Hope and confidence support personal recovery by helping individuals with mental illness to rediscover meaning, enhance social connections, and build fulfilling lives. Digital recovery narrative interventions may help stimulate these recovery processes by providing access to hopeful lived-experience stories.

This pilot feasibility randomized controlled trial evaluated the feasibility, acceptability, and exploratory outcome signals of STORY MINE, a novel digital intervention based on hopeful recovery narratives, to support personal recovery among adult service users receiving specialized mental health care at a Dutch psychiatric institute.

Adult service users receiving outpatient specialized mental health care were recruited through clinician referral and self-enrollment. Participants (N=28) were randomized (1:1) to either intervention (STORY MINE access for 12 wk alongside care as usual) or control (care as usual only). Feasibility and acceptability were assessed via platform usage data, evaluation questions embedded within the intervention, and postintervention feedback. Quantitative outcomes were assessed at baseline and postintervention using validated self-report questionnaires on mental health confidence, hope, self-stigma, and personal recovery. Descriptive statistics and exploratory effect sizes with 95% CIs were calculated. Qualitative feedback was analyzed thematically to explore user experiences and perceived impact.

All participants (N=28) completed self-report questionnaires, while 13 of 14 participants in the intervention group provided evaluation feedback. Feasibility and acceptability were rated positively (mean 7.7, SD 2.52). Engagement was low, with a mean of 2.77 (SD 1.49) active login days per participant over 12 weeks, with some participants reporting minor technical barriers to use. Participants reported mixed perceived recognition (identification with narratives) and relevance (perceived applicability), but qualitative findings indicated perceived benefits including increased meaning-making, inspiration, and connectedness to recovery narratives. Some reported STORY MINE contributed to their recovery process (eg, narratives provided practical tips and evoked meaning-making and more positive self-evaluation). However, mixed emotional responses were reported; one participant reported narratives triggered distressing memories. Exploratory analyses showed small negative effect sizes for mental health confidence (Cohen d=-0.32, 95% CI -1.07 to 0.42), hope (Cohen d=-0.45, 95% CI -1.20 to 0.30), and self-stigma (Cohen d=-0.33, 95% CI -1.08 to 0.42), and a medium negative effect size for personal recovery (Cohen d=-0.53, 95% CI -1.28 to 0.22). These effect estimates decreased after excluding 2 participants experiencing an acute mental health crisis during the study period.

STORY MINE appears feasible and acceptable as a supplement to specialized mental health care, although low engagement and mixed emotional responses highlight the need for refinement, particularly to improve user engagement, emotional safety, perceived relevance, and accessibility of the intervention. Findings should be interpreted cautiously given the pilot design and small sample size. A fully powered randomized controlled trial is warranted to evaluate effectiveness.

Esports athletes face substantial psychological stressors comparable to those experienced by traditional athletes, yet mental health tools tailored to their specific needs remain scarce.

This study addresses this critical gap by introducing MindAthlete, a prototype for a user-centered mobile health (mHealth) app intended to enhance mental health monitoring and support among esports athletes.

A 3-stage development process was used over 5 months. First, structured qualitative interviews were conducted online via Google Meet with 7 experienced (sports) psychologists recruited through snowball sampling within professional esports networks. The interviews explored current mental health monitoring practices and key feature requirements for MindAthlete. Data were analyzed using Mayring's approach to qualitative content analysis. Subsequently, a 32-screen high-fidelity prototype was developed in Figma based on the identified requirements. In the final stage, usability testing was conducted with 25 semiprofessional and professional esports athletes recruited via convenience and snowball sampling. Participants interacted with the Figma prototype and completed an online questionnaire administered via LimeSurvey, which included demographic items, the validated 10-item System Usability Scale (SUS) rated on a 5-point Likert scale, and open-ended questions on navigation, aesthetics, and overall functionality. Inferential analyses included Mann-Whitney U tests, Kruskal-Wallis tests, and Spearman correlations. Open-ended responses were analyzed using Mayring's content analysis.

Expert interviews identified 8 core features for mental health monitoring in esports, clustered around 3 themes: continuous self-monitoring, structured assessment, and intervention and insight. Athlete usability testing yielded a median SUS score of 77.5 (IQR 67.5-87.5), classifying usability as "good" and exceeding a benchmark median of 68.3 derived from comparable mHealth apps. No significant differences were found by sex, age, years of professional experience, or prior mHealth usage. Qualitative feedback highlighted strengths including intuitive navigation and appealing aesthetics, alongside areas for improvement such as shorter animations and clearer initial onboarding. However, findings must be interpreted in light of the sample's demographic homogeneity, which limits generalizability to the broader esports population.

This research provides a stakeholder-driven, empirically validated blueprint for esports-specific mental health monitoring via mHealth. Future work will focus on technical implementation, integration of wearable sensor data, and broader evaluations with larger, more diverse samples to confirm generalizability and enhance usability.

Biological aging clocks offer estimations of aging and dementia, yet scalability is limited. We introduce a large-scale, cross-national speech clock derived from 2928 individuals across five Latin American countries, spanning healthy controls (HCs), mild cognitive impairment (MCI), Alzheimer's disease (AD), and non-language/language-dominant frontotemporal dementia (nldFTD/ldFTD). Multimodal acoustic and linguistic features were trained with supervised models to estimate chronological age, generating speech age gaps (SAGs) as cross-sectional markers of deviations from chronological age, with positive values interpreted as relatively older-appearing speech profiles. SAGs differentiated diagnostic groups (HCs < patient groups, with AD < nldFTD < ldFTD). This pattern was associated with clinical/cognitive domains. SAGs correlated with phosphorylated tau (p-Tau217) in AD and social exposome in HCs and AD. Brain clocks (structural/functional/combined) were associated with SAG in AD, nldFTD, and ldFTD. Epigenetic age correlated with SAGs in HCs and AD across Hannum, Retroclock, and OMICmAge, whereas ldFTD associations were limited to Retroclock and OMICmAge. These results indicate that SAGs capture cross-sectional multilevel aging-related variation and may offer a scalable, culturally adaptable, low-cost biomarker candidate for research in underrepresented global settings.

Three-quarters of sexual assault (SA) survivors meet criteria for posttraumatic stress disorder (PTSD) 1 month after SA, and PTSD is highly comorbid with substance use disorders. Intervening early is critical to preventing the onset or escalation of these conditions.

To assess the preliminary effectiveness of Skills Training in Affective Recovery (STAR), a brief video, and TextSTAR, a 3-week daily text message program on reducing posttraumatic stress and substance misuse symptoms among SA survivors during an SA medical forensic examination.

This pilot sequential, multiple-assignment randomized clinical trial recruited women from 4 US SA medical forensic examination programs from March 12 to November 3, 2025, who had experienced past 7-day SA. Participants were randomized to the video program or treatment as usual (TAU; no video) at the SA medical forensic examination and reassessed at 1 week; nonresponders-those above the threshold for acute stress or opioid misuse-were randomized to the text program or no text program. Participants completed weekly follow-up surveys for 1 month. Data analysis was conducted from December 2025 to April 2026.

The study's video program is a 17-minute video that educates and encourages social support, positive coping including mindfulness, and self-exposure to feared but safe stimuli. The study's text program is a 3-week daily text message program that emphasizes social support, positive coping, and exposure.

Primary outcome of acute or posttraumatic stress was measured at 1 and 4 weeks via the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Primary outcome of drug use was measured at 1 and 4 weeks with the Tobacco, Alcohol, Prescription Medication, and Other Substance Use Part 1. Exploratory outcome of pain was measured at 1 and 4 weeks with the Brief Pain Inventory.

Fifty women (mean [SD] age, 28.9 [10.1] years) were enrolled in the study. Those randomized to the study's video program had lower odds of acute stress (odds ratio, 0.13; 95% CI, 0.02-0.78). Those randomized to the video program also had lower pain at 1 week (mean [SD] score, 2.1 [2.2]) compared with those assigned to TAU (mean [SD] score, 3.6 [2.6]). Linear regression revealed that the video (mean [SE] estimate, -0.25 [0.14]; z = -1.73; P = .08) and text (mean [SE] estimate, -0.41 [0.14]; z = -2.95; P = .003) programs were negatively associated with week 4 pain scores.

In this preliminary randomized clinical study for recent SA survivors, the video program was associated with immediate reductions in acute stress and pain; the text program was associated with reductions in week 4 pain. These results suggest that the study's video and text programs were easy-to-administer interventions that can be used in the short-term clinical setting where survivors receive care in the immediate aftermath of SA.

ClinicalTrials.gov Identifier: NCT06456190.

Understanding spending on mental health could help inform policymakers on decisions about where to direct mental health care resources and help evaluate whether spending aligns with public health priorities. Despite this, the magnitude and distribution of mental health expenditures in the US remain poorly characterized.

To estimate aggregate mental health expenditures by sociodemographic characteristics, type of insurance, mental health disorders, and type of service.

This was a cross-sectional analysis of the 2021-2023 Medical Expenditure Panel Survey (MEPS), an annual, nationally representative survey of the civilian noninstitutionalized US population. Analyses focused on individuals who made at least 1 outpatient mental health visit in 2021, 2022, or 2023. Data analysis was conducted from August 2025 to January 2026.

Outpatient mental health visits.

Overall and per-100-person expenditures stratified by sociodemographic characteristics and diagnostic categories.

The analysis included all survey participants (N = 67 532 person-year observations; mean [SD] age, 39.8 [0.25] years; 35 608 [50.7%] female) and identified those with reported outpatient mental health visits in 2021, 2022, and 2023 (n = 15 407; mean [SD] age, 45.0 [0.36] years; 9500 [60.0%] female). The estimated annualized aggregate total health care expenditures as measured in the MEPS in 2021-2023 were $2.5 trillion (95% CI, $2.3 trillion to $2.7 trillion), with $174 billion (95% CI, $152 billion to $196 billion) in mental health expenditures representing 7.0% (95% CI, 6.4%-7.7%) of all medical expenditures. This represented an annual mean of $523 (95% CI, $474-$571) per person overall and $2473 (95% CI, $2266-$2679) per person among those with any treated mental health disorder. Mood disorders and anxiety and fear-related disorders accounted for the highest aggregate expenditures ($74 billion [95% CI, $62 billion to $86 billion] and $69 billion [95% CI, $58 billion to $81 billion], respectively). Expenditures per treated individual were highest for substance use disorders ($9569 [95% CI, $6943-$12 195]), schizophrenia ($9370 [95% CI, $6685-$12 055]), and bipolar disorders ($7382 [95% CI, $6027-$8737]). Overall, expenditures on ambulatory services accounted for $107 billion (95% CI, $93 billion to $121 billion), while expenditures on medication accounted for $36 billion (95% CI, $31 billion to $40 billion) and those for home health care and inpatient treatment accounted for $20 billion (95% CI, $11 billion to $29 billion) and $12 billion (95% CI, $8 billion to $15 billion), respectively.

This cross-sectional study found that expenditures on mental health disorders in the US vary widely at the per-person and population levels, but they are consistently low relative to the societal burden of mental disorders. Research that leads to more effective treatments, decreases provision of low-value care, and supports better matching of patients' impairment with the appropriate level of care could help optimize treatment access while controlling expenditures.

Mental disorders are a leading cause of disability worldwide, and their burden continues to increase across Africa. Despite growing need, access to care remains limited, with treatment gaps reaching up to 90% in some settings. These gaps reflect longstanding constraints in workforce, financing, infrastructure, and sociocultural factors, alongside uneven policy implementation. At the same time, countries and communities across the continent are developing new approaches to mental health care that can complement conventional, specialist-centered models and offer transferable lessons for mental health system transformation globally.

This Special Communication proposes 4 transferable design principles for scalable and culturally responsive mental health systems, synthesized into a comprehensive conceptual framework and context-sensitive implementation road map: (1) workforce and educational transformation, (2) community-based care architecture, (3) systems integration, and (4) cultural and pluralistic care. Evidence from multiple African countries demonstrates that nonspecialist clinicians, including community health workers and peer supporters, can deliver screening and brief psychological interventions when reinforced by training and supervision. Community-based models are increasingly shifting care closer to where people live, incorporating recovery-oriented approaches that emphasize social reintegration. Integration of mental health into primary care, HIV services, and maternal health platforms has shown promise, though sustainability remains dependent on broader health system capacity. At the same time, pluralistic care systems, in which individuals engage biomedical and traditional professionals, highlight the need for approaches that are culturally responsive and grounded in human rights. Across these design principles, progress is evident, but implementation remains uneven, and much of the current evidence is limited by short-term evaluations and reliance on symptom-based measures.

Closing the treatment gap in Africa will require more than scaling existing services. It will depend on strengthening locally led research and context-sensitive implementation, embedding innovations within national systems, and investing in workforce development, supervision, and governance. African mental health innovations are not only responses to constrained resources, but also contributions to the broader understanding of how scalable, equitable, and culturally responsive mental health systems can be designed across diverse global settings.

Mental health difficulties are rising amongst young adults in the United Kingdom, and access to mental health services is limited. Digital single-session interventions (SSIs) offer free, scalable mental health support and may help to meet this treatment gap. To inform adaptation and implementation of SSIs, we sought to understand where young adults look for mental health support and how they perceive a behavioural activation-based SSI called Action Brings Change (ABC) and its hosting platform.

A qualitative study using semi-structured interviews.

Interviews were conducted with N = 22 young adults (aged 19-25) in the United Kingdom to explore: (1) where they look for mental health support when they start to struggle and (2) what they think of ABC and a website developed for adolescents to access it from. Data were analysed using the Framework Method.

Four themes were generated: (1) Where to turn when seeking help and support; (2) 'I think people just go off vibes really': Establishing trust with SSIs; (3) Will this work? Ambivalence towards SSIs; (4) Is this for me? Considerations for engagement with SSIs. Young adults valued both online and in-person support, so long as it was deemed trustworthy; social media content in particular was viewed as untrustworthy. Young adults expressed both hope for and scepticism towards SSIs, highlighting considerations for how to improve trust and engagement with SSIs.

SSIs can offer an accessible complement to existing mental health provision. Findings underscore the importance of co-developed, person-centred design and partnering with trusted providers for dissemination.

This study aimed to describe how emergency nurses (ENs) experience secondary traumatic stress (STS) within their practice environments, focusing on the strategies they use to cope and the supportive resources they draw upon to manage its impact on their lives.

This paper presents the qualitative findings from a larger mixed-methods survey study on STS among ENs.

A geographically diverse U.S. sample of ENs was recruited through social media to participate in an online survey. All participants (n = 275) were asked to respond to open-ended survey questions, and 118 of these participants provided answers to at least one open-ended question. A self-selected sample of 20 ENs completed semi-structured interviews. Inductive content analysis was used to analyse open-ended survey responses and interview transcripts.

Three themes reflected ENs' experiences with STS: STS Is Real-It's Going to Affect Your Life; Something Must Be Wrong With Me: A Culture of Disconnection; and It's a Systems Issue, but We're in It Together. Participants described individual, unit, and organizational factors that influenced their experiences of STS and their access to and use of coping strategies and supportive resources.

ENs and nurse leaders acknowledged the impact of STS on their personal and professional lives and emphasized how the practice environment shaped their experiences. They perceived the accessibility of organizational resources, leadership behaviours, and team culture as influencing the individual strategies ENs use to manage the effects of repeated exposure to others' traumatic experiences. STS is a predictable occupational hazard for ENs; thus, healthcare organizations must invest in nurse-identified supports to preserve workforce well-being and clinical expertise.

Assessing organizational readiness to address STS is recommended to ensure ENs receive effective, timely support. In response to these assessments, healthcare organizations should develop and implement policies that prioritize the mental health and well-being of ENs, including proactive support systems and accessible mental health resources.

This study identifies participant-perceived individual, team, leadership, and organizational conditions that may hinder or support ENs' management of STS. These findings identify potential targets for organizational assessment and support strategies intended to foster healthier practice environments and promote safe, high-quality care.

Consolidated Criteria for Reporting Qualitative Research (COREQ).

This study did not include patient or public involvement in its design, conduct, or reporting.

The risk of cognitive decline after losing a spouse remained mixed. This study aims to investigate the association between spousal loss and risk of cognitive decline, assess whether this association varies by sex and age, and identify modifiable factors.

We conducted a prospective cohort study using harmonized data from six population-based ageing surveys: the US Health and Retirement Study and its sister surveys in England, Mexico, China, India and South Africa, incorporating their respective Harmonized Cognitive Assessment Protocol (HCAP) sub-studies. Spousal loss (yes vs no) was the exposure. Cognitive outcomes (i.e., orientation, memory, executive function and language) were assessed using HCAP neuropsychological batteries. We conducted parallel analyses in six cohorts. Associations between spousal loss and cognitive outcomes were estimated using generalized linear models, and summarised estimates were derived via random-effects meta-analyses. Sex stratification and restricted cubic splines were used to examine how these associations vary by sex and age, respectively.

The analytical cohort consisted of 18,551 individuals aged 61.39 (6.40) to 71.06 (7.22) years. Widowhood prevalence ranged from 14.1% in the China Health and Retirement Longitudinal Study to 53.9% in Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI). Spousal loss was associated with poorer memory (multivariable-adjusted β = -0.07, 95% confidence interval [CI]: -0.12 to -0.01) and executive function (multivariable-adjusted β = -0.08, 95% CI: -0.13 to -0.03) in the meta-analysis, with no significant associations for orientation or language. While results were generally consistent in five cohorts, the English Longitudinal Study of Ageing (ELSA) showed divergent patterns (orientation: β = 0.10, 95% CI: 0.06-0.13; memory: β = 0.05, 95% CI: 0.02-0.08; language: β = 0.16, 95% CI: 0.12-0.19). Sex-stratified analyses indicated poorer executive function among men (multivariable-adjusted β = -0.14, 95% CI: -0.19 to -0.08) and poorer memory among women (multivariable-adjusted β = -0.07, 95% CI: -0.14 to -0.01) following widowhood. Nonlinear age-related effects on cognition were observed in ELSA, Longitudinal Ageing Study in India, and HAALSI. Higher education, internet use and body mass index were negatively associated with the risk of cognitive decline among widowed participants.

Spousal loss is associated with domain- and sex-specific differences in cognitive performance, with substantial heterogeneity across study populations. Future research should integrate biopsychosocial markers to develop context-sensitive interventions for widowed older adults.