculum. Paired t-tests were conducted to evaluate changes in self-efficacy before and after the curriculum. Residents across all years of training reported improved knowledge and comfort in assessing, diagnosing and treating depression, suicide, and attention-deficit/hyperactivity disorder (ADHD) after delivery of the didactic mental health curriculum (all p ≤ 0.05, n = 15), and many of these improvements were sustained at six months. Areas for improvement include increasing first-year exposure to mental health training, creating longitudinal experiences, including direct clinical involvement within the Med-Psych service line, and expanding supported faculty time and resources for development.

Integrated behavioral health (IBH) in primary care settings has been touted as improving access to behavioral health services. In this case report, we describe a representative IBH team nested in a family medicine residency clinic, led by a behavioral health faculty clinician. Using this patient as an example, we identify ways in which the team was able to achieve elements of the quintuple aim (population health, enhanced patient experience, cost reduction, health equity, and provider well-being). We additionally utilize this case report to provide examples of learning opportunities for medical residents.

Social determinants of health play a critical role in mental health outcomes, yet their influence on access to and response to transcranial magnetic stimulation (TMS) for major depressive disorder (MDD) remains poorly understood. As TMS is an effective intervention for treatment-resistant depression and may serve a clinically vulnerable population, characterizing the social context of patients receiving TMS is essential. We examined social needs and assets in a TMS-treated cohort and evaluated their relationship to treatment response, hypothesizing greater social need burden among non-responders.

We conducted a retrospective analysis of adults who received an acute course of TMS for MDD at Butler Hospital between 2019 and 2021. Depressive symptom severity, response, and remission were assessed using the Inventory of Depressive Symptomatology-Self Report (IDS-SR). Social needs and assets were measured using a modified Accountable Health Communities Health-Related Social Needs (AHC-HRSN) Screening Tool, including items assessing community engagement.

Seventy-four patients were included in the analysis. Baseline social needs were not significantly associated with TMS response or remission. Patients accessing TMS generally demonstrated high levels of social assets and minimal deficits in basic needs and substance use; however, most reported social isolation and substantial functional impairment. Several domains of self-reported social needs improved following TMS treatment, independent of clinical response.

Patients receiving TMS exhibited relatively high social assets despite pronounced psychosocial burden associated with depression. Several self-reported psychosocial domains improved following treatment, including isolation/loneliness, difficulty with concentration, and ability to complete errands independently. These findings suggest that TMS may coincide with functional improvements beyond depressive symptom reduction and highlights opportunities to integrate supportive psychosocial services alongside treatment that may further optimize clinical outcomes and reduce social unmet needs. Further investigation is needed to understand how social context influences access to and outcomes of TMS care.

Though perinatal psychiatric disorders affect the entire family, most perinatal mental health interventions only include mothers. Here, we detail the implementation of a single-session, virtual, family support group for partners and family members of mothers with perinatal psychiatric disorders.

The family support group was created within a mother-baby partial hospital program for people experiencing perinatal psychiatric disorders. Patients in the program provided consent to contact their partner or family member. This person was offered participation in a complementary, one-hour virtual support group. Led by a clinical psychologist, the support group was designed to serve as a standalone psychoeducational intervention on perinatal mood disorders. Sessions were offered bi-weekly to facilitate access. Participants were asked to complete an anonymous survey soliciting mixed-method feedback about the group.

Of 105 people who consented to contacting their family members regarding the support group, 70 (65%) family members reported interest, and of these, 45 (64%) attended a support group session. Among the 13 participants who provided feedback (29%), there was a high level of satisfaction (Client Satisfaction Questionnaire-8 M=27.25; score >24=high satisfaction) and the perception that participation increased their knowledge of and empathy toward their family member's experiences. The most common feedback was a desire for more sessions.

In this pilot study, a virtual family support group was feasible and yielded high participant satisfaction. Future research should examine how this or other digital programs could make perinatal mental health care more accessible for partners and family members.