Schizophrenia spectrum disorders (SSDs) often feature debilitating social cognitive impairments, with limited treatment options. This study used a target engagement approach to examine the effects of individually-targeted repetitive transcranial magnetic stimulation (rTMS) to the dorsomedial prefrontal cortex (DMPFC) on social cognitive network functional connectivity (i.e., mentalizing and simulation networks) in individuals with SSDs.

We conducted a double-blind, randomized, sham-controlled trial in adults with SSDs (NCT04418011). Participants received two weeks of DMPFC stimulation with 10 Hz rTMS, intermittent theta burst stimulation (iTBS), or sham stimulation. They completed pre- and post-treatment functional magnetic resonance imaging, including a social processing task. Treatment was personalized using functional connectivity mapping and electric field modelling. Primary outcomes were changes in individualized within-mentalizing and between mentalizing-simulation network functional connectivity after active stimulation versus sham, compared using effect sizes. Secondary outcomes were safety and tolerability.

Analyses included 46 participants who completed treatment (10 Hz rTMS: n=15; iTBS: n=15; sham: n=16). iTBS produced a significantly greater increase in within-mentalizing network connectivity, with a large effect size, while 10 Hz rTMS did not differ from sham. Effects on between-network connectivity were negligible-to-small for both active conditions. Participants receiving iTBS reported higher pain ratings, but adverse event and discontinuation rates did not differ across groups.

Individualized DMPFC-targeted iTBS demonstrated target engagement via increased mentalizing network connectivity relative to sham, and was feasible, safe, and well-tolerated in adults with SSDs. A larger and longer clinical trial powered to assess change in social cognitive outcomes is ongoing (NCT06118268).

Interoception, the processing and perception of internal bodily signals, regulates a wide range of psychological and somatic functions, including emotional experiences, bodily symptom perception, self-awareness and decision-making, highlighting its important role in the maintenance of bodily and mental homeostasis. Traditionally, interoception has been studied within single organ domains, with findings often generalized to interoception as a whole. However, evidence suggests interoceptive abilities may be domain-specific rather than a general ability. This pilot study investigated how perceptual and affective dimensions of interoception relate across organ systems. Thirty-three healthy adults completed comparable magnitude estimation and sustained stimulation tasks, allowing for comparisons across the respiratory, esophageal, and cardiac domain in a within-subjects design. Respiratory sensations were evoked through inspiratory resistive loads, esophageal sensations through balloon inflations, and cardiac sensations via graded cycle ergometer exercise. Interoceptive sensitivity, the ability to perceptually discriminate between stimulation levels, was quantified as the slope of intensity ratings relative to stimulation intensity. Acute affective responses were assessed through unpleasantness ratings during sustained stimulation. Results revealed no significant correlations in interoceptive sensitivity across domains, with Bayesian analyses providing anecdotal support for the null hypothesis. In contrast, acute affective responses showed partial convergence: respiratory unpleasantness ratings correlated significantly with both esophageal and cardiac ratings, whereas esophageal and cardiac ratings were not significantly correlated. These findings support a multidimensional model of interoceptive processing, where interoceptive sensitivity appears domain-specific, while acute affective responses show partial generalization across organ systems. The results caution against generalizing findings from single-organ paradigms to overall interoceptive functioning.

Depression is one of the leading causes of disability in Chile and significantly affects adults' well-being and social participation. Despite its high prevalence, depression stigma has been scarcely studied in the country. Because its manifestations vary across sociocultural contexts, understanding how it is configured in Chile is essential for developing contextually relevant interventions. Within this framework, depression stigma is examined through its core components -stereotypes, prejudice, and discrimination- by analyzing the beliefs, emotions, and behaviors directed toward people living with depression The aim of this study is to explore, from the perspective of Chilean adults, the socially shared beliefs about people living with depression, as well as the emotions and behaviors directed toward them, and to examine the extent to which these contents are understood as expressions of depression stigma.

A qualitative study was conducted using purposive sampling and minimum group representativeness criteria based on gender, socioeconomic status, and history of depression. Sixty-six adults from three regions of Chile took part in individual semi-structured interviews. Interviews were transcribed, reviewed, returned to participants for checking, and coded by two independent coders. Data were then analyzed using a deductive-inductive content analysis approach supported by Atlas.ti, and findings were triangulated.

Findings were organized into three analytical macro-categories - beliefs, emotions, and behaviors directed toward people with depression - consistent with the cognitive, affective, and behavioral components of stigma described in the literature. Within beliefs, contents related to affective characteristics, behavioral characteristics, and dispositional attributions associated with people with depression emerged. Within emotions, compassionate emotions, defensive and discomfort-related responses, and affective disconnection were identified. Within behaviors, overprotection, social distancing, invalidation and judgment emerged, along with interaction scripts based on avoidance or support.

Depression stigma in Chile is configured through contents that, to varying degrees, are understood as stereotypes, prejudice, and discrimination. Beliefs combine elements linked both to mental health literacy and to stereotypes; emotions are primarily interpreted as expressions of prejudice; and behaviors reflect both subtle and overt forms of discrimination. Additionally, some themes showed divergent interpretations among participants, particularly between those with and without a history of depression. Taken together, these findings contribute to a better understanding of how this phenomenon is structured in the Chilean context and provide input for the development of culturally relevant assessment instruments and intervention strategies.

As digital technologies become increasingly embedded in daily life, their roles in mental health care have expanded and diversified. Digital tools are being explored as interventions for obsessive-compulsive disorder (OCD) across the care continuum, including symptom recognition, access to care, treatment, and self-management. However, there is limited empirical understanding of how individuals living with OCD use digital technologies in situ to navigate their health care journeys or how they envision technology shaping future models of care.

This study aimed to explore how individuals living with OCD use digital technologies to navigate their health care experiences and to understand the perceived roles of technology across the OCD care continuum.

We conducted semistructured interviews (N=24) with adults who self-reported a diagnosis of OCD and were recruited through online OCD communities and advocacy networks. Interviews were conducted via Health Insurance Portability and Accountability Act (HIPAA)-compliant Zoom between May and December 2024 (median duration 51, IQR 6.25 minutes). Transcripts were coded in Dedoose (version 9.2.22) using a constructivist grounded theory approach. Coding proceeded iteratively through open and focused coding, with theoretical saturation reached after 15 interviews. Constant comparison and analytic memos guided the development of a conceptual framework describing the relationships between technology and OCD health care.

Participants (median age 26, IQR 12.8 years; range 20-64 years; 16/24, 67% female; 7/24, 29% male; 1/24, 4% nonbinary) described technology as integral to 3 aspects of the OCD health care journey. The first aspect was discovery and understanding, in which social media and online content helped participants identify their symptoms, relate them to the diagnosis, and seek care. The second aspect was facilitating OCD health care, in which digital tools such as telehealth platforms, apps, and wearables helped participants bridge gaps in care. The third aspect was imagining the future, in which participants viewed emerging technologies as potential ways to improve symptom recognition and management.

Digital technologies are reshaping how individuals with OCD identify symptoms, engage with treatment, and envision future care delivery. Participants described using online communities, telehealth, and mobile health tools to address barriers across the OCD health care continuum, while emphasizing interest in technologies that provide adaptive and real-time symptom support. These findings underscore the importance of incorporating lived experience into digital mental health innovation and suggest that technology may support a shift toward more continuous, personalized, and accessible OCD care models.

The healthcare industry is the largest private employer in the United States, yet workforce shortages persist. The Health Resources and Services Administration (HRSA) estimates that 92 million people live in primary care health professional shortage areas (HPSAs), 64 million in dental HPSAs, and 137 million in mental health HPSAs. An aging population and rising chronic illness rates place a growing burden on the healthcare system, with projected shortages exceeding 140,000 physicians and 100,000 registered nurses by 2038. Recruiting younger learners into healthcare careers is therefore critical. This study evaluated whether a traditional informational presentation or a presentation combined with hands-on activities was more effective at increasing high school students' interest in healthcare careers.

Two medical students visited eight high school chemistry classes, providing either a 30-minute informational presentation with time for questions, or a 10-minute presentation followed by 30 minutes of hands-on healthcare activities, including practicing vital signs and learning intubation techniques. Both presentations discussed motivations for working in healthcare and potential career paths. Students completed anonymous pre- and post-surveys assessing healthcare career interest. Surveys were paired using anonymous identifiers. Parental consent and student assent were obtained per institutional review board requirements.

The study included 129 consented participants, primarily 10th-grade students (n=124). Prior healthcare exposure was reported by 54%, and 62% had previously considered a healthcare career. On a scale of 1-10, baseline interest averaged 4.29. Interest increased by 0.64 (±1.16) in the presentation-only group and by 0.68 (±1.27) in the presentation plus hands-on group. These changes were statistically significant (p<0.001), with no significant difference between groups. Overall, 44% of students reported increased interest, 43% no change, and 12% decreased interest.

Both approaches were influential in reaffirming students' interest or disinterest in a healthcare career. However, they did not differ significantly in their effect on interest. Future studies including broader student populations and expanded hands-on activities may better clarify effective strategies for engaging undecided students.

Depression during pregnancy is an important public health concern, with national recommendations calling for universal screening throughout prenatal care. However, recent analysis within the Sanford Health system (2011-2021) found that depression during pregnancy was diagnosed in 11.20% of all pregnancies but in only 4.55% of Black pregnancies, suggesting underdiagnosis in this population. This study aims to identify barriers to effective prenatal depression screening for Black women and assess potential solutions to improve provider practices and patient outcomes. This qualitative study will involve up to 25 semi-structured informational interviews with prenatal care providers within the Sanford Health system. Providers will be recruited via email using a voluntary participation approach. Interviews will last 15-20 minutes and be conducted in person or via phone in a private setting. Recruitment will continue until thematic saturation, anticipated within 12-25 interviews. We anticipate identifying several recurring themes representing provider-perceived barriers to screening for depressive symptoms during Black pregnancy. Based on preliminary literature and project rationale, expected themes may include time constraints in clinical workflow, limited training in culturally sensitive screening, differences in patient-provider communication, provider uncertainty regarding follow-up procedures, and perceived stigma surrounding mental health. Additional themes may reflect systemic, cultural, or institutional gaps that influence screening practices across clinics. Identifying provider-perceived barriers will inform targeted recommendations for improving depression screening during Black pregnancy within the Great Plains region. Insights from this study may guide development of provider training initiatives, workflow modifications, and system-level supports that promote equitable mental health screening. Ultimately, this work aims to support earlier identification and treatment of depression, reduce disparities in prenatal care, and strengthen culturally responsive practices within regional health systems.

Obesity affects over 40% of adults in the U.S., and bariatric surgery, particularly Roux-en-Y gastric bypass (RYGB), is among the most effective treatments for sustained weight loss and comorbidity reduction. However, emerging evidence has linked bariatric surgery to an increased risk of alcohol use disorder (AUD), particularly in the years following surgery.

To review the evidence surrounding the incidence, timing, mechanisms, and risk factors associated with AUD following bariatric surgery, with an emphasis on RYGB.

A comprehensive review of the literature examining postoperative rates of AUD among bariatric surgery patients was conducted, highlighting trends, mechanisms, and subpopulations at risk.

RYGB is associated with a significantly increased risk of developing AUD, with incidence rising notably 2-8 years postoperatively. Risk factors include younger age, male gender, preoperative substance use, poor mental health, low social support, and undergoing RYGB rather than other surgical procedures. The delayed increase in AUD appears to result from both physiological changes such as faster alcohol absorption and higher peak blood alcohol levels and psychological factors like addiction transfer. Additionally, bariatric surgery increases risks for alcohol-related liver disease and psychiatric hospitalization related to alcohol misuse.

AUD is a significant long-term risk following RYGB, warranting routine preoperative screening, patient education, and long-term postoperative monitoring. Use of validated screening tools and provision of behavioral health support are critical to mitigate this risk and ensure optimal long-term outcomes for bariatric surgery patients.

This comprehensive register-based study examines fatal at-fault crashes of motor vehicle drivers with alcohol and other substance findings. We categorized substances with possible impact on driving into three categories: alcohol, medicines without addiction potential, and other substances, including illegal substances and medications with addiction potential. We analyzed the differences in crash circumstances and risk factors using odds ratios (ORs), comparing at-fault drivers with different substance combinations to those who were non-impaired.

Our material comprises crash data from the Finnish Road Accident (FRA) database in 2019-2022. Multidisciplinary Road Traffic Accident Investigation Teams (RAITs) investigate all fatal crashes in depth, and the Finnish Crash Data Institute (OTI) maintains the FRA database. RAITs have access to all police records, including medico-legal autopsy findings and toxicological data from virtually all deceased drivers.During the study period, there were 750 at-fault motor vehicle drivers of fatal crashes. Our final study material consisted of all data with information on alcohol and other substance findings, including 234 drivers with substance findings, and 446 non-impaired drivers.

Alcohol was clearly the most prevalent substance, used by 75% of the drivers with substance findings. The mean alcohol concentration in alcohol-only cases was 1.64‰, and in cases with alcohol and other substances, 1.45‰. Drivers with substance findings were much more likely to have prior DUI offenses (OR = 21.9 [10.6-45.0]). Moreover, drivers using substances other than alcohol had even higher odds of previous DUIs (OR = 31.9 [13.5-75.3]). Drivers with alcohol findings were more likely <25 years old compared to non-impaired drivers (OR = 2.10 [1.31-3.37]). Drivers with substance findings had higher odds of causing a crash while speeding compared to non-impaired drivers (for example, speeding at least 30 km/h: OR = 5.88 [4.00-8.62]). We found no statistically significant differences between drivers who had used alcohol alone and those who had used alcohol and other substances.

Alcohol with high concentrations dominated among at-fault drivers with substance findings in fatal road traffic crashes. Substance use co-occurred with other forms of risk taking such as speeding. Young drivers were overrepresented among drivers with alcohol findings. Despite new illegal substances and increasing drug use, alcohol still has a major impact on fatal crashes. This means that traditional measures for tackling DUI problems still apply but we must be open for new innovations, too.

Sleep is multidimensional, and it remains unclear which aspects are most relevant to cognition and dementia risk. We aimed to apply a data-driven approach to identify clusters of sleep variables that reflect meaningful sleep composites and examined their association with cognition and dementia risk.

This was a prospective observational cohort study that used data from the Sleep and Dementia Consortium, comprising 5 US population-based cohorts. Participants aged ≥45 and ≥60 years were included in the cognitive and dementia analyses, respectively. All were free of dementia and stroke at baseline. Participants had methodologically consistent, home-based polysomnography, self-report habitual sleep, neuropsychological assessments, and dementia risk surveillance. A cluster around latent variables analysis was used to derive 9 latent sleep composites from 44 sleep metrics. Global cognitive composite z scores were derived from principal component analysis. Linear regression models assessed associations between sleep composites and cognitive performance. Cox proportional hazard models assessed associations between sleep composites and incident dementia. Results were considered statistically significant if p < 0.05.

The pooled cognitive analysis included 5,958 participants (mean ± SD age 70 ± 11 years, 32% female). The incident dementia analysis included 5,471 participants (74 ± 12 years, 31% female). There were 1,134 incident dementia cases (median follow-up time of 5-19 years). Nine sleep composites were identified, together explaining 49% of the total variance in the original 44 sleep metrics: Sleep quantity and efficiency, sleep fragmentation, light non-rapid eye movement (NREM) predominance, N3 predominance, spindle number and duration, REM sleep bouts, respiratory disturbances, slow oscillation-spindle coupling, and spindle amplitude. Of these, composites reflecting greater sleep quantity and efficiency (i.e., longer and more consolidated sleep; pooled β per one-unit change in composite, 0.03; 95% CI 0.004-0.06; p = 0.033) and stronger slow oscillation-spindle coupling (pooled β, 0.04; 95% CI 0.003-0.07; p = 0.039) were associated with better global cognition. However, no significant associations were identified between the 9 sleep composites and dementia risk.

Sleep composites were not significantly associated with dementia risk. However, longer, more consolidated sleep and stronger slow oscillation-spindle coupling were associated with cognitive performance. These composites may be useful in guiding further investigations of sleep-brain health relationships.

Mass casualty events (MCE), such as campus shootings, can severely impact the mental health of students, faculty, and staff. This study examined the psychological effects of an MCE at a minority-serving institution and explored how sense of belonging, cardiorespiratory fitness, and treatment preferences influenced recovery. To measure the impact of the MCE on mental health an anonymous survey was administered four to five months post-MCE to university students, faculty and staff. Within the survey, participants were asked to retrospectively report their depression (PHQ-9) and anxiety (GAD-7) symptoms as they recalled them two weeks prior to the MCE, and as they experienced them in the two weeks preceding survey completion. The survey also included current measures of sense of belonging (SBS), perceived discrimination (PEDQ), estimated cardiorespiratory fitness (eCRF), and intervention preference to cope with the impacts of the MCE. Participants reported significant perceived increases in PHQ-9 and GAD-7 scores from the pre-MCE recall to current time-periods. Increases in depression (PHQ-9 scores) from pre-MCE to recent recall were larger among respondents with lower pre-MCE anxiety (GAD-7 scores), higher perceived discrimination (PEDQ), and those currently receiving treatment for anxiety or depression; respondents not receiving treatment showed no significant change. Among students, lower belonging scores were associated with greater increases in depression. Neither belonging nor perceived discrimination were strongly linked to individual variables, indicating their multifactorial nature. Most participants reported a preference to learning about alternative interventions such as exercise or meditation over pursuing university counseling services.