Heat exposure is an increasingly important climate-related determinant of mental health, yet the biological mechanisms linking heat to psychiatric outcomes remain insufficiently integrated. This narrative review synthesizes evidence from climate medicine, thermoregulation, neuroscience, psychoneuroimmunology, sleep research, psychopharmacology, epidemiology, and psychiatry to examine how acute and chronic heat exposure may influence mental health. Heat acts as a multi-system biological stressor by challenging thermoregulation, increasing autonomic and cardiovascular strain, disrupting hydration, impairing sleep and circadian rhythms, activating stress-response systems, and contributing to neuroinflammation, oxidative stress, mitochondrial dysfunction, blood-brain barrier disruption, and neurotransmitter alterations. These pathways may interact with psychotropic medication exposure and impaired behavioral thermoregulation, particularly among people with severe mental illness, older adults, individuals receiving lithium, people with cognitive impairment, substance use disorders, outdoor workers, and those living in poorly cooled environments. Heat-related psychiatric vulnerability is therefore transdiagnostic but heterogeneous, with relevance to distress, depression, anxiety, mood instability, psychosis, substance-related crises, cognitive dysfunction, delirium, and suicide-related outcomes. The review also distinguishes pathways supported by stronger human evidence from mechanisms supported mainly by experimental, preclinical, severe-spectrum, or indirect evidence. It proposes an integrative biological model and an evidence-informed translational agenda focused on exposure assessment, biomarkers, sleep and circadian monitoring, medication safety, risk prediction, physiological adaptation, heat-mitigation strategies, heat-health action plans, and implementation-oriented evaluation.

Older age is typically characterized by decrements in cognitive performance relative to younger adults, though it may not necessarily reach clinical impairment. Dietary supplementation with ubiquinol, the reduced form of the antioxidant and cellular energizer CoQ10, may support cognitive function in older individuals. In the current randomized clinical trial of 111 adults aged 60 years and older (ubiquinol, n = 61; placebo, n = 50), 90 days of ubiquinol (200 mg) supplementation resulted in plasma CoQ10 levels being four times that of the placebo group at study end (p < 0.001). We found that ubiquinol supplementation did not facilitate group differences (controlling for baseline values and relevant demographics) in cognitive function, blood biomarkers reflective of oxidative stress or inflammation, measures of cardiovascular health, or subjective mood at study end. However, regression analyses revealed a positive association between change in plasma CoQ10 and memory performance, as well as a negative association between change in oxidative stress and memory performance at study end in those who received ubiquinol but not placebo. We conclude that adequately powered future clinical trials should examine whether long-term supplementation with ubiquinol can support cognitive function in older adults at risk of cognitive decline or with health conditions predisposing them to risk factors associated with decline.

Fundus fluorescein angiography (FFA) is the gold standard for diabetic retinopathy (DR) staging, yet whether angiographic phase affects deep learning performance remains unknown. Using 7508 FFA images from 863 eyes, stratified into venous, recirculation, and late phases, we developed Swin Transformer- and ConvNeXt-based DR staging models under the International five-grade and Chinese six-grade classification systems. Multiclass and binary (NPDR vs. PDR) classification tasks were evaluated. This study provides the first systematic quantification of angiographic phase effects on FFA-based DR staging. Phase-related performance was analyzed using generalized linear mixed-effects models with beta regression. ConvNeXt generally outperformed Swin Transformer, particularly in multiclass classification. Across all experimental settings, performance showed a consistent numerical decline from the venous to the late phase. Under the International five-grade system, ConvNeXt accuracy declined from 86.67% to 81.87%; however, Bonferroni-adjusted comparisons revealed no statistically significant phase-related differences (all adjusted p > 0.05), with small effect sizes (|SMD| < 0.2). Binary classification remained highly stable across phases, with accuracies exceeding 91%. Grad-CAM visualizations demonstrated progressively diffuse model attention in later phases. These findings support phase-flexible FFA acquisition for binary DR screening, whereas venous- or recirculation-phase images remain preferable for high-precision multiclass staging, guiding phase-aware AI development.

Proactive mental health consultation-liaison (C-L) services in neonatal intensive care units (NICUs) are increasingly recognized as essential to infant health and family functioning, yet there is limited guidance on how to develop sustainable and effective programs in real-world clinical settings. This paper describes the development, implementation, and iterative refinement of a NICU mental health C-L program using a learning health system (LHS) framework. Grounded in a theory-driven model that conceptualizes the infant as the identified patient, the program was designed to target proximal mechanisms influencing infant regulation, parent-infant interaction, and medical course. Consistent with LHS principles, program elements were introduced incrementally and refined through embedded data collection, rapid feedback loops, and multidisciplinary team learning. Data sources emphasized feasibility, reach, implementation processes, and acceptability rather than hypothesis-driven outcome testing. Over six years, this approach supported the expansion of multiple integrated service components, including dyadic intervention services, parent mental health screening and referral pathways, unit-wide family engagement initiatives, and neurobehavioral care practices. Rather than presenting a fixed protocol, this paper offers a replicable framework for developing NICU mental health C-L services that balances developmental theory, implementation realities, and sustainability. The LHS approach provides a pragmatic roadmap for NICUs seeking to build or refine mental health services in contexts characterized by clinical complexity, evolving evidence, and system-level constraints.

Depressive symptoms are highly prevalent among university students, yet the psychosocial correlates linking exposure to potentially traumatic or severe adverse events with depressive symptoms remain incompletely understood. This study examined the association between traumatic event exposure and depressive symptoms among Chinese university freshmen, focusing on the mediating role of interpersonal difficulties and the moderating role of only-child status. A cross-sectional survey was conducted among 8079 freshmen from three universities in Shandong Province, China. Depressive symptoms were measured using the PHQ-9, traumatic event exposure was assessed using the Severe Traumatic Events Questionnaire, and interpersonal difficulties were evaluated using the Comprehensive Diagnostic Scale of Interpersonal Relationships. Mediation and moderated mediation analyses were performed using Hayes' PROCESS macro (Model 15), controlling for sex, age, and residence. Results showed that traumatic event exposure was positively associated with depressive symptoms (β = 0.194, 95% CI [0.169-0.221]). A statistically significant indirect association through interpersonal difficulties was observed (indirect effect = 0.110, 95% bootstrap CI [0.097-0.124]). Only-child status moderated both the direct association between traumatic event exposure and depressive symptoms and the association between interpersonal difficulties and depressive symptoms. These findings suggest that interpersonal difficulties may represent an important factor associated with the relationship between traumatic event exposure and depressive symptoms, and that only-child status may influence the strength of these associations among university students.

Aim: This study aims to explore how competitive psychology mediates the relationship between involution and depression-anxiety-stress among college students from three universities in Anhui Province, China. Background: Against the global involution trend, college students excessively pursue academic achievements, leading to heightened self-involution and psychological issues like anxiety and depression, while competitive psychology's mediating role here remains under-explored. Methods: A multi-cross-sectional survey in three Anhui universities used convenience sampling to collect 592 samples. Results: Three validated scales assessed involution, competitive psychology, and depression-anxiety-stress, with mediation analysis via SPSS Process 3.3. The results showed strong positive correlations between the three variables (r = 0.827, 0.638, p < 0.001), and competitive psychology significantly mediated the involution-depression-anxiety-stress relationship (r = 0.110). Conclusions: The observed data are consistent with a correlational mediation model among college students from three universities in Anhui Province. The findings provide theoretical references for local university educational practice and mental health guidance, without causal inference or nationwide policy generalization; future research should explore related mechanisms and interventions. Clinical Relevance: This study provides empirical evidence for nursing and mental health professionals to design targeted psychological interventions for college students, helping mitigate the negative impacts of involution and competitive pressure on mental health in clinical practice.

Mental health professionals are exposed to clients' traumatic experiences, placing them at risk for vicarious trauma (VT). However, such exposure may also facilitate vicarious post-traumatic growth (VPTG). The present study examined the mediating role of rumination (intrusive and deliberate) in the relationship between VT and VPTG, and the moderating role of clinical supervision. The personal trauma history of the therapist was kept as a covariate. Using a cross-sectional correlational design, data were collected from 278 mental health professionals, including psychologists, counsellors, social workers, and therapists, through purposive sampling. Correlational analyses and moderated mediation analyses were conducted using IBM SPSS. The analysis revealed that VT is positively related to VPTG, and deliberate rumination mediates the relationship between VT and VPTG. Clinical supervision moderates the association between vicarious trauma and deliberate rumination and the association between deliberate rumination and vicarious post-traumatic growth. The findings highlight the role of participation in clinical supervision in shaping these relationships. This study contributes to the limited empirical literature on VT and VPTG and offers implications for clinical supervision practices and professional training.

Mental health remains a global concern for which the burden of care frequently falls onto non-clinical platforms. This study employed Interpretative Phenomenological Analysis to explore how Twitch.tv is unexpectedly being used to curate communities wherein mental health is discussed and supported. Using semi-structured interviews with six Twitch Partners, we generated three superordinate themes: 1. Positive Experiences of Streaming, 2. Negative Psycho-social Sense-making in Relation to Streaming, and 3. Emotional Dilemmas Regarding Stream-related Payments. Twitch Partners face challenges around balancing pressures of generating and maintaining communities, whilst addressing individual relationships and the needs of members within. This paper documents strategies that Twitch Partners employ to protect their own mental wellbeing whilst supporting their communities, and notes how monetised content can impact such strategies and generate additional stress. These findings highlight the need to explore and evaluate platform support for streamer wellbeing, including signposting, moderation resources, mental health guidance, and training.

Non-suicidal self-injury (NSSI) is a significant public health concern among university students. Accumulating evidence suggests that deficits in executive function (EF) are associated with NSSI; however, little is known about how specific EF components relate to the specific psychological functions that motivate self-injury. This study aimed to investigate the fine-grained associations between EF dimensions and NSSI functions in university students with past-year NSSI using network analysis. Altogether, 1078 Chinese university students (82.6% female; Mage = 19.07, SD = 1.03) who had engaged in at least one NSSI behavior in the past year were enrolled. Executive function was assessed using the Adolescent Executive Function Scale, which measures three dimensions: inhibitory control, cognitive flexibility, and working memory. NSSI functions were assessed using the 19-item function subscale of the Adolescent Non-Suicidal Self-Injury Assessment Questionnaire. A Gaussian graphical model was used to estimate the network. Expected influence (EI) and bridge expected influence (BEI) were computed to identify core nodes and bridge nodes, respectively. Of the 231 possible edges, 117 (50.65%) were non-zero, with the strongest within-community edge linking "coping with sadness and disappointment" (F3) and "expressing despair and hopelessness" (F4). Across communities, the most prominent edge was between "inhibitory control" and "having a desire to harm myself and cannot stop". The three highest EI values were observed for "having a desire to harm myself and cannot stop," "letting others make changes," and "self-punishment". "Inhibitory control" showed the highest BEI in the EF community, while "having a desire to harm myself and cannot stop" showed the highest BEI in the NSSI function community. Both EI and BEI demonstrated excellent stability (CS coefficients = 0.75). In university students with past-year NSSI, inhibitory control and the uncontrollable urge to self-injure function as critical bridge nodes linking executive dysfunction to NSSI functions, while self-punishment and interpersonal influence motives emerge as central drivers in the network. These findings highlight inhibitory control, the uncontrollable urge to self-injure, self-punishment, and interpersonal influence as promising targets for precision interventions aimed at disrupting the maladaptive cycle maintaining NSSI in this population.

Background: Psychiatric inpatients may be vulnerable to head trauma; however, associations among psychiatric diagnosis, trauma mechanisms, and acute trauma-related neuroimaging findings among patients requiring neurosurgical consultation remain unclear. Methods: This retrospective observational study included psychiatric inpatients referred for neurosurgical consultation after head trauma at a tertiary neuropsychiatric specialty hospital between July 2022 and December 2025. Psychiatric diagnoses were grouped into psychotic, mood, substance use, organic/symptomatic, and other disorders. Trauma mechanisms were classified as falls, self-harm, assault/fight-related injuries, and other trauma types. Radiological findings were classified as trauma-related abnormalities or secondary incidental findings, including age-related changes. Associations were evaluated using chi-square tests, with false discovery rate correction applied to global and binary comparisons. Exploratory multivariable regression models were used as sensitivity analyses. Results: The cohort comprised 461 psychiatric inpatients who sustained head trauma, underwent radiological imaging, and were referred for neurosurgical consultation. Trauma mechanisms differed significantly across psychiatric diagnostic groups (χ² = 30.89, p = 0.002). Falls were the most common mechanism (189/461, 41.0%). Assault/fight-related trauma showed the clearest diagnosis-associated pattern (χ² = 19.72, p < 0.001, Cramér's V = 0.207) and remained the only significant binary outcome after false discovery rate correction. Acute trauma-related imaging findings were observed in 35 patients (7.6%) and were not associated with psychiatric diagnosis (χ² = 6.16, p = 0.187). Calcifications were the most frequent imaging finding (191/461, 41.4%). Conclusions: In psychiatric inpatients, while head trauma patterns and neuroimaging findings have the potential to be explained by psychiatric diagnoses, they may also reflect unmeasured behavioral and clinical factors.