To explore how fathers in Singapore experience, interpret, and cope with the emotional and mental health demands of raising an autistic child, and how stigma and support contexts influence coping and help-seeking.

Qualitative.

Interpretative phenomenological analysis guided this qualitative study. Purposive sampling recruited 17 fathers (aged 31-55 years) of autistic children under 18 years living in Singapore, with confirmed DSM-5 diagnoses by trained developmental behavioural paediatricians. The sample was multi-ethnic (Chinese n = 9; Malay n = 5; Indian n = 1; Other n = 2), broadly reflecting the national distribution. Most fathers held university-level education and were in full-time employment. Fathers completed one-to-one in-depth semi-structured interviews from September to October 2025.

Three themes were identified: (1) Fatherhood disrupted: Grief and the spectre of an unscripted future; (2) Holding it together: functioning as a moral metric and the quiet toll of self-reliance; (3) Guarded disclosure: navigating stigma, masculinity and the search for safe spaces.

These findings highlight that fathers' mental health experiences and help-seeking are shaped by identity-level processes that current services have not adequately addressed. Cultural stigma surrounding autism and masculine role expectations influence how fathers interpret and respond to psychological distress by encouraging functional self-monitoring and discouraging emotional disclosure, thereby delaying help-seeking and under-recognition of clinically relevant distress in fathers. The study reveals a significant need to understand paternal experiences in greater depth before designing interventions, and points to the importance of father-inclusive support structures that recognise the intersection of disability-related stigma with culturally specific masculine identity standards. Further research is needed to examine the longer-term trajectories of paternal coping and the potential consequences of sustained reliance on functional self-monitoring as the primary indicator of wellbeing.

Nurses and allied health professionals should recognise fathers of autistic children as distinct, underserved recipients of mental health support whose experiences are shaped by identity-level processes rather than symptom recognition alone. Practice should explicitly invite fathers into psychoeducation, coaching and care-planning conversations rather than defaulting to mothers as the sole service interface. Engagement strategies should use functional, role-sustaining language that aligns with how fathers conceptualise their own wellbeing, while remaining alert to the risk that such framing may inadvertently reinforce avoidance of emotional processing. Service pathways should integrate autism-specific peer-based entry points with clearly signposted escalation routes to professional mental health care. Culturally attuned practice should acknowledge the compounded effects of courtesy stigma, affiliate stigma and Confucian-influenced masculine norms, so that help-seeking can be framed as an expression of paternal duty rather than an admission of failure. Nurses are often the first and most sustained professional contact for these families; they are well placed to lead a two-step engagement pathway: first using capability-oriented language to lower the threshold to contact, then, within a trusting relationship, introducing emotion- and identity-level reflection and clear escalation to specialist care. Embedding father-inclusive, gender-sensitive and culturally safe competencies in nurse education and advanced practice would help nurses detect paternal need that symptom-based screening alone is likely to miss.

What problems did the study address? Fathers of autistic children are disproportionately vulnerable to mental health difficulties yet remain peripheral to autism caregiving research and services. This is particularly the case in Asian contexts, where culturally specific masculine norms and disability-related stigma shape paternal help-seeking in under-examined ways. This study addressed how fathers in Singapore experience, interpret and cope with the mental health demands of raising an autistic child, and how stigma and support contexts influence their coping and help-seeking. What were the main findings? Fathers described their child's autism diagnosis as a turning point that disrupted expected fatherhood trajectories and required them to reconstruct what it meant to be a competent and caring father. They conceptualised mental health through functional capacity and moral duty rather than through emotional distress language, and they navigated compounded help-seeking barriers arising from the intersection of courtesy stigma, affiliate stigma and Confucian-influenced masculine norms. Autism-specific, peer-based, activity-embedded support emerged as the most acceptable form of help, while professional mental health services were positioned as a last resort. Where and on whom will the research have an impact? The findings will inform nurses, mental health clinicians, paediatric and early intervention professionals and policymakers designing father-inclusive autism caregiving services in Singapore and comparable multi-ethnic Asian contexts. The study will also extend the global autism caregiving evidence base by contributing an underrepresented Southeast Asian paternal perspective that foregrounds identity, masculinity and cultural stigma as central to paternal mental health.

COREQ guideline.

This study did not include patient or public involvement in its design, conduct or reporting.

An increasing incidence in child and adolescent mental health difficulties calls for the development of effective person-centred mental health services. This study aims to investigate the experiences of young persons, main caregivers, and healthcare professionals within a child and adolescent mental health in-patient unit, with the aim to potentially develop person-centred practices.

A philosophical inquiry based on the SECI model within the concept of Ba was used. Three different methods were adopted, including the draw, write, and tell method with the young persons, semi-structured interviews with the main caregivers, observations using the Workplace culture critical appraisal tool - revised, and the world café method with healthcare professionals.

An indicative thematic analysis was completed collaboratively with two young persons, two main caregivers, and two healthcare professionals who previously took part in the data collection. Six themes emerged namely, power imbalance and communication, devaluing, boredom, support and feelings of isolation, getting out, and environment. Some themes were common for all three participant groups while others were specific to one group.

It was evident that although some person-centred moments were present, most notably, the formation of trusting relationships with some of the healthcare professionals, and feelings of support between healthcare professionals. However, several challenges toward the formation of person-centred practice remain.

To investigate the multimodal clinical influencing factors of Alzheimer's disease (AD) onset, and to establish and test a risk prediction tool derived from these determinants and additional clinical measures, thus facilitating early intervention and risk classification in individuals at high risk for AD.

A retrospective cohort of 502 high-risk individuals for AD (exhibiting cognitive decline or family history) who visited our hospital was included. A total of 502 participants were randomly split into a training cohort (n = 350) and a validation cohort (n = 152) in a 7:3 proportion. Demographic characteristics, clinical indicators, biomarkers, and genetic markers were collected. In the training set, univariate analysis and least absolute shrinkage and selection operator (LASSO) regression were first applied for variable screening, followed by multivariate logistic regression to pinpoint independent influencing factors. Random forest (RF), XGBoost, and deep learning models were constructed using Python, with performance evaluated using area under the curve (AUC). The optimal model was selected, and feature importance was analyzed.

Between the training and validation sets, no statistically significant baseline characteristic differences were found (p > 0.05). Multivariate logistic regression identified the apolipoprotein E epsilon 4 allele (APOE ε4) genotype, cerebrospinal fluid (CSF) p-tau181/amyloid-beta 42 (Aβ42) ratio, and diabetes as independent risk factors for AD (p < 0.05), while serum folate levels, Mini-Mental State Examination (MMSE) scores, and Montreal Cognitive Assessment (MoCA) scores served as independent protective factors (p < 0.05). In the validation set, the RF model achieved the highest AUC (0.879), followed by XGBoost (0.869) and deep learning (0.844), with the CSF p-tau181/Aβ42 ratio identified as the most predictive feature.

The RF model, based on integrated multimodal clinical influencing factors and clinical indicators, demonstrates potential for AD risk stratification in high-risk populations when evaluated on a validation cohort.

Workplace violence (WPV) is a pervasive occupational hazard in health-care settings and has increasingly been recognized as a major threat to health-care workers' mental health. Previous studies have consistently shown that WPV is associated with a range of adverse psychological outcomes, including depression and anxiety. However, despite the growing body of evidence documenting these associations, the underlying mechanisms through which WPV affects mental health remain insufficiently understood.

This study aims to examine the associations between WPV and depression and anxiety among health-care workers and to assess whether perceived work stress mediates these associations.

A cross-sectional survey was conducted among health-care workers in Xi'an, China, using a multistage stratified cluster sampling design. Logistic regression models were used to assess associations between WPV and mental health outcomes, and the Karlson-Holm-Breen method was applied to assess the mediating role of perceived work stress.

A total of 39,773 participants were included in the final analysis, of whom 46.18% reported experiencing WPV. WPV was associated with higher odds of depression (OR = 3.79, 95% CI: 1.76-8.15) and anxiety (OR = 3.81, 95% CI: 2.11-6.90). Perceived work stress partially mediated these relationships, accounting for 18.90% of the association with depression and 15.63% with anxiety.

WPV was significantly associated with depression and anxiety among health-care workers and perceived work stress may represent a potential pathway linking WPV to these outcomes. Interventions should focus on preventing WPV and strengthening mental health support for affected staff.

Professional values and moral resilience are recognized as essential attributes of nursing practice. In critical care settings, where nurses routinely face ethical complexity and high-stakes decisions, it is important to understand how these attributes shape professional competence.

To examine the relationship between professional values and professional competence among critical care nurses, and to determine whether moral resilience mediates this relationship.

This descriptive and correlational study was conducted among nurses working in the critical care units of six hospitals between August and October 2025. The reporting was conducted in accordance with the STROBE guidelines. Three validated instruments were used: a professional values scale (range 1-5, with higher scores indicating stronger professional values), a moral resilience scale (range 1-4, with higher scores indicating greater moral resilience) and a professional competence scale (range 1-5, with higher scores indicating greater professional competence).

In total, 201 nurses participated in the study. Mean scores were high for professional values (4.45 ± 0.61 out of 5), moral resilience (3.27 ± 0.43 out of 4) and professional competence (4.26 ± 0.36 out of 5). Professional values were significantly and positively correlated with professional competence (r = 0.329, p < 0.001), whereas moral resilience showed no significant association with either variable. The direct effect of professional values on professional competence was significant (β = 0.193, p < 0.001), whereas the indirect effect through moral resilience was non-significant (β = 0.003, 95% CI [-0.005, 0.014]).

Professional values appear to play an important role in promoting professional competence among critical care nurses, whereas moral resilience did not mediate this relationship. Strengthening ethics-based education and professional value development may enhance competence in critical care practice.

Nurse educators and managers should prioritize the integration of professional values into nursing curricula, continuing professional development and clinical practice to strengthen professional competence among critical care nurses. Because moral resilience was not associated with competence, resilience-supporting initiatives may be directed primarily at nurses' well-being and retention rather than competence.

Posttraumatic stress disorder (PTSD) symptoms are among the most prevalent mental health sequelae in children and adolescents following earthquakes. A recently introduced metric under network theories of psychopathology, network temperature, quantifies the global stability of a symptom network.

To examine the developmental trajectory of network temperature in children and adolescents after earthquakes, we established eight prospective cohorts (2-4 waves per cohort; total N = 5,794) after the Wenchuan, Yaan, and Jiuzhaigou earthquakes. We assessed PTSD symptoms across three postdisaster periods: early (≤2.5 years), middle (3.5-5.5 years), and late (8.5-10 years).

PTSD symptom network temperatures decreased across all eight cohorts. In the early post-Wenchuan period, adolescents declined more slowly than children. Across earthquakes, the early-period decline in children was faster after the Wenchuan earthquake than after the Yaan earthquake; for adolescents, the early-period decline rate followed the order Wenchuan < Jiuzhaigou < Yaan. Across post-earthquake periods, Wenchuan adolescents declined more slowly in the early period than in the middle/late period, whereas Yaan adolescents declined faster in the early period than in the middle period.

Across all earthquake types and post-earthquake periods, the PTSD symptom network system became increasingly stable and resistant to change. These findings underscore the necessity of early intervention alongside efforts to prevent deterioration. However, the rate of this decline varied by sample (children versus adolescents), earthquake, and post-earthquake period. Clinically, this calls for intervention strategies that are adjusted according to these factors.

Alopecia areata (AA) is an autoimmune, inflammatory condition characterized by non-scarring hair loss on the scalp, face, or body. It can significantly affect a person's quality of life (QoL) and mental health.

Using a modified Delphi method, a panel of expert dermatologists developed a practical treatment algorithm to help clinicians deliver personalized, safe care to diverse patients with AA.

The approach to the algorithm introduces a broader definition of disease severity, incorporating not only Severity of Alopecia Tool (SALT) scores but also quality-of-life impact and the rate of disease progression.

Recent therapeutic advances have expanded access to effective, safe treatments for a broader population of AA patients. Ritlecitinib, a Janus kinase 3/TEC inhibitor, is currently the only oral Janus kinase inhibitor approved for adolescents and adults aged 12 years and older, whereas baricitinib, a Janus kinase1/2 inhibitor, is approved for adults aged 18 years and older. However, questions on the long-term safety of these therapies, access, and personalization still need to be addressed.

Future efforts should validate and refine the algorithm across real-world cohorts and ensure equitable access to personalized treatment for patients with AA.

Background Occupational stress is a major public health concern with significant implications for mental and physical health. Teachers are particularly vulnerable due to sustained emotional demands, workload pressures, and administrative responsibilities. Evidence regarding occupational stress among school teachers in Kerala remains limited. Objectives To assess the prevalence of occupational stress among teachers working in selected private schools in Ernakulam district, Kerala, and to identify sociodemographic, occupational, lifestyle, and clinical factors associated with occupational stress. Methods A cross-sectional study was conducted among teachers working in selected private schools in Ernakulam district, Kerala. Teachers employed for at least one month were included. Data were collected using a semi-structured questionnaire covering sociodemographic, occupational, lifestyle, and clinical variables. Occupational stress was assessed using the validated Teachers' Occupational Stress Scale (TOSS). Stress levels were categorized as low, moderate, and high. Blood pressure and anthropometric measurements were recorded using standard procedures. Data were analyzed using SPSS version 21. Associations were assessed using the chi-square test, and multivariable logistic regression analysis was performed to identify factors independently associated with moderate-to-high occupational stress. Results A total of 111 teachers participated, of whom 98.2% were female and 52.3% were aged ≥42 years. Based on TOSS, 64.0% (95% CI: 55.1%-72.9%) had moderate stress, 29.7% (95% CI: 21.2%-38.2%) had low stress, and 6.3% (95% CI: 1.8%-10.8%) had high stress. Occupational stress was significantly associated with blood pressure status (p = 0.014), teaching experience (p = 0.015), weekly teaching hours (p < 0.001), and commuting distance (p < 0.001). Teachers with less than five years of experience and those handling fewer than 30 teaching hours per week had significantly higher odds of moderate-to-high occupational stress. Conclusion Moderate occupational stress was common among teachers working in selected private schools in Ernakulam district. Shorter teaching experience and fewer weekly teaching hours were independently associated with moderate-to-high occupational stress. Workplace interventions focusing on mentoring, workload management, and mental health support may help improve teacher well-being.

While the musculoskeletal symptoms of axial spondyloarthritis (axSpA) are well appreciated, emerging evidence demonstrates that patients newly diagnosed with axSpA experience a substantial mental health burden. There is increasing awareness of the need for mental health screening and integrated psychological support as part of comprehensive axSpA management. The primary aims of our study were to assess the prevalence of depression and anxiety in patients with a new diagnosis of axSpA within the past 24 months and to establish the relationship between axSpA disease activity and the severity of anxiety or depression symptoms. The secondary exploratory analysis was to assess the relationship between interventions received (none, biologics, physiotherapy, and patient support groups) and the severity of anxiety or depression symptoms.

We conducted a single-centre cross-sectional observational study in a tertiary axSpA rheumatology clinic. Of the 95 eligible patients, 66 patients (response rate 69.5%) completed a comprehensive questionnaire assessing patient demographics, disease activity using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), quality of life using the Ankylosing Spondylitis Quality of Life (ASQoL) score, and depressive and anxiety symptoms using standardised screening tools, Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder-7 (GAD-7), respectively. Linear regression analysis was performed to assess the correlation between BASDAI and PHQ-9, as well as GAD-7.

Based on the PHQ-9 scores, 81.8% (54/66) of patients had a score of 5 or more, which is equivalent to having symptoms of mild depression. Of these, 57.4% (n = 31/54) reported moderate-severe symptoms of depression (PHQ-9 ≥10). Similarly, 65.2% (n = 43/66) reported anxiety symptoms, with 53.3% (n = 23/43) experiencing moderate-severe symptoms of anxiety (GAD-7 ≥10). Linear regression analysis demonstrated a strong positive correlation between disease activity (BASDAI) and depression (coefficient = 1.77, 95% CI 1.30-2.23, R² = 0.473, p < 0.0001) and between disease activity and anxiety (coefficient = 1.32, 95% CI 0.79-1.85, R² = 0.279, p < 0.0001). Multivariate analysis demonstrated that disease activity independently predicted both depressive (coefficient 1.79, p value < 0.0001) and anxiety symptoms (coefficient 1.33, p value < 0.0001), even after adjusting for age, gender, employment status, diagnostic delay, and quality of life.

This study demonstrates a high prevalence of undiagnosed depression and anxiety in newly diagnosed axSpA patients, with disease activity as an independent predictor of mental health burden. These findings support the urgent need for routine mental health screening at diagnosis and the integration of psychological care within holistic axSpA management. Further prospective research is required to evaluate optimal screening strategies and psychological intervention models to address this substantial treatment gap.

Work-related mental disorders comprise conditions of psychological distress in which causal factors are associated with elements of the work environment. These disorders impose substantial economic and social burdens on affected workers and are frequently associated with alcohol consumption and the use of other psychoactive substances.

To conduct an epidemiological analysis of reported cases of work-related mental disorders in Brazil between 2012 and 2021, investigating their association with alcohol and other drug misuse.

This analytical, quantitative study was based on notification data obtained from the Department of Informatics of the Brazilian Unified Health System. Sociodemographic characteristics, work-related conditions, and information on alcohol consumption and the use of other drugs were collected. Data were analyzed using statistical tests and multivariate analytical techniques.

Work-related mental disorders predominantly affected women, individuals with higher educational attainment, and those who self-identified as White or Brown. Alcohol consumption and the use of other drugs showed limited statistical significance as factors associated with the reported cases.

Strategies aimed at improving working conditions, expanding access to psychological support, and preventing substance misuse are essential to address work-related mental disorders, a major public health concern in Brazil. Identifying risk factors associated with these disorders may inform more effective interventions and promote improved work organization, thereby reducing their impact on the health of the working population and on the national economy.