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.

Previous research on childhood maltreatment has predominantly focused on the independent effects of emotional abuse (EA) or emotional neglect (EN), providing limited insight into how combinations of these co-occurring subtypes are associated with adolescent adjustment. Based on shattered assumptions theory, this longitudinal study examined how combined patterns of EA and EN were associated with adolescents' internalizing problems, as well as the indirect associations involving personal belief in a just world (PBJW) and general belief in a just world (GBJW). A total of 484 Chinese adolescents (51.03% girls; M_age ± SD = 12.77 ± 0.72, Range_age = 11-16) were followed over a six-month interval. Polynomial regression and response surface analyses revealed that: (1) when EA and EN increased simultaneously, adolescents reported higher levels of internalizing problems; (2) when EA and EN were imbalanced, internalizing problems became more severe as the discrepancy between them widened, particularly when EA exceeded EN; and (3) PBJW, but not GBJW, accounted for significant indirect associations between joint EA-EN patterns and internalizing problems. These findings reveal the complex role of combined emotional maltreatment experiences in relation to psychological distress and highlight the stronger association of active emotional abuse, relative to passive neglect, with internalizing problems. This study extends the understanding of maltreatment patterns and offers insights for interventions that aim to strengthen adolescents' personal just world beliefs.

Disaster response requires a diverse set of skills, yet there is no universally agreed definition of the specific competences needed. Therefore, this study aimed to explore how disaster responders acquire competence.

A qualitative study using inductive thematic analysis. Individual interviews with disaster responders who had worked in a leading position.

The study included 14 participants from 7 nationalities, all of whom were experienced disaster responders from different professions. From the analysis, four themes arose describing different ways of acquiring the competences and skills required to function as a disaster responder. Previous background, formal training, mental preparedness, and personal traits all had a role in how competences and skills were acquired among disaster responders.

Formal training alone cannot fully prepare disaster responders for the reality of a disaster but needs to be combined with personal experiences from both disasters and other contexts as well as mental preparation. Personal traits also play a role for acquisition of competence. When designing training programs, technical disaster-specific skills should serve as the core, but equal emphasis should be placed on non-technical skills, especially teamwork, leadership, mentoring, and gender awareness within response teams. These elements contribute to developing capable and well-prepared responders.

Background: Childhood maltreatment is a critical societal and public health concern significantly associated with adult mental health outcomes. Recent research suggests that impaired personality functioning may mediate this association.Objective: The aim of the present study was to examine personality functioning impairment (PFI) as a potential mediator between different types of childhood maltreatment and self-reported adult mental health problems in a large community-based sample. In addition, this study sought to identify the domains and subdomains of PFI that have the strongest mediating effects between different types of childhood maltreatment and adult mental health problems.Method: 1,148 adults, with a mean age of 43.49 years (SD_age = 5.80; 85.89% female) were included in the analysis. Childhood maltreatment was measured with the Childhood Trauma Questionnaire (CTQ-SF), PFI with the Levels of Personality Functioning Questionnaire - Adult (LoPF-Q Adult), and mental health problems with the Brief Symptom Inventory (BSI-18). Mediation analyses were conducted through structural equation modelling.Results: A total of 352 (30.69%) reported at least one type of childhood maltreatment, with emotional abuse being most common (14.48%). Emotional abuse and neglect showed the strongest association with PFI (r = 0.41 and r = 0.45, p < .001) and adult mental health problems (r = 0.32 and r = 0.30, p < .001). Overall, PFI significantly mediated the effects of all types of childhood maltreatment, but when self- and interpersonal functioning were considered separately, only self-functioning remained a significant mediator.Conclusions: Taken together, the present findings suggest that PFI, particularly self-functioning, may present an important pathway linking childhood maltreatment to adult mental health outcomes. In addition, findings revealed emotional maltreatment to be particularly important in the context of PFI and adult mental health. Integrating trauma-informed practices within community-based child programmes may foster resilience and counteract unfavourable mental health outcomes.

To investigate the prevalence of anxiety symptoms and associated factors among dental students, and to provide evidence for developing targeted mental health intervention strategies.

A cross-sectional survey was conducted among dental students at Shanghai Jiao Tong University School of Medicine using stratified sampling from November to December 2025. The data were collected via electronic questionnaires. Anxiety symptoms were assessed using the Generalized Anxiety Disorder scale (GAD-7), and sleep status was evaluated using the Insomnia Severity Index (ISI). Demographic characteristics, academic factors and lifestyle information were also collected. Logistic regression models were used to examine the associations between the factors and anxiety symptoms.

A total of 99 dental students were included, and the detection rate of anxiety symptoms was 11.1%. Univariate analysis showed that gender, academic pressure, and sleep status were associated with anxiety symptoms (P＜0.05). Multivariate logistic regression analysis indicated that high academic pressure (OR=5.610, 95%CI: 1.002-31.477) and poor sleep status (OR=1.300, 95%CI: 1.082-1.560) were independent associated factors for anxiety symptoms.

A certain proportion of dental students suffer from anxiety symptoms, academic pressure and sleep status are key associated factors. Comprehensive interventions are recommended by optimizing the academic environment and improving sleep habits to promote the mental health of dental students.

Resident physicians are at high-risk for depressive symptoms, yet most of those meeting depression criteria do not seek care. Resident physicians with disabilities are at higher risk for depressive symptoms. However, their mental health treatment-seeking behaviours remain poorly understood. This study investigates associations between self-identified disability-status, mental health symptom recognition, and treatment-seeking among first-year residents with depressive symptoms.

We analysed data from the 2020-2022 cohorts of the Intern Health Study, a longitudinal study of first-year resident physicians. Depressive symptoms were assessed quarterly with the Patient Health Questionnaire (PHQ-9); scores ≥10 indicated a positive depression screen. Residents who screened positive at least once during internship and identified their disability-status were included. Mental health symptom recognition and treatment-seeking were assessed via quarterly surveys throughout the first residency year. Associations between disability-status, symptom recognition, and treatment-seeking were examined using weighted logistic regression adjusting for sex and specialty-type. Post-stratification and attrition weights addressed nonrepresentative sampling and loss to follow-up. Sensitivity analyses excluded interns reporting psychological disabilities.

Of 5,062 interns, 1,386 (27.4%) screened positive for depression during internship; 940 identified their disability-status and were included (127 [13.5%] with disabilities). Compared to nondisabled interns, those with disabilities were significantly more likely to recognise mental health symptoms (adjusted weighted-OR = 4.5, 95% CI: 1.8-14.7) and seek treatment (adjusted weighted-OR = 3.2, 95% CI: 2.1-5.0). Results remained significant in sensitivity analyses excluding psychological disabilities.

Among depressed first-year residents, self-identified disability-status was associated with significantly greater symptom recognition and treatment-seeking. These findings suggest disability-related experiences may be associated with reduced normalisation of depressive symptoms in residency, offering insights for reducing stigma and treatment barriers in medical training.

Inequitable access to early developmental support persists across both universal and specialised services for priority populations. However, real-world evidence on the impact of implementing proportionate universalism framework (universal plus targeted supports commensurate with needs) within service systems is limited. To address this gap, we aim to implement and evaluate a codesigned model of care called the Strengths-based, Tiered, Accessible Resources and Supports for Kids (hereafter, STARS for Kids) model to improve early identification and delivery of appropriate support for child developmental vulnerabilities, parental mental health and family psychosocial needs across the first 2000 days of life, from pregnancy to the start of school.

This study will be conducted in three phases alongside the codesign phase that will be integrated across the life of the study. First, the impact evaluation phase will be conducted using a multisite, individually randomised controlled trial to evaluate the effectiveness of the STARS for Kids tiered care model (intervention group) against enhanced usual care (control group). Parents/carers of children aged 6 months to 3 years (140 per site) will be recruited using opportunistic contacts in three sites: (i) a multicultural site with a high immigrant population in South Western Sydney in New South Wales (NSW), Australia; (ii) a regional/rural site including an Aboriginal community on Biripi land in Taree in NSW; and (iii) a low socioeconomic site, the City of Wanneroo in Western Australia. Additionally, a nested trial will evaluate the My Toddler and Me Enhanced Video Programme intervention against enhanced usual care among children identified with emotional dysregulation. Second, the implementation evaluation phase will be conducted with consumers and service providers (approximately 15-20 per group and site). Underpinned by the consolidated framework for implementation research, it will evaluate the perceived feasibility, satisfaction, benefits, barriers and facilitators of the model. Third, the economic analysis and dynamic simulation modelling phase will ascertain the cost-benefits and model the impact of the STARS for Kids intervention across the life course for children and families. The primary outcome (parent or carer-reported completion of child developmental checks) and secondary outcomes (changes in child developmental vulnerabilities, parental mental health and family psychosocial needs between the intervention and control groups) will be compared by intention-to-treat analysis using generalised mixed models to account for group, time and interactions. Interview data from the implementation evaluation phase will be thematically analysed to identify, refine and integrate themes representing participant experiences.

The South Western Sydney Local Health District Human Research Ethics Committee approved this protocol for the South Western Sydney and Taree sites in NSW (2024/ETH01146) and Ramsay Ethics approved this protocol for the Wanneroo site in Western Australia (2025/ETH/0002). Site-specific research governance approvals were granted for all three sites. Given the substantial proportion of Aboriginal and/or Torres Strait Islander communities in Taree, an Aboriginal Health and Medical Research Council ethics application was approved for the Taree site (2478/25). Findings from this study will be published in reports and refereed journals and presented at appropriate conferences and community forums following consultations with the relevant steering committees and consumer groups.

ACTRN12624000806561.

This study aims to evaluate, through a longitudinal research, the association between lifestyle habits, modifiable risk behaviors, and mental health with quality of life (QoL) among professionals of the Federal Network of Professional, Scientific, and Technological Education (education professionals) in Brazil. A total of 600 professionals (including teachers and administrative technicians) were longitudinally evaluated in 2022 and 2023. Four validated questionnaires were used: the WHOQOL-bref to assess quality of life (QoL), the DASS-21 for mental health, the Back-PEI for physical activity, and PeNSE for dietary markers. The statistical analysis included Relative Risk (RR) tests and adjusted analysis using a Poisson regression model with robust variance. The main findings indicate that women exhibit poorer QoL in the physical domain (RRadj = 1.19, p = 0.005) and psychological domain (RRadj = 1.14, p = 0.045). Being employed and over 60 years old is a protective factor for QoL in the psychological domain (RRadj = 0.67; p < 0.05). The regular consumption of ultraprocessed foods is a risk factor for QoL all domains (RRadj > 1.15, p < 0.05). Irregular consumption of vegetables/greens (RRadj > 1.11, p < 0.05) and fruits (RRadj > 1.10, p < 0.05) indicated a risk of low QoL. Participants with low frequency or no physical activity had a higher risk of worse quality of life scores across all domains (RRadj > 1.20; p < 0.001). Exposure to television for 5 hours or more during the day was a risk factor for low QoL in the physical domain (RRadj = 1.33, p = 0.005) and social relationships (RRadj = 1.32, p = 0.003). Computer use was not associated with QoL (p > 0.05). Higher frequency of alcohol consumption was associated with higher scores in the social relationships domain (RRadj = 0.83, p = 0.037). Regarding mental health, depressive, anxiety, and stress symptoms were associated with low QoL across all domains (RRadj > 1.33, p < 0.01) in both men and women. The results of this longitudinal study may encourage healthier lifestyle habits and support public policies aimed at improving the well-being of education professionals.

Despite extensive research on self-rated health (SRH), the extent to which mental health contributes to SRH and whether this relationship varies across countries remains underexplored. This study quantifies the contribution of depressive symptoms to SRH and examines cross-national variation in this association. Using data from adults aged 55+ from 28 countries in the Survey of Health, Ageing, and Retirement in Europe (SHARE, wave 9, 2022) (N = 69 447), we applied four approaches: (i) country-specific pseudo-R² models assessing the contribution of depressive symptoms (EURO-D) to SRH, adjusting for sociodemographic factors, physical health, and functional limitations; (ii) partial correlation networks to visualize relationships among SRH, depressive symptoms, and physical health; (iii) Blinder-Oaxaca decompositions to quantify cross-country differences in SRH attributable to depressive symptoms; and (iv) stratification by gender. Depressive symptoms explained nearly as much variance in SRH as physical health. Partial correlation networks showed SRH as central to all health measures, with correlations between SRH and depressive symptoms ranging from 0.15 (Israel) to 0.37 (Romania). Decomposition analyses identified three patterns: countries with low prevalence but stronger SRH-depression associations (e.g. Denmark, Sweden), countries with higher prevalence but weaker SRH-depression associations (e.g. Estonia, Lithuania), and countries with both low prevalence and weak associations (e.g. Greece, Spain). Gender differences in SRH were not meaningfully explained by differences in depressive symptoms. In conclusion, this study finds that depressive symptoms independently contribute to SRH, but their influence varies cross-nationally, reflecting culturally shaped understandings of 'health'.

AI is already in the mental health consulting room, whether clinicians invite it or not. OpenAI reports more than 800 million regular users of ChatGPT and more than 40 million people turning to the platform daily for health questions, yet the evidence remains limited on the clinical efficacy of large language model-based mental health chatbots. Professional guidance and regulation remain fragmented. Clinicians are therefore practicing in a gap between a patient reality that cannot be ignored and a professional infrastructure not yet built. We argue that neither enthusiastic adoption nor principled abstention is sufficient in the current environment. The clinician who refuses to discuss clinically material patient AI use is not preventing that use; they may lose visibility into a factor materially affecting the therapeutic process. The clinician who adopts AI without structured evaluation exposes patients and practice to avoidable harm. The stance we propose is structured harm reduction within the therapeutic relationship: inviting discussion at intake, integrating material use into case formulation, discussing benefits and limits, establishing crisis boundaries, monitoring throughout treatment, and addressing termination planning. Clinician-initiated use is a separate choice requiring evidence, consent when applicable, privacy safeguards, and accountability. We propose a phased clinical framework spanning preintake to termination anchored by the gather, understand, inform, document, and evaluate (GUIDE) mnemonic as an operational wrapper for daily practice. GUIDE and the phased framework are conceptual, unvalidated proposals. We distinguish ethical recommendations, established legal duties, and predicted standards; scope the legal discussion to the United States; integrate equity and subgroup performance; and offer proportionate implementation. The patients who seek care in an AI-saturated world deserve professional infrastructure capable of holding innovation and patient protection in informed balance.