To evaluate the integration of Indigenous healing practices within an interprofessional team-based primary care clinic.

Guided by the Two-Eyed Seeing and Eco-Normalization frameworks, a developmental evaluation was conducted from November 2023 to July 2024, and included surveys, semistructured interviews, and a facilitated sharing circle. Quantitative data were analyzed descriptively. Deductive content analysis-using the Eco-Normalization Framework and the Empathy Map analysis-was used for qualitative data analysis.

An interprofessional team-based primary care clinic in Winnipeg, Man, in Canada.

Indigenous and non-Indigenous patients (n=9) and health care providers (n=14).

An Indigenous Elder, Knowledge Keeper, and mental health counsellor were integrated into the study to embed Indigenous ways of knowing into care. Perspectives of patients and health care providers regarding the perceived value of integrating Indigenous ways of knowing and healing were explored.

Nine themes emerged: valuing Indigenous ways of knowing and healing; culturally relevant, holistic care; incorporating Indigenous healing practices; whole-person care; collaboration within a team-based model; relationship building; barriers to health care access; lost traditional knowledge and continuation of intergenerational trauma; and centrality of emotional health. Patients and providers reported improved cultural safety, enhanced trust, and deeper engagement. Key facilitators included interdisciplinary collaboration, community partnerships, and integration of ceremony and land-based healing. Challenges included systemic barriers beyond the clinic and sustainability concerns.

Integrating Indigenous knowledge into team-based primary care can advance culturally safe, holistic, and equity-oriented health services. Structural transformation, sustainable funding, Indigenous governance, and embedding Indigenous ways of knowing into health professional education are critical for scaling and sustaining such models. Our findings support the Truth and Reconciliation Commission of Canada's Calls to Action.

This naturalistic study characterized clinical profiles of outpatient young adults with concurrent substance use and nonsubstance mental health symptoms in addition to evaluating reach and outcomes of a dialectical behaviour therapy skills training group.

Descriptive statistics were generated to characterize demographic and clinical profiles of young adults (N = 612) who initiated services at a psychiatric specialty clinic between June 2016 and January 2020. Chi-square, independent t-tests and logistic regression models were used to examine factors associated with engagement with dialectical behaviour therapy skills training group. Paired samples t-tests were utilized to evaluate psychiatric symptom and functional impairment outcomes associated with group completion.

Self-report measures indicated a high rate of substance use and co-occurring nonsubstance mental health concerns in the sample as a whole. Young adults who engaged in group programming differed significantly from those who did not on several clinical and demographic variables; however, no variables were significantly associated with group engagement in regression models. While referral and attendance rates were relatively low (30.6% and 15.4% of total sample), for those completing dialectical behaviour therapy skills training group we observed positive pre-post change outcomes on measures of psychiatric symptoms and functioning (d = 0.35-0.69).

Taken together, these findings provide initial support for offering dialectical behaviour therapy skills training as an adjunctive intervention for young adults with concurrent disorders. Future research identifying factors for enhancing engagement and examining outcome with more controlled conditions are warranted.

Medical residents frequently experience anxiety, depression, burnout and suicidal ideation. Existing support strategies have shown limited benefit. The Impact de la Pair-Aidance Étudiante sur la Santé Mentale des internes de Médecine de première année (PAESSM) study will evaluate whether embedding Mental Health First Aid (MHFA)-trained peer supporters within a first-year residency cohort is associated with improved mental well-being and reduced psychological distress over 12 months.

PAESSM is a non-randomised controlled mixed-methods quasi-experimental study in Lyon, France involving the two Lyon medical schools. Two contemporaneous cohorts will be followed for 12 months: first-year residents exposed to a structured peer-support programme and second-year residents receiving usual support resources without a structured peer-support network. About 430 residents are eligible in each cohort, with anticipated enrolment of approximately 260 per group. In the intervention cohort, around 10% of first-year residents will complete certified MHFA training and act as peer supporters. Online questionnaires will be administered at baseline and at 3, 6, 9 and 12 months. The primary outcome is 12-month mental well-being measured by the Warwick-Edinburgh Mental Well-Being Scale. Secondary outcomes include anxiety and depression symptoms, suicidal ideation, job strain and help-seeking behaviours. The primary analysis will use longitudinal targeted maximum likelihood estimation adjusted for prespecified baseline covariates and informative censoring. Sensitivity analyses will include mixed-effects models and complete-case analyses. A qualitative sub-study will explore peer supporters' experiences and implementation processes.

Ethical approval was obtained from the Comité de Protection des Personnes Nord-Ouest IV (Ref: 2025-A01549-40). In accordance with French legislation applicable to minimal-risk research, formal written informed consent was waived and participants will provide documented non-opposition before inclusion. Findings will be disseminated through peer-reviewed publications, conference presentations and communication with institutional stakeholders and residents.

NCT07161284.

The mental health of medical students has been widely discussed, with studies reporting a high prevalence of mental health issues, including depression, anxiety, suicidal ideation and burnout. Yet, few have explored the relationship between material, social and health deprivation and these outcomes in medical students, despite the higher risk of psychological disorders when exposed to precarious living conditions.

Our study aimed to explore longitudinal associations between experiencing deprivation and mental health outcomes among Swiss medical students while adjusting for protective factors.

Data were collected from hour-long online surveys at two time points (November-December 2022 and November-December 2023) of an open cohort study of medical students from the University of Lausanne, Switzerland (UNIL). Data were analysed using hierarchical multiple regression models.

This study was carried out by Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois (CHUV)) and the Centre for Primary Care and Public Health, UNIL.

Our sample included medical students enrolled in any year of medical school studies, excluding those enrolled as part of an exchange programme. At time points T3 and T4, there were, respectively, 1941 and 1267 eligible students for participation; the final sample consisted of 631 medical students having participated at both time points (67.5% female, mean age 22.11).

Deprivation was evaluated with the Deprivation in Primary Care Questionnaire (DIPCare-Q) index. Mental health variables included depression symptoms, anxiety symptoms, suicidal ideations and burnout symptoms (emotional exhaustion, cynicism, academic efficacy). Protective factors included coping skills (emotion-focused, problem-focused and help-seeking) and social support (practical and emotional support).

In our final regression model, controlling for demographics (ie, age, gender, year of study and mother tongue), protective factors and baseline mental health scores, a higher overall baseline deprivation index was predictive of increased depression (β=0.14, p<0.001) and anxiety (β=0.06, p=0.046) symptoms over time, but not for suicidal ideation or burnout symptoms.

Results demonstrated a significant association between deprivation and mental health longitudinally. Findings suggested that social support was protective from an increase in suicidal ideations over time. The implementation of interventions that provide material and social support may help promote improved mental health and health equity among medical students.

There is increasing evidence that green care (from nature-in-everyday life and nature-based health promotion to nature-based therapy) can promote mental health and well-being. However, there is contradictory evidence and few large-scale international studies focused on health inequities. The GreenME project aims to identify ways in which effective green care can be scaled-up to improve adult mental health and well-being equity while contributing to multiple socio-ecological co-benefits across the Global North.

GreenME's approach is threefold: (i) to diagnose the current status of green care in project consortium countries through a grey literature review and stakeholder interviews, (ii) to increase scientific evidence on the relationship between green care and mental health and well-being equity using modified randomised controlled trials and a population-level socioecological cross-sectional survey study and (iii) to empower green care actors by co-creating a set of tools with consortium countries' participating stakeholders. GreenME will: (a) produce a catalogue of identified successful green care models and best practices; (b) design a robust but adaptable protocol for testing the pathways, effectiveness and cost-effectiveness of nature-based therapies; (c) identify the mental health equity impact of green care and (e) co-create solutions for national and EU-level policies and develop online resources for nature-based therapy providers. GreenME is conceptualised and designed to increase the use of green care and its integration within a multi-scalar green care framework which could ultimately promote just and sustainable healthy communities.

Ethical approval has been obtained individually from each partner/site (UAB CERec 6594, 6851, UAB-CERec180, UAB-CERec178 and CEEAH 7269; UOC CE23-PR29, CE240PR07, CE24-PR59, CE24-PR55; l'Hospital de Mataró CEIm 11/2; CEIm Fundació Sant Joan de Déu PIC-82-25; Alma Mater Stadiorum Universita di Bologna, Proj nos. 0157655, 0075975; ILS, no number 'Survey in Workpackage 2', no number 'Workshops in Workpackage 5'; Swedish Ethics Review Committee, 2024-2810-01, 2025-0195401; University of Kent, CREAG064-04-024; University of Salford Ethics Administration, Ref 0189, 4552; Institute of Psychiatry and Neurology Bioethics Committee, no number; Committees on Ethics and Scientific Research, Res no 32/RKF/2023U). All study results will be disseminated through peer-reviewed publications, scientific conferences and via reports and workshops for stakeholders at the regional (European Union), national and local levels.

ISRCTN13105773, ISRCTN71485431, ISRCTN11841855, ISRCTN14970007 and ISRCTN15381820.

Mental health conditions are prevalent during adolescence, but access to early evidence-based treatments remains limited. Scalable, online, theory-based transdiagnostic interventions delivered in primary care have the potential to reduce this treatment gap, but the effectiveness remains unknown. The objective is to investigate whether an online transdiagnostic emotion regulation treatment for adolescents with mental health conditions is superior to an active control treatment.

This single-blind, randomised clinical superiority trial will evaluate the effectiveness and cost-effectiveness of an online transdiagnostic emotion regulation treatment for adolescents with mental health conditions within primary care in Sweden. We aim to include 388 participants (adolescents aged 12-17 years with mental health conditions and their parents), recruited through primary care and self-referral. Patients will be randomised to either an online transdiagnostic emotion regulation treatment or an active control treatment. Participants will receive 6 weeks of therapist-guided online transdiagnostic emotion regulation treatment or an active control treatment consisting of 6 weeks of online supportive treatment. Parents will participate in parallel with their adolescents in both conditions and will receive an online parent course. The primary outcome, assessed by blinded assessors, will be clinical global symptom severity measured with the Clinical Global Impressions-Severity scale. Treatment effectiveness will be evaluated through blinded assessment and self-assessment at primary endpoint (immediately after treatment) and 3 months after treatment. In addition, a health economic evaluation will be conducted. The study will be undertaken between October 2023 and July 2026.

The study has obtained ethical approval from the Swedish Ethical Review Authority. Findings will be disseminated in peer-reviewed publications and presented at scientific conferences.

NCT06067165.

Anxiety disorders are highly prevalent mental health conditions characterized by physiological dysregulation that includes heightened stress responses, low-grade systemic inflammation, and metabolic imbalance, which together contribute to impaired quality of life. Although yoga-based interventions are increasingly used as complementary therapies, evidence isolating the effects of slow pranayama (yoga breathing) and savasana (corpse pose) on psychological outcomes and biochemical markers in anxiety disorders remains limited. This randomized controlled study evaluated the effects of slow pranayama and savasana, implemented as adjuncts to routine psychiatric care, on anxiety severity, quality of life, and selected biochemical markers in individuals with anxiety disorders. A total of 150 people diagnosed with anxiety disorders were allocated to either routine psychiatric care alone (control group) or routine care plus slow pranayama and savasana (intervention group) for 8 weeks. We assessed anxiety severity using the Hamilton Anxiety Rating Scale, quality of life using the World Health Organization Quality of Life-Brief questionnaire, and biochemical markers such as serum cortisol, brain-derived neurotrophic factor (BDNF), inflammatory markers, and metabolic parameters. Outcomes were analyzed using mixed-design analysis of covariance with Bonferroni correction, and correlational analyses were performed between psychometric, quality-of-life, and biochemical variables. Of the enrolled participants, 112 completed the study. Significant Group × Time interactions were observed for anxiety severity scores and the physical, psychological, and environmental domains of quality of life, with improvements noted only in the pranayama group. Serum cortisol levels decreased and BDNF levels increased significantly in the intervention group compared with controls. Inflammatory and metabolic parameters did not show statistically significant changes after correction, although favorable directional trends were observed. Anxiety severity and quality-of-life scores demonstrated significant correlations with cortisol, BDNF, and inflammatory and metabolic markers. Slow pranayama and savasana appear to be safe, feasible, and effective adjuncts to standard psychiatric care, improving anxiety severity and quality of life while favorably modulating stress-related physiological markers in people with anxiety disorders.

Schizophrenia spectrum disorders (SSDs) often feature debilitating social cognitive impairments, with limited treatment options. This study used a target engagement approach to examine the effects of individually-targeted repetitive transcranial magnetic stimulation (rTMS) to the dorsomedial prefrontal cortex (DMPFC) on social cognitive network functional connectivity (i.e., mentalizing and simulation networks) in individuals with SSDs.

We conducted a double-blind, randomized, sham-controlled trial in adults with SSDs (NCT04418011). Participants received two weeks of DMPFC stimulation with 10 Hz rTMS, intermittent theta burst stimulation (iTBS), or sham stimulation. They completed pre- and post-treatment functional magnetic resonance imaging, including a social processing task. Treatment was personalized using functional connectivity mapping and electric field modelling. Primary outcomes were changes in individualized within-mentalizing and between mentalizing-simulation network functional connectivity after active stimulation versus sham, compared using effect sizes. Secondary outcomes were safety and tolerability.

Analyses included 46 participants who completed treatment (10 Hz rTMS: n=15; iTBS: n=15; sham: n=16). iTBS produced a significantly greater increase in within-mentalizing network connectivity, with a large effect size, while 10 Hz rTMS did not differ from sham. Effects on between-network connectivity were negligible-to-small for both active conditions. Participants receiving iTBS reported higher pain ratings, but adverse event and discontinuation rates did not differ across groups.

Individualized DMPFC-targeted iTBS demonstrated target engagement via increased mentalizing network connectivity relative to sham, and was feasible, safe, and well-tolerated in adults with SSDs. A larger and longer clinical trial powered to assess change in social cognitive outcomes is ongoing (NCT06118268).

Interoception, the processing and perception of internal bodily signals, regulates a wide range of psychological and somatic functions, including emotional experiences, bodily symptom perception, self-awareness and decision-making, highlighting its important role in the maintenance of bodily and mental homeostasis. Traditionally, interoception has been studied within single organ domains, with findings often generalized to interoception as a whole. However, evidence suggests interoceptive abilities may be domain-specific rather than a general ability. This pilot study investigated how perceptual and affective dimensions of interoception relate across organ systems. Thirty-three healthy adults completed comparable magnitude estimation and sustained stimulation tasks, allowing for comparisons across the respiratory, esophageal, and cardiac domain in a within-subjects design. Respiratory sensations were evoked through inspiratory resistive loads, esophageal sensations through balloon inflations, and cardiac sensations via graded cycle ergometer exercise. Interoceptive sensitivity, the ability to perceptually discriminate between stimulation levels, was quantified as the slope of intensity ratings relative to stimulation intensity. Acute affective responses were assessed through unpleasantness ratings during sustained stimulation. Results revealed no significant correlations in interoceptive sensitivity across domains, with Bayesian analyses providing anecdotal support for the null hypothesis. In contrast, acute affective responses showed partial convergence: respiratory unpleasantness ratings correlated significantly with both esophageal and cardiac ratings, whereas esophageal and cardiac ratings were not significantly correlated. These findings support a multidimensional model of interoceptive processing, where interoceptive sensitivity appears domain-specific, while acute affective responses show partial generalization across organ systems. The results caution against generalizing findings from single-organ paradigms to overall interoceptive functioning.

Depression is one of the leading causes of disability in Chile and significantly affects adults' well-being and social participation. Despite its high prevalence, depression stigma has been scarcely studied in the country. Because its manifestations vary across sociocultural contexts, understanding how it is configured in Chile is essential for developing contextually relevant interventions. Within this framework, depression stigma is examined through its core components -stereotypes, prejudice, and discrimination- by analyzing the beliefs, emotions, and behaviors directed toward people living with depression The aim of this study is to explore, from the perspective of Chilean adults, the socially shared beliefs about people living with depression, as well as the emotions and behaviors directed toward them, and to examine the extent to which these contents are understood as expressions of depression stigma.

A qualitative study was conducted using purposive sampling and minimum group representativeness criteria based on gender, socioeconomic status, and history of depression. Sixty-six adults from three regions of Chile took part in individual semi-structured interviews. Interviews were transcribed, reviewed, returned to participants for checking, and coded by two independent coders. Data were then analyzed using a deductive-inductive content analysis approach supported by Atlas.ti, and findings were triangulated.

Findings were organized into three analytical macro-categories - beliefs, emotions, and behaviors directed toward people with depression - consistent with the cognitive, affective, and behavioral components of stigma described in the literature. Within beliefs, contents related to affective characteristics, behavioral characteristics, and dispositional attributions associated with people with depression emerged. Within emotions, compassionate emotions, defensive and discomfort-related responses, and affective disconnection were identified. Within behaviors, overprotection, social distancing, invalidation and judgment emerged, along with interaction scripts based on avoidance or support.

Depression stigma in Chile is configured through contents that, to varying degrees, are understood as stereotypes, prejudice, and discrimination. Beliefs combine elements linked both to mental health literacy and to stereotypes; emotions are primarily interpreted as expressions of prejudice; and behaviors reflect both subtle and overt forms of discrimination. Additionally, some themes showed divergent interpretations among participants, particularly between those with and without a history of depression. Taken together, these findings contribute to a better understanding of how this phenomenon is structured in the Chilean context and provide input for the development of culturally relevant assessment instruments and intervention strategies.