Adolescents with depression continue to face substantial barriers to treatment, which may be unevenly distributed across racial and ethnic groups. We examined recent trends in adolescent major depressive episode (MDE) and disparities in untreated MDE in the United States.

We analyzed 2021-2024 National Survey on Drug Use and Health public-use data for adolescents aged 12-17 years. Outcomes were past-year MDE, depression-related treatment receipt, untreated MDE, and untreated MDE with severe role impairment. Survey-weighted logistic regression accounted for the complex survey design and adjusted for sociodemographic, clinical, substance-use, insurance, and county-type characteristics. Adjusted probabilities and absolute differences versus non-Hispanic White adolescents were estimated using marginal standardization.

Among 43,828 adolescents, weighted past-year MDE prevalence declined from 20.5% in 2021 to 14.8% in 2024. Among adolescents with MDE, treatment receipt increased from 41.8% to 52.2%, while untreated MDE decreased from 58.2% to 47.8%. In the fully adjusted model (n = 8,066), adjusted untreated probabilities were higher among non-Hispanic Black (61.1%), American Indian or Alaska Native (63.6%), Asian (59.8%), multiracial (59.2%), and Hispanic adolescents (57.7%) than among non-Hispanic White adolescents (46.3%), corresponding to absolute differences of 11.4-17.3% points. Uninsured adolescents and those living in nonmetropolitan counties also had higher odds of untreated MDE.

Adolescent MDE declined and treatment receipt improved, but substantial inequities in treatment connection remained. Surveillance should track equity-focused treatment metrics alongside symptom prevalence.

ObjectivesDigital health interventions (DHIs) are increasingly used to support chronic disease management and psychological needs of young people. Yet, evidence on how psychological support is integrated and youths are involved remains limited. This scoping review mapped the characteristics of DHIs, physical and psychological outcomes, youth involvement, and implementation challenges.MethodsFollowing PRISMA-ScR guidelines, a systematic search of studies published between 2015 and 2026 was conducted through PubMed, Embase, Scopus and Google Scholar. Eligible studies included those evaluating DHIs for young people (10-24 years) with chronic diseases and reported at least one psychological or psychosocial outcome. Data were extracted on intervention characteristics, psychological support components, physical and psychological outcomes, youth involvement, and implementation challenges.Results19 studies were included. Mobile apps and telehealth were the most common type of intervention, with cognitive behavioural therapy being the most frequently incorporated psychological framework. Psychological outcomes integrated and evaluated within DHIs varied across studies. Youth participation in the DHI design was generally limited to consultations rather than co-design. Common implementation barriers included low engagement and issues with digital access.ConclusionConsiderable heterogeneity exists in psychological support approaches, intervention characteristics, and youth participation during DHIs development. Future DHIs should explicitly prioritize meaningful integration of psychological support and youth involvement.

Poor school achievement in comprehensive education (~ age 15) has been associated with the later risk of mental disorders, but it remains unclear whether school achievement in upper secondary education (~ age 18) is also associated with this risk. We examined whether school achievement in upper secondary education is associated with the later risk of mental disorders and whether school achievement in comprehensive education modifies these associations.

We studied all individuals born in Finland between 1980 and 2001 (N = 579 781). Individuals were followed from graduation from upper secondary education (ages 18-20) until first mental disorder diagnosis, emigration, death, or December 31, 2023. Matriculation examination grade point average (GPA) at the end of upper secondary education was the main exposure. Time to a mental disorder diagnosis was the outcome. Associations were estimated using Cox proportional hazards models, including sibling-stratified analyses and stratification across comprehensive education GPA groups.

Upper secondary GPA showed no consistent association with any mental disorder diagnosis as a broad category. Greater upper secondary GPA was generally associated with smaller risk of substance use disorders and greater risk of depression, anxiety, eating, and personality disorders. Reduction in GPA from comprehensive to upper secondary education was associated with greater risk of schizophrenia, and improvement with greater risk of bipolar disorder.

Associations between school achievement in upper secondary education and later mental disorders are disorder-specific, with higher school achievement associated with either an increased or decreased risk depending on the specific disorder.

ObjectivesIn many low- and middle-income countries, comprehensive, first contact primary health care is fragmented by the delivery of centralized programs focused on specific health conditions. Indonesia's 2023 primary health care reform restructured community health services to provide integrated rather than condition-specific services, representing one of the broadest primary health care integration efforts in a middle-income country to date. We sought to understand the outcomes, barriers, and facilitators of early implementation of this reform.MethodsWe conducted a convergent mixed-method study in one of the first areas to implement primary health care reform. We used descriptive statistics to quantify service delivery outcomes from a survey of 14 village health facilities and data extracted from monthly reports from two village health facilities and 11 community health posts. We sought to understand barriers and facilitators to implementation via 24 patient interviews, seven key informant interviews, and four focus group discussions with healthcare providers. We used deductive-inductive qualitative analysis guided by the Consolidated Framework for Implementation Research. Findings were integrated to understand factors that impacted service delivery outcomes.ResultsIn the initial months of implementation, both health facilities and health posts offered integrated services to all patients simultaneously, but neither introduced new screening services (e.g., mental health) immediately. At health facilities, patient visits substantially increased across all age groups, with more modest changes seen at health posts. The convenience of getting services at community health posts increased patient visits, but scheduling incompatibility and a low sense of belonging were barriers to attendance for teenagers and working adults. Insufficient training, staff, and resources posed barriers to introducing new services.ConclusionsIt is possible for a middle-income country to move from condition-specific community health programs toward integrated primary health care. Doing so requires investment in human resources, intersectoral collaboration, and outreach to less engaged segments of the population.

Research on participation after traumatic brain injury (TBI) has focused predominantly on frequency-based, individual-level outcomes, overlooking how systemic and interpersonal contexts shape participation. While qualitative research has explored these influences, the literature remains fragmented. The purpose of this study was to synthesize qualitative literature on participation experiences of individuals with TBI, focusing on systemic, interpersonal, and individual influences.

We conducted a meta-synthesis following ENTREQ guidelines, searching five databases from inception to July 2026. We included qualitative studies examining participation among adults with TBI. We synthesized results using Thomas and Harden's thematic synthesis, guided by the social ecological model.

Of 3140 studies, 28 met inclusion criteria. Three themes emerged: (1) environmental challenges and adaptation described how systemic barriers placed adaptive burden on individuals, mediated by interpersonal support; (2) stigma and support in social participation examined how societal stigma shaped relationships, exacerbating symptoms and withdrawal; and (3) cultural narratives and identity highlighted how dominant narratives influence self-perception and participation satisfaction.

Participation after TBI is shaped by the interplay of systemic, interpersonal, and individual factors. Future research should address systemic and interpersonal influences, fostering environments, relationships, and narratives that promote meaningful participation and inform multi-level interventions.

Mental health problems have long-lasting impacts and often begin in adolescence, yet young people face multiple barriers to accessing care and support, including a fragmented system, limited awareness of services and stigma. Afloat was developed to guide users to suitable support.

This study aimed to (a) co-develop a mobile app to support young people's access to mental healthcare and support; and (b) evaluate its acceptability, potential impact on service use, mental health outcomes and economic implications.

Afloat was co-developed with young people to provide information on available support, and included personal stories from peers and links to care resources. A pilot evaluation involved 105 participants aged 16-25 years from London, UK. Participants completed surveys at baseline and 3 months to assess changes in mental health, service use, stigma and self-identification of mental health issues. App usage was monitored through analytics. A budget-impact analysis estimated financial implications of Afloat implementation.

Participants reported high acceptability and satisfaction. After 3 months, there was an increase in the likelihood of help-seeking and a reduction in mental health symptoms. The increase in actual service use was significant only among those with mild-to-moderate symptoms. Budget-impact analysis indicated potentially increased costs from additional service use.

Afloat shows preliminary promise as a tool associated with increased help-seeking and improved mental health. Long-term benefits of timely intervention may offset short-term costs from increased service use, although this requires formal evaluation. Further research is required to assess long-term outcomes and economic implications.

Racial and ethnic inequities persist in perinatal opioid use disorder (OUD) care, with pregnant and postpartum people of color facing structural barriers to using medications to treat OUD (MOUD). Because access to clinical research is often mediated through treatment settings, these structural barriers may also shape who is reached, recruited, and retained in perinatal OUD trials. The Medication Treatment for OUD in Expectant Mothers trial (NCT03918850) provided an opportunity to assess how site-level and policy contexts influenced equitable recruitment, including gaps between projected and actual enrollment.

We employed a convergent parallel mixed-methods design integrating thematic analysis of semi-structured qualitative interviews with non-White and/or Hispanic trial participants and research staff, site survey data, state policy classifications, and administrative enrollment data from the 13 trial sites. We examined how clinical structures, staffing composition, and policy environments shaped equitable recruitment. For each site, we calculated a recruitment ratio (actual/expected non-White and/or Hispanic enrollment).

Among the 13 trial sites, 3 exceeded projected recruitment of non-White and/or Hispanic participants, 7 fell below projections, and 2 enrolled no non-White and/or Hispanic participants. Recruitment ratios (actual/expected) ranged from 0.0 to 6.3. Sites that exceeded projections commonly reported the inclusion of peer clinical staff and integration of prenatal and OUD care and were more often located in states without mandated reporting of MOUD during pregnancy. Qualitative analyses of participant (n = 17) and research staff interviews (n = 32) identified themes of trust, representation, and lived experience, emphasizing their importance for equitable recruitment and engagement.

Equity in perinatal substance use disorder (SUD) research depends not only on inclusive trial design but also on the relational and policy conditions that build trust and enable participation. Beyond demographic targets, findings point to institutional practices, community partnerships, and supportive policy environments as actionable levers to promote equitable recruitment and engagement in perinatal SUD research.

Pregnant and parenting youth experiencing homelessness (PPYEH) and their children face significant health challenges, yet few interventions exist to address their health needs. The purpose of this community-based participatory research was to evaluate the preliminary effectiveness of a site-based health empowerment program to improve health, health care access, and reproductive health among PPYEH living in emergency shelter or transitional living programs.

This mixed-methods study included intake, exit, and follow-up surveys with PPYEH, as well as a focus group and semistructured interviews with PPYEH and shelter staff. We conducted descriptive analyses of quantitative data to assess program satisfaction, mental health, contraceptive use and access, and thematic analysis of qualitative data.

Our evaluation demonstrated high program satisfaction, improved mental health, and enhanced access to reproductive resources and acceptability of contraceptive options. PPYEH and staff reported Empowering Parents for Wellness in Shelter connected youth with primary, dental, vision, sexual, and mental health care, which promoted youth resilience and agency in navigating the health care system. PPYEH felt their health improved through increased knowledge of topics including nutrition, allergies, healthy relationships, and sexually transmitted infections. Every interviewed participant recommended expanding Empowering Parents for Wellness in Shelter to other shelters.

Our findings suggest that site-based health empowerment programs embedded within shelters and housing programs may represent an acceptable and promising strategy to increase health care access, improve child and adolescent health, and support reproductive goals. The program underscores the importance of centering the voices of those with lived experiences of homelessness in the cocreation of programs that address their unique health needs.

Neglected tropical diseases (NTDs) contribute to the global burden of mental health conditions, largely mediated through mechanisms of stigma and social exclusion. Within this group, skin NTDs are particularly prominent, as visible deformities often drive stigma reinforced by cultural myths, fear of contagion, social isolation, and associated poverty. The WHO recommends a collaborative cross-sectoral approach in its NTD Road Map 2021-30, integrating care for people with NTDs. This study was conducted as a pilot to assess the feasibility, acceptability, and impact of a person-centred intervention care package on mental health outcomes and stigma among people with skin NTDs in Nigeria.

This quasi-experimental mixed-methods study, with a before-and-after design, was conducted from August 2023 to June 2025 in five local government areas in Nigeria among people with skin NTDs (leprosy, lymphatic filariasis, and Buruli ulcer) using a convenience sampling technique. Depression, anxiety, and well-being were assessed before and after implementation of a package of person-centred care interventions. In addition, 10 focus group discussions were conducted among people with skin NTDs, along with 21 key informant interviews with healthcare workers and relevant stakeholders to explore the feasibility of scaling up interventions.

At baseline, 456 people with skin NTDs were enrolled [37.9% female; median age 45 (IQR 25-80) years], of whom 315 were followed up at endline providing paired data. The proportion screening positive for depression decreased from 213/315 (67.6%) to 88/315 (27.9%), and anxiety from 201/315 (63.8%) to 56/315 (17.8%). Well-being improved, with 156/315 (49.5%) reporting good well-being at baseline compared with 193/315 (61.3%) at endline. Additionally, a package of interventions-including capacity building for health workers, referral systems, peer support groups, livelihood support activities, and anti-stigma campaigns-was feasible, acceptable, and well integrated into existing contexts, with perceived improvements in mental health outcomes and stigma.

This pilot study suggests that the person-centred care package is feasible and acceptable in this low-resourced setting in Nigeria and is associated with improvements in mental health outcomes and stigma among people with skin NTDs in Nigeria.

Early intervention in psychosis (EIP) is increasingly framed as a youth-oriented model of care, but its translation into reproducible service structures remains uneven across healthcare systems. Although clinical practice guidelines and quality standards address clinical high risk for psychosis (CHR-P) and first-episode psychosis (FEP), their organisational recommendations have received limited focused synthesis. This study examined the service-architecture recommendations embedded in international early psychosis guidance.

We conducted a secondary framework synthesis of a completed systematic review of 26 international guidance documents, comprising 24 clinical practice guidelines and two quality standards. Recommendations concerning service configuration and organisation were retained and mapped onto four service-design domains: access and entry, team model and service setting, coordination and continuity of care and youth-friendly delivery context. Endorsement frequencies and harmonised grading patterns were summarised descriptively at document level.

Organisational recommendations were identified in 17 CHR-P-relevant and 22 FEP-relevant documents. The strongest convergence concerned specialised service structures, including multidisciplinary CHR-P services or dedicated pathways in 16/17 documents and specialised outpatient EIP teams in 20/22 FEP documents. Coordination and continuity components were also recurrent, particularly inter-service integration and assertive community treatment or intensive case management for FEP. Access arrangements, transition policies and youth-friendly delivery contexts were frequently mentioned, but were less consistently operationalised or supported by directive grading.

International early psychosis guidance converges on a recognisable organisational architecture, but service-design domains are specified with unequal consistency. By reorganising recommendations already embedded in existing guidance, the framework may support service planning, benchmarking, pathway redesign and policy development, while identifying areas requiring more operational guidance.