Physical activity is associated with depressive symptoms in later life, but this association may depend on the form of exercise-related support and older adults' digital engagement. This study examined whether physical activity volume (PAV) and exercise guidance (EG) were associated with depressive symptoms among young-old adults in China and whether these associations varied by internet use frequency (IUF) and self-perceived digital proficiency.

Data were drawn from the 2020 to 2023 waves of the China Longitudinal Aging Social Survey (CLASS). The analytic sample included 5643 adults aged 60-75 years. Generalized estimating equations (GEE) were used to examine the associations of PAV and EG with depressive symptoms, as well as their interactions with IUF and self-perceived digital proficiency.

PAV and EG were associated with lower depressive symptom scores in the full sample, although the association for PAV was less consistent across subgroup and moderation models. More frequent internet use was associated with lower depressive symptom scores and was more consistently related to the EG-depressive symptoms association than to the PAV-depressive symptoms association. The interaction between PAV and IUF was evident mainly among rural respondents. Among internet users, high self-perceived digital proficiency was associated with lower depressive symptom scores and showed a clearer conditional association with EG than with PAV.

Digital engagement was more consistently related to the depressive-symptom relevance of EG than to PAV itself. These findings suggest that supporting young-old adults' mental health may require attention not only to physical activity levels but also to accessible EG and age-friendly digital support.

Cognitive remediation is an evidence-based intervention designed to improve the functional cognition of people with mental health conditions. Employ Your Mind is a vocational rehabilitation program with embedded cognitive remediation that is facilitated by trained mental health workers, referred to as Learning Coaches within this context. Providing effective training and support to Learning Coaches forms a significant component to the implementation of the program. To date, there has been limited examination of Learning Coaches' experiences of delivering the Employ Your Mind program. These perspectives are important for the wider implementation of cognitive remediation interventions to improve access for people with mental health conditions.

Semi-structured interviews were conducted between March-April (2025) with purposively sampled Employ Your Mind Learning Coaches and their managers, from three community-based mental health organizations involved in a 12-month Employ Your Mind Demonstration Project (2023-2024) led by WISE IDEA. Qualitative data underwent reflexive thematic analysis procedures and were compared against the Kirkpatrick Model of Evaluation.

Learning Coaches and their managers (N = 9) described their experiences of the Employ Your Mind training and implementation as a journey of learning and skill development. Learning Coaches noted enhancements in their therapeutic approach (Kirkpatrick Model Level 3: Behaviour), improved job satisfaction in observing positive consumer outcomes (Kirkpatrick Model Level 4: Results) and the significance of ongoing support and supervision to navigate implementation challenges.

This study informs the development of future training for vocational rehabilitation programs with embedded cognitive remediation. Several enablers for the successful training and implementation of the Employ Your Mind program were identified and are discussed from the Learning Coach and managerial perspective.

Panic disorder is highly debilitating and contributes a significant amount to anxiety-related disability-adjusted life years globally. To understand this burden, the current study provides an up-to-date understanding of the descriptive epidemiology of panic attacks and panic disorder in the Australian population. Data were from the most recent 2020-2022 National Survey of Mental Health and Wellbeing, a large-scale population-based study conducted in Australian households with respondents aged 16-85 years of age (n = 15,893). Panic attacks and panic disorder experienced across the lifetime, within the past 12 months and within the past 30-days were assessed by the Composite International Diagnostic Interview according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnostic criteria to facilitate direct comparisons with the 2007 National Survey of Mental Health and Wellbeing (n = 8841). The lifetime prevalence of panic attacks and panic disorder was ~27% and 4%, respectively. Those with panic disorder indicate a median age of onset in their early 20s and the experience of panic disorder is not trivial, with nearly half of all cases (45%) falling within the 'severe' range in terms of severity and functional impairment. There were significantly elevated odds in select subgroups of the population with evidence that panic attacks and panic disorder remain a pressing concern for the Australian population, and particularly so in 2020-22 for younger cohorts (16-24), females, those who have never been married, and people who reside in inner regional areas. Despite improvements in access to mental health services, there remains a strong need for improved mental health services and targeted prevention programmes.

The Swiss postgraduate education regulations stipulate that teaching be guided by cross-disciplinary "General Learning Objectives" (GLOs) based on the CanMEDS roles. Notwithstanding these regulations, teaching activities and performance criteria for GLOs are scarcely evident in postgraduate training programmes. The primary aim of this study was to determine the reasons why too little emphasis is placed on GLOs in postgraduate training programmes. A secondary aim was to define a reduced set of needs-based cross-disciplinary competencies that trainees should develop during their postgraduate medical training.

A Delphi study was conducted to survey postgraduate trainees and heads of training centres throughout Switzerland. In two rounds of surveys, data were collected on (1) why too little emphasis is placed on GLOs in postgraduate training and (2) which GLOs are considered relevant. Based on these results, the GLOs were then consolidated into competency domains.

The main reason for the underemphasis on GLOs was the high workload of postgraduate trainees. Based on the data from both survey rounds, the following five competency domains were formulated and prioritised by the research team: "patient safety", "communication in physician-patient relationships", "mental health of physicians", "collaboration in interprofessional teams" and "clinical ethics".

The results of the Delphi study confirm the need for action and provide important insights into how sub-aspects of GLOs are weighted by clinicians. Barriers to implementation of GLOs include the high workload imposed on postgraduate trainees and the lack of awareness about GLOs. The final concept comprised five cross-disciplinary competency domains that provide an application-oriented framework to underpin postgraduate medical training.

Families of children with disabilities in low-resource settings face heightened challenges to family functioning and wellbeing. Improving a child and caregiver's environment in these settings requires a broader understanding of the family ecosystem. This study aims to investigate factors that should be considered to enhance family functioning and inform family-centered interventions.

We conducted 34 in-depth interviews with 30 caregivers of children with disabilities aged 6-8 years enrolled in a larger cluster randomized trial of the Sugira Muryango parenting intervention. Additionally, six focus group discussions were conducted with 36 community workers, and 6 Early Childhood Developmental (ECD) advocates participants. Guided by the SAFE Model for child protection, content analysis was used to understand threats to child protection and caregivers' well-being among caregivers of children with disabilities enrolled in Sugira Muryango.

Consistent with the domains outlined in the SAFE Model, our analysis revealed the following threats to child safety: 1) Safety/Freedom from harm, including father's mental health and substance abuse, abandonment and stigma related to a child's disability; 2) Access to basic physiological needs and healthcare, including lack of basic necessities (food, utilities and housing), additional needs related to caring for a child with disabilities, caregiver mental health needs, limited access to health insurance and mother illness; 3) Family and connection to others, including the single-parent dilemma, lack of support from family and community, and father abandonment; and 4) Education and economic security, including additional expenses due to the child's disability and financial stress related to health care costs.

Improving family functioning and wellbeing among caregivers of children with disabilities in limited resources requires a deep understanding of socioecological forces operating on the family system. These findings provide further evidence of how the threats to child safety highlighted by the SAFE Model can inform how researchers, and policy makers design and implement family-centered interventions tailored to children with disabilities in low-resource settings.

This study examined the cross-sectional associations between Wushu participation and internalizing problem behaviors, including depression, anxiety, and stress, among Chinese primary and secondary school students. It also explored whether organizational forms of participation and Wushu event categories were associated with these mental health indicators.

A cross-sectional research design was adopted, with a valid sample of 6,642 participants. Questionnaires were used to assess Wushu participation and levels of depression, anxiety, and stress. Demographic information, including gender, grade, age, residence, and parental educational attainment, was also collected. Harman's single-factor test was conducted to assess common method bias, followed by descriptive statistics and correlation analyses. Multiple linear regression models were used to estimate the adjusted cross-sectional associations of Wushu participation, organizational form, and event category with depression, anxiety, and stress after controlling for selected demographic covariates. Collinearity and residual diagnostics were also performed.

(1) The common method bias test showed that the first common factor explained 26.19% of the total variance, lower than the critical standard of 40%. (2) Wushu participation was significantly negatively correlated with depression (r = -0.261), anxiety (r = -0.251) and stress (r = -0.207) (all p < 0.01); depression, anxiety and stress were significantly positively correlated with one another (r = 0.423-0.473, all p < 0.01). (3) In the adjusted models, Wushu participation was significantly and negatively associated with depression β = -0.191, anxiety β = -0.166, and stress β = -0.156 all p<0.001. Organizational form and event category were also associated with the three mental health indicators p < 0.05 or p < 0.001.

Among Chinese primary and secondary school students, higher levels of Wushu participation were cross-sectionally associated with lower levels of depression, anxiety, and stress. Organizational form and Wushu event category were also associated with these mental health indicators, suggesting that participation context may be relevant when considering the potential public health value of Wushu practice.

Large language models (LLMs) are immensely popular, being adopted by the general public for information and assistance in tasks, and increasingly in mental health support. This is especially true at a time when psychiatric care is limited by cost, availability, and stigma. More patients are using generative artificial intelligence (AI) for mental health guidance without professional medical oversight, and without disclosing usage to practitioners. This creates a clinical blind spot in which there lies a gap between what the practitioner knows and what has already altered the patient's presentation. Undisclosed AI use can undermine the trust-building cycle in a clinical relationship, as patients may defer trust to a source the clinician is not aware exists, while arriving with AI-generated interpretations that might differ from clinical judgment. This narrative literature review synthesizes emerging evidence of how patient use of LLMs can complicate psychiatric clinical decision-making to raise awareness among mental health practitioners. Patients report utilizing AI to augment or substitute for therapy due to cost and accessibility, and finding the experience to be validating and non-judgmental. Having received potentially biased or inaccurate AI-generated information, patients may present with AI-generated self-diagnoses, altering symptom framing and affecting treatment adherence and the therapeutic relationship. Daily interactions with AI chatbots have been reported to coincide with delusional thinking, contributing to an emerging phenomenon of AI-associated psychosis, putting patients further at risk. The variation in the types of AI chatbots also raises safety concerns, including hallucination, sycophancy, and model bias. These risks dramatically change how a patient may present themselves in a clinical encounter. To screen for AI use at intake as well as practitioner education to recognize sycophancy and other AI-associated risks, frameworks developed by professional societies are all needed. Prospective research designs to study the tools patients use are lacking. The clinical reality is that patients and technology are both outpacing the clinical training and guidelines needed to address this growing challenge.

This study aimed to compute the spatially varying associations between seven chronic health conditions-high blood pressure, asthma, chronic obstructive pulmonary disease (COPD), stroke, cancer, diabetes, and frequent mental distress-and key environmental, built-environment, and socioeconomic determinants at the fine, census-tract scale in Harris County, Texas, USA.

The study uses three methods: Ordinary Least Squares (OLS), Geographically Weighted Regression (GWR), and Multiscale Geographically Weighted Regression (MGWR) to develop association models using 2022 data. The study further validates the developed models using data from 2020 to 2024.

MGWR outperformed both OLS and GWR for every health outcome, increasing the adjusted R² (for example, from 0.57 to 0.75 for blood pressure and from 0.58 to 0.70 for cancer) and reducing the corrected Akaike Information Criterion (AICc) by several hundred points. Poverty and particulate matter (PM_2.5) were the most consistent predictors, with the strongest positive coefficients concentrated in central, eastern, and southeastern tracts near industrial corridors and in lower-income communities. Different determinants operated at distinct spatial scales, and re-estimating the framework for 2020, 2021, 2023, and 2024 reproduced the 2022 patterns (|ΔR²| ≤ 0.09), confirming the stability of the models. These fine-resolution results identify specific high-burden neighborhoods that global models may overlook.

By allowing each determinant to act at its own spatial scale, MGWR produced a transferable framework for identifying vulnerable communities and estimating chronic disease burden where health data are sparse or missing. The fine-resolution, census-tract results can help guide place-based public health interventions toward the eastern and southeastern areas of Harris County where poverty, air pollution, and chronic disease prevalence coincide, supporting more efficient and targeted resource allocation.

BACKGROUND: Insomnia is a common condition that adversely affects work productivity, and a significant proportion of individuals with acute insomnia disorder (AID) eventually develop chronic insomnia disorder (CID). However, it remains unclear whether workplace impairment and daily activity impairment occur early in the course of insomnia. METHODS: This cross-sectional study included 295 AID and 305 CID participants. Multiple linear regression was used to assess associations between insomnia, workplace and daily activity impairment, and related factors (daytime sleepiness, depressive and anxiety symptoms). Restricted cubic spline (RCS) analysis was also conducted to explore nonlinear relationships. Mediation analysis was performed to assess the potential mediating effects of daytime sleepiness and depressive and anxiety symptoms between insomnia and workplace and daily activity impairment. RESULTS: No significant differences were found between the AID and CID groups in presenteeism or productivity-loss costs (P>0.05). Insomnia severity, daytime sleepiness, and depressive and anxiety symptoms were the correlated factors of workplace and daily activity impairment (P<0.05). A nonlinear relationship between depressive symptoms and presenteeism, as well as between daytime sleepiness and daily activity impairment, was identified in both groups (P_overall<0.01, P_nonlinearity<0.05). Mediation analysis showed that in the AID group, depressive symptoms mediated the effects on absenteeism and daily activity impairment (mediation proportions: 37.02% and 28.61%, respectively). In the CID group, anxiety symptoms had a greater mediating effect on presenteeism and daily activity impairment (mediation proportions: 53.01% and 31.70%, respectively). CONCLUSIONS: Presenteeism and productivity-loss costs occur in AID and are comparable with those resulting from CID. Depressive and anxiety symptoms are also important mediators of workplace and daily activity impairment in AID. We recommend investing in portable and effective interventions to improve work productivity.

The frequency of online psychotherapy, including pure online (PO: videoconference [PO-VC], telephone [PO-TEL], asynchronous therapist-guided [PO-Async]), or blended (BLD) modalities, has grown exponentially, yet how the therapeutic alliance (TA), a key outcome predictor, compares across these formats and face-to-face (FTF) treatment remains unclear. To compare the TA strength and the TA‒outcome association across FTF, PO, and BLD modalities, a systematic narrative review (Preferred Reporting Items for Systematic Reviews and Meta-Analyses/Synthesis Without Meta-analysis [PRISMA/SWiM]) was performed by searching PubMed, PsycARTICLES, and Web of Science. Studies were deemed eligible if they quantitatively compared TA across at least two modalities in adults with depressive or anxiety disorders. PO arms were classified as telepsychotherapy (PO-VC/TEL) or therapist-guided digital interventions (PO-Async). The findings were synthesized by direction and consistency. Nine studies, including three primary randomized controlled trials (RCTs) and six secondary analyses, were finally included in this study. TA strength was broadly comparable across all three modalities. One study found significantly lower patient-rated working alliance inventory (WAI) scores at Week 2 in PO-Async versus FTF, resolving by Week 8. The TA‒outcome association was mixed, varying by modality, rater perspective, and timepoint. The results showed that TA was broadly equivalent across FTF, PO, and BLD formats, although asynchronous PO might show a transient week-2 lag. The TA‒outcome association was less consistent in PO/BLD than in FTF. As a preliminary hypothesis, digital delivery may shift the functional emphasis of the alliance from affective bonding toward task/goal engagement.