Caregiving in first-episode psychosis (FEP) is challenging. Although family interventions in FEP are effective, relatively few caregivers access them, and most do not directly address caregivers' own mental health needs. Digital interventions present a novel opportunity to support individual caregiver well-being.

This study evaluated the feasibility, acceptability, and preliminary benefits of Altitudes, a blended digital health intervention for FEP caregivers.

Participants engaged in a 6-month trial of the Altitudes platform, which features psychoeducation, therapy content, and social networking. Caregivers completed assessments at baseline, mid-treatment (3 months), and post-treatment (6 months). Feasibility was measured by engagement and retention rates; acceptability was evaluated through user experience questionnaires. Exploratory outcomes included distress, self-compassion, loneliness, experiences of caregiving, and expressed emotion.

Caregivers found the intervention highly acceptable, with high retention and sustained engagement in the platform's human support elements. At follow-up, caregivers reported lower distress, increased compassionate self-responding, increased positive caregiving experiences, and reduced loneliness. All effects had wide confidence intervals, warranting cautious interpretation.

Altitudes is a feasible and acceptable digital intervention for FEP caregivers and may benefit multiple domains of caregiver mental health. Future research is needed to support its effectiveness and strengthen long-term engagement.

Paratonia is an involuntary, variable resistance to passive movement that affects 90%-100% of patients with advanced dementia, interferes with care and contributes to caregiver burden. Botulinum toxin A is a candidate treatment but has no approved indication, and whether community-dwelling caregivers would attend quarterly outpatient treatment has not been characterised. In an online survey of 274 caregivers, 65.3% reported the care-recipient's paratonia exerted a moderate to extreme impact on their own physical, emotional and mental well-being, and 84.6% reported they would attend an outpatient clinic if treatment were effective. Caregiver willingness suggests the feasibility of clinic-based treatment models.

Compassion is central to moral and relational functioning, yet its determinants and systemic effects remain a subject of debate. The study linked to the current protocol will examine how fear of and openness to compassion from others are associated with well-being, emotional openness, and prosocial behavior. Additionally, it investigates how spirituality, religiosity, and secularism shape interpretations of compassion and altruism among working adults from diverse religious and ethnic backgrounds.

This research protocol refers to a future study, not started yet, that will employ a concurrent mixed-methods design, combining quantitative and qualitative online survey data with qualitative Microsoft Teams face-to-face interviews to examine how adults interpret compassionate acts through religious, secular, or blended lenses. Biographical and socio-demographic characteristics will be treated as independent variables, psychological outcomes as dependent variables, and received compassion as a moderating variable influencing these associations. Guided by the Social Ecological Model, both strands will be analyzed across individual, interpersonal, organizational, and community levels. Quantitative and qualitative findings will be integrated through joint displays and side-by-side interpretation, enabling statistical patterns to be directly compared with narrative themes and producing a coherent multilevel account of how compassion shapes well-being and relational functioning. The quantitative component will incorporate precise regression-based moderation models, covariate adjustment protocols, and missing data handling, while the qualitative strand will rely strictly on thematic analysis to avoid inappropriate methodological crossover.

As this is a research protocol, no assumptions are made regarding the direction, magnitude, or significance of findings. The study to which the protocol refers is designed to examine how individuals interpret acts of compassion received from others through religious, secular, or blended frameworks and whether these interpretations are associated with psychological and relational outcomes. Findings will be interpreted as exploratory and context dependent, with conclusions limited to the study sample and design.

Findings of the future study may contribute to future discussions concerning compassion within public health, education, and social care contexts; however, any practical recommendations should be regarded as preliminary and exploratory pending further research using longitudinal and representative designs.

Previous research provides evidence that the postpartum period is a crucial time for individuals who have just given birth to understand and engage in their health to mitigate current and future risks. The present study is a scoping review of research on educational tools that address pregnancy-related complications for postpartum patients. We aimed to determine the extent to which these tools exist and how they have been studied among postpartum people. PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Embase were searched from inception to June 2025 to identify publications on patient-facing educational tools for the postpartum period that focus on pregnancy-related complications. Educational tools were evaluated for application to the Capability, Opportunity, and Motivation (COM-B) framework for health behavior change. Of 3216 records, 32 studies met the inclusion criteria, and 11 patient educational tools were accessible for analysis. Two reviewers independently screened and assessed the titles, abstracts, and full texts of identified articles for inclusion. These tools were delivered through a variety of media, including mobile applications and traditional written pamphlets. Topics of the tools included postpartum mental health, hypertensive disorders of pregnancy, gestational diabetes, breastfeeding after a complicated pregnancy, and warning signs for postpartum morbidity and mortality. Enhancers to postpartum care were addressed more often in the educational tools than barriers to postpartum care. The educational tools most often covered the following facilitators of behavior change identified by the COM-B framework: psychological capability, social opportunity, and reflective motivation. This scoping review highlights the limited availability of educational tools for postpartum care and recovery that address pregnancy-related complications. Findings of this scoping review suggest that educational tools that address pregnancy-related complications for postpartum patients were limited in topics covered, language availability, and diversity of postpartum populations tested. Further research is needed to expand the network of accessible postpartum educational tools and to assess the efficacy and acceptability of these educational tools in historically marginalized populations. Structuring these tools within a framework for behavior change such as COM-B may be a useful method for better understanding and improving postpartum care engagement and access to educational resources.

Porphyrias are rare metabolic disorders stemming from impaired heme biosynthesis, with neuroporphyrias comprising a subset characterized by neuropsychiatric symptoms due to toxic intermediary buildup in the nervous system. Here, we explore the case of a 67-year-old man with no previous psychiatric history who was taken to the emergency department for psychiatric symptoms, including delusional speech, grandiosity, irritable mood, and psychomotor agitation. He was involuntarily admitted under the Portuguese Mental Health Act with a provisional diagnosis of mania with psychotic symptoms. Despite initial treatment with valproic acid, clinical deterioration prompted a metabolic workup leading to a diagnosis of acute porphyria. The patient was discharged fully recovered and remained stable during follow-up, relieved after understanding his diagnosis. Although rare, porphyric attacks can be fatal or cause long-term neurological damage. This case underscores the importance of recognizing neuroporphyria, highlighting the need for comprehensive evaluation and timely intervention to mitigate potential adverse outcomes.

The objective of this study is to evaluate differences in patient-reported symptom outcomes among individuals with postural orthostatic tachycardia syndrome (POTS) stratified by the presence or absence of co-occurring endometriosis.

We conducted a retrospective cohort analysis of 458 POTS patients evaluated at our autonomic center between 2018 and 2024. POTS diagnosis required documented orthostatic intolerance with a heart rate elevation of ≥30 beats per minute during the initial 10 minutes of head-up tilt table testing. Endometriosis was confirmed through surgical pathology reports where available, or via clinical documentation from a gynecology specialist. Patient-reported outcome measures were then compared between those with and without concurrent endometriosis.

Among 1,322 female POTS patients, 229 (17.3%) also carried a diagnosis of endometriosis. Those with concurrent endometriosis demonstrated greater autonomic symptom severity, evidenced by elevated Composite Autonomic Symptom Score 31 (COMPASS-31) scores across several domains. Although the prevalence of anxiety and depression did not differ significantly between groups, both cohorts exhibited substantially higher rates than the general population.

Co-occurring endometriosis was associated with heightened autonomic dysfunction across several symptom domains, indicating that endometriosis may amplify the severity of POTS-related complaints. Both POTS groups demonstrated substantially elevated rates of anxiety and depression relative to the general population, revealing a considerable mental health burden irrespective of comorbid endometriosis. These results emphasize the need for thorough autonomic symptom evaluation and routine mental health screening in patients with POTS.

Compared to metropolitan residents, rural residents face disparities in access to local mental health providers that are even larger than for other health care services. Telehealth appears to be a solution: patients should be able to more easily access providers from metro areas, reducing disparities in access. We consider how provider composition in telehealth or changes in provider behavior enabled by telehealth are associated with access to telehealth.

We present descriptive evidence from multivariate regressions using National Health Interview Survey and Medical Expenditure Panel Survey data.

In recent years, rural and publicly insured patients have become relatively less likely to see a mental health provider. Simultaneously, access to any telehealth services is 8-9 percentage points lower for non-metro residents, even after accounting for potential differences in mental health care utilization and internet access. We also show that self-payment is associated with telehealth utilization.

We caution that telehealth in mental health may disproportionately benefit patients with higher insurance reimbursement or higher probability of self-pay and thus not reduce the mental health access gap for rural patients. Expansions in telehealth need to be combined with policies to promote equitable reimbursement and reduce barriers for providers to bill insurance.

Caregivers of adolescents at elevated suicide risk are tasked with significant responsibility following their child's Emergency Department (ED) visit, such as monitoring warning signs, restricting lethal means access, or encouraging coping. Caregiver uncertainties regarding post-discharge support, coupled with resource constraints limiting the health system's capacity to provide ongoing assistance, call for scalable strategies to address these challenges. Digital interventions, such as text messaging, offer a pathway for low‑burden and accessible post-discharge approaches to support families. Building on a pilot of a text-based intervention for parents (TESP), developed to increase caregiver follow-through with suicide prevention recommendations and improve caregiver well-being, this qualitative mixed‑methods study sought input from health system stakeholders (clinical providers, administrative leaders and decision makers) to investigate TESP's eventual implementation potential. Twenty-one providers and system-level staff from three EDs completed semi-structured interviews and surveys rating TESP's acceptability, perceived feasibility, and appropriateness. A thematic framework was applied to the interview transcripts to identify salient themes. TESP was seen favorably, and ratings across the domains were moderate‑to‑high. Additional themes highlighted the intervention's focus on validating caregivers' experiences and reinforcing safety recommendations in a scalable way. Key implementation facilitators centered on system-level organizational structure, workflow automation, and increasing perception of value from health system staff and parents alike. The findings show TESP's promise as a feasible, acceptable strategy to improve post-discharge safety for youth at risk for suicide, while highlighting the importance of provider and leader feedback to anticipate and address implementation barriers in resource-constrained care settings like the ED.

Suicide-specific group psychotherapy is a novel approach to suicide prevention with promising supporting data. However, limited research examines telehealth delivery for suicide-specific interventions. This study described treatment engagement and suicide-related coping (SRC) trajectories among Veterans receiving a group suicide safety planning intervention before and after a transition from in-person to telehealth delivery.

Project Life Force (PLF) is a group suicide safety planning intervention evaluated within a randomized clinical trial. During the COVID-19 pandemic, PLF transitioned from in-person to telehealth, creating naturalistic pre-pandemic in-person and pandemic-era telehealth cohorts. This report focused on participants randomized to PLF and described treatment initiation, engagement, completion, and SRC trajectories across cohorts.

: Baseline suicidal ideation and SRC were higher in the pre-pandemic in-person cohort than the pandemic-era telehealth cohort. The telehealth cohort showed higher rates of treatment initiation descriptively than the in-person cohort, while treatment engagement and completion among treatment initiators were more similar across delivery periods. Both cohorts showed improvement in SRC that was sustained over time.

Elevated treatment initiation occurred with virtual delivery of PLF. Both pre-pandemic in-person and pandemic-era telehealth cohorts showed similar patterns of group engagement as well as development and sustainment of SRC over time. As telehealth can reduce barriers to care, these data lend support to the promise of virtual, group-based, suicide-related interventions. Since treatment modality was determined by the pandemic and not randomized, delivery context, cohort characteristics, and pandemic-related factors may have impacted observed patterns. Randomized studies comparing delivery modalities should clarify potential treatment modality differences.

The online version contains supplementary material available at https://doi.org/10.1007/s41347-026-00719-y.

The rapid integration of technology into healthcare led to the creation of the "Digital Navigator" role to support patient uptake of digital health tools. The need for this role is particularly acute in mental health care, where digital tools show promise but patient engagement is low without human support and people with serious mental illness face disproportionate barriers to digital inclusion. However, as no survey of active trainings for this role yet exists, our team assessed existing programs to determine the challenges and opportunities for sustainably integrating this training into healthcare, including mental health settings.

To determine whether these training programs are applicable to digital navigators operating in healthcare settings (including mental health care) by answering the following questions: (1) What do these programs offer in terms of healthcare-relevant content and teaching materials? (2) How are trainees evaluated within these programs? (3) How are these programs accessed and delivered?

A pragmatic search on 6 August 2025, was conducted for programs using the first 5 pages of Google, querying ChatGPT, and referring to the National Digital Inclusion Alliance guide.

Our search found 38 unique results, 29 of which were excluded (Appendix B). While all 9 trainings surveyed covered technological support, fewer covered health-care-specific competencies, and only one included trainer-led evaluation of soft skills. Qualitative summaries of all 9 programs are in Appendix C.

We indicate several directions for improving the applicability and sustainability of these programs within mental healthcare, including evaluation of soft skills through roleplay, training durable troubleshooting skills, utilizing Large Language Models for asynchronous training, leveraging existing volunteer pipelines and upskilling healthcare staff.