The significance of community mental health workers in coordinating hospital discharge of patients with diagnosed mental health conditions is globally recognised, yet research on their experiences is scarce. This study contributes to knowledge through a qualitative empirical intrinsic case study of community mental health workers' experiences. This study aimed to explore community mental health workers' experiences of care-coordinating patients diagnosed with mental health conditions discharged from the hospital into community mental health integrated services. Guided by constructivist inquiry, the qualitative study focused on co-constructing meaning to understand community mental health workers' experiences in care coordination. Two theoretical lenses informed the study: Ecological Systems Theory, to understand multi-level influences, and Normalisation Process Theory, to explore how care coordination practices are embedded in discharge processes. Fourteen community mental health workers aged 18 and above were recruited from one NHS Trust in Northwest England from October 2021 to June 2022. Data were collected through semi-structured interviews, audio-recorded, transcribed verbatim, and analysed using reflective thematic analysis, generating themes and subthemes. Analysis identified 13 subthemes grouped into four major themes: (1) Experiences of collaborative working; (2) Challenges and enablers to care coordination; (3) Experiences of organisational system and culture; and (4) Community Mental Health Workers' personal experiences of professional growth. Findings highlight poor communication, staff shortages, high caseloads, limited community mental health services, and challenges in care coordination. The study provides valuable insights for improving community mental health workers' clinical practice and informs future research and policy development in community mental health care.

The COVID-19 pandemic increased perinatal mental health needs and disrupted routine obstetric care, disproportionately affecting Black and economically disadvantaged communities. Michigan's Perinatal Collaborative Care Model (Peri CoCM), a publicly funded virtual program, launched during the pandemic and continued after the public health emergency. This qualitative study examined participant experiences with Peri CoCM, including perceived usefulness, acceptability, and barriers/facilitators to engagement, particularly among marginalized perinatal people to inform post-COVID service delivery.

Eligible participants were pregnant or up to one year postpartum Peri CoCM patients recruited from a May-July 2025 referral cohort. Nine women ages 27-42 completed one-hour, semi-structured Zoom interviews between August and September 2025; the sample intentionally overrepresented self-identified Black women. Interviews were recorded, transcribed, verified against audio, and analyzed by a coding team using grounded-theory-informed thematic analysis with constant comparison.

Participants reported positive experiences with Peri CoCM across four thematic areas: (1) Pathways to care, (2) Perceived impacts of program, (3) Importance of culturally responsive care, and (4) Recommendations for program optimization. Trusted referrals from obstetric and other providers facilitated entry into care, often for anxiety, depression, grief, or first-time mental health support. Participants described Peri CoCM as accessible, supportive, and valuable during pregnancy and postpartum. Virtual options, flexible scheduling, compassionate behavioral health clinicians, and consistent follow-up reduced barriers and promoted openness. The short-term model helped some transition to longer-term therapy, while clinicians supported insurance navigation, medication decisions, and community resource connections. Participants gained coping skills, validation, and self-understanding. They emphasized culturally responsive provider fit and recommended longer continuity, broader wraparound services, and sustained no-cost access to reduce stress and improve engagement.

Michigan's Peri CoCM was perceived as a low-barrier, relationship-centered, culturally responsive virtual pathway supporting perinatal wellbeing and systems navigation in the post-COVID era. Cost transparency and flexible delivery were central to acceptability and expanded access to equitable care.

Postpartum depressive symptoms are common and can adversely affect maternal and infant health. Traditional Chinese medicine health literacy may play an important role in promoting physical and mental recovery during the puerperium. However, evidence regarding the association between traditional Chinese medicine health literacy and postpartum depressive symptoms remains limited, and the underlying mediating mechanisms are unclear.

To explore the relationship between Traditional Chinese Medicine health literacy and depressive symptoms in postpartum women, and to examine the sequential mediating role of social support and self-efficacy.

Using convenience sampling, this cross-sectional study was conducted in Chengdu, China from December 2025 to April 2026. A total of 501 postpartum women completed measures of traditional Chinese medicine health literacy, social support, self-efficacy, and depressive symptoms. After adjusting for covariates, sequential mediation was examined by PROCESS 4.1 Model 6. Bias-corrected bootstrap (5,000 resamples) was used to generate 95% confidence intervals; indirect effects were deemed significant if the interval did not include zero. All tests were two-tailed with α = 0.05.

The scores of traditional Chinese medicine health literacy, postpartum social support, self-efficacy, and depressive symptoms were (118.21 ± 14.56), (47.72 ± 11.41), (29.22 ± 6.44), and (7.16 ± 4.99), respectively. Depressive symptoms were significantly negatively correlated with traditional Chinese medicine health literacy, social support, and self-efficacy (all p < 0.001). Traditional Chinese medicine health literacy exerted a direct negative effect on depressive symptoms (β = -0.206, 95% CI: -0.299 to -0.112). In addition, three significant indirect pathways were identified: the independent mediating pathway through social support (β = -0.102, 95% CI: -0.167 to -0.050), the independent mediating pathway through self-efficacy (β = -0.102, 95% CI: -0.148 to -0.059), and the sequential mediating pathway from social support to self-efficacy (β = -0.033, 95% CI: -0.053 to -0.018). The total indirect effect accounted for 53.6% of the total effect.

Intervention strategies designed to improve postpartum women's traditional Chinese medicine health literacy, strengthen social support and boost self-efficacy may aid the prevention and control of postpartum depressive symptoms. The actual effectiveness of relevant intervention programs needs to be further verified in subsequent longitudinal studies and intervention trials.

The health workforce in Bangladesh is undergoing demographic and structural changes, including increasing feminization and imbalances in specialty distribution. Understanding career choices among young doctors is important for workforce planning. A concurrent mixed-methods study was conducted in 2023 among 159 young medical professionals. Quantitative data were analysed using descriptive and inferential statistics, whereas qualitative data from interviews were analysed thematically. The findings from both components were integrated through triangulation, and an ecological model of career progression was developed to synthesize multilevel influences. Participants were mostly female (59.7%) with a mean age of 26.1 years. Almost all (99.4%) intended postgraduate training, mainly in clinical fields (93.0%), with medicine (53.5%) and surgery (34.0%) most preferred. Government service was the top career choice (65.4%). A large proportion also expressed interest in studying abroad (79.9%), and 28.3% planned permanent migration. Career decisions were influenced by work-life balance (91.2%), mental satisfaction (85.5%), personal interest (84.3%), and family responsibilities (76.7%). Qualitative findings revealed that career progression is often unplanned and delayed due to limited guidance, restricted exposure to non-clinical careers, and early career uncertainty. Structural barriers included lengthy recruitment processes, limited postgraduate training opportunities, inappropriate workplace conditions, and restricted career advancement in both the public and private sectors. Overall, career progression reflects interacting influences at individual, social, training, institutional, and policy levels, with global opportunities serving as an alternative pathway amid perceived domestic constraints. Career progression among young doctors in Bangladesh is influenced by both individual motivations and structural constraints. Strengthening career guidance, expanding training opportunities, and improving working conditions are essential for building a balanced and sustainable health workforce.

Adolescent suicide constitutes a critical public health challenge in low-income and middle-income countries (LMICs), where structural deficits in mental health infrastructure compound an already substantial burden. In Nigeria, where suicidal ideation among secondary school students has been documented at a lifetime prevalence of 22.9%, curative clinic-based responses are neither scalable nor sustainable. School-based universal interventions offer a pragmatic upstream alternative. The Youth Aware of Mental Health (YAM) programme has demonstrated robust efficacy in European contexts, reducing incident suicide attempts by approximately 50%; however, its transferability to the West African educational and cultural environment remains untested. This protocol describes a study designed to culturally adapt YAM for Nigerian secondary schools and assess the feasibility of conducting a definitive cluster randomised controlled trial in Lagos State.

This study employs a hybrid type 1 effectiveness-implementation design, structured as a two-arm parallel-group cluster randomised feasibility trial across 10 public secondary schools in Lagos State. Approximately 600 adolescents aged 13-17 years will be recruited. Prior to the trial, YAM will be systematically adapted using the Method for Programme Adaptation through Community Engagement framework, producing the YAM-Nigeria curriculum. Schools will be randomised to receive either the culturally adapted YAM-Nigeria programme (five sessions of 45-60 min each delivered by trained external facilitators) or enhanced usual practice (standard health education curriculum supplemented with suicide awareness materials). Primary feasibility outcomes include school recruitment rates (target ≥60%), student consent rates (target ≥70%), retention at the 3-month follow-up (target ≥75%), implementation fidelity (target ≥80% adherence) and acceptability (target ≥70% student satisfaction). Secondary exploratory outcomes include suicidal ideation, depression, mental health literacy, stigma and help-seeking behaviour, measured to estimate the SD and intraclass correlation coefficient required to power a future definitive trial. Progression to a definitive phase III trial will be governed by pre-specified traffic light criteria.

Ethical approval has been granted by the Lagos State University Teaching Hospital Health Research Ethics Committee (Ref: LREC/06/10/2656) and the Liverpool School of Tropical Medicine Research Ethics Committee (Ref: RGETEM045). A two-stage consent process requiring written parental consent and adolescent assent will be implemented. Findings will be disseminated through open-access peer-reviewed publications, policy briefs for the Lagos State Ministries of Health and Education and plain-language summaries for participating communities.

ISRCTN registry, ISRCTN69846459. Registered on 24 November 2025.

To identify actions of primary care physicians (PCPs) that influence referral to specialist assessment for dementia from the perspective of people with symptoms of dementia and/or their significant others.

A descriptive qualitative design was used, involving 33 semistructured interviews that explored presenting symptoms, consultations with health professionals, tests undertaken and challenges encountered while navigating the prediagnostic phase of dementia. Interview data were mapped deductively to the Candidacy Framework to examine engagement with PCPs and to identify participant-perceived actions that facilitated or impeded timely diagnosis.

Online interviews were conducted between August 2022 and June 2023 with participants across Australia.

Participants were 37 people who had navigated the dementia diagnosis process as a patient or significant other (partner/spouse, adult child, sibling or friend).

Successfully communicating concerns and asserting candidacy was described by participants as determining the diagnosis trajectory. Participants reflected that PCPs assessed available information to determine the need for specialist referral. Participants detailed that following PCP referral and support provision, diagnosis proceeded to a specialist. We also identified participant-reported system-level and PCP-related barriers to facilitating a timely diagnosis, including PCP time-constraints and workload-constraints, dementia-specific knowledge and referral pathway inconsistency. From participants' perspectives, access to a specialist referral and timely diagnosis was facilitated or impeded by an interplay of actions by people experiencing symptoms, significant others, and PCPs.

Primary care barriers and enablers to timely diagnosis spanned across patient, significant other, PCP and system levels. Recommendations to provide timely, accurate and equitable dementia diagnoses include (1) Raise community awareness of dementia symptoms, helping people communicate their concerns effectively with their PCP; (2) Enhance PCP knowledge of dementia to improve their ability to refer and diagnose and (3) Develop clear diagnostic pathways to ensure that individuals receive the appropriate diagnosis and care they need.

The Russian invasion of Ukraine in February 2022, following the conflict in 2014, resulted in indiscriminate shelling, systematic torture and conflict-related sexual violence (CRSV), suggesting possible war crimes and crimes against humanity (WCCAH). This study explores the experiences of Ukrainian veterans and former prisoners of war (POWs) since 2014 to systematically document reported abuses and inform accountability.

We conducted a series of semistructured key informant interviews (KIIs) of 40 Ukrainian veterans and former POWs (20 male, 20 female) from the 2014 and 2022 invasions between August and November 2025. The KII instrument contained 32 open-ended questions covering demographics, abuses, psychological impact and justice. Data analysis involved qualitative thematic analysis with quantitative descriptors from coded interviews.

Participants reported numerous abuses consistent with previously documented WCCAH including attacks on civilian infrastructure; systemic torture, beatings, electrocution, starvation, denied medical care, deliberate targeting of Ukrainian nationality, unlawful killings of civilians and hors de combat; and CRSV targeting both male and female captives and civilians. Internally, female veterans reported facing discrimination, restrictive roles and military sexual assault. Self-reported trauma symptoms consistent with post-traumatic stress disorder, anxiety, depression, sleep disturbances and moral injury were cited as major consequences of the wars.

Reported incidents appear deliberate and widespread and may constitute violations consistent with WCCAH. Psychosocial barriers undermine protection and prevention efforts for justice. Stigma, particularly for male survivors of CRSV, and fear of harming loved ones still in captivity obstruct evidence-gathering and truth-telling. Self-reporting of severe trauma symptomatology necessitates an immediate humanitarian response prioritising recovery of veterans and former POWs through structured, accessible, long-term psychological and psychiatric services. Restrictive roles, discrimination and military sexual assault reveal a need to establish mechanisms that combat internal sexual violence and reinforce professional military hierarchy.

This article reframes preparation for critically ill patients as a dynamic, compounding process that spans 3 temporal phases: strategic, operational, and reflective. Using concepts such as shared mental models, psychological safety, adaptive capacity, and the 3A's prebriefing framework (anticipate, align, and adapt), the article outlines how teams can better navigate uncertainty and complexity in real time. This article describes the consequences of preparation deficit and preparation debt, and provide practical tactics for rapid appraisal, decision-making in motion, and structured reflection. Together, these strategies create a preparation architecture that enhances performance, reduces error, and strengthens team and system resilience.

As recognized members of the mental healthcare team, pharmacists are uniquely positioned to support use of prescription digital therapeutics (DTx) for schizophrenia. However, their specific role in care is yet to be clarified.

To develop recommendations for how pharmacists can embed prescription DTx within healthcare systems, improve access to and engagement with these treatments.

A modified Delphi approach captured US pharmacists' perspectives on prescription DTx for schizophrenia. A 4-member expert steering committee developed a consensus framework on scale, access, and data to inform the creation of an online survey. Ten pharmacy experts with mental- and digital-health experience (average experience: 23.7 years) completed the survey and its results were used to formulate 24 Delphi panel questions (17 yes/no; 7 multiple-choice). Pharmacy experts and steering committee members (N=14) voted on the Delphi panel questions. Consensus was defined as ≥70% agreement. Questions failing to reach consensus statements in round 1 were discussed and subjected to a second vote. If consensus was not achieved after round 2, "no consensus achieved" was documented and the highest-voted category was noted.

Consensus statements were achieved on 20/24 (83%) questions (scale, n=8; access, n=10; data, n=2). Of these, 17/20 (85%) questions achieved consensus statements after one voting round; 3/20 (15%) required a second round. Four questions did not achieve consensus statements. The accepted statements informed recommendations regarding pharmacists' involvement in optimizing prescription DTx use for schizophrenia.

Recommendations included: Pharmacists can facilitate expanding scale by supporting integration of prescription DTx into pharmacy systems and addressing adoption barriers through prescriber education and partnerships; support access by being involved when a prescription DTx is introduced to a patient; and leverage clinical data that are a priority to stakeholders to drive awareness, usage, and adoption.

Multiply marginalized children with disabilities experience discrimination and inequity and consequently disparities in access to health care, health outcomes, and mortality. We gathered information about the health care experiences of multiply marginalized children with disabilities to describe lived experience-based solutions for improving health care and outcomes for this population.

A qualitative exploratory study using focus group and individual interviews with multiply marginalized young adults with disabilities and the caregivers of multiply marginalized children with disabilities in the United States and territories. We asked how services could be changed to better support their health and well-being using an initial deductive approach combined with ongoing inductive thematic analysis.

The study team conducted 5 focus groups and 4 individual interviews with 33 young adults and caregivers in English, Spanish, and ASL. Negative health care experiences include biased and discriminatory professional behavior, barriers to access, and the necessity and burden of advocacy. Proposed solutions focused on professional growth, mental health, disability-centered design, and lived experience leadership. An underlying sentiment was the desire for equitable treatment.

Advancing health equity for multiply marginalized children with disabilities is within reach. Starting points for health care professionals and system leaders include addressing biases and developing reflective and empathic practices and systems, including child and family mental health in care, and using disability-centered design to proactively and flexibly support access. Implementation should be done with lived experience leadership and the centering of human dignity for multiply marginalized children with disabilities and their families.