Although there is a high need for mental health support among individuals with experience of forced migration, there are barriers to accessing in-person interventions. Online delivery offers an alternative. This study aimed to examine the feasibility and acceptability of online-delivered Teaching Recovery Techniques (TRT) for young people who had experienced forced migration and reported symptoms of PTSD.

The study used an open, single-arm trial design with a mixed-methods approach. Participants (n = 16; 62.5% male; 17-23 years) were recruited via an upper secondary school in Sweden. Fidelity checklists were used to capture adherence to the manual, psychological symptom and life satisfaction questionnaires were administered (n = 16), and a focus group discussion (n = 3) and interview (n = 1) explored participants' perspectives.

High fidelity was observed, with all components delivered except for elements of the final session. Technical challenges were noted, including limited platform functionality for private communication and unstable internet connectivity, and privacy concerns were raised where participants lacked private spaces. The format was adapted, including merging groups, delivering sessions twice weekly rather than weekly, and reducing session duration from 90 to 60 min. Of 16 participants, 9 completed post-intervention measures; descriptive data suggested completers were less likely to be female and had higher symptom scores. Qualitative data indicated symptom improvements and emphasised facilitators' relational qualities, but benefits were described as transient and insufficient to address ongoing stressors, with participants preferring in-person delivery.

Online TRT needs enhanced technical support, privacy safeguards, and closure procedures; future trials should test efficacy and long-term outcomes.

Healthcare professionals (HCPs) face significant mental health challenges, yet barriers such as stigma, discrimination, and systemic issues hinder help-seeking. This study examines the barriers and facilitators to accessing wellbeing provision at a mental health NHS Foundation Trust in England. Three focus groups, comprising doctors and nurses from diverse backgrounds, were conducted, with reflexive thematic analysis employed to identify stressors, coping strategies, and mitigating factors. Findings highlighted stressors such as overwhelming workloads, clinical risks, and operational challenges, while coping mechanisms included flexible working, and supervision. Barriers to help-seeking were attributed to limited awareness of resources, organisational culture, and manager-employee dynamics. Recommendations include reviewing staffing levels, wellbeing-focussed managerial training, and improving the accessibility and authenticity of wellbeing services. Addressing these factors can cultivate an environment that reduces burnout, encourages help-seeking, and enhances patient care. These findings provide guidance to employers seeking to develop effective interventions to support HCP wellbeing in the workplace.

To develop strategies to lower barriers to sexual and reproductive health (SRH) care for migrant women (MW) in Milan, Lombardy, Italy.

SRH is a fundamental human right, yet MW experience poorer SRH outcomes than non-MW due to cultural, linguistic, legal, and financial barriers. Despite Italy's universal healthcare system (Servizio Sanitario Nazionale, SSN), disparities persist.

Quantitative SRH data from the health information system of a non-governmental organization (NGO) clinic in Milan was used to describe the demographic, socioeconomic, and administrative profile of MW with SRH needs, and to examine factors associated with SRH-related consultations. Qualitative data were collected through semi-structured interviews with 29 stakeholders, including MW, healthcare workers, NGO representatives, and policymakers. Thematic analysis was guided by a socio-ecological framework across individual, organizational, societal, and policy levels.

SRH needs were the most frequent presentations among MW accessing the clinic. Most MWs came from Romania, Morocco, and Peru. Nearly half of those eligible for SSN registration were not enrolled, primarily due to lack of awareness. Economic vulnerability was strongly linked to SRH needs, while language proficiency alone showed no significant effect. Interviews underscored the importance of culturally sensitive care and mental health support. They also emphasized the inconsistent enforcement of regulations across government facilities and legislative gaps that leave certain groups, particularly undocumented EU nationals, without essential services. Community networks and stronger coordination across providers - including formal collaboration between NGOs and the SSN - were identified as promising levers to improve SRH access and equity in Milan and similar settings.

Hispanic adolescents experience disproportionately high rates of mental health issues and face systemic barriers to accessing care, yet their perspectives remain underrepresented in research. Understanding how they define mental health is critical, as it shapes beliefs, priorities, and help-seeking behaviors. This study employed Photovoice, a community-based participatory research (CBPR) method, to explore Hispanic adolescents' conceptualizations of mental health and their priorities. Twelve adolescents (ages 13-17) from two youth centers in Greater Boston were divided into three groups. Each group participated in three meetings (a preparatory workshop, a focus group, and a feedback workshop) between June 2024 and February 2025. Participants took photographs reflecting their views on mental health, followed by reflective discussions using the SHOWeD technique. Reflexive thematic analysis was used to analyze data. Mental health was defined as the ability to feel, express, and manage emotions. Adolescents' mental health priorities were (i) self-expression and coping with distress; (ii) the role of immigrant families in adolescent mental health; (iii) the influence of peers, trusted adults, and safe community spaces in adolescent mental health; and (iv) mental health stigma. Participants emphasized creative outlets and open dialogue, while identifying cultural expectations and intergenerational silence as barriers to emotional well-being. Results underscore the need for culturally responsive mental health promotion that centers adolescent voices. Interventions should foster safe spaces for expression, validate lived experiences, and address stigma within immigrant families and communities. Intervention strategies must be multisystemic and multilayered-including family and community settings-to advance mental health equity and ensure sustainable support for Hispanic adolescents.

Depression is the most common mental health problem in women during pregnancy, associated with psychological, social, and medical factors characteristic of this stage. However, a lack of knowledge and limited attention to this condition can aggravate its consequences and restrict access to appropriate treatment. This research seeks to fill a gap in the scientific literature by exploring the association between eating habits and dietary diversity with depressive symptomatology in a group with high psychosocial vulnerability: pregnant adolescents.

A cross-sectional analytical study was conducted with a sample of 344 pregnant adolescents attending prenatal care at the National Institute of Perinatology (INPer), a tertiary care center. Non-probabilistic sampling was used for recruitment. Relevant information was collected using a pre-validated structured questionnaire administered via interview. Depressive symptomatology was assessed using the Edinburgh Postnatal Depression Scale (EPDS), with a score of ≥12 considered indicative of a higher risk of depression. Eating habits were evaluated based on meal omission, activities performed during meals, and dietary diversity, comparing them with national recommendations. Food group consumption was assessed using a semi-quantitative Food Frequency Questionnaire (FFQ). Robust variance Poisson regression models were employed to evaluate the independent association between undesirable eating habits, inadequate food group intake, and the presence of depressive symptomatology.

A significant association was observed between the presence of depressive symptoms (EPDS ≥ 12) and the omission of main meals. Specifically, skipping breakfast was associated with a higher prevalence of EPDS scores ≥ 12 (aPR = 1.55; 95% CI: 1.10-2.19; p = 0.013). Similarly, adolescents who skipped lunch showed a higher prevalence of depressive symptomatology compared to those who did not (aPR = 2.02; 95% CI: 1.11-3.68; p = 0.022). Regarding food groups, only insufficient intake of milk and dairy products was significantly associated with the presence of depressive symptoms (aPR: 1.78; 95% CI: 1.16-2.73; p = 0.008).

This cross-sectional study found a significant association between breakfast skipping, distraction while eating, and inadequate dairy intake with a higher prevalence of depressive symptoms in socially vulnerable pregnant adolescents treated at a tertiary care center. However, due to the study's design, causality or the direction of the relationship cannot be established (it could be bidirectional), and it cannot be affirmed that modifying the diet will necessarily reduce depression. Furthermore, the results are not generalizable to all pregnant adolescents, and future research (longitudinal or interventional) is needed to better understand these associations before developing specific dietary interventions.

Background: Suicide remains a leading cause of death in the United States, with more than 49,000 fatalities in 2023. Rural counties consistently face higher suicide mortality rates than urban areas, reflecting deep-seated mental health inequities. Methods: This study analyzes 39 U.S. states with suicide mortality rates exceeding the national average, as defined by the Centers for Disease Control and Prevention (CDC) (>14.1 per 100,000), to examine rural-urban disparities and their intersectional demographic factors. Age-adjusted mortality data (2019-2023) from HDPulse were analyzed using IBM SPSS Statistics, version 31.0. Counties were classified by USDA Rural-Urban Continuum Codes and stratified by region, sex, age, and race. Subgroup differences were tested using a two-way ANOVA (p < 0.01). Results: Rural suicide rates were significantly higher than urban rates (28.69 vs. 20.20 per 100,000; p < 0.001). The West reported the highest mortality and widest rural-urban gap (38.23 vs. 24.83), while the Northeast had the lowest. Men had higher rates than women, particularly in rural settings (37.12 vs. 11.77). The largest rural-urban gap occurred among young adults (20-39 years). American Indian/Alaska Native populations experienced the highest rates (rural: 58.73; urban: 35.15). The literature review highlighted limited healthcare access, social stigma, substance use, and economic hardship as variables commonly associated with rural-urban differences in suicide mortality. Conclusions: Suicide mortality is markedly elevated in rural America across all subgroups, with the greatest risks among young adults, men, and American Indian/Alaska Native populations. Tailored prevention strategies and expanded mental health infrastructure are critical for high-burden states.

Migration and place of birth are increasingly recognised as social determinants of health among sexual minority populations. Among men who have sex with men (MSM), being born outside the country of residence may shape access to healthcare, community resources, and social capital networks. In Japan, however, little is known about how being born outside Japan is associated with social capital, health behaviours, and mental health among MSM.

Data were drawn from a large cross-sectional online survey conducted in 2025 of 8150 MSM living in Japan, recruited via community-based in-person outreach and targeted geo-social networking application advertisements. Multivariable logistic regression analyses examined associations between country of birth and social, behavioural, and health-related outcomes.

Foreign-born MSM were younger and more concentrated in the Greater Tokyo metropolitan region. Being born outside Japan was associated with higher odds of HIV testing across all timeframes and higher levels of both gay and heterosexual social capital. Foreign-born MSM were also more likely to have disclosed their sexuality to friends and family. However, they were less likely to be aware of LGBT or HIV prevention organisations, despite higher participation once engaged. No differences were observed in suicidal ideation or unprotected anal intercourse with casual partners, although foreign-born MSM were more likely to report unmet need for mental health care.

Foreign-born MSM in Japan demonstrate strong engagement in HIV prevention and higher social capital, alongside persistent barriers to community awareness and mental health service access. These findings highlight the importance of addressing structural and informational barriers and supporting community-based organisations to improve equitable health and wellbeing outcomes among MSM in Japan.

Older adults in under-resourced communities experience high levels of social isolation, chronic illness, and reduced access to healthcare, which can undermine mental well-being. Open Source Wellness's Community As Medicine^® (CAM) program is an evidence-based, community-delivered, clinically integrated program that combines trauma-informed, culturally-relevant, experiential group health coaching with social connection to improve mental and physical well-being. This qualitative study, conducted in early 2025, examined how participation in CAM supports mental well-being among older adults (age 65+) in under-resourced communities who are managing chronic physical and mental health challenges.

Semi-structured interviews were conducted with participants who completed CAM. Transcripts were analyzed using reflexive thematic analysis to explore relational and experiential processes associated with improved well-being.

Participants entered CAM with internalized ageist beliefs and low expectations for personal change. As they engaged in new behaviors, experienced successes, and observed similar progress among peers, they gained motivation, confidence, and a sense of control. Four interconnected themes appear to explain the mechanisms through which CAM supports mental well-being: (1) belonging and inclusion through trust and safety; (2) personal accountability through relational accountability; (3) self-efficacy through social learning and reciprocal support; and (4) agency through positive actions.

Findings suggest that CAM supports mental well-being by creating conditions that help older adults overcome internalized ageism and feel connected, capable, and in control of their lives. These results identify actionable strategies that community organizations and health systems can adapt to support mental well-being for older adults in under-resourced communities.

Background/Objectives: In Phenylketonuria (PKU), engaging in regular physical activity and exercise (PA/E) is important for physical and psychological health, but additional considerations may be required to facilitate uptake and performance as well as to optimise metabolic control. The aim of this study, therefore, was to investigate the stakeholder perspectives on the barriers, facilitators, and solutions to completing PA/E, sport, and nutrition in PKU. Methods: In total, 7 in-person and 6 online semi-structured focus groups (FGs) were conducted with individuals with PKU (n = 31), caregivers (n = 13), clinicians (n = 17), and medical industry professionals (n = 14) in PKU (n = 75 total participants). Three main questions about the barriers, facilitators, and solutions to performing PA/E with PKU were explored. Identified themes were mapped onto the capability, opportunity, motivation, and behaviour (COM-B) model of behaviour change with anonymous quotes from relevant stakeholders used to illustrate the findings. Results: Five common themes were identified. Most notably, individuals with PKU and their caregivers stated fatigue, poor recovery, low energy, and fear around the impact of exercise on blood phenylalanine (Phe) control were barriers to PA/E. Individuals with PKU were aware of the potential benefits of exercise, stating PA/E impacted positively on their mental well-being, daily functioning, and happiness and improved their self-confidence and long-term health. Identified solutions to PA/E participation included greater knowledge in regard to the impact of PA/E on Phe levels, improvements in advice on amount and supplementation with protein substitutes, tailored PKU nutritional advice, more awareness of PA/E within and outside the PKU community, specific PKU guidelines for PA/E, more scientific research, and PA/E events. Misalignment was evident, such that individuals with PKU reported additional barriers to PA/E, whereas other key stakeholder groups perceived the same barriers as the general public. Conclusions: There seems to be a misalignment between individuals with PKU, caregivers, clinicians, and industry professionals regarding PA/E, sport, and nutrition. Individuals with PKU and caregivers reported additional barriers to undertaking PA/E, sport, and nutrition compared to the general public. This suggests that further education and collaboration is needed through stakeholders to better understand how such barriers could be overcome in respect of PA/E, sport, and nutrition in individuals with PKU.

Introduction: Mental disorders, particularly depression and anxiety, represent a leading source of morbidity and disability in young adults, a group increasingly exposed to cumulative psychological processes and environmental stressors. Although evidence links healthy dietary patterns with improved mental health symptoms, the specific contribution of nut consumption (rich in anti-inflammatory, antioxidant, and neuroprotective compounds) remains insufficiently examined in this population. Current evidence also lacks robust data on the dose-response effects of nut consumption and mechanistic pathways involving biomarkers relevant to brain function and mental health. The Nuts4Brain-RCT will investigate the impact of a 6-month mixed-nut consumption intervention on mental health symptoms, cognitive functioning, sleep quality, overall well-being, health-related quality of life, and biochemical brain function mediators in young adults. Methods and analysis: A 6-month, randomized, single-blinded, three-arm, dose-response, parallel-group clinical trial will be conducted with 135 university students aged 18-24 years from the University of Castilla-La Mancha, Cuenca, Spain. The participants will be randomly assigned in a 1:1:1 ratio to one of three groups: (1) a control group maintaining their habitual diet while avoiding nut consumption; (2) a 30 g/day mixed-nut consumption group; or (3) a 60 g/day mixed-nut consumption group. The nut consumption intervention will include unsalted, unroasted walnuts, almonds, hazelnuts, and pistachios. The primary outcomes will include depressive (BDI-II) and anxiety (GAD-7) symptoms, perceived stress (PSS-10), cognitive performance (NIH Toolbox), and plasma brain-derived neurotrophic factor (BDNF). Assessments will take place at baseline and at 3 (intermediate), 6 (end of intervention) and 12 months (follow-up). Repeated-measures mixed-effects models will be applied to estimate the effects of nut consumption and dosage on mental health outcomes. Ethics and dissemination: The study adheres to the principles of the Declaration of Helsinki and the Singapore Statement on Research Integrity and obtained approval from the Clinical Research Ethics Committee of the Virgen de la Luz Hospital, Cuenca, Spain (REG: 2025/E0125). The findings will be disseminated through high-impact open-access peer-reviewed publications, presentations at scientific conferences, and social media platforms. Trial registration: ClinicalTrials.gov. Identifier: NCT07292610.