In recent decades, the potency of cannabis resin increased globally, raising concerns, as higher potency has been associated with increased risk of psychiatric harms at the individual level. The aim here was to examine whether changes over time in the potency of seized cannabis resin samples were associated with psychiatric harms at the population level.

Data on ∆-9-tetrahydrocannabinol (THC) concentration in seized cannabis resin were obtained from forensic departments in Denmark (2000-2022), the country reporting the highest potency in Europe. Data on admissions to cannabis treatment, incidence of cannabis-induced psychosis, and dual diagnosis (schizophrenia and cannabis use disorder) were obtained from national registers. Time-dependent associations between potency and the outcomes were examined with mixed-effects linear regression models and associations across age and sex were explored. Candidate time lags were 0-10 years.

THC concentration increased almost fourfold: mean 8.3-31.2% from 2000 to 2022. In fully adjusted models, THC was positively associated with first-time cannabis treatment entry at lags of 0-6, strongest at year 0 (p < 0.0001); incidence of cannabis-induced psychosis at lags of 0-4, strongest at year 0 (p < 0.0001); and incidence of dual diagnosis at lags of 0-1, strongest at year 0 (p < 0.01). No positive associations were found in unadjusted models. Subgroup analyses indicated associations in older patients and women.

Potency of seized cannabis resin increased almost fourfold from 2000 to 2022. Changes in cannabis potency were positively associated with psychiatric harms at the population level across all outcomes.

The prison population in England and Wales exceeds 88,000, with a high turnover - 47% of sentenced admissions in 2023 served less than 12 months. Transitions from prison to the community are recognised as high-risk periods for medication-related harm, driven by complex health needs, short custodial stays, and fragmented healthcare systems. While national and international guidance exists to support safe medication management, implementation during prison-community transitions remains inconsistent, and evidence on both the drivers of unsafe medication practices and potential solutions is limited.

This study explored the human, organisational, and environmental factors influencing medication safety during transitions from prison to the community, as well as potential solutions for improvement, from the perspective of staff involved in these transitions.

Qualitative semi-structured interviews were conducted with 12 staff members working in roles relevant to transitions from prison to the community, including general practitioners, pharmacists, and prison officers. Participants were recruited through professional networks and snowball sampling. Data were thematically analysed using the Systems Engineering Initiative for Patient Safety (SEIPS) framework.

Five main factors impacting medication safety during transitions were identified: release practices, care coordination and communication issues, staffing shortages, IT system limitations, and patient-related factors. Key findings highlighted risks associated with immediate releases, discontinuity in medication regimens, insufficient staffing for discharge planning, and poor information transfer between prison and community healthcare providers. These challenges were further compounded by patient-level issues such as low health literacy, substance use, and housing instability. Staff proposed several improvements to enhance medication safety during prison-to-community transitions, including electronic prescribing for timely access to medication, improved information transfer, dedicated discharge teams to ensure medication follow-up, early discharge planning to address medication needs, and multi-disciplinary meetings to coordinate complex care.

Medication safety during transitions from prison to community healthcare requires coordinated efforts to address organisational challenges, including short-notice releases and inadequate information transfer, as well as human factors such as communication barriers and staffing constraints. Improvements that clarify roles, enhance processes and technology, and foster cross-system collaboration are essential to ensuring continuity of care and medication safety.

Two people, one with lived experience of care transitions and one carer, contributed to study design, recruitment strategies, participant materials, and the analysis plan through quarterly input. Findings were shared with a wider group of lived experience representatives, carers, professionals, and policy makers, who informed interpretation and dissemination. While PPI members did not directly participate in coding or analysing the data, their input ensured that the study design and interpretation were informed by real-world perspectives.

Trans and gender diverse (trans) young people experience higher rates of physical and mental ill-health due to chronic exposure to gender minority stress. Consequently, trans young people report higher health and mental healthcare service utilisation. Disconcertingly, negative experiences of healthcare services are prevalent among trans young people, especially those with additional marginalised identities and backgrounds who experience multiple forms of marginalisation. Patient-reported experience measures (PREM) are auseful tool for improving patients' healthcare experiences however existing PREMs are not relevant, appropriate, nor inclusive of the unique healthcare experiences of trans young people, especially those facing additional forms of marginalisation.

This study will co-develop and validate a PREM for trans young people aged 12 to 25 years attending health and mental healthcare services. This PREM will capture how healthcare experiences should affirm all aspects of trans young people's identities in health and mental health services, including but not limited to their gender.

Underpinned by a 'co-production' framework, the proposed study comprises four stages informed by a Lived Experience Advisory Group (LEAG) made up of eight trans young people from across Australia. Stage 1 is a scoping review of qualitative studies exploring the experiences of marginalised young people using healthcare services. Stage 2 is semi-structured, one-to-one interviews with multiply marginalised trans young people aged 12 to 25 years in Australia (n = 30) and healthcare professionals of trans young people in Australia (n = 30). Candidate PREM items generated from Stages 1-2 will be appraised in a multi-stakeholder modified e-Delphi Consensus Survey (N = 90; Stage 3) comprising multiply marginalised trans young people (n = 30), healthcare professionals (n = 30), and parents/caregivers of trans young people (n = 30). Lastly, in Stage 4, PREM items will be reviewed by trans young people in two cognitive debriefing focus groups (N = 14) to improve clarity, understandability, and interpretation.

This study will co-produce and validate a PREM to effectively measure the quality of trans young peoples' experiences utilising health and mental healthcare services. The PREM will subsequently be implemented into integrated youth health services as part of a multi-staged quality improvement project evaluating an integrated gender service model of care operating in Victoria, Australia.

The Whole of Self Affirming Care Lived Experience Advisory Group together with trans members of the research team in designated peer and non-peer research roles have contributed to the design of the present study protocol and corresponding manuscript. These individuals will also contribute to analysis, interpretation, and write-up of all subsequent data and outputs.

International graduate students contribute significantly to Canadian universities through their roles in research, teaching, and the enrichment of academic and cultural life. Despite these contributions, they face distinct mental health challenges related to cultural adjustment, financial pressures, and social isolation. Campus-based mental health services are often their primary source of support, yet little is known about the experiences of those providing this care. This study employed interpretative phenomenological analysis to explore the lived experiences of 13 campus-based mental health service providers across two Ontario universities. Semi-structured interviews revealed the complex, emotionally layered realities of supporting international graduate students in resource-constrained and culturally diverse contexts. Four interrelated themes emerged: witnessing intersecting pressures and cultural transitions; building trust and connection; embracing linguistic and cultural diversity; and navigating structural and cultural dimensions of care. Providers described the intensity of working with students balancing academic demands, familial expectations, and immigration uncertainties, often compounded by stigma and systemic limitations such as session caps and wait times. They emphasized the relational work of trust-building, the challenge of bridging linguistic and cultural gaps, and the tension of operating within predominantly Western models of therapy. Many also extended their responsibilities beyond traditional counseling, acting as advocates, navigators, and informal case managers, while reflecting critically on their own positionality and the limits of cultural understanding. By centering service providers' perspectives, this study underscores the need for institutional investment in culturally responsive, flexible, and accessible campus-based mental health care, alongside policy reforms addressing systemic barriers.

Syrian refugee women in Türkiye face intertwined challenges, trauma, displacement, economic hardship, and sociocultural pressures that impact their mental health. This study aimed to explore the relationships among trauma symptoms, psychological distress, depression, resilience, and spirituality in widowed Syrian refugee women. It also examined how demographic and contextual factors-such as age, education, length of stay in Türkiye, and residency location-contribute to mental health outcomes.

A cross-sectional quantitative design was employed, utilizing both online and paper-based self-administered questionnaires. A total of 167 widowed Syrian refugee women residing in Türkiye participated in the study. Standardized scales were used to assess trauma (Impact of Event Scale-Revised), psychological distress (Kessler K-10), depression (Center for Epidemiologic Studies Depression Scale), resilience, and spiritual well-being. Data analysis was conducted using SPSS Version 30. Analytical procedures included Pearson correlation, hierarchical multiple regression, one-way analysis of variance, and Tukey's HSD post hoc tests.

Trauma, psychological distress, and depression were strongly interrelated (r = 0.522-0.622, p < 0.001), indicating a high level of co-occurrence among mental health symptoms. Resilience and spirituality were negatively associated with both distress (r = -0.218 and -0.327) and depression (r = -0.270 and -0.333, all p < 0.001), suggesting their protective roles. Age (β = 0.261, p = 0.004) and years lived in Türkiye (β = -0.162, p = 0.043) significantly predicted trauma and depression. Spirituality (β = -0.289 to -0.290, p < 0.001) and resilience (β = -0.208, p = 0.013) predicted lower distress and depression; residency had an impact on all psychological outcomes (p < 0.05). Participants in rural areas reported better mental health outcomes compared to those in urban areas.

These findings highlight the dual role of individual psychological resources and broader structural conditions in shaping refugee women's mental health. Culturally sensitive, trauma-informed interventions must therefore target both emotional coping mechanisms and the systemic inequalities influencing displaced women's well-being.

Dementia caregiving represents a major public health challenge, with spousal caregivers assuming the greatest burden. Spouses, themselves typically older adults, provide high intensity, long-term, and largely unpaid care across all stages of cognitive decline. Despite their central role in dementia care, the health consequences experienced by spousal caregivers remain insufficiently characterized in the literature and inadequately addressed in clinical and public health practice. This structured narrative review synthesizes current evidence on the multidimensional impact of dementia caregiving on the physical, psychological, cognitive, social, and financial health of spousal caregivers. It further contextualizes these consequences within the trajectory of dementia progression, and identifies interventions, support systems, and policy considerations necessary to mitigate caregiver burden. Spousal caregivers experience disproportionate burden due to continuous, escalating responsibilities that often mirror the progressive deterioration of their partners. Emotional burdens, including uncertainty during pre-diagnostic stages, role strain, conflict, loss of intimacy, and anticipatory grief. Physically, spouses endure musculoskeletal strain, sleep disruption, poor nutrition, and heightened frailty risk. Psychologically, spousal caregivers exhibit elevated rates of depression, anxiety, loneliness, and stress-related disorders. Socially, caregivers experience substantial isolation, stigma, and erosion of social networks. Financial hardship, including early retirement, reduced employment, and uncompensated care hours, further exacerbate stress. Evidence suggests that chronic caregiving stress contributes to biological changes such as immune dysregulation, inflammation, acceleration, aging, and potential cognitive decline in caregivers themselves. Caregiver burden influences patient outcomes as evidenced by increased emergency department use, falls, and earlier institutionalization in persons with dementia whose caregiver is subjected to a high burden. Current care models rarely include routine, caregiver assessment or structured guidance following diagnosis, resulting in substantial unmet needs. Effective mitigation requires integrated, stage-sensitive interventions, including psychosocial support, caregiver education, respite services, culturally tailored programs, and digital health tools, alongside broader policy reforms to reduce financial and structural barriers.

Complex psychosis (CP) remains one of the most challenging conditions in mental health, characterized by persistent symptoms, cognitive impairment, functional disability, and reduced autonomy. Traditional rehabilitation approaches, although essential, are often insufficient to address the multidimensional needs of these individuals. Over the past decade, rapid advances in digital health have opened new opportunities to enhance psychosocial rehabilitation, improve engagement, and personalize treatment pathways. This narrative review synthesizes current evidence on the use of digital and immersive technologies in the rehabilitation of people with CP, including virtual reality (VR), augmented reality (AR), telerehabilitation platforms, mobile health (m-Health) applications, digital phenotyping, and AI-assisted cognitive remediation. We examine clinical trials, feasibility studies, and real-world implementations published between 2015 and 2025, highlighting the efficacy of VR-based social cognition training, remote cognitive remediation, ecological momentary interventions, and hybrid digital-in-person rehabilitation models. Mechanisms of action, transfer to real-world functioning, and predictors of engagement are described. Barriers such as digital literacy, access disparities, privacy concerns, and clinical integration are critically discussed. We also outline future directions, including adaptive algorithms, biosensor integration, and the development of multimodal digital ecosystems tailored to individual recovery trajectories. By integrating technological innovation with recovery-oriented care, digital rehabilitation tools have the potential to transform the treatment landscape for people with CP. This review offers a roadmap for clinicians, researchers, and policymakers seeking to incorporate evidence-based digital solutions into modern psychiatric rehabilitation.

Background and Objectives: There are known associations between bipolar disorder and obesity, but it has not been well characterized in older adults with bipolar disorder (OABD). This study aims to examine body mass index (BMI) and its clinical correlations in OABD. Materials and Methods: A secondary analysis was conducted using data from the Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) project, an international harmonized dataset of OABD cohorts. To examine the relationship between BMI and clinical characteristics (e.g., sex, psychiatric history, symptom severity, medication use, comorbidities), multivariable linear regression and multinomial logistic regression models with random effect for study cohort were used, with BMI as a continuous and as an ordinal (underweight vs. healthy weight vs. overweight vs. obese) dependent variable, respectively. Results: Of 1,226 OABD participants with BMI data, 405 (33.0%) were classified as overweight (BMI 25-29.99) and 462 (37.7%) as obese (BMI > 30). In linear regression models, higher BMI was associated with younger age, higher number of somatic comorbidities, and anticonvulsant use, while lower BMI was associated with lithium use. In logistic regression models, obesity was associated with cardiovascular comorbidity, musculoskeletal comorbidity and endocrine comorbidity. Conclusions: A high proportion of individuals with OABD are overweight or obese. Several demographic and clinical correlations of higher BMI were found, including younger age, higher number of medical comorbidities and anticonvulsant use. Clinicians should monitor and manage weight changes and associated comorbidities, and promote lifestyle and health interventions to minimize the risk of negative health outcomes associated with high BMI.

Background and Objectives: Metacognition-related processes (e.g., confidence calibration, self-evaluation and the use of feedback) have been linked to cognitive insight, self-evaluation, and daily functioning in psychosis. However, clinic-based assessments only provide limited information. Digital methods may capture state-like variations and contextual factors, but it is unclear to what extent they operationalise core metacognitive monitoring constructs versus adjacent self-evaluative/insight-related constructs. We mapped digital approaches used to assess metacognition-related constructs across the psychosis spectrum, summarising the associated feasibility and validity. Materials and Methods: We conducted a scoping review (PRISMA-ScR) of psychosis-spectrum studies that used digital tools to assess metacognition-related targets. These included ecological momentary assessment/experience sampling (EMA/ESM), task-based paradigms with confidence ratings, and hybrid approaches. Searches covered MEDLINE (via PubMed), Scopus, and IEEE Xplore, with the final search run on 15 December 2025. We charted constructs, operationalisations, feasibility/engagement indices and reported links with clinical or functional measures. Results: The empirical evidence map comprised 13 studies directly assessing metacognition-related constructs; eight additional implementation/methodological sources were synthesised separately to contextualise feasibility, reporting, ethics, and governance. EMA studies more often assessed adjacent self-evaluative constructs, including context-linked self-appraisal bias, conviction, and self-report-context mismatch in daily life, whereas task-based studies more directly assessed confidence-accuracy calibration and feedback updating. Across EMA studies, greater momentary symptom severity and more restricted contexts were often associated with inflated self-evaluations and divergence from observer-rated functioning. Task-based studies indicated that confidence calibration and feedback utilisation may diverge from objective performance; in performance-controlled paradigms, some studies reported comparable metacognitive sensitivity/efficiency, but the overall evidence remains uncertain. Passive sensing was common in psychosis research but was rarely explicitly tied to metacognitive constructs. Conclusions: Current digital work spans both core metacognitive monitoring constructs and adjacent self-evaluative/insight-related constructs, rather than a single unitary construct. Clinical translation remains hypothesis-generating: interpretability may be improved by combining clinical anchors, low-burden EMA, and optional contextual streams, but thresholds, workflows, and signal-action rules require prospective validation.

Background and Objectives: Chronic kidney disease (CKD) is an increasingly important global health challenge and is frequently accompanied by psychiatric symptoms, including anxiety. A multidimensional assessment of anxiety in hemodialysis (HD) using the Endler Multidimensional Anxiety Scales (EMAS) has not, to our knowledge, been previously reported. We aim to evaluate the reliability, convergent validity, and exploratory domain-level structure of EMAS in HD patients treated at a dialysis center in Craiova, Romania. Materials and Methods: A total of 103 HD patients underwent clinical and sociodemographic/socioeconomic profiling, cognitive screening using the Mini-Mental State Examination (MMSE), and EMAS administration at two time points (4-week interval) for test-retest evaluation. The anxiety subscale of the Depression, Anxiety, and Stress Scale-21R (DASS-21R) was administered to assess convergent validity. Internal consistency (Cronbach's α), temporal stability (test-retest correlations and intraclass correlation coefficients), and convergent validity (Pearson correlations) were computed. Exploratory factor analyses were conducted on EMAS domain scores (state, trait, and perceived anxiety domains) as an exploratory structural check. Results: EMAS state and trait anxiety scores were higher in women than in men, while perceived anxiety showed a more heterogeneous pattern across dimensions. Total state anxiety increased with age, particularly after 50 years. Domain-level internal consistency was good for state and acceptable for trait components (standardized α ≈ 0.84 and 0.78 across administrations), whereas perceived anxiety domains showed low cross-domain coherence, consistent with context-specific appraisal. The DASS-21R anxiety subscale showed good internal consistency (α = 0.863). Convergent validity analyses indicated small, domain-specific associations between EMAS scores and DASS-21R anxiety. Domain-level EFA supported a theoretically coherent pattern in which state and trait domains clustered distinctly, while perceived anxiety domains formed a partially separable factor; this pattern was broadly consistent across both administrations. Conclusions: In this HD cohort, EMAS demonstrated good reliability and limited but domain-specific evidence of convergent validity, and exploratory domain-level analyses supported its multidimensional organization. Further studies with larger samples are warranted for item-level structural testing and to inform feasibility-oriented shortening for potential clinical use.