Rural communities face persistent shortages of behavioral health clinicians, requiring primary care physicians to assume expanded mental health care roles. Our study assessed physicians' access to behavioral health resources, such as referral networks, licensed and non-licensed mental health providers, and telehealth supports, and examined whether perceived sufficiency of access upon referral differs between rural and urban physicians.

We analyzed data from the 2022 National Sample Survey of Physicians, a nationally representative survey of active US physicians. Practice ZIP Codes were categorized as rural or urban using Rural Urban Commuting Area (RUCA) codes. Descriptive statistics were calculated, and weighted logistic regression assessed the association between rurality and physician perceived sufficiency for mental health providers upon referral. Models were adjusted for physician demographics, specialty, and practice characteristics.

Most respondents practiced in urban settings (93.1%). Fewer than half of physicians (38.1%) reported access to licensed mental health providers, and only 10% reported access to call-in services or non-licensed support providers. A quarter (24.4%) of respondents agreed that patients had sufficient access upon referral. Rural physicians more often reported referral relationships with accessible mental health providers (55.3% vs. 44.5%). In adjusted models, rurality was not associated with sufficient access to behavioral health services upon referral.

While rural behavioral health workforce shortages receive much attention, both rural and urban physicians reported limited access to mental health resources. These findings highlight gaps in behavioral health infrastructure across geographical settings and opportunities to strengthen referral networks, telehealth support, and integration of mental health services across practice settings.

Healthcare workers (HCWs) in Vietnam face compounding occupational stressors placing them at elevated risk for diminished job satisfaction, depression, and anxiety. Longitudinal within-person evidence linking occupational stress to job satisfaction remains sparse in Southeast Asian low- and middle-income countries such as Vietnam.

A three-wave prospective cohort study enrolled 1,500 healthcare workers (HCWs; physicians, nurses, pharmacists, technicians) from 15 healthcare facilities in Ho Chi Minh City (T1: January-March 2023; T2: July-September 2023; T3: January-March 2024). Occupational stress (Effort-Reward Imbalance, ERI), psychological resources (resilience, perceived social and organizational support), coping responses (adaptive and maladaptive coping), and mental health outcomes were assessed at each wave using established self-report instruments adapted for Vietnamese use. Latent growth curve (LGC) modeling characterized job satisfaction trajectories across three waves; Random Intercept Cross-Lagged Panel Modeling (RI-CLPM) estimated within-person indirect associations between psychological resources and job satisfaction as the primary outcome. Multiple imputation and cluster-robust standard errors were applied.

Twelve-month retention was 92.6%. Mean job satisfaction (JSS) scores declined from T1 to T2 (mixed-effects contrast: b = -5.10, p < .001) and, to a significantly smaller degree, from T2 to T3 (b = -1.25, p < .001; contrast-of-contrasts b = 3.85, p < .001). Exploratory comparisons suggested heterogeneity in decline magnitude across professional groups; partial scalar invariance provided incomplete support for these comparisons, which remain exploratory because they were unadjusted for group-level occupational and demographic differences. Deviations in observed ERI composite scores at T1 were associated with subsequent deviations in resilience, adaptive coping, maladaptive coping, total perceived social support, and organizational support at T2. These variables were, in turn, associated with job satisfaction at T3, including a primary resilience (Brief Resilience Scale, BRS) pathway indirect association (ERI→BRS→JSS = -1.28, 95% Monte Carlo CI [-1.71, -0.85]). All five primary indirect associations were statistically significant (Benjamini-Hochberg q < 0.001).

Job satisfaction declined across the study period, with exploratory evidence of heterogeneity across professional groups. Within-person patterns were consistent with Conservation of Resources theory. These preliminary findings identify candidate targets for future intervention research; pre-registered replication is needed.

Alcohol use disorder (AUD) and alcohol associated liver disease (ALD) commonly co-occur, and integrated approaches to treatment are associated with better outcomes. This study aimed to develop an online module, the Program for Advanced Training of Hepatologists in Alcohol Use Disorder Management (PRATHAM), to enroll and train hepatologists, and to evaluate changes in participants' knowledge, attitudes, practices, and self-perceived competence pre- and post-training.

This included identification of specific needs, establishing learning objectives, designing a curriculum, and developing didactic presentations for hepatologists. Interested participants were enrolled in the online module and were asked to submit pre-tests, clinical cases, and a post-test, which included an evaluation of knowledge, attitudes, practice, and self-perceived competence. Descriptive statistics and the Wilcoxon signed-rank test were used to analyze the data. An intention-to-treat analysis was used to address missing data.

An 8-week curriculum was developed for 18 hepatologists from five different countries. Of these, 17 completed the pre-test, and 11 filled out the post-test proforma. Eleven complex clinical cases were discussed. There was a significant improvement in the participants' knowledge, practice, and self-perceived competence pre- and post-training. However, no significant change in attitudes was noted.

This study underscores the importance of tailored educational interventions in medical specialties such as hepatology, where practitioners frequently encounter patients with AUD. The significant improvements in practice, self-efficacy, and knowledge highlight the potential of targeted training programs to enhance patient care. Future studies could engage a more diverse group of hepatologists and evaluate patient outcomes.

Depression is a leading cause of disability among university students. While medical students are often assumed to be at highest risk, cross-disciplinary comparisons in South Asia remain scarce. This study examined depressive symptom differences between medical and non-medical students in Pakistan and evaluated the concurrent psychometric performance of the PHQ-9 and DASS-21.

A cross-sectional survey of 602 undergraduate students (424 medical, 178 non-medical) was conducted at universities in Lahore, Pakistan. Measures included the PHQ-9 and DASS-21. Analyses comprised descriptive statistics, Wilcoxon rank-sum tests, multivariable linear regression (separate models for PHQ-9 and each DASS-21 domain), confirmatory factor analysis, item response theory using a graded response model, and symptom network analysis with stability testing.

Non-medical students had higher PHQ-9 scores than medical students (median 10.0 vs. 9.0). In adjusted models, non-medical students scored higher on PHQ-9 (β = -1.43, p = 0.004), DASS Depression (β = -1.82, p = 0.003), and DASS Anxiety (β = -2.31, p = 0.001); the DASS Stress difference was non-significant (β = -0.89, p = 0.089). Female gender predicted higher scores across all domains (all p < 0.001). Each additional hour of sleep was associated with lower PHQ-9 scores (β = -0.37, p = 0.010). Prior depression treatment was the strongest predictor (β = 4.15, p < 0.001). DASS-21 confirmatory factor analysis showed adequate fit (CFI = 0.954, TLI = 0.948, RMSEA = 0.052), but latent factor correlations were very high (Depression-Stress r = 0.939; Anxiety-Stress r = 0.949). Cronbach's α ranged 0.82-0.88 across scales. Item response theory indicated that self-worth, concentration, down, and appetite items showed the highest discrimination; interest (anhedonia) showed the lowest (a = 0.468). In network analysis, self-worth, concentration, and downheartedness were the most central nodes; stability coefficients ranged 0.31-0.44. Measurement invariance across discipline was supported. Model R² values were low (0.029-0.041).

Non-medical students reported higher depressive and anxiety symptoms than medical students in this Pakistani sample, although academic discipline explained only a small proportion of variance. Both instruments performed adequately, though the DASS-21's near-unity latent correlations may raise questions about subscale distinguishability in this population. Cognitive and self-worth symptoms emerged as the most informative for screening purposes. Campus mental health strategies should address the whole student population, with particular attention to female students and sleep health.

Previous studies have confirmed that digital cognitive behavioral therapy (dCBT) is an effective intervention for alleviating depressive symptoms. However, there are no specific dCBT programs available for Chinese adolescents. Therefore, we developed a smartphone-based cognitive behavioral therapy program. This study aims to evaluate the efficacy and feasibility of dCBT for Chinese adolescents with depressive symptoms.

The Digital Cognitive Behavioral Therapy for Chinese Adolescents with Depressive Symptoms (CADS-D) study is a single-center, two-arm, open-label randomized controlled trial. A total of 200 adolescents aged 12-18 years with depressive symptoms will be recruited. Key exclusion criteria include severe depressive symptoms or suicide risk, comorbid psychiatric disorders other than depressive disorders, severe physical illness or disability preventing dCBT use, current or recent treatment for depression, and inability to complete follow-up. Participants will be randomly assigned to either the intervention group, receiving the 6-week dCBT program MOCA, or the control group, receiving the regular school mental health curriculum. Assessments will be conducted at baseline (T1), post-intervention at week 6 (T2), and at a 3-month follow-up at week 18 (T3). The primary outcome is the change in depressive symptom severity from T1 to T2. Secondary outcomes, assessed at both T2 and T3, include feasibility and changes from baseline in self-reported depressive symptoms, anxiety symptoms, psychological resilience, and quality of life enjoyment and satisfaction. The first participant was enrolled in May 2025, and the study is currently ongoing.

Findings from the CADS-D trial will provide empirical evidence regarding the efficacy and feasibility of dCBT among Chinese adolescents. If dCBT proves effective in alleviating depressive symptoms in adolescents, it will enhance therapeutic access for a wider adolescent population in China.

The study was registered with ClinicalTrials.gov (NCT07163013; https://clinicaltrials.gov/study/NCT07163013 ) on 9 September 2025.

Psychiatric hospital care is multimodal and typically comprises pharmacotherapy, psychotherapy, social therapy, occupational therapy, exercise therapy, and various forms of creative therapies. The use, acceptance and effectiveness of these interventions may be shaped by gender and further diversity-related factors including age, migration background, sexual orientation, religious beliefs and socioeconomic status. The impact of such diversity-related factors on psychiatric inpatient care processes and outcomes has not been comprehensively examined in German psychiatric hospitals.

PSY-DIVER is a participatory mixed-methods research project conducted by the LVR Institute for Research and Education. The project runs from 1 November 2025 to 31 October 2028 and comprises four linked components: participatory project governance including a co-creation workshop, clinical routine data analyses, qualitative interviews followed by quantitative online surveys, and a two-round Delphi process to develop recommendations for clinical practice. In the routine data component, routine data from the nine psychiatric LVR hospitals with approximately 500,000 inpatient and day-care clinic cases and 1.7 million outpatient cases from 2015 to 2024 will be analysed, with a planned extension to more recent retrospective data during the project period. Structured routine data will be enriched by automated extraction of additional diversity-related variables from clinical free text using a rule-based natural language processing pipeline and locally hosted large language models in a secure local environment. Primary data collection will include 31 semi-structured interviews with mental health service users, relatives, and professionals, as well as online surveys with approximately 300 service users, 100 relatives, and 100 professionals. Integrated findings from these project parts will inform a structured consensus process with approximately 40 professional experts and experts by experience to formulate recommendations for a more diversity-sensitive psychiatric hospital care.

PSY-DIVER is designed to generate a detailed empirical account of how gender and other diversity-related factors are associated with treatment allocation, treatment processes and treatment outcomes in psychiatric hospital care. By combining large-scale routine data, primary stakeholder data and a participatory consensus process, the study aims to provide an evidence base for more equitable and diversity-sensitive psychiatric services.

German Clinical Trials Register (DRKS00040088), registered on April 30, 2026.

Non-affective psychosis is associated with elevated risk of suicide, self-harm, and reduced life expectancy. Symptoms of dissociation are common in non-affective psychosis, and dissociative experiences are known to be linked to multiple markers of elevated clinical risk, including sleep disturbance and negative affect. The present review represents the first comprehensive quantification of dissociative phenomena severity across multiple instruments in non-affective psychosis.

Six databases (Embase, MEDLINE, PsycINFO, PubMed, Scopus, Web of Science) were searched from inception and systematically screened. Eligibility was established against ICD/DSM criteria or service-defined categorisation, including first-episode psychosis, brief limited intermittent psychotic symptoms, and at-risk of psychosis mental states. In total, data were extracted for 22 measures. Four random effects meta-analyses were conducted for measures with three or more independent datasets: the Dissociative Experiences Scale (DES) (k = 51; n = 3,878); the Cambridge Depersonalization Scale (CDS) (k = 6; n = 351); the Examination of Anomalous Self Experience scale, using the dichotomous scoring method (EASE-D) (k = 11; n = 340); and the Examination of Anomalous Self Experience scale, using the continuous scoring method (EASE-C) (k = 6; n = 235).

DES data yielded a pooled mean of 21.28 (95% CI 19.19-23.38), consistent with moderately elevated dissociation. CDS data yielded a pooled mean of 36.38 (95% CI 26.89-45.87), also raised relative to community norms. EASE-D pooled means (M = 17.76 95% CI 15.29-20.24) and EASE-C pooled means (M = 74.86 95% CI 52.36-97.35) both indicated high and clinically relevant loads of basic self-disturbance. High heterogeneity (I² > 85%) across measures highlights considerable variability in dissociative severity across samples, suggesting that levels of dissociation and dissociative experiences are not uniform in populations who experience non-affective psychosis.

The present findings emphasise the importance of assessing dissociation in non-affective psychosis, and where necessary, intervening clinically. Nonetheless, the development of trauma-informed, dissociation-targeted clinical interventions is required to optimise approaches to support. Throughout the literature, there is a pressing need for more harmonised measurement efforts and further mechanistic research.

Residential greenspace is linked to mental and cardiometabolic health, but longitudinal studies on detailed greenspace and dementia incidence are limited.

We followed 2993 dementia-free participants in the Swedish National Study on Aging and Care Kungsholmen for 16 years; 477 developed clinically diagnosed dementia. Greenspace was assessed using normalized difference vegetation index within 100-, 250-, and 500-m residential buffers. Cox models estimated hazard ratios (HRs) per interquartile-range greenspace increment and tested effect modification by air pollution, road traffic noise, blue space, age, sex, and apolipoprotein E-ε4 (APOE-ε4).

Higher greenspace within 100 m was associated with lower dementia incidence (HR = 0.79, 95% confidence interval [CI] = 0.64-0.96), whereas associations for larger buffers were attenuated. Associations were stronger in women (HR = 0.69, 95% CI = 0.54-0.89) than men (HR = 0.93, 95% CI = 0.71-1.24).

Close residential greenspace may reduce dementia risk in older adults, particularly women.

Chronic spontaneous urticaria (CSU) is a mast cell-driven inflammatory disease frequently accompanied by anxiety, depression, sleep disturbance, fatigue, and impaired quality of life. Pruritus, disturbed sleep, psychosocial burden, and treatment-related effects are established contributors to this neuropsychiatric and functional burden. Whether immune-to-brain signalling provides an additional mechanism in a susceptible subgroup remains unknown. This hypothesis-driven narrative review examines the blood-brain barrier (BBB) as one potential interface linking CSU-associated inflammation to central effects. CSU studies report systemic inflammatory, vascular, and neuroimmune signals, including cytokine signatures, circulating matrix metalloproteinase-9, and substance P-MRGPRX2-related findings. Their potential neurovascular relevance is inferred from experimental or other disease settings rather than demonstrated in CSU per se. Our targeted search identified no human CSU studies assessing regional BBB permeability with dynamic contrast-enhanced magnetic resonance imaging or tracer methods, blood-cerebrospinal fluid barrier function with the albumin quotient, serum S100B, or brain endothelial tight-junction integrity, including claudin-5 or occludin. Structural and functional neuroimaging findings in CSU do not establish barrier dysfunction. Systemic mastocytosis provides comparative evidence for mast-cell-related neuropsychiatric manifestations, although barrier involvement remains unproven. We therefore propose neurovascular alteration as a testable, non-exclusive risk modifier whose relevance to CSU pathophysiology and psychiatric symptoms remains to be established.

Although millions of adults seriously consider suicide each year, clinical trials often exclude individuals experiencing suicidal ideation (SI). This analysis sought to describe the use of a range of psychiatric treatment modalities in individuals with mood disorders with and without a history of suicide attempt or SI.

Individuals with mood disorders (n=211; M=93/F=118) who had previously participated in psychiatric research at the National Institutes of Health Clinical Center completed a follow-up clinical assessment (range=1-20 years since study participation). In addition to clinical outcomes, participants were asked about psychiatric treatment use since discharge, treatment indication, and perceived helpfulness of the intervention. Differences between participants who did and did not report SI and/or history of suicide attempt at index visit were analyzed using general linear models.

Individuals with SI on index visit had generally similar clinical outcomes as those who did not report SI on index visit, but they were more likely to report use of psychiatric medications or ketamine at follow-up. Few group differences were noted with regard to perceived helpfulness or use of treatments for suicide-related indications. Individuals with a history of suicide attempt on index visit were more likely to report suicide attempts and psychiatric hospitalization at follow-up.

Individuals with SI or with a history of suicide attempts frequently use psychiatric services, particularly psychiatric medications and hospitalizations. The results underscore the need for effective, suicide-focused treatments for individuals with suicidal thoughts and behaviors.

www.clinicaltrials.gov (NCT02543983).